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Legal Medicine Medical Jurisprudence

Notes from the lectures of Dr. Tony Rebosa

PHYSICIAN PATIENT RELATIONSHIP

- contractual, meeting of the minds - duciary: mutual trust and condence - consensual - When patients sue the doctor, the physician-patient relationship is broken. No more mutual trust if they want your license revoked

Rights of Patients
Right to give consent to tx and Dx procedures - bssed on PRINCIPLE OF AUTONOMY - conscious coherent legal age (18); minors unless benecial or life-saving - spouse, direct desc, dir ascendants, p>m grandparents, siblings full>half, subst parents - emergency: physician, last resort: Courts of Law - well informed (risks complics alternatives discussed) voluntary, legal - nal arbiter of his body Right to religious belief - Jehovah's witnesses and blood transfusion Right to condentiality and privacy (free fr unwarranted publicity, not to be identied; examples of relationships with statutory privileged communication - Physician Patient including medical staff attending to px) - waived right: implied, HIV-positive going against best interest of the public, once patient sues you - right to privacy and condentiality must not be over and above the best interest of the public Right to choose treatment Right to immediate emergency treatment up until he is stable - when stable, transfer to government institution - NO DEPOSIT POLICY Right to refuse necessary treatment Right to disclosure of information - cultural barriers and peculiarities but ultimately you have to tell the patient his condition - foreign bodies - do not intigate, mitigate --> before surgery, try to get in touch with the previous surgeon/doctors Right to choose his physician - unless emergency, charity or service case in private or government hospital Right to withdraw from physician-patient relationship - patient us not duty-bound to explain why they went to another doctor - doctor also has the right to withdraw from the pp relationship (Solis: consent of patient, give him/her time to look for another doctor; Rebosa et al.: no need for consent of patient) - case: anesthetics for surgery on an ectopic preg case high on cannabinoid, emergency going into coma post-operatively -> case against you is ABANDONMENT

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Rights of Doctors
Inherent - right to choose px (except being called during war, sentenced to hard labor, except EMERGENCY resulting to serious injuries/life-threatening) - right to refuse if there is threat to life and limb (except in EPIDEMICS as in Code of Ethics - administrative) - right to limit the practice of your profession (ex. Pedia only treats kids) - right to abandon practice anytime - right to decide management (doctrine of...) - right to decide fees etc. PF (except charity cases, emergency) *promissory note in case patient dies as evidence you charged (vs. post-dated cheque -> estafa CRIMINAL CASE, mas matatakot yung px, will comply) - right to withdraw from the physician-physician relationship (esp litigious proles) - right to avail of hospital services (vs. PIRACY)

Incidental - right of way while responding to an emergency/treating (minor trafc rules) - right to be free from execution of instruments (in case bankrupt) - right to compensation* Simple Contractual Fee Contingency (based on outcome: unethical) Retainer Fee (company doctors, based on length of time) Fee-splitting/Dichotomous (unethical, medicine is not a business) Package Deal/"Pakyawan" (unethical to stie and kill the competition, compromising quality for prot) - right to certain private and public ofces -right to membership to certain societies - right to perform certain services

Constitutional - enjoyed by all citizens (Bill of Rights)

DAMAGES
Liquidated damages - already in the contract form; contract of adhesion Exemplary damages Moral damages Actual damages - proven with receipt Compensatory - ex. Loss of income Nominal VIOLATION OF LAW Civil Criminal VIOLATION OF CODE OF ETHICS Administrative Ex. Immorality, decided on by Board of Medicine Reprimand, suspend, or revoke license Reinstatement within 2 years

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DOCTRINES
Not laws but principles usually applicable only in civil cases Generally, only the doer of the act is litigated Parties will be the ones to invoke the applicability of these doctrines Medical malpractice - as much as possible, 1 lawyer for all involved; if not, lawyers must coordinate with each other since lawyers will only protect the best interest of his client Civil liabilities - doer and somebody else

VICARIOUS LIABILITY
employer-employee relationship Employer has right to hire and re 1. Person who gets injured 2. Responsible for the injury sustained 3. Made civilly liable (hospital, employer, management) A. Captain of the Ship doctrine - surgeon will pay for damages in negligence of the anesthesiologist - OR B. Borrowed Servant doctrine - resident makes a boo-boo; resident loses license and goes to jail but attending physician is liable - UST is a juridical person but is not a natural person who can be subjected to a licensure exam and usually hospitals are owned and managed by non-doctors - no contract for treatment between hospital and patient, meron pag doctor (INDEPENDENT CONTRACTOR THEORY) C. Ostensible Agent doctrine - "pseudo employees" radiologist, pathologists, house anesthesiologist (no actual physical contact) - hospital owns equipment, chose radiologist - sharing of fee for CXR and other procedures 4D's of Malpractice Duty - may nanganganak Deriliction - di mo pinaanak Damage - namatay yung nanay Direct - kaninong kasalanan *Hospital - vicarious liability (kasalanan ng empleyeado),corporate liability (hospital has to keep you safe inside premises) - provide venue, equipment, personal

RES IPSA LOQUETOR

- "the thing speaks for itself" - craniotomy without anesthesia, removing the healthy part of the body, leaving a cellphone inside the body

CONTRIBUTORY NEGLIGENCE
- dealing with senile patients, >40 CP Clearance - patient also negligent

CONTINUING NEGLIGENCE
- continuously negligent when 2nd visit, you don't change treatment

ASSUMPTION OF RISK
- experimental tx and px agrees

FORSEEABILITY
- px is unconscious and goes into seizure, falls over bec stretcher has no railings

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LAST CLEAR CHANCE

*Criminally liable: contributory negligence, last clear chance

Good RESCUE
-

Samaritan Doctrine

SOLE RESPONSIBILITY vs. SHARED RESPONSIBILITY

- sole: co-management - shared: referral (to Dx but not to Tx so no physician-patient relationship) Government can't be sued without consent Private charity hospital immune from suit: Trust Fund doctrine - specic fund for charity case Implied Waiver - as an indigent patient you already know services are different Public Policy theory - incumbent upon the private sector to help Indepdendent Contractor - contract for tx between doctor and patient

STANDARD OF CARE
Locality Similar locality National - CME: 250 units

THE COURT
Medical Records Owned by hospital Only the courts can order medical records Subpoena subsicandum? Writ of manlamus

Cannot testify: Children of tender age Senile Previously charged of Perjury Ordinary witness vs expert knowledge Doctor is usually both ordinary and expert witness

Contempt: Direct - inside the courtroom; decorum *ne of up to P200 and prison of up to 10 days Indirect - there was an order of the court for you to do something / failing to show up despite due notice *ne of up to P30000 and prison term of up to 6 mos

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