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RECISTRATION Uy
BILLS AND INDEX ‘SERVICE

Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SE

'TEENTH (17TH) CONGRES|
First Regular Session

1025

House Bill No.

Introduced by: Rep. BERNADETTE R.-HERRERA-DY

ACT PROCLAIMING THE RIGHTS AND OBLIGATIONS OF PATIENTS,
PROVIDING A GRIEVANCE MECHANISM THEREOF, AND FOR OTHE]
PURPOSES

EXPLANATORY NOTE

This bill aims to provide a “Magna Carta of Patient Rights and Obligations”. It
borrows from and builds upon $.B. 151 authored by Sen. Pia Cayetano and filed
during the 16" Congress. It is designed to give life to the following constitutional
policies:

Section 15, Article of the Constitution provides that "(t)he State shall protect and
promote the right to health of the people and instill health consciousness." In addition,
Section 11, Article 12 states that "(t)he State shall adopt an integrated and
comprehensive approach to health and development which shall endeavor to make
essential goods, health and other social services, available to the people at affordable
costs."

This measure sets forth a list of guarantees for patients who receive medical care,
the duties and responsibilities of the government vis-a-vis the people's concomitant
rights and obligations, and a grievance mechanism ~ mediation — that will be able to
enforce or adjudicate upon patient rights and obligations whenever issues arise. The
measure guarantees patients access to medical information, fair treatment, and
autonomy over medical decisions, among others. It provides for individual and
societal rights, as well as obligations of patients, health care practitioners, and health
care institutions. This framework of rights and obligations are designed to help realize
decent, humane, and quality healthcare.

Premises considered, immediate passage of this bill is earngstly sought.

REP. BERNADETTE(HERRERA-DY



Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH (17TH) CONGRESS
First Regular Session

No. 1038

House

Introduced by: Rep. BERNADETTE R. HERRERA-DY

AN ACT PROCLAIMING THE RIGHTS AND OBLIGATIONS OF PATIENTS,
PROVIDING A GRIEVANCE MECHANISM THEREOF, AND FOR OTHER
PURPOSES

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

SECTION 1. Short Title. - This Act shall be known as the "Magna Carta of
Patient Rights and Obligations of 201_."

SEC. 2. Declaration of Policy. - It is hereby declared the policy of the State to
promote the right to health of the people and instill health consciousness among them,
It shall likewise protect and enhance the right of all people to human dignity thereby
establishing the Magna Carta of Patient's Rights and Obligations in order to ensure a
decent, humane and quality Health Care for all patients and Health Care Providers.

SEC. 3. Definition of Terms. - As used in this Act, the following terms shall be
defined as follows:

a. Emergency Patient - one who is in immediate threat of dying or losing life or
limb;

b. Health Care - measures taken by a Health Care Provider or in a Health Care
Institution in order to determine a patient's state of health or to restore or maintain
it;

¢. Health Care Institution - a site devoted primarily to the maintenance and
operation of facilities for the prevention, diagnosis, treatment and care of
individuals suffering from illness disease, injury or deformity if in need of
medical and nursing care;

4d. Health Care Provider - any physician, dentist, nurse, pharmacist or paramedic
and other supporting health personnel, including, but not limited to, dental and
‘medical technicians and technologists, nursing aides, therapists, nutritionists
trained in Health Care and/or duly registered and licensed to practice in the

1


Philippines as well as traditional and alternative Health Care practitioner, and
e. Patient - a person who avails of the health and medical care services.

SEC. 4. Individual Rights of Patients. - The following individual rights of
Patients shali be respected by all those involved in the delivery of Health Care
services;

a, Right to Good Quality Health Care and Humane Treatment - Every person
has a right to a continuity of good quality Health Care without discrimination and
within the limits of the resources, manpower and competence available for health
and medical care. In the course of such care, his human dignity, convictions,
integrity, individual needs and culture shall be respected

If a Patient cannot immediately be given treatment that is medically
necessary, he shall be informed of the reason for the delay and be treated in
accordance with his best interests, Provided, that the treatment applied shall be in
accordance with generally accepted medical principles

Emergency Patients shall be extended immediate medical care and treatment
without requiring, as a prerequisite thereof, any pecuniary consideration.

b. Right to Dignity - The Patient's dignity, culture and value shall be respected at
all times in medical care and teaching. Likewise, terminally ill patients shall be
entitled to humane terminal care to make dying as dignified and comfortable as
possible.

c. Right to be Informed of His Rights and Obligations as a Patient - Every
person has the right to be informed of his rights and obligations as a Patient, In
line with this, the Department of Health, in coordination with Health Care
Providers, professional and civic groups, the media, health insurance corporations,
people's organizations and local government organizations, shall launch and
sustain a nationwide information and education campaign to make known to the
people their rights as Patients, as provided in this Act. It shall also be the duty of
Health Care Institutions to inform Patients of their rights as well as of the
institution's rules and regulations that apply to the conduct of the Patient while in
the care of such institution, These rights and rules and regulations shall be posted
in a bulletin board conspicuously placed in a Health Care Institution

d. Right to Choose a Physician / Health Institution - The Patient is free to
choose the services of a physician or health institution of his choice except when
he chooses to be confined in a charity ward. In this case, the attending physician
shall be the consultant under whose service the patient was admitted as appearing
in the Doctor's Order Sheet of the Medical Record. The Patient shall have the
yht to seek a second opinion and subsequent opinions, if necessary, from
another physician or health institution, and to change his physician or health
institution.

e. Right to Informed Consent - The Patient has a right to self-determination and
to make free decisions regarding himself/herself. However, the attending



physician shall inform the Patient of the consequences of his/her decisions.

‘A Patient who is mentally competent and is of legal age, or in his incapacity
or age of minority, his legal representative, has a right to a clear explanation, in
layman's terms, of all proposed or contemplated procedures, whether diagnostic
or therapeutic, including the identity and professional circumstances of the person
or persons who will perform the said procedure or procedures. The explanation
shall include the amount of information necessary and indispensable for him to
intelligently give his consent, including, but not limited to, the benefits, risk, side
effects and the probability of success or failure, as a possible consequence of said
proposed procedure or procedures, including the implications of withholding
consent. In the explanation, the comprehensive ability of the patient shall also be
considered, taking into account his level of education, the dialect or language that
he speaks and understands, and if possible, with the use of anatomic sketch or any
materials or visual aids that may aid the patient, or his legal representative, in
fally understanding the proposed procedure or procedures.

The right to informed consent shall likewise consider the voluntariness in
which the Patient or his/her legal representative has given his/her consent, seeing
to it that the Patient or his legal representative was allowed to ask questions, or
that he/she is given the chance to consult his/her kin, or to seek another expert
opinion. If the patient is unconscious or is unable to express his/her will,
informed consent must be obtained whenever possible from a legal representative,
Provided however, That when medical intervention is urgently needed, the
consent of the patient may be presumed, Provided further, That a physician
should always try to save the life of a Patient who is unconscious due to suicide
attempt.

In the case of a Patient who is legally incompetent or is a minor, the consent
of a legal representative is required, Provided however, That the Patient must be
involved in the decision making process to the fullest extent allowed by his
mental capacity. If the legally incompetent Patient can make rational decisions,
his/her decisions must be respected, and he/she has the right to forbid disclosure
of such information to his/her legal representative.

If the patient's legal representative forbids treatment, but, in the opinion of
the physician, it is contrary to the patient's best interest, the physician may
challenge this decision in court, Provided however, That in emergency cases, the
physician shall act in the patient's best interest, Provided further, That in
emergency cases where there is no one who can give consent on the patient's
behalf, the physician can perform any emergency diagnostic or treatment
procedure in the best interest of the patient

£ Right to Refuse Diagnostic and Medical Treatment - The Patient has the
right to refuse diagnostic and medical treatment procedures, provided that the

following conditions are satisfied
i, The Patient is of legal age and is mentally competent;
ii, The Patient is informed of the medical consequences of his/her
refusal:
iii. The Patient releases those involved in his care from any obligation


relative to the consequences of his/her decision; and
iv. The Patient's refusal will not jeopardize public health and safety.

g. Right to Refuse Participation in Medical Research - The Patient has the
right to be advised of plans to involve hinvher in medical research that may affect
the care or treatment of histher condition. Any proposed research shall be
performed only upon the written informed consent of the Patient.

h. Right to Religious Belief and Assistance - The Patient has the right to receive
spiritual and moral comfort, including the help of a priest or minister of his/her
chosen religion. He/she also has the right to refusc medical treatment or
procedures which may be contrary to his religious beliefs, subject to the
limitations described in paragraph 6 of this Section:

i. Right To Privacy and Confidentiality - The patient has the right to privacy
and protection from unwarranted publicity. The right to privacy shall include the
patient's right not to be subjected to exposure, private or public, either by
photography, publications, video-taping, discussion, or by any other means that
would otherwise tend to reveal his person and identity and the circumstances
under which he was, he is, or he will be, under medical or surgical care or
treatment.

The Patient and his/her legal representative has the right to be informed by
the physician or his/her legal representative of the patient's continuing Health
Care requirements following discharge, including instructions about home
medications, diet, physical activity and other pertinent information,

All identifiable information about a patient's health status, medical condition,
diagnosis, prognosis and treatment, and all other information of a personal kind,
must be kept confidential even after death, Provided, That descendants may have
a right of access to information that will inform them of their health risks.

All identifiable Patient data must also be protected. The protection of the data
must be appropriate as to the manner of its storage. Human substance from which
identifiable data can be derived must be likewise protected

Confidential information can be disclosed in the following cases:
i, When the patient's medical or physical condition is in controversy ina
court litigation and the court, in its discretion, orders the patient to
submit to physical or mental examination of a physician;

ii, When public health or safety so demands;

iii. When the Patient, or in his incapacity, his/her legal representative,
expressly gives the consent:

iv. When the patient's medical or surgical condition is discussed in a
medical or scientific forum for expert discussion for his/her benefit or for
the advancement of science and medicine, Provided however, That the
identity of the Patient should not be revealed; and

v. When it is otherwise required by law.

j, Right to Disclosure of, and Access to, Information - In the course of the



patient's treatment and hospital care, the Patient or his/her legal guardian has the
right to be informed of the result of the evaluation of the nature and extent of
his/her disease. Any other additional or further contemplated medical treatment
on surgical procedure or procedures, shall be disclosed and may only be
performed with the written consent of the patient.

The disclosure of information may be withheld if giving the information to
the Patient will cause mental suffering or further impair his health, Provided, That
such disclosure may be withheld or deferred to some future opportune time upon
due consultation with the patient's immediate family, Provided further, That such
information must be given in a way that is appropriate to the local culture and in a
manner the Patient can understand

The Patient has the right to choose who he/she desires should be informed on
his behalf, Provided however, That the Patient also has the right not to be
informed on his explicit request, unless it is required for the protection of another
person's life

The Patient has the right to be given, and examine, an itemized bill for
hospital and medical services rendered, He is entitled to a thorough explanation
of such bill

k. Right to Correspondence and to Receive Visitors - The Patient has the right
to communicate with his/her relatives and other persons and to receive visitors
subject to reasonable limits prescribed by the rules and regulations of the Health
Care Institution

I. Right to Medical Records - The Heaith Care institution and the physician
shall ensure and safeguard the integrity and authenticity of the medical records.

The Patient, upon his/her request, is entitled to a medical certificate and
clinical abstract, He/she has the right to view, and obtain an explanation of, the
contents of his/her medical records from the attending physician, except for
psychiatric notes and other incriminating information obtained about a third party.

The Patient may also obtain from the Health Care Institution a reproduction,
at his/her expense, of his/her medical records, except for the psychiatric notes and
incriminating evidence referred to above, Provided, That any relevant document
that the Patient may require for insurance claims shall be made available to him
within a reasonable period of time

m. Right to Health Education — Every person has the right to health education
that will assist him in making informed choices about personal health and about
available health services. The education shall include information about healthy
lifestyles and about methods of prevention and early detection of illnesses, The
personal responsibility of everybody for his own health should be stressed

n. Right to Leave Against Medical Advice - The Patient has the right to leave a
hospital or any other Health Care Institution regardless of his physical condition.
Provided, That


i, He/she is informed of the medical consequences of his/her decision;

ii, He/she releases those involved in his/her care from any obligation relative
to the consequences of his/her decision; and

iii, His/her decision will not prejudice public health and safety.

o. Right to Express Grievances. - Every Patient has the right to express valid
complaints and grievances about the care and services received and to know the
disposition of such complaints, in accordance with Sections 7-8 of this Act.

SEC. 5. Societal Rights of Patients. - In addition to the individual rights of
Patients, the Patient has likewise the following socictal rights:

a. Right to Health - The Patient has the right to access quality Health Care and
physicians who are free to render clinical and ethical judgment without
interference or external pressure, He has likewise the right to regain/and or
acquire the highest attainable standard of health in a non-discriminatory, gender
sensitive and equal manner which health authorities and Health Care Providers
must progressively contribute to realize.

b. Right to Access to Quality Public Health Care - The Patient has the right toa
comprehensive and integrated Health Care delivery system with the necessary
manpower and facility resources. He shall also have the right to a functioning
public health and Health Care facilities, needed programs, such as public health
insurance, goods and services in sufficient quantity. He shall likewise be provided
with health facilities and services with adequate provision for essential drugs,
regular screening programs, appropriate treatment of prevalent diseases, illnesses,
injuries and disabilities. Towards this end, the government shall approximate the
international standard allocation for the health sector as set by the World Health
Organization.

c. Right to a Healthy and Safe Workplace - The Patient has the right to a
healthy natural workplace environment with adequate supply of safe and potable
water and basic sanitation, industrial hygiene, prevention and reduction of
exposure to harmful substances, preventive measures for occupational accidents
and diseases, and an environment that discourages abuse of alcohol, tobacco and
drug use, and the use of other harmful substances,

d. Right to Medical Information and Education Programs - The Patient has
the right to medical information and education programs on immunization;
prevention, treatment and control of diseases; behavior related concerns; and
disaster relief and emergency situations during epidemics and similar health
hazards. The State shall endeavor to provide these information through lectures,
symposia, quad-media, posters and the like.

e. Right to Participate in Policy Decisions - The Patient has the right to
participate in policy decisions relating to patient's right to health at the
‘community and national levels.

f. Right to Access to Health Facilities - The Patient has the right to be admitted



to primary, secondary, tertiary and other specialty hospitals when appropriate and
necessary,

g. Right to an Equitable and Economical Use of Resources - The Patient has
the right to an equitable and economical use of resources such that health
institutions, projects and programs of the State are equitably established and
implemented in various regions of the country.

h. Right to Continuing Health Care - The Patient has the right to avail of, or
secure access to, programs that will ensure continuity of care in the form of
hospice care, rchabilitation, chemotherapy, radiothcrapy arid other similar
modalities.

i, Right to Be Provided Quality Health Care In Times of Insolvency - The
Patient has the right, at all times, to access quality medical care in spite of
insolvency. ‘The State must provide for a system of payment to Health Care
Institutions and Providers for all the valid and necessary medical expenses of the.
poor and marginalized citizens.

SEC. 6. The Obligations of Patients. - The Patient shall fulfill the following
obligations and responsibilities regarding his/her medical care and/or personal
behavior

a. Know Rights - The Patient shall ensure that he knows and understands what
his/her rights as a Patient are and shall exercise those rights responsibly and
reasonably.

b. Provide Adequate, Accurate and Complete Information - The Patient shall
provide, to the best of his/her knowledge, adequate, accurate and complete
information about all matters pertaining to his/her health, including medications
and past or present medical problems, ailments, medical history, consultation with
other physicians, results of diagnostic work-up and treatment, to his/her Health
Care Provider.

c. Report Unexpected Health Changes - The Patient shall report unexpected
changes to his/her condition or symptoms, including pain, to his/her Health Care
Provider.

d, Understand the Purpose and Cost of Treatment - The Patient shall ensure
that he/she understands the purpose and cost of any proposed treatment or
procedure before deciding to accept it. He/she shall notify his/her Health Care
Provider if he/she does not understand any information about the proposed care or
treatment. The Patient shall insist upon explanations until adequately informed
and shall endeavor to make ail the necessary consultations before reaching a
decision

e. Accept the Consequences of Own Informed Consent - The Patient shall
accept all the consequences of his/her own informed consent. If he/she refuses
treatment or docs not follow the instructions or advice of the Health Care
Provider, he/she must accept the consequences of such decision and relieve the


Health Care Provider of any liability as a result of the exercise of his/her right to
self-determination.

£ Settle Financial Obligations. - The Patient shall ensure that the financial
obligations as a result of his/her Health Care are fulfilled as promptly as possible
Otherwise, he/she shall make the appropriate arrangements to settle unpaid
hospital bills and/or professional fees in accordance with Republic Act No. 9439
The patient must seck support from the State in order to establish a system of
payment to Health Care Institutions and Providers.

g. Respect the Rights. of Health Care Providers, Health Care Institutions
and Other Patients - The Patient is obligated to give due respect to the rights and
well-being of Health Care Providers, Health Care Institutions and other Patients.
He shall act in a considerate and/or cooperative manner and shall give respect to
the rights and properties of others. He shall follow the policies, rules and
regulations, and procedures of Health Care Institutions,

h. Obligation to Self - The Patient shall refrain from indulging in unhealthy food
consumption; addiction forming substance foods such as tobacco, alcohol and
drugs; lifestyles that have an adverse impact on health, such as sexual
promiscuity and reckless activities: and contamination of the environment, The
Patient is obligated to maintain a state of wellness

i. Provide Adequate Health Information and Actively Participate in His/Her
‘Treatment. - The Patient shall ensure that he/she has adequate health information
that will allow him/her to actively participate in the formulation of his/her
diagnostic and treatment plans. When he/she signs an informed consent, it is
assumed that he has the necessary information.

J. Respect the Right to Privacy of Health Care Providers and Institutions. -
‘The Patient has the obligation to submit grievances to the proper authorities or
venue and not resort to unwarranted publicity in the media. He/she shall not
disclose to the public any alleged complaint against Health Care Providers and/or
Institutions if it has not been fully decided by a court or administrative tribunal of
prosper jurisdiction,

k. Exercise Fidelity on Privileged Communication - A patient-physician
relationship is a fiduciary one where mutual trust, respect and confidence are
expected. All communications are privileged and the patient’ is obliged not to
breach this privileged communication especially if it involves a third party

1. Respect a Physician's Refusal to Treat Him - While the Patient has the right
to choose his/her physician, he/she is also obligated to respect the physician's
decision to choose whom he/she will treat.

m. Respect the Physician's Decision on Medical Reasons based on His/Her
Religious Beliefs - The Patient is obliged to respect the physician's religious
beliefs. If the Patient is a minor or is legally incapacitated, his/her parents or legal
representatives are obliged to likewise respect the physician's decision on mailers
relating to medical reasons despite their religious beliefs


n. Ensure Integrity and Authenticity of Medical Records - The Patient is
obliged to ensure the integrity and authenticity of his/her medical records. Any
manner of alteration of his/her records is a criminal offense subject to the
provisions of the Revised Penal Code.

. Participate in the Training of Competent Future Physicians - The Patient is
obligated to participate in the training of future physicians provided that
necessary information is provided to him/her and the appropriate ethical
considerations are observed.

p. Report Infractions and Exhaust Grievance Mechanism. - The Patient shall
immediately inform his/her Health Care Provider of any perceived or alleged
infraction of his/her rights as set forth in this Act through proper channels in order
to promote mutual trust, respect and confidence , between the Provider and the
and Patient. The Patient shall exhaust the grievance mechanism mediation
provided in Sections 7-8 of this Act before filing any administrative or legal
action.

SEC. 7. Grievance Mechanism. - Any written complaint arising from violation of
any of the rights of patients shall first be submitted for mediation. There shall be two
(2) forms of mediation: the hospital-based mediation and the barangay-based
mediation.

The hospital-based mediation committee shall be composed of a physician who
shall be appointed by the hospital and shall act as chairperson and two other (2)
physicians recommended by the Philippine Medical Association local component
society and acceptable to both parties as members. The chairperson and the members
of the committee must be in good standing of the PMA and its local component
society.

The barangay-based mediation committee shall be composed of the local health
officer as chairperson, one from the religious or duly accredited people’s organization,
and one from the PMA local component society who is a member In good standing.

The mediation procedure shall not be adversarial in nature. The Patient and the
Health Care Provider shall be given the opportunity to discuss the complaint and
efforts shall be made for its amicable settlement No monetary compensation nor legal
counsels shall be involved at this stage.

The aggrieved party shall be given thirty (30) days from occurrence of the
incident to file his/her written complaint for mediation. Upon receipt of the written
complaint, the concerned mediation committee shall have ninety (90) days to resolve
the complaint.

‘A successful mediation shall bar the filing of any judicial or administrative
actions.

SEC. 8. Second-Tier Mediation. - When mediation fails or no agreement is
reached after the lapse of the ninety (90) day period, the mediation committee shall


refer the complaint to the PMA through its local component society for appropriate
administrative action.

‘The PMA local component Society shall serve as the second tier mediation. It
shall be composed of the president of the local society as the presiding officer and one
representative from each of the following: component medical society, specialty
society corresponding to the case, the People’s Health Watch or other civic
organizations, and a representative from the local religious organization. The PMA
component society shall render its decision within Sixty (60) days from receipt of the
complaint.

In the event that the second tier medication fails, the case shall be automatically
referred to the PMA Commission on Ethics which shall likewise render its decision
within sixty (60) days from receipt of the complaint.

Resort to mediation and referral to the PMA Commission on Ethics shall be a
condition precedent to the filing of a legal action in court.

All parties to the complaint shall be bound by the rules on confidentiality on all
levels of the mediation.

All minutes of the mediation proceedings shall not be disclosed to any party
unless authorized by the court of law. Any discussion held or admissions made therein
shall not be used for or against any party in subsequent or other proceedings

In the event there is compensation, it shall be limited to actual monetary loss due
to treatment related to physical injuries. It shall not cover for "pain and suffering" or
other explicit non-monetary loss. An award shall bar the patient from filing any other
legal actions.

SEC. 9. Prescriptive Period. - The time during which the case is submitted for
mediation shall toll the running of the prescriptive period for the filing of a civil or
criminal case under the Revised Penal Code or any administrative case under existing
laws.

SS) 10. Inclusion in School Curriculum, Licensure Examinations and
Training. - The provisions of this Act shall be considered in the medical and
medical-related school curriculum and licensure examinations, including trainings and
seminars of traditional and alternative Health Care Providers or practitioners.

SEC. 11. Rules and Regulations. - The Secretary of Health. in consultation with
the Philippine Medical Association, the Philippine Hospital Association, the
Philippine Institute of Traditional and Alternative Health Care and other concerned
private agencies, non-governmental organization and people's organizations shall
promulgate such rules and regulations as may be necessary for its implementation
within One Hundred Eighty (180) days from the effectivity of this Act.

SEC. 12: Repealing Clause. - All Acts, Executive Orders, Rules and Regulations,

or parts thereof that are inconsistent with the provisions of this Act are hereby
repealed or modified accordingly.

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. 13. Effectivity. - This Act shall take effect fifteen (15) days after the date of
its publication in at least two (2) major newspapers of general circulation

Approved,