‘Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
First Regular Session

House BittNo. 742

EXPLANATORY NOTE

Ghost Surgery is a practice that has become prevalent in many
hospitals in the country. What exactly is ghost surgery, how does it happen
and what are the grave consequences of such illegal and unethical practice
are addressed in this bill, which is proposed to be enacted into law.

A. What is Ghost Surgery.

It is surgery performed on voluntarily unconscious patients
which makes it possible to substitute surgeons without the
patient's knowledge and permission thereby intentionally
misleading the patient about the surgeon's identity which defeats
the informed consent to the surgery.

B. How does it happen.

The methods in which “Ghost Surgery” is carried out is as
follows: Well known and popular city surgeons who are
éxtremely busy would schedule their surgeries in two to three (2
to 3) hospitals with overlapping time frames. Since there is no
way said surgeon can be physically present in all these hospitals
at the same time, the surgeon just takes the time to show his
face while the patient is still awake before the actual surgery .
The surgeon then leaves the hospital and proceeds to the other
hospital(s) to do the same. The patient meanwhile presumes
that said surgeon will be his or her operating surgeon. The
patient is then operated upon but actually by another Surgeon or
Resident Surgeon whichever the case, but without the patient's
knowledge and consent. The Attending Surgeon and the
Operating Surgeon who had an internal arrangement on this
case will then split the fees.


Another method in which “Ghost Surgery” is carried out
is as follows: In the provinces an attending doctor who is NOT a
surgeon admits a patient for surgery in a hospital. A Surgeon-
Colleague or a Resident Surgeon will do the actual surgery
without the patient's knowledge, permission and consent. During
the whole operation or surgery, patients are led to believe that
the surgery was actually performed by his or her “attending
doctor *. Once again fee splitting is practiced.

Any well known and busy Anaesthesiologist can likewise be
guilty of practicing GHOST ANAESTHESIA for the same reasons
as that of the GHOST SURGEONS. Fee-splitting is also widely
practiced in this case.

The hospitals where such unethical, illegal and immoral
practices are performed are very much aware of the GHOST
PRACTICE AND FEE-SPLITTING.

C. Illegal and ethical consequences

Surgical ghosts are ethically questionable and legally
dangerous. Patients do not believe that surgeons are
interchangeable (fungible, in legal terms). A patient's choice of
surgeons is as important as the informed consent to the surgery
Intentionally misleading the patient about the surgeon's identity
is fraud and defeats the informed consent to the surgery.

An operation properly performed by a surgeon operating without
the consent of the patient, albeit the patient suffers no injuries
except those which foreseeably follow from the operation, could
not justify the substitution of surgeons. The mental anguish
resulting from the belated knowledge that the operation was
performed by a doctor to whom the patient had not given
consent is legal basis for the award of damages. Furthermore,
substitution of surgeons without the patient’s knowledge and
permission is an intentional invasion of another's rights, and
punitive damages may be properly assessed in an appropriate
case.

The patient is entitled to choose his own physician and he should be
permitted to acquiesce in or refuse to accept the substitution. The surgeon's
obligation to the patient requires him to perform the surgical operation: (1)
within the scope of authority granted by the consent to the operation; (2) in
accordance with the terms of the contractual relationship; (3) with complete


disclosure of all facts relevant to the need and the performance of the
operation; and (4) to utilize his best skill in performing the operation. It
should be noted that it is the operating surgeon to whom the patient grants
consent to perform the operation and the patient is entitled to the services
of the particular surgeon with whom he or she contracts. The surgeon, in
accepting the patient is obligated to utilize his personal talents in the
performance of the operation to the extent required by the agreement
creating the physician-patient relationship. He cannot properly delegate to
another the duties which he is required to perform personally.

Medical ethics should be important to all doctors. The life-threatening
risks, post operation hazards, possible surgery failure and other related
grave consequences on the patients and their families who may be victims of
ghost surgery will be damaging not only to the individuals and families
concerned but to the whole society as well. Ghost surgery is a legally and
ethically dangerous that must not be promoted

Considering the merits of this bill, approval hereof is_ earnestly

requested. (
oa .v
LUIS R. ym FUERTE
J


‘Republic of the Bbilippines
HOUSE OF REPRESENTATIVES

@uezon City

FIFTEENTH CONGRESS
First Regular Session

HOUSE BILLNO. 742

Introduced by HONORABLE LUIS R. VILLAFUERTE

AN ACT PROHIBITING THE PRACTICE OF GHOST SURGERIES BY
MEDICAL DOCTORS AND HOSPITALS

Be it enacted by the Senate and House of Representatives in Congress
assembled:

SECTION 1. TiTLE - This Act shall be known as “The Ghost Surgery
Act”.

SEc. 2. DECLARATION OF PoLIcy — The State recognizes the need to
establish safeguards to protect its citizens from the dangerous practice of
“ghost surgery” which is ethically and legally questionable and dangerous
Due to many potential risks in possible failure and_ life-threatening
consequences as well as damage from surgeries, the practice of ghost
surgery not only betrays the trusts of patients to his surgeon who delegates
the surgery to another surgeon which the patient does not know or has
never met before or learned only of the substitute or surrogate surgeon only
after the operation thereby denominating such surgeries as “ghost
surgeries.” It is therefore hereby stated as state policy that “ghost

surgeries” (including ghost anesthesia) are prohibited and declared unlawful.


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The State recognizes that patients should have the right to opt out and
to demand that their surgeon will perform their operation and that the
patient is entitled to the services of the particular surgeon with whom he or
she contracts with. Even if the “ghost surgeon” performed skillfully and to
the benefit of the patient, even if there was no “malice” and “intent to
injure”, the whole practice of “ghost surgery” in itself implies deception and
dishonesty which is hereby declared as mala prohibita. There is no excuse
for not letting a patient know that another doctor other than the one the
patient recognizes and authorizes will actually perform the patient’s surgery.

The State recognizes that the practice of “ghost surgery” (including
ghost anesthesia) is an intentional invasion of another person’s rights. Thus,
a patient's choice of surgeon and anesthesiologist is as important as the
informed consent to the surgery.

To have another physician operate on one's patient or apply
anesthesia without the patient's written consent is a deceit. And to
intentionally mislead the patient about the surgeon's or anesthesiologist’s
identity is fraud.

The State recognizes that the patient is entitled to choose his own
physician and the patient should be permitted to acquiesce in or refuse to
accept the substitution. The surgeon's obligation to the patient requires him
to perform the surgical operation. The surgeon cannot properly delegate to

another the duties which he is required to perform personally.


Sec. 3. Definition of Terms - For purposes of this Act:

‘A Ghost Surgeon shall be defined as a surgeon who operates on:

1. a patient who belongs to another surgeon who was contracted for,
2. a patient that belongs to another doctor who is NOT a Surgeon

In both instances the patients are unaware of the switch and are
deliberately not being informed of such practice.

If the situation occurs where anesthesia is administered to a patient
under similar or analogous circumstances, such shall be deemed “ghost
anesthesia” and is subject to the provisions of this Act.

Sec. 4. Scope.

1. This Act shall apply to doctors and hospitals who intentionally
perform surgeries or apply anesthesia on patients without the
patient’s knowledge and consent that they will be the actual doctor
who will perform the operation or surgery irrespective of whether or
Not splitting of fees actually occur with the doctor whom the patient
originally contracted to perform the surgery

2. This Act shall not cover or apply to:

a. Teaching institutions under supervised operation by experienced

surgeons. Teaching the next generation of medical doctors and
the necessity of hands-on experience is a must in such a
situation. The inexperience of “student doctors” under this

situation of “supervised operation” is for the most part backed


SEc.

up by experienced medical doctors teaching them, so no harm
comes to the patient.

Under special arrangements with private patients, and with
reference to the usual form of consent to operation, the surgeon
may use the services of assisting residents or other assisting
surgeons when the operation reasonably requires the
employment of such assistance and it has the patient’s consent
and approval.

5. Implementing Rules and Regulations. - The Secretary of

Health shall issue the rules and regulations necessary to carry out the

Purpose of this Act.

SEC.

6. Effectivity Clause. - This Act shail take effect fifteen (15)

days following its publication in the Official Gazette or in two (2) national

newspapers with general circulation.

Approved,