legmed medical jurisprudence

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MEDICAL JURISPRUDENCE

A/y. Edwin L. Dimatatac, MD

•  Health Profession under PRC

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Health Professions under PRC

•  DenDstry (R.A. No. 9484) •  Medical Technology (R.A. No. 5527) •  Medicine (R.A. No. 2383, as amended) •  Midwifery (R.A. No. 7392) •  Nursing (R.A. No. 9173) •  NutriDon and DieteDcs (P.D. No. 1286) •  Optometry (R.A. No. 8050)

Health Professions under PRC

•  Pharmacy (R.A. No. 5921) •  Physical Therapy and OccupaDonal Therapy (R.A. 5680)

•  Radiologic and X-‐Ray Technology (R.A. No. 7431)

•  Sanitary Engineering (R.A. No. 1364) •  Social Workers (R.A. No. 4373) •  Veterinary Medicine (R.A. 9268)

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•  Health related professions are generally regulated by law and have a Code of Ethics applicable to the profession

•  Law and Code of Ethics embody the ideals expected of the health professional, and serve basis for self-‐regulaDon and administraDve liability.

PRIVACY/MEDICAL PRIVACY/CONFIDENTIALITY

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MEDICAL PRIVACY

•  Privacy -‐ the state of being free from intrusion or disturbance in one's private life or affairs

•  Confiden.ality -‐ privacy of informaDon and its protecDon against unauthorized disclosure

•  Medical or Health Privacy – protecDon of the confidenDal nature of personal health informaDon, includes communicaDons between health provider and paDent, personal data and informaDon about disease or paDent’s condiDon as contained in medical records

Rules of Court, Rule 128 Sec. 24

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Rules of Court, Rule 128 Sec. 24 •  DisqualificaDon by reason of privileged communicaDon. — The following persons cannot tesDfy as to ma/ers learned in confidence in the following cases: xxx

•  (c) A person authorized to pracDce medicine, surgery or obstetrics cannot in a civil case, without the consent of the paDent, be examined as to any advice or treatment given by him or any informaDon which he may have acquired in a/ending such paDent in a professional capacity, which informaDon was necessary to enable him to act in capacity, and which would blacken the reputaDon of the paDent. xxx

Medical Records

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Medical Records

•  Medical Records – owned by hospital or physician but personal data contained therein belongs to paDent

•  Custodian of records have a duty not to disclose or release contents of medical records unless authorized by law or ordered by court unless paDent consents

•  Electronic Medical Records, Telemedicine – poses challenges to health informaDon privacy

•  The Electronic Commerce Act of 2000 (See R.A. 8792 §§ 5, 7, 31-‐33) provides that any person with access to electronic data messages or documents has the obligaDon of confidenDality or the duty not to convey the informaDon to, or share it with, any other person. Under this law, unauthorized access to computer systems is punishable by a fine and mandatory imprisonment.

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•  The anD-‐wiretapping law (See R.A. No. 4200 §§ 1-‐2) may also be applied where a person who is not authorized by parDes to a private communicaDon record or communicate its contents. The act would probably cover doctor-‐paDent communicaDon which is privileged and confidenDal, and which therefore should not be recorded or disclosed without consent.

Specific Health Privacy LegislaDon

•  Republic Act No. 8504 (handling of informaDon, both the idenDty and status, of persons with HIV)

•  Republic Act No. 9165 (confidenDality of records of those who have undergone drug rehabilitaDon)

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Specific Health Privacy LegislaDon

•  Republic Act No. 9262 (confidenDality of records pertaining to cases of violence against women and their children)

•  Republic Act No. 8595 (ensuring privacy and safety of rape vicDms)

•  Duty of confidenDality may extend to those who may have access to the private informaDon, including custodian of records.

•  Under the Philippine AIDS PrevenDon and Control Act of 1998, the duty of maintaining paDent confidenDality is imposed on all persons involved in handling and maintaining paDent records. The law extends the duty not just to health professionals but also to health instructors, co-‐workers, employers, recruitment agencies, insurance companies, data encoders, and other custodians of medical records.

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•  R.A. No. 8504 “Philippine AIDS PrevenDon and Control Act of 1998": See §§ 15-‐17, 30-‐42

•  Wri/en informed consent -‐ requisite for HIV tesDng

•  Compulsory HIV tesDng unlawful •  Medical confidenDality of all medical informaDon

•  ViolaDon of ConfidenDality and discriminatory acts and policies penalized

PHYSICIAN AND HOSPITAL LIABILITY

•  SOURCES OF OBLIGATION

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Sources of ObligaDon

•  Delict •  Quasi-‐delict •  Contract •  Quasi-‐contract

•  Who is considered to be pracDcing medicine? A.  A medical student diagnosing and treaDng a

paDent under the supervision of the doctor B.  A denDst because we call him/her a doctor C.  Someone interviewed by Anthony Taberna

on his show who offers to treats AIDS with a miracle drug for free

D.  An optometrist who examines the eye and provides eyeglasses

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PracDce of Medicine A person shall be considered as engaged in the pracDce of medicine (a) who shall, for compensaDon, fee, salary or reward in any form, paid

to him directly or through another, or even without the same, physical examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condiDon or any ailment, real or imaginary, regardless of the nature of the remedy or treatment administered, prescribed or recommended; or

(b) who shall, by means of signs, cards, adverDsements, wri/en or printed ma/er, or through the radio, television or any other means of communicaDon, either offer or undertake by any means or method to diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condiDon; or

(c) who shall use the Dtle M.D. aqer his name. (Republic Act No. 2382, §10)

The following are NOT acts consDtuDng the pracDce of medicine

(a) any medical student duly enrolled in an approved medical college or school under training, serving without any professional fee in any government or private hospital, provided that he renders such service under the direct supervision and control of a registered physician;

(b) any legally registered dentist engaged exclusively in the practice of dentistry;

(c) any duly registered masseur or physiotherapist, provided that he applies massage or other physical means upon written order or prescription of a duly registered physician, or provided that such application of massage or physical means shall be limited to physical or muscular development;

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(d) any duly registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or other similar appliances or who is engaged in the mechanical examination of eyes for the purpose of constructing or adjusting eye glasses, spectacles and lenses;

(e) any person who renders any service gratuitously in cases of emergency, or in places where the services of a duly registered physician, nurse or midwife are not available;

(f) any person who administers or recommends any household remedy as per classification of existing Pharmacy Laws; and

(g) any psychologist or mental hygienist in the performance of his duties, provided such performance is done in conjunction with a duly registered physician.

(Republic Act No. 2382, §11)

•  Can a person pracDce medicine without a duly issued medical license from PRC?

•  What is “illegal pracDce of medicine”? •  Physician Liability •  Grounds for reprimand, suspension or revoca.on of registra.on cer.ficate

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Physician Liability

•  Administra@ve Liability •  Civil Liability •  Criminal Liability

The Code of Medical Ethics

Ü Duties of Physicians to their patients

Ü Duties of Physicians to the Community

Ü Duties of Physicians to their colleagues and to the profession

Ü Duties of Physicians to allied professionals

Ü Relationship of Physicians with the Health Products Industry

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DUTIES OF PHYSICIANS TO THEIR PATIENTS

•  Competence based on current standards

•  Free to choose patients except if emergency

•  Refer when needed •  Good faith and Strict honesty •  Preserve confidential information •  Reasonable fees

DUTIES OF PHYSICIANS TO THE COMMUNITY

Ü Cooperate with proper authoriDes for health promoDon or with government in administraDon of jusDce

Ü A/end to vicDms of epidemic and public calamity, except if personal safety is at stake

Ü Report unlicensed medical pracDDoners Ü SoliciDng paDents unethical Ü Physicians in mulDmedia must be well informed Ü Shall not endorse medical or health product

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DUTIES OF PHYSICIANS TO THEIR COLLEAGUES AND TO

THE PROFESSION •  Gratuitous service to a colleague, his or her spouse,

children and parents •  Consultation with colleague when necessary,

Observe proper protocol of referral system •  Full Disclosure of any pharmaceutical support in case

of articles and presentations •  Report corrupt or dishonest conduct to proper forum •  May accept funds for CME but CME should be free

from commercial influence

DUTIES OF PHYSICIANS TO ALLIED PROFESSIONALS

•  No payment of receipt of commissions

from allied health worker for cases referred

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RELATIONSHIP OF PHYSICIANS WITH THE HEALTH PRODUCTS

INDUSTRY

Ü No material gain from product samples by may try new products on paDents provided they consent

Ü Giqs of reasonable value that would benefit paDent may be accepted from health product company; donaDons for charitable purpose may be requested

Ü Research acDviDes should be ethical, responsible and valid

Which is a Ground for reprimand/suspension/revocation of license to practice medicine? A.  Doctor taking videos of himself having sexual

intercourse with a woman but the taking of videos is without the woman’s consent

B.  Doctor adverDsing his name, profession, clinic address and clinic hours

C.  Issuing a medical cerDficate when the diagnosis indicated in the medical cerDficate is later proven to be wrong

D.  AssisDng the aborDon of a woman with an ectopic pregnancy

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Grounds for reprimand, suspension or revoca.on of registra.on cer.ficate

(1) ConvicDon by a court of competent jurisdicDon of any criminal offense involving moral turpitude;

(2) Immoral or dishonorable conduct; (3) Insanity; (4) Fraud in the acquisiDon of the cerDficate of registraDon; (5) Gross negligence, ignorance or incompetence in the

pracDce of his or her profession resulDng in an injury to or death of the paDent;

(6) AddicDon to alcoholic beverages or to any habit forming drug rendering him or her incompetent to pracDce his or her profession, or to any form of gambling;

(7) False or extravagant or unethical adverDsements wherein other things than his name, profession, limitaDon of pracDce, clinic hours, office and home address, are menDoned.

(8) Performance of or aiding in any criminal aborDon; (9) Knowingly issuing any false medical cerDficate; (10) Issuing any statement or spreading any news or rumor

which is derogatory to the character and reputaDon of another physician without jusDfiable moDve;

(11) Aiding or acDng as a dummy of an unqualified or unregistered person to pracDce medicine;

(12) Viola@on of any provision of the Code of Ethics as approved by the Philippine Medical Associa@on.

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Can a physician refuse to a/end an emergency?

Refusal of a physician to a/end a paDent in danger of death is not a sufficient ground for revocaDon or suspension of his registraDon cerDficate if there is a risk to the physician's life.

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AdministraDve Liability •  ViolaDon of Code of Ethics •  ViolaDon of Medical Act of 1959 Sec. 24 (but some of those enumerated are also grounds for civil and/or criminal liability)

•  E.O. No. 212 (July 10, 1987) – ReporDng of treatment of Serious and Less Serious Physical Injuries to nearest government health authority

PRC Procedure Formal complaints should be submi/ed in person at the PRC office. Formal complaints undergo four stages: • Docke@ng and Calendar -‐ this starts from the date of filing of the complaint to when the noDce of pre-‐trial is sent to the parDes. • Pre-‐trial and Deposi@ons – covers the pre-‐trial, deposiDons, and other pracDces designed to dispense with, or limit Dme for the recepDon of evidence

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PRC Procedure •  Recep@on of Evidence – evidence for both the complainant and for the respondent are presented as well as the rebu/al evidence.

•  Decision-‐making – discussions and vote on the case and the preparaDon and signing of the decision.

CRIMINAL LIABILITY

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Can the fact of being a doctor be considered an aggravaDng

circumstance?

CRIMINAL LIABILITY * Degree of InstrucDon as an AlternaDve Circumstance • Illegal PracDce of Medicine • False Medical CerDficate • AborDon pracDced by a physician or midwife •  SimulaDon of births, subsDtuDon of one child for another and concealment or abandonment of a legiDmate child. • Criminal Negligence

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Reckless Imprudence •  The elements of reckless imprudence are: (1) that the offender does or fails to do an act; (2) that the doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material damage results from the reckless imprudence; and

(5) that there is inexcusable lack of precauDon on the part of the offender, taking into consideraDon his employment or occupaDon, degree of intelligence, physical condiDon, and other circumstances regarding persons, Dme and place.

Reckless Imprudence The allegations in the information in this case that the accused acted with reckless negligence in diagnosing, prescribing for, and treating the deceased Susana Tam, knowing that she did not possess the necessary technical knowledge or skill to do so, thus causing her death, sufficiently charge the crime of homicide through reckless imprudence, since ordinary diligence counsels one not to tamper with human life by trying to treat a sick man when he knows that he does not have the special skill, knowledge, and competence to attempt such treatment and cure, and may consequently reasonably foresee harm or injury to the latter. In a similar case wherein the accused, not being a regular practitioner, undertook to render medical assistance to another, causing physical injuries to the latter, said accused was found guilty and convicted by this Court of physical injuries through imprudence under the old Penal Code (U. S. vs. Feliciano Divino, 12 Phil., 175). [People vs. Vda. de Golez, 108 Phil. 855, 859(1960)]

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•  Whether or not a physician has committed an “inexcusable lack of precaution” in the treatment of his patient is to be determined according to the standard of care observed by other members of the profession in good standing under similar circumstances bearing in mind the advanced state of the profession at the time of treatment or the present state of medical science [Cruz vs. Court of Appeals, 282 SCRA 188, 199-200(1997)(This case involves a hysterectomy performed for myoma allegedly in a hospital with inadequate facilities and untidy surroundings. The accused was acquitted because of lack of expert testimony to establish standard of care.]

•  The crime is committed if a person undergoes to treat a patient even if he is not qualified, and in the process causes injury to the patient.

•  Inexcusable lack of precaution is determined based on accepted standard of care of the medical profession.

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Negligence of a doctor resulDng to injury to a paDent may be ground for criminal liability. It is also basis for civil liability and award of damages under what law?

NEGLIGENCE CAUSING INJURY TO A PATIENT

•  The Medical Act imposes the penalty of imprisonment, fine, or both for any person found guilty of illegal practice of medicine. This refers to the act of engaging in the practice of medicine (defined in §10) without complying with the prerequisites provided by the same act (as provided in §8). There is no penalty under the Medical Act of 1959 for gross negligence, ignorance or incompetence other than administrative liability. (Republic Act No. 2382, §§8,10 and 28)

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¨ Gross negligence, ignorance, or incompetence in the pracDce of Medicine resulDng in an injury to or death of the paDent may be basis for award of damages under the Civil Code which makes every person who negligently causes damage to another liable to indemnify the la/er for the same. (New Civil Code, , arts. 19-‐21, 2176.)

Civil Liability

•  Direct Liability under arDcle 2176 •  Vicarious Liability, arDcle 2180 in relaDon to arDcle 2176

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•  Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-‐exisDng contractual relaDon between the parDes, is called a quasi-‐delict and is governed by the provisions of this Chapter.

•  Culpable Act or Negligence •  Damage to another •  Causal rela@on between the culpable act or negligence and the damage to another

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•  Elements of Medical Negligence

Elements of Medical Negligence

•  duty •  breach •  injury •  proximate causaDon

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•  TEST to determine negligence: Did the defendant in doing the alleged negligent act use that reasonable care and cau@on which an ordinarily prudent person would have used in the same situa@on? If not, he is guilty of negligence.

•  Conduct is said to be negligent when a prudent man in the posi@on of the torSeasor would have foreseen that an effect harmful to another was sufficiently probable to warrant his foregoing the conduct or guarding against its consequences.

•  Negligence – Conduct which creates undue risk of harm to others; risk means a danger which is apparent or should be apparent, to one in the posi@on of the actor; determina@on of negligence is a ques@on of foresight on the part of the actor (FORSEEABILITY); effect harmful to other was sufficiently probable to warrant his conduct or guarding against its consequence (PROBABILITY)

•  The fault or negligence of the obligor consists in the omission of that diligence which is required by the nature of the obliga@on and corresponds with the circumstances of the persons, of the @me and of the place.

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•  PROXIMATE CAUSE: that cause, which, in natural and con@nuous sequence, unbroken by any efficient intervening cause, produces the injury, and without which the result would not have occurred.

•  Burden of Proof •  Proof Required

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Burden of Proof •  BURDEN OF PROOF: duty of a party to present evidence

on the facts in issue necessary to establish his claim or defenses by the amount of evidence required by law

•  Plain@ff alleging DAMAGE because of the negligent act of defendant has the burden of proving such negligence

•  It is even presumed that a person takes ordinary care of his concerns

•  Quantum of proof required is preponderance of evidence •  Excep@on: when rules or the laws provide for cases when

negligence is presumed

•  Doctrine of Res Ipsa Loquitur

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Doctrine of Res Ipsa Loquitur

•  the accident was of a kind which does not ordinarily occur unless someone is negligent; and

•  that the instrumentality or agency which caused the injury was under the exclusive control of the person charged with negligence.

•  the injury suffered must not have been due to any voluntary acDon or contribuDon on the part of the person injured

•  The doctrine of res ipsa loquitur, operates more as a rule of evidence than a substanDal basis of a cause of acDon.

•  The doctrine of res ipsa loquitur warrants a presumpDon or inference of negligence on the part of the person having charge of the instrumentality causing damage.

•  Direct evidence as to specific act of negligence causing injury absent or not readily available

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Doctrine of Informed Consent Elements in a malpracDce acDon based upon the

doctrine of informed consent: (1) the physician had a duty to disclose material risks; (2) he failed to disclose or inadequately disclosed those

risks; (3) as a direct and proximate result of the failure to

disclose, the paDent consented to treatment she otherwise would not have consented to; and

(4) plainDff was injured by the proposed treatment. The paDent must point to significant undisclosed

informaDon relaDng to the treatment which would have altered her decision to undergo it.

[Li v. Soliman, G.R. No. 165279, June 7, 2011]

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•  Possible defenses of Physician

Possible Defenses of a Physician

1.  No negligence 2.  Plaintiff’s Own Negligence is cause of

injury 3.  Assumption of risk (related to informed

consent) 4.  Act of God/Accident/Force Majeur

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PaDent’s own Negligence Doctrine of Contributory Negligence

•  Art. 2179. When the plainDff’s own negligence was the immediate and proximate cause of his injury, he cannot recover damages. But if his negligence was only contributory, the immediate and proximate cause of the injury being the defendant’s lack of due care, the plainDff may recover damages, but the courts shall miDgate the damages to be awarded. (See also Cayao-‐Lasam vs. Ramolete, 574 SCRA 439(2008)]

VICARIOUS LIABILITY •  ArDcle 2180 -‐ The obligaDon imposed by ArDcle 2176 is demandable not only for one's own acts or omissions, but also for those of persons for whom one is responsible. Xxx

•  The owners and managers of an establishment or enterprise are likewise responsible for damages caused by their employees in the service of the branches in which the la/er are employed or on the occasion of their funcDons.

•  Employers shall be liable for the damages caused by their employees and household helpers acDng within the scope of their assigned tasks, even though the former are not engaged in any business or industry.

•  •  The State is responsible in like manner when it acts through a special agent; but not when the damage has been caused by the official to whom the task done properly pertains, in which case what is provided in ArDcle 2176 shall be applicable.

•  •  Lastly, teachers or heads of establishments of arts and trades shall be liable for damages caused by their pupils and students or apprenDces, so long as they remain in their custody.

•  •  The responsibility treated of in this arDcle shall cease when the persons herein menDoned prove that they observed all the diligence of a good father of a family to prevent damage. (1903a)

•  Captain of Ship Doctrine •  Borrowed Servant Doctrine

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VICARIOUS LIABILITY

Employers shall be liable for the damages caused by their employees and household helpers acDng within the scope of their assigned tasks, even though the former are not engaged in any business or industry.xxx The responsibility treated of in this arDcle shall cease when the persons herein menDoned prove that they observed all the diligence of a good father of a family to prevent damage.

Give an Example of a Doctrine that makes a physician

vicariously liable

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VICARIOUS LIABILITY

• Captain of Ship Doctrine • Borrowed Servant Doctrine

CONSENT FORMS AND WAIVER OF LIABILITY

•  Art. 1174. Except in cases expressly specified by the law, or when it is otherwise declared by s@pula@on, or when the nature of the obliga@on requires the assump@on of risk, no person shall be responsible for those events which could not be foreseen, or which, though foreseen, were inevitable.

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CONSENT FORMS AND WAIVER OF LIABILITY

•  Release Forms: Consent on Admission and Consent to Operation. “Both release forms consist of two parts. The first part gave CMC permission to administer to Corazon any form of recognized medical treatment which the CMC medical staff deemed advisable. The second part of the documents, which may properly be described as the releasing part, releases CMC and its employees “from any and all claims” arising from or by reason of the treatment and operation.”

•  The documents do not expressly release CMC from liability for injury to Corazon due to negligence during her treatment or operation. Neither do the consent forms expressly exempt CMC from liability for Corazon’s death due to negligence during such treatment or operation. Such release forms, being in the nature of contracts of adhesion, are construed strictly against hospitals. Besides, a blanket release in favor of hospitals “from any and all claims,” which includes claims due to bad faith or gross negligence, would be contrary to public policy and thus void.

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•  Even simple negligence is not subject to blanket release in favor of establishments like hospitals but may only mitigate liability depending on the circumstances. When a person needing urgent medical attention rushes to a hospital, he cannot bargain on equal footing with the hospital on the terms of admission and operation. Such a person is literally at the mercy of the hospital. There can be no clearer example of a contract of adhesion than one arising from such a dire situation. Thus, the release forms of CMC cannot relieve CMC from liability for the negligent medical treatment of Corazon.

•  [Nogales vs. Capitol Medical Center, 511 SCRA 204, 228-29(2006)]

Hospital Liability

•  Direct Liability under arDcle 2176 Corporate liabiliDes -‐ those arising from the failure of hospitals to furnish accommodaDons and faciliDes necessary to carry out its purpose or to follow the established standard of conduct to which it should conform.

•  Vicarious Liability

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•  Under 2176, two things must be proven: that the hospital did not exercise reasonable care and cauDon required of prudent hospitals; and second, that this failure is the cause of injury to the paDent.



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Give an example of a hospital duty provided by law

DuDes of Hospitals provided by Law

1.  DUTY TO OBTAIN LICENSE 2.  DUTY TO RENDER IMMEDIATE EMERGENCY

MEDICAL ASSISTANCE 3.  DUTY NOT TO REQUIRE DEPOSIT IN

EMERGENCY AND SERIOUS CASES 4.  DUTY NOT TO CAUSE DETENTION OF

PATIENTS DUE TO NONPAYMENT

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HOSPITAL CODE OF ETHICS

•  The Primary objecDve of the hospital are the following:

•  1.2 To provide the best possible faciliDes for the care of the sick and injured at all Dmes;

•  1.3 To constantly upgrade and improve methods for the care, the cure, amelioraDon and prevenDon of disease; and

HOSPITAL CODE OF ETHICS

•  1.4 To promote the pracDce of medicine by Physicians within the insDtuDon consistent with the acceptable quality of paDent care.

•  These objecDves require an efficient organizaDon, a competent administrator, a qualified medical staff, other well-‐trained personnel and adequate physical faciliDes with all of which services are made available at all Dmes consistent with community needs.

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Corporate Negligence

•  (1) A duty to use reasonable care in the maintenance of safe and adequate faciliDes and equipment;

•  (2) A duty to select and retain only competent physicians;

•  (3) A duty to oversee all persons who pracDce medicine within its walls as to paDent care; and

•  (4) A duty to formulate, adopt and enforce adequate rules and policies to ensure quality care for the paDents

What doctrine may be used to make a hospital liable for acts of an independent contractor such as a

physician who performs a negligent act causing injury to

paDent?

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Vicarious Liability

•  1. vicarious liability for acts of an employee •  2. the doctrine of apparent authority or agency by estoppel

Doctrine of Apparent Authority

•  It must be stressed that under the doctrine of apparent authority, the ques@on in every case is whether the principal has by his voluntary act placed the agent in such a situa@on that a person of ordinary prudence, conversant with business usages and the nature of the par@cular business, is jus@fied in presuming that such agent has authority to perform the par@cular act in ques@on.

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•  Hospital's manifestaDons -‐ described as an inquiry whether the hospital acted in a manner which would lead a reasonable person to conclude that the individual who was alleged to be negligent was an employee or agent of the hospital.

•  PaDent's reliance -‐ as an inquiry on whether the plainDff acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care and prudence

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CASE 1

•  13/F underwent an appendectomy. Apparently, patient was not weighed prior to the operation.

•  The Operation was scheduled at 5PM but started 5:45PM because the surgeon arrived only at that time. Patient was finally brought out of the OR at 7PM and brought back to her room. Patient did not wake up and had a “weak heartbeat” but was apparently revived. Surgeon and anesthesiologist then left.

•  Approximately 15 minutes later, patient suffered convulsions. The family physician, surgeon and a cardiologist were called and after examining patient, doctors consulted with each other.

•  The cardiologist then informed the parents that the “infection went up to her head” and that the anesthesiologist will be called.

•  The anesthesiologist arrived only at 10:30PM.

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•  Upon arriving and aeeing 2 small bottles and a big bottle of dextrose hanging above the bed of the child, the anesthesiologist said, "What is this? Christmas tree or what?"

•  When asked why the child is deteriorating, the anesthesiologist answered, "that is nothing, the child will regain consciousness and if the child will not regain consciousness, I will resign as a doctor.”

•  Patient never regained consciousness and died 3 days later.

CASE 2 •  Elderly male consulted clinic and found to

have BP 210/100 and HR 112. Patient was given Capoten 25mg and advised to go to a hospital. Physician instructed clinic ambulance to stand-by for conduction. After resting for a few minutes, patient said that he will just look for a companion. A nurse was asked to look for the patient but he could not be found. After a few minutes, the doctor left.

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•  Patient apparently went to the hospital and was treated in the emergency room for four hours. Upon being discharged and prior to arriving home, patient experienced nausea, abnormal palpitation and uneasiness and had to be brought back to the hospital. He was admitted for treatment but the following morning, he suffered a stroke. He never completely recovered and eventually died months later.

CASE 3 •  A video was uploaded in YouTube showing

an operation wherein medical staff extracted a can of body spray lodged in a patient’s rectum. Throughout the entire operation, the staff were seen to laugh and jeer, and several of them exclaimed, “baby out!” when the spray can was finally removed. The hospital apparently asked the patient’s permission to take the video of the unusual case, and the patient agreed.

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CASE 4 •  Several sex videos found their way in

the internet showing a physician having sex with various female partners. Videos were apparently taken without the knowledge and consent of the women, some of whom were his patients. Immorality complaints were filed against the physician before the Professional Regulations Commission.

•  The physician’s license was revoked as he was found guilty of immorality and dishonorable and/or unethical conduct offensive to the profession. Physicians are expected to show respect for women and their patients, and to uphold the honor, dignity and integrity of the medical profession.

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•  THANK YOU

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