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A Consolidated
Position Paper of the University of the Philippines Manila on the
Proposed Medical Malpractice Bill Submitted to the Senate and the
House Committee on Health by UP Manila Chancellor Marita V.T. Reyes,
M.D.
The
University of the Philippines Manila, the Health Sciences Center
of the University of the Philippines System, agrees with the objectives
of House Bill 4955 and Senate Bills 2298 and 2303 “to strengthen
the right of a patient to quality medical care.”
As
such, it recognizes the intentions of the sponsors of these bills
to ensure patient safety by providing them with professional health
care services. The University strongly objects, however, to the
proposal to punish medical malpractice as a mechanism to enhance
the quality of health care. It takes this position for the following
reasons:
- The
bill will further increase the already high cost of health care
as doctors and other health professionals would be forced to practice
“defensive medicine” and to secure “high premium” malpractice
insurance. Under such a system, physicians will be requiring patients
to undertake additional diagnostic tests and procedures to confirm
a diagnosis and avoid the subjective assessment of a patient’s
condition. Other health professionals will also find it difficult
to act as independent practitioners.
- The bill
will erode the sanctity of the patient-health professional relationship
because it will spawn doubts and mutual distrust on both sides,
thereby destroying the very foundation of ideal health care delivery
and depriving patients of their right to self determination which
is enshrined in the Magna Carta of Patients’ Rights. It will provide
an opportunity for third parties including non-relatives, to sue
medical practitioners even if the patient does not want to do
so. Patients owe it to themselves to choose the medical practitioner
they trust.
- It will
further deplete the ranks of doctors and health professionals
as they will shy away from providing health care because of the
“criminal implications” of their slightest errors and the stiff
penalties that will be imposed on them. The risks and implications
on their career as well as the possible financial burdens will
encourage selective treatment of patients. It will also discourage
health professionals from conducting free medical missions for
indigent patients and providing free treatments for those working
in government hospitals. The bill will further drive many health
practitioners to practice abroad because of higher benefits and
better legal protection. It will also discourage future generations
from pursuing medical-related professions because the care of
the sick will no longer be imbued with nobility, only risks.
- There are
enough existing laws, regulations, mechanisms and institutions
at all levels of health care that regulate and monitor the practice
of medicine in the Philippines. The laws include the Revised Penal
Code and the Medical Act of 1959, while the institutions include
the Professional Regulation Commission, the Philippine Medical
Association Ethics Committee, the specialty societies, the courts,
and the ethics/audit unit of hospitals. All these laws, regulations,
mechanisms and institutions can be strengthened.
- The bill
violates the Constitution’s Equal Protection Clause and promotes
class legislation. Why are medical practitioners being singled
out for such a harsh law which is characterized by sweeping but
vague definitions? If passed into law, the Philippines will be
the only country to have such a restrictive and harsh measure.
- It will
unduly punish legitimate medical practitioners who act in good
faith and whose mistakes are unintentional. Many of the so-called
“malpractices” vaguely defined by the bill are in fact system
errors such as overworked health professionals or dilapidated/obsolete
equipment, to name a few. This reflects the sad state of our ailing
health care system due to the comparatively low budget allocated
for health.
As part of
its mandate to contribute to the improvement of the health care
delivery system in the Philippines, the UP Manila community is proposing
the following measures with long-term benefits to our health-care
system in general and patient in particular:
- The government
should increase the budget for health care so that it can implement
health care programs that are accessible and affordable to as
many poor Filipinos as possible. Many government hospitals lack
the necessary facilities and equipment for better diagnosis and
treatment of illnesses.
- Greater
attention and effort should be given to improving the system of
health care by every member of the health care team by understanding
the system as an organized unit with a set of patients, technologies,
and practitioners and how each part of the system contributes
to promoting safety and reducing risks for patients.
- There should
be continuing effort to improve the quality of health professional
education in the country. Medical and paramedical education should
be regulated through the strict implementation of laws and imposition
of sanctions on violators. The Professional Regulation Commission
should exercise its mandate of screening the competence of new
health professionals.
- The government
should also be responsible for informing the public about the
rights of patients and the actions that can be taken when these
rights are violated. Likewise, government must assure that bio-ethics
is included in the curriculum for all health professionals.
- All individuals
and groups involved in health care, whether providers of access
or service, should take upon themselves the continuing responsibility
to help improve quality and work within the system. By its nature,
health care has risks and errors that cannot always be avoided.
But these can be kept to a minimum as humanly as possible through
substantial changes in the organization and system of delivery
of health care and periodic individual assessments.
- The UP
Manila National Institutes of Health (NIH) should conduct an in-depth
study on the issues surrounding medical malpractice and the formulation
of appropriate long-term solutions to improving the health-care
delivery system in the Philippines.
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REBYU
DISKUSYON
TAMPOK