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Father Saturnino Urios University The Philippine Legislature

COLLEGE OF LAW maintained the pre-existing medico-


legal system in full force in the
Administrative Code. In 1908, the
LEGAL MEDICINE Philippine Medical School
incorporated the teaching of Legal
Course Outline Medicine, one hour a week to the
fifth year medical students. In 1919,
the University of the Philippines
I. LEGAL MEDICINE created the Department of Legal
A. Legal Medicine, defined Medicine and Ethics with the head
Legal Medicine- branch of which deals having the salary of 4,000.00 pesos
with application of medical knowledge per annum, half-time basis, with Dr.
to the purposes of law and in the Sixto de los Angeles as the chief. On
administration of justice. It is the January 10, 1922, the head of the
application of basic and clinical, Department of Legal Medicine and
medical and paramedical sciences to Ethics became the Chief of the
elucidate legal matters. Medico-Legal Department of the
B. History of Legal Medicine in the Philippine General Hospital without
Philippines pay.
In 1858, the first medical textbook On March 10, 1922,-the Philippine
printed including pertinent Legislature enacted Act. No. 1043
instructions related to medico-legal which became incorporated in the
practice by Spanish physician, Dr. Administrative Code as Section
Rafael Genard y Mas, Chief Army 2465 and provided that the
Physician, entitled "Manual de Department of Legal Medicine,
Medicina Domestica." In 1871, University of -the Philippines,
teaching of legal medicine, included became a branch of the Department
as an academic subject in the of Justice. On December 10, 1937,
foundation of the School of Commonwealth Act. No. 181 was
Medicine of the Real y Pontifica passed creating the Division of
Universidad de Santo Tomas. Investigation under the Department
On March 31, 1876 by virtue of the of Justice. The Medico-Legal
Royal Decree No. 188, of the King Section was made as an integral part
of Spain, the position of "Medico of the Division with Dr. Gregorio T.
Titulares" was created and made in Lantin as the chief. On March 3,
charge of public sanitation and at the 1939, the Department of Legal
same time medico-legal aid in the Medicine of the College of
administration of justice. In 1894, Medicine, University of the
rules regulating the services of those Philippines was abolished and its
"Medico Titular y Forences" was functions were transferred to the
published. In 1895, medico-legal Medico-Legal Section of the
laboratory was established in the Division of Investigation under the
City of Manila and extended at the Department of Justice.
same time its services to the On July 4, 1942, President Jose P.
provinces. Laurel consolidated by executive
In 1898, American Civil order all the different law-enforcing
Government preserved the Spanish agencies and created the Bureau of
forensic medicine system. In 1901, Investigation on July 8,1944. In
Philippine Commission created the 1945 immediately after liberation of
provincial, insular and municipal the City of Manila, the Provost
Board of Health (Act Nos. 157, 307 Marshal of the United States Army
and 308) in the Philippines and created the Criminal Investigation
assigned to the respective inspectors Laboratory with the Office of the
and presidents of the same, medico- Medical Examiner as an integral part
legal duties of the "Medico and with Dr. Mariano Lara as Chief
Titulares" of the Spanish regime. Medical Examiner. On June 28,
1945, the Division of Investigation, Forensic Medicine Application of
under the Department of Justice was medical science to elucidate legal
reactivated. On June 19, 1947, problems
Republic Act. No. 157 creating the C. Scope
Bureau of Investigation was passed. The scope of legal medicine is quite
The Bureau of Investigation was broad and encompassing. It is the
created by virtue of an executive application of all branches of medicine
order of the President of the and other allied sciences to law and
Philippines. Under the bureau, a administration of justice. The
Medico-Legal Division was created knowledge of the nature and extent of
with Dr. Enrique V. de los Santos as wounds has been acquired in surgery,
the Chief. abortion in gynecology, sudden death
June 18, 1949, Republic Act 409 and effects of trauma in pathology, etc.
which was later amended by aside from having knowledge of the
Republic Act 1934 provides (Sec. basic medical sciences, like anatomy,
38) for the creation of the office of physiology, biochemistry, physics and
the Medical Examiners and Criminal other allied sciences
Investigation Laboratory under
thej^jice Department of the City of D. The Law of Hippocrates
Manila. The Hippocratic Oath is an oath historically taken
On December 23, 1975, Presidential by physicians. It is one of the most widely known
Decree 856 was promulgated and of Greek medical texts. In its original form, it
Sec. 95 provides: A. Persons requires a new physician to swear, by a number of
authorized to perform autopsies: 1. healing gods, to uphold specific ethical standards.
Health officers 2. Medical officers of
law enforcement agencies 3.
Members of the medical staff of Oath taken by doctors and medical school
accredited hospitals B. Autopsies students to practice medicine honestly and
shall be performed in the following adhere to accepted medical ethics.
cases: 1. Whenever required by
special laws; 2. Upon order of a
competent court, a mayor and a III. LAW AND THE PRACTICE OF
provincial or city fiscal; 3. Upon MEDICINE
written request of police authorities, A. Basis of State Regulation
4. Whenever the Solicitor General, 1. Constitution
provincial or city fiscal deem it 2. Statutes
necessary to disinter and take 3. Other pertinent rules,
possession of the remains for regulations, orders
examination to determine the cause B. Reason for Regulation
of death; 5. Whenever the nearest the state has the right to exercise police
kin shall request in writing the power to protect its citizenry from
authorities concerned to ascertain unqualified practitioners of medicine
the cause of death.
II. MEDICAL JURISPRUDENCE First, it is a profession like law, and as
A. Medical Jurisprudence, defined such, was subject to state regulation.
Medical Jurisprudence- knowledge of Second, medical practitioners posed
law in relation to the practice of peculiar risks to the public health and
medicine. It concerns with the study of safety that other professions such as law
the rights, duties and obligations of did not pose. Third, and most important
medical practitioner with particular historically, physicians have been
reference to those arising from doctor- closely involved in the state public
patient relationship health regulations as they applied to
epidemic disease and sanitation.
B. Distinguished from Legal Medicine
and Forensic Medicine C. Practice of Medicine, what
Legal Medicine Application of medicine constitutes
to legal cases
- a PRIVILEGE or FRANCHISE (not a BY PROVISION OF LAW not considered to
right) granted by the state to any person constitute practice of medicine:
to perform medical acts UPON
COMPLIANCE WITH LAW (the state 1) Any MEDICAL STUDENT DULY
has the right to exercise police power to ENROLLED IN AN APPROVED MEDICAL
protect its citizenry from unqualified COLLEGE (should be under the DIRECT
practitioners of medicine.), that is, the CONTROL AND SUPERVISION OF
MEDICAL ACT OF 1959 as amended REGISTERED DOCTOR-TEACHERS)
(R.A. 2382) which has been
promulgated by the State in the exercise 2) Registered DENTIST (prescriptions
of police power to protect. should be done within the limits of the
practice of dentistry, although OTC
D. Requisites to the Practice of prescriptions for systemic conditions cannot
Medicine (R.A. 2382) be charged. While prescriptions for systemic
conditions (i.e. antibiotics) that requires
Section 8. Prerequisite to the practice of license numbers constitutes illegal practice of
medicine. No person shall engage in the medicine.)
practice of medicine in the Philippines unless
he is at least twenty-one years of age, has 3) Registered MASSEUR or
satisfactorily passed the corresponding Board PHYSIOTHERAPIST
Examination, and is a holder of a valid 4) Registered OPTOMETRIST
Certificate of Registration duly issued to him
by the Board of Medical Examiners. 5) Any person who RENDERS ANY
SERVICE GRATUITOUSLY in cases of
E. Acts constituting practice of EMERGENCY OR in places where the
medicine services of a PHYSICIAN, NURSE OR
Who shall, for COMPENSATION, FEE, MIDWIFE ARE NOT AVAILABLE.
SALARY or REWARD IN ANY FORM,
PAID TO HIM DIRECTLY OR THROUGH 6) Any person who administer or recommends
ANOTHER, or EVEN WITHOUT THE any household remedy as per classification of
SAME, PHYSICALLY EXAMINE any existing PHARMACY LAWS (sale of sample
person, AND DIAGNOSE, TREAT, drugs is prohibited by law.)
OPERATE, or PRESCRIBE ANY REMEDY
for any HUMAN DISEASE (physicians are 7) CLINICAL PSYCHOLOGIST with the
NOT forbidden to treat animals provided that prescription and direct supervision of a
no compensation is done, otherwise they will registered PHYSICIAN
be charge of illegal practice of veterinary
medicine), INJURY, DEFORMITY (i.e. 8) PROSTHETIST
dermatology & plastic surgery), PHYSICAL,
MENTAL or PHYSICAL CONDITION or
any AILMENT, REAL or IMAGINARY (i.e. 2. By decisions of courts
psychiatry), regardless of the nature of the BY DECISION OF COURT are not
remedy of treatment ADMINISTERED, considered to constitute practice of
PRESCRIBED or RECOMMENDED medicine:
From the above provision, the following acts 1) One who TAKES BP READING
constitute the practice of medicine: 1) (those who take BP and also
Physically examine a person AND diagnose; suggests medication in relation to
2) Physically examine a person AND treat; the BP reading constitutes the
3) Physically examine a person AND operate; practice of medicine.)
and 2) The use of an ELECTRIC
4) Physically examine a person AND VIBRATOR and SUN RAY LAMP
prescribe any remedy by an UNLICENSED PERSON.
F. Acts not construed to be practice of 3) The use of an ELECTRIC
medicine MACHINE by BARBERS in giving
1. By provisions of law (R.A. treatment to one who SOUGHT TO
2382) BEAUTIFY HIS BODY RATHER
THAN TO SECURE TREATMENT CHARGING IS NOT. Compensations
OF A DISEASE OR DEFORMITY. may only be accepted in form of
4) Application of MEDICATED voluntary donations. Related to the
MASSAGE by a duly registered constitutional guarantee to religious
masseur or physiotherapist (i.e. freedom. - If a person acted in
sauna). pursuance of his religious belief and the
5) HOSPITAL  Not a natural act is in accordance with the tenets of
person but a JURIDICAL PERSON, the church he professes, then his act is
a corporation, thus incapable of not deemed to be a practice of medicine
practicing medicine. (for a more but a part of his religious freedom. If the
detailed discussion, see Only Natural act is deceitful or not in accordance with
Persons can Practice Medicine, p3) the principles of the church, then such
 Does not have the duty to treat the act of diagnosis and/or treatment
patient, it is the sole duty (contract) becomes illegal.
of the physician to treat the patient.
 H. Limited practice without any
certificate of registration (R.A.
THREE-FOLD DUTY of a hospital:  2382)
Provide VENUE and BUILDING  Provide
EQUIPMENT  Provide PERSONNEL Section 12. Limited practice without any
certificate of registration. Certificates of
INDEPENDENT CONTRACTOR THEORY registration shall not be required of the
- A patient entering a hospital does not enter following persons:
into contract with the hospital but with the
physician who treats him. The physician is (a) Physicians and surgeons from other
beyond control of the hospital in so far as the countries called in consultation only and
manner of treatment to the patient concerned. exclusively in specific and definite cases, or
those attached to international bodies or
6) NURSE ANESTHETIST (a nurse who had organization assigned to perform certain
special training in anesthesia that carries out definite work in the Philippines provided they
the order of the anesthesiologist, although shall limit their practice to the specific work
they themselves cannot give out the orders.) assigned to them and provided further they
shall secure a previous authorization from the
G. Faith Healing Board of Medical Examiners.
FAITH HEALING - The Philippines
DOES NOT HAVE AN OFFICIAL (b) Commissioned medical officers of the
RELIGION, due to the constitutional United States armed forces stationed in the
provision that says “the separation Philippines while rendering service as such
between the state and the church is only for the members of the said armed forces
inviolable”. - THERE IS NOTHING IN and within the limit of their own respective
THE MEDICAL ACT EXEMPTING territorial jurisdiction.
FAITH HEALING FROM THE
DEFINITION OF THE ACTS WHICH (c) Foreign physicians employed as exchange
CONSTITUTE PRACTICE OF professors in special branches of medicine or
MEDICINE. But there is a surgery whose service may in the discretion of
constitutional guarantee to religious the Board of Medical Education, be necessary.
freedom. Art. III, Sec. 5, Philippine
Constitution (1986): No law shall be (d) Medical students who have completed the
made respecting an establishment of first four years of medical course, graduates
religion, or prohibiting the free exercise of medicine and registered nurses who may be
thereof. The free exercise an enjoyment given limited and special authorization by the
of religious profession and worship, Secretary of Health to render medical services
without discrimination or preference, during epidemics or national emergencies
shall forever be allowed. No religious whenever the services of duly registered
test shall be required for the exercise of physicians are not available. Such
civil or political rights. - FAITH authorization shall automatically cease when
HEALING IS ALLOWED BUT the epidemic or national emergency is
declared terminated by the Secretary of  In spite of all these, the Board of Medicine
Health. (Board) of the PRC, in a letter dated March 8,
1993, denied respondent's request for a
license to practice medicine in the Philippines
I. Penalties for illegal practice of on the ground that the Board “believes that
medicine (R.A. 2382) no genuine reciprocity can be found in the
law of Japan as there is no Filipino or
Section 28. Penalties. Any person found foreigner who can possibly practice there.”
guilty of "illegal practice of medicine" shall  Respondent then filed a Petition for Certiorari
be punished by a fine of not less than one and Mandamus against the Board before the
thousand pesos nor more than ten thousand RTC of Manila. RTC ruled for the Yasuki.
pesos with subsidiary imprisonment in case of  The Board and the PRC (petitioners) appealed
insolvency, or by imprisonment of not less the case to the CA, stating that while
than one year nor more than five years, or by respondent submitted documents showing that
both such fine and imprisonment, in the foreigners are allowed to practice medicine in
discretion of the court. Japan, it was not shown that the conditions for
the practice of medicine there are practical
and attainable by a foreign applicant, hence,
reciprocity was not established; also, the
J. Cases:
power of the PRC and the Board to regulate
1. Board of Medicine, Dr. Raul
and control the practice of medicine is
Flores vs. Yasuyuki Ota, G.R.
discretionary and not ministerial, hence, not
No. 166097, July 14, 2008
compellable by a writ of mandamus.
BOARD OF MEDICINE, DR. RAUL
 The CA denied the appeal and affirmed the
FLORES (now DR. JOSE S.
ruling of the RTC.
RAMIREZ),Present:in his capacity as
Chairman of the Board, PROFESSIONAL ISSUES:
REGULATION COMMISSION,-versus-
YASUYUKI OTA, WHETHER THE COURT OF APPEALS
COMMITTED A REVERSIBLE ERROR IN
FACTS: FINDING THAT RESPONDENT HAD
ESTABLISHED THE EXISTENCE OF
 Yasuyuki Ota (respondent) is a Japanese
RECIPROCITY IN THE PRACTICE OF
national, married to a Filipina, who has
MEDICINE BETWEEN THE PHILIPPINES
continuously resided in the Philippines for
AND JAPAN.
more than 10 years. He graduated from
Bicol Christian College of Medicine on RULING:
April 21, 1991 with a degree of Doctor of
Medicine. After successfully completing a The Court denies the petition for lack of merit.
one-year post graduate internship training at There is no question that a license to practice
the Jose Reyes Memorial Medical Center, he medicine is a privilege or franchise granted by the
filed an application to take the medical board government. It is a right that is earned through
examinations in order to obtain a medical years of education and training, and which
license. He was required by the (PRC) to requires that one must first secure a license from
submit an affidavit of undertaking, stating the state through professional board examinations.
among others that should he successfully
pass the same, he would not practice [T]he regulation of the practice of medicine in all
medicine until he submits proof that its branches has long been recognized as a
reciprocity exists between Japan and the reasonable method of protecting the health and
Philippines in admitting foreigners into the safety of the public. That the power to regulate
practice of medicine. and control the practice of medicine includes the
 Respondent submitted a duly notarized power to regulate admission to the ranks of
English translation of the Medical those authorized to practice medicine, is also
Practitioners Law of Japan duly authenticated well recognized. Thus, legislation and
by the Consul General of the Philippine administrative regulations requiring those who
Embassy to Japan, Jesus I. Yabes; thus, he was wish to practice medicine first to take and pass
allowed to take the Medical Board medical board examinations have long ago been
Examinations in August 1992, which he recognized as valid exercises of governmental
subsequently passed. power.
As required by the said laws, respondent practice therein. Requiring respondent to
submitted a copy of the Medical Practitioners Law prove first that a Filipino has already been
of Japan, duly authenticated by the Consul granted license and is actually practicing
General of the Embassy of the Philippines in therein unduly expands the requirements
Japan, which provides in Articles 2 and 11, thus: provided for under R.A. No. 2382 and P.D.
Article 2. Anyone who wants to be medical No. 223.
practitioner must pass the national examination  Indeed, to be granted the privilege to practice
for medical practitioner and get license from the medicine, the applicant must show that he
Minister of Health and Welfare. possesses all the qualifications and none of
xxx the disqualifications. It must also appear that
Article 11. No one can take the National Medical he has fully complied with all the conditions
Examination except persons who conform to one and requirements imposed by the law and the
of the following items: licensing authority.
1. Persons who finished regular medical  In this case, there is no doubt as to the
courses at a university based on the School competence and qualifications of respondent.
Education Laws (December 26, 1947) and He finished his medical degree from Bicol
graduated from said university. Christian College of Medicine. He completed
2. Persons who passed the preparatory test for a one-year post graduate internship training at
the National Medical Examination and practiced the Jose Reyes Memorial Medical Center, a
clinics and public sanitation more than one year government hospital. Then he passed the
after passing the said test. Medical Board Examinations which was
3. Persons who graduated from a foreign given on August 8, 1992 with a general
medical school or acquired medical practitioner average of 81.83, with scores higher than 80
license in a foreign country, and also are in 9 of the 12 subjects.
recognized to have the same or more academic  The SC ruled that it is not the impossibility or
ability and techniques as persons stated in item 1 prohibition against Filipinos that would
and item 2 of this article. account for the absence of Filipino physicians
holding licenses and practicing medicine in
R.A. No. 2382, which provides who may be Japan but the difficulty of passing the board
candidates for the medical board examinations, examination in the Japanese language.
merely requires a foreign citizen to submit
competent and conclusive documentary evidence, “Granting that there is still no Filipino who
confirmed by the Department of Foreign Affairs has been given license to practice medicine in
(DFA), showing that his country’s existing laws Japan, it does not mean that no Filipino will
permit citizens of the Philippines to practice ever be able to be given one," the court said
medicine under the same rules and regulations
governing citizens thereof.
IV. PHYSICIANS AND PATIENT VIS-À-
PRC is authorized to prescribe additional
VIS CONTRACT
requirements or grant certain privileges to
foreigners seeking registration in the Philippines if
A. Physician-Patient Relationship,
the same privileges are granted to or some
commencement and termination
additional requirements are required of citizens of B. Nature of Physician-Patient
the Philippines in acquiring the same certificates Relationship
in his country. 1. Consensual
2. Fiduciary
 Nowhere in said statutes is it stated that the
foreign applicant must show that the V. LIABILITIES OF PHYSICIAN
conditions for the practice of medicine in ARISING FROM WRONGFUL ACT
said country are practical and attainable by OR OMISSION
Filipinos. Neither is it stated that it must A. Administrative Liabilities
first be proven that a Filipino has been 1. Personal Disqualifications
granted license and allowed to practice his 2. Criminal Acts
profession in said country before a foreign 3. Unprofessional Conduct
applicant may be given license to practice
in the Philippines. B. Civil Liabilities
 It is enough that the laws in the foreign 1. Medical malpractice
country permit a Filipino to get license and
a. Loenila Garcia-Rueda vs.  Rogelio Ramos vs.
Wilfredo L. Pascasio, et al, Court of Appeals,
G.R. No. 118141, September G.R. No. 124354,
5, 1997 December 29, 1999
b. Noel Casumpang, et al vs.  Dr. Ninevetch Cruz
Nelson Cortejo, G.R. No. vs. Court of Appeals,
171127, March 11, 2015
G.R. No. 122445,
c. Dr. Rubi Li vs. Spouses
November 18, 1997
Soliman, G.R. No. 165279,
June 7, 2011
C. Criminal Liabilities
d. Rogelio Ramos vs. Court of
1. Issuance of false medical
Appeals, G.R. No. 124354,
certificates
December 29, 1999
2. Abortion
e. Professional Services Inc. vs.
3. Simulation/substitution of births
Natividad and Enrique Gana,
4. Failure to report treatment of
G.R. No. 126297, January
physical injuries
31, 2007
5. Refusal to render treatment in
f. Leah Alesna Reyes, et al vs.
emergency cases
Sisters of Mercy Hospital,
6. Criminal negligence or
G.R. No. 130547, October 3,
imprudence
2000
7. Violation of special laws – i.e.
g. Dr. Victoria L. Batiquin, et
Dangerous Drugs Act, Pharmacy
al. vs. Court of Appeals, G.R.
Law
No. 118231, July 5, 1996
8. Other violation of RPC that may
h. Dr. Idol Bondoc vs. Marilou
be committed by anyone
Mantala, G.R. No. 203080,
November 12, 2014
VI. HOSPITAL AND ITS LIABILITIES
i. Dr. Emmanuel Jarcia Jr. and
A. Vicarious liability
Dr. Marilou Bastan vs.
1. Professional Services Inc. vs.
People of the Philippines,
Natividad and Enrique Gana,
G.R. 187926, February 15,
G.R. No. 126297, January 31,
2012
2007
2. Rogelio P. Nogales vs. Capitol
2. Doctrines applicable in medical
Medical Center, G.R. No.
malpractice cases
142625, December 19, 2006
a. Doctrine of Respondeat
B. Attendance to emergency or serious
Superior or Doctrine of
cases (RA 8344)
Vicarious Liability or
C. Transfer of patient (RA 8344)
Doctrine of Imputed
Negligence
VII. MEDICAL WITNESS; PHYSICIAN
b. Doctrine of Res Ipsa
AND EVIDENCE
Loquitor
A. Evidence
c. Doctrine of Contributory
B. Witness
Negligence
1. Who may be a witness and who
d. Doctrine of Continuing
may not be a witness
Negligence
2. Ordinary witness vs. Expert
e. Doctrine of Assumption of
Witness
Risk
C. Physician-Patient Privilege (Rule
f. Doctrine of Last Clear
130, Section 24c)
Chance
1. Requisites
g. Doctrine of Foreseeability
2. Cases:
h. Fellow Servant Doctrine
a. Ma. Paz Fernandez Krohn
i. Rescue Doctrine
vs. Court of Appeals, G.R.
j. Deep Pocket Rule
No. 108854, June 14, 1994
3. What may be recovered
a. Cases:
b. Nelly Lim vs. Court of
Appeals, G.R. No. 91114,
September 25, 1992
c. Josielene Lara Chan vs.
Johnny T. Chan, G.R. No.
179786, July 24, 2013

D. Expert Testimony (Rule 130, Section


49)
1. Requisites for admissibility of
expert evidence
2. Cases:
a. People vs. Rogelio Pelones,
G.R. Nos. 86159-60,
February 28, 1994
b. Dr. Ninevetch Cruz vs. Court
of Appeals, G.R. No.
122445, November 18, 1997
c. Rogelio E. Ramos, et al. vs.
Court of Appeals, G.R. No.
124354, December 29, 1999
d. Leah Alesna Reyes, et al. vs.
Sisters of Mercy Hospital, et
al., G.R. No. 130547,
October 3, 2000

E. Hearsay Rule
1. Grounds for Admissibility
2. Requisites for Admissibility
3. Case:
a. Ma. Paz Fernandez Krohn
vs. Court of Appeals, G.R.
No. 108854, June 14, 1994

F. Dying Declaration
1. Duties of Physician with regards
to Dying Declaration

VIII. INFORMED CONSENT


A. Informed Consent, defined
B. Doctrine of Informed Consent
C. Who can give informed consent
D. Case:
1. Rogelio P. Nogales vs. Capitol
Medical Center, G.R. No.
142625, December 19, 2006