Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

THIRTEENTH CONGRESS
1* Regular Session

House Bill No. 261

Introduced by RODRIGUEZ D. DADIVAS_

This bill seeks to stop the common practice of hospital or health care institution
owners in detaining their patients on the sole basis of the latter's failure to fully settle
its financial obligations. Collection of hospital bills is indeed a legitimate business
concem but detaining a patient to ensure his/her payment would only add up the
Patient's bills even more because of his/her extended stay. This happens always
especially to poor patients.

This bill provides a compromise acceptable to both parties. Patients most especially
from the fow-income sector should be given the right to leave, while the hospitals or
health care institutions will be provided a leeway so as not to jeopardize its
investments.

Under this bill, patients in emergency shall be extended medical attention without
any deposit, pledge, mortgage or any form of advance payment for treatment. The
bill also provides a patient's right to be informed of his/her illness in a manner and
language understandable to him or her. He/she or his legal guardian has the right to
examine and be given itemized bill of the hospital and medical services rendered in
the facility of by his/her physician and other health care providers, regardiess of the
manner and source of payment. The patient is entitled to a thorough explanation of
such bills

This measure also provides for a grievance mechanism wherein patients are entitled
to air hisfner complaint arising from violation of any of the rights of patients under this
bill to be submitted for mediation. However, the hearing procedure is not adversarial
in nature. The patient and the health care provider or practitioner shall be given the
opportunity to discuss the cause of complaint and effort ‘shall be made for its
settlement.

There are also other provisions on this bill that promote the right to health of the

Fn.reyibil patenterights


Republic of the Philippines.
HOUSE OF REPRESENTATIVES

‘Quezon City

THIRTEENTH CONGRESS
1 Regular Session

House Bill No. 261

AN ACT
DECLARING THE RIGHTS AND OBLIGATIONS OF PATIENTS AND
ESTABLISHING A GRIEVANCE MECHANISM FOR VIOLATIONS THEREOF AND
FOR OTHER

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

Title |: Title and Declaration of Policies

Section 1. Short Title. — This Act shall be known as the “Magna Carta of
Patient's Rights and Objigations.”

Sec. 2. Declaration of Policy. - It shall be the policy of the State to protect
and promate the nght to health of the people and instif! heath and consciousness
among them. It shall likewise be the policy of the State for Congress to give the
highest priority to the enactment of measures that protect and enhance the right of
all people to human dignity. Towards this end, the State shall ensure, provide and
protect the rights of patients to decent, humane and quality health care.

Sec. 3. Definition of Terms. — As used in this Act, the following terms are
defined as follows:

1) Advance Directive — is a document with written instructions made by a
person before he/she reaches the terminal phase of a terminal iliness or a
persistent vegetative state and incapable of making decisions about
medical treatment when the question of administering the treatment arises
tt includes, but is not limited to, @ heatth care proxy or a living will. It is
preferably, a duly notarized document executed by a person of legal age
and of sound mind, upon consultation with a physician and family
members. It directs health care providers to administer terminal care when
the person executing such directive reaches the terminal phase of his
terminal iliness

2) Emergency — an unforeseen combination of circumstances which is
unanticipated and episodio, life-threatening; and there is disablity of
function which calls for immediate medical intervention to preserve the life
and limb of a person and/or patient as may be determined by a
responsible heatth care worker.


3) Health Care - measures taken by a health care provider or that are taken
in a health care institution in order to determine a patient's state of health
or to restore or maintain it.

4) 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 iliness, disease, injury, or deformity if in need of
medical and nursing care.

5) Health Care Professional/Practitioner — any physician, dentist, nurse,
pharmacist or paramedical and other supporting health personnel,
including, but not limited to, medical and dental technicians and
technologists, nursing aides, therapists, nutritionists trained in health care
and/or duly registered and licensed to practice in the Philippines as well as
traditional and altemative health care practitioners.

6) Health Maintenance Organization - any entity licensed by the
appropriate govemment regulatory agency, which arranges for coverage
designated health services needed by plan members for a fixed prepaid
premium.

7) Human Experimentation — the physician’s departure from standard
medical practice of treatment for the purpose of obtaining new knowledge
or testing a scientific hypothesis on human subjects.

8) Indigent Patient — a patient who has no visible means of income or
whose income is insufficient for the subsistence of his family.

9) Informed Consent — the voluntary agreement of a person to undergo or
be subjected to a procedure or other bodily intervention based on his
understanding of the relevant consequences of receiving a particular
treatment, as clearly, truthfully and reasonably explained by the health
care provider in a manner and language understandable to the patient
‘Such permission must be in writing.

10)Mass Media — embraces means of communication that reach and
influence large numbers of people, including print media, especially
newspapers, periodicals, and popular magazines, radio, television, and
movies, and involved in the gathering, transmission and distribution of
news, information, messages, signals and all forms of written, oral and
visual communications.

11)Media Practitioner — any person who is engaged in the practice of mass
media.

12)Medically Necessary — a service or procedure which is appropriate and
Consistent with diagnosis and which, using accepted standards of medical
practice, could not be omitted without adversely affecting the patient's
condition.

13)Patient — a person who avails himself or herself of health and medical
care services or is otherwise the subject of such services.

14)Public Health and Safety — the state of well-being of the population in
general, the protection of which may require the curtailment or suspension
of certain rights of patients.

15) Terminal Care — is an array of services offered by a team of doctors,
nurses, therapists, social workers, clergy and volunteers which provide
active total care directed at maintaining or improving the comfort of a
person suffering from terminal illness, including the management of pain
and physical symptoms, and the provision of spiritual, psychological and



emotional support for the person and his family in an institution, a hospital
or at the patient's home. Care does not hasten nor postpone death. It
affirms life and regards dying as a normal process. Care continues so that
the remaining life can be lived to the fullest until a dignified and peaceful
death comes in the terminal phase of the person's iliness.

16)Terminal ltiness ~ is an iliness of condition resulting in death within the
foreseeable future.

17)Terminal Phase — is the stage of terminal illness when there is no real
prospect of recovery or remission of symptoms on either a permanent or
temporary basis.

18)Traditional and Alternative Health Care — the sum total of knowledge,
skills, and practices on health care, other than those embodied in
biomedicine, used in the prevention, diagnosis and elimination of physical
or mental disorder.

19)Traditional and Alternative Health Care Practitioner/Provider - a
person who practices other forms of non-allopathic, occasionally non-
indigenous or imported healing methods, such as reflexology,
acupuncture, massage, acupressure, chiropractic, nutritional therapy, and
other simitar methods.

20)Unwarranted Public Exposure — a situation where the patient is
subjected to exposure, private or public, either by photography,
Publication, videotaping, discussion, TV broadcasting or radio
broadcasting, or by any other means that would otherwise tend to reveal
his person or identity and circumstances under which he has or will be
under medical or surgical treatment without his/her consent/

Title Hl: Declaration of Rights
Sec. 4. The Rights of Patients. - The following rights of the patient shall be
respected by all those involved in his care:

1) Right to Appropriate Medical Care and Humane Treatment. - Every
person has a right to health and medical care corresponding to his state of health,
without any discrimination and within the limits of the resources, manpower and
competence available for health and medical care at the relevant time.

The patient has the right to appropriate health and medical care of good
quality. in the course of such care, his human dignity, convictions, integrity, individual
needs and culture shall be respected

If any person cannot immediately be given treatment that is medically
necessary he shall, depending on his state of health, either be directed to wait for
care, or be referred or sent for treatment elsewhere, where the appropriate care can
be provided. if the patient has to wait for care, he shall be informed of the reason for
the delay.

Patients in emergency shall be extended immediate medical care and
treatment without any deposit, pledge, mortgage or any form of advance payment for
treatment.


2) Right to Informed Consent. — The patient has a right to a clear, truthful
and substantial explanation, in a manner and language understandable to the
Patient, of all proposed procedures, whether diagnostic, preventive, curative,
Tehabllitative or therapeutic, wherein the person who will perform the said procedure
shall provide his name and credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to recuperation, and probability of
success and reasonable risks involved: Provided, That the patient will not be
subjected to any procedure without his written informed consent, except in the
following cases:

a) in emergency cases, when the patient is at imminent risk of physical injury,
decline or death if treatment is withheld or postponed. In such cases, the
physician can perform any diagnostic or treatment procedure as good
practice of medicine dictates without such consent;

b) when the health of the population is dependent on the adoption of a mass
health program to control epidemic;

¢) when the law makes it compulsory for everyone to submit a procedure;

d) when the patient is either a minor, or legally incompetent, in which case, a
third party consent is required

©) when disclosure of material information to patient will jeopardize the
success of treatment, in which case, third party disclosure and consent
shall be in order;

f)_ when the patient waives his right in writing.

Informed consent shall be obtained from a patient concemed if he is of legal
age and of sound mind. In case the patient is incapable of giving consent and a third
party consent is required, the following persons, in the order of priority stated
hereunder, may give consent:

i spouse;

ii, son or daughter of legal age;

ii, —_ either parent;

iv. brother or sister of legal age, or
¥. guardian

if a patient is a minor, consent shall be obtained from his parents or legal
guardian. If next of kin, parents or legal guardians refuse to give consent to a
medical or surgical procedure necessary to save the life or limb of a minor or a
Patient incapable of giving consent, courts, upon the petition of the physician or any
Person interested in the welfare of the patient, in a summary proceeding, may issue
an order giving consent.

3) Right to Privacy and Confidentiality. — The privacy of the patients must
be assured at all stages of his treatment. The patient has the right to be free from
unwarranted public exposure, except in the following cases: a) when his mental or
physical condition is in controversy and the appropriate court, in its discretion, order
him to submit to @ physical or mental examination by a physician; b) when the public
health and safety so demand; and c) when the patient waives this right in writing.


The patient has the right to demand that all information, communication and
records pertaining to his care be treated as confidential. Any health care provider or
practitioner involved in the treatment of a patient and all those who have legitimate
access to the patient's record is not authorized to divulge any information to a third
party who has no concem with the care and welfare of the patient without his
consent, except: a) when such disclosure will benefit public health and safety; b)
when it is in the interest of justice and upon the order of a competent court; and c)
when the patients waives in writing the confidential nature of such information; d)
when it is needed for continued medical treatment or advancement of medical
science subject to de-identification of patient and shared medical confidentiality for
those who have access to the information.

Informing the spouse or the family to the first degree of the patient's medical
condition may be allowed; Provided That the patient of legal age shall have the right
to choose on whom to inform. In case the patient is not of legal age or is mentally
incapacitated, such information shall be given to the parents, legal guardian or his
next of kin.

4) Right to Information — In the course of his/her treatment and hospital
care, the patient or his/her legal guardian has a right to be informed of the resutt of
the evaluation of the nature and extent of hisher disease, any other additional or
further contemplated medical treatment on surgical procedure or procedures,
including any other additional medicines to be administered and their generic
counterpart including the possible complications and other pertinent facts, statistics
or studies, regarding his/her iliness, any change in the plan of care before the
change is made, the person's participation in the plan of care and necessary
changes before its implementation, the extent to which payment maybe expected
from Philheaith or any payor and any charges for which the patient maybe liable, the
disciplines of heath care practitioners who will fumish the care and the frequency of
services that are proposed to be fumished.

The patient or his legal guardian has the right to examine and be given an
itemized bill of the hospital and medical services rendered in the facility or by his/her
Physician and other health care providers, regardless of the manner and source of
Payment, He is entitled to a thorough explanation of such bill

The patient or his/her legal guardian has the right to be informed by the
physician or his/her delegate of his/her continuing health care requirements following
discharge, including instructions about home medications, diet, physical activity and
all other pertinent information to promote health and well-being.

At the end of his/her confinement, the patient is entitled to a brief, written
summary of the course of hisher illness which shall include at least the history,
physical examination, diagnosis, medications, surgical procedure, ancillary and
laboratory procedures, and the plan of further treatment, and which shall be provided
by the attending physician. He/she is likewise entitled to the explanation of, and to
view, the contents of medical record of his/her confinement but with the presence of
hisfher attending physician or in the absence of the attending physician, the
hospital's representative.


Notwithstanding that he/she may not be able to settle his accounts by reason
of financial incapacity, he/she is entitled to reproduction, at his/her expense, the
pertinent part or parts of the medical record the purpose or purposes of which he
shall indicate in his/her written request for reproduction. The patient shall likewise be
entitled to medical certificate, free of charge, with respect to his/her previous
confinement.

5) The Right to Choose Health Care Provider and Facility. - The patient is
free to choose the health care provider to serve him as well as the facility except
when he is under the care of a service facility or when public health and safety so
demands or when the patient expressly waives this right in writing,

‘The patient has the right to discuss his condition with a consultant specialist,
at the patient's request and expense. He also has the right to seek for a second
opinion and subsequent opinions, if appropriate, from another health care provider!
practitioner.

6) Right to Seif-Determination. - The patient has the right to avail
himseltiherself of any recommended diagnostic and treatment procedures. Any
person of legal age and of sound mind may make an advance written directive for
physicians to administer terminal care when he/she suffers from the terminal phase
of a terminal lliness: Provided That a) he is informed of the medical consequences of
his choice; b) he releases those involved in his care from any obligation relative to
the consequences of his decision; c) his decision will not prejudice public health and
safety.

7) Right to Religious Belief. — The patient has the right to refuse medical
treatment or procedures which may be contrary to his religious beliefs, subject to the
limitations described in the preceding subsection: Provided, That such a right shall
not be imposed by parents upon their children who have not reached the legal age in
a life threatening situation as determined by the attending physician or the medical
director of the facility.

8) Right to Medical Records. — The patient is entitled to a summary of his
medical history and condition. He has the right to view the contents of his medical
records, except psychiatric notes and other incriminatory information obtained about
third parties, with the attending physician explaining contents thereof. At his expense
and upon discharge of the patient, he may obtain from the health care institution a
reproduction of the same record whether or not he has fully settled his financial
obligation with the physician or institution concerned.

The health care institution shall safeguard the confidentiality of the medical
records and to likewise ensure the integrity and authenticity of the medical records
and shali keep the same within a reasonable time as may be determined by the
Department of Health.

The health care institution shall issue a medical certificate to the patient upon
request. Any other document that the patient may require for insurance claims shall
also be made available to him within forty-five (45) days from request.


9) Right to Leave. - The patient has the right to leave hospital or any other
health care institution regardless of his physical condition: Provided, That a) he/she
is informed of the medical consequences of his/her decision/ b) he/she releases
those involved in his/her care from any obligation relative to the consequences of his
decision; c) his*her decision will not prejudice public health and safety.

No patient shall be detained against his/her will in any health care institution
on the sole basis of his failure to fully settle his financial obligations. However,
he/she shall only be allowed to leave the hospital provided appropriate arrangements
have been made to settle the unpaid bills: Provided, further, That unpaid bills of
patients shall be considered as loss income by the hospital and health care
provider/practitioner and shall be deducted from gross income as income loss only
on that particular year.

10) Right to Refuse Participation in Medical Research. - The patient has
the right to be advised if the health care provider plans to involve him in medical
research, including but not limited to human experimentation which may be
performed only with the written informed consent of the patient: Provided, That, an
institutional review board or ethical review board in accordance with the guidelines
set in the Declaration of Helsinki be established for research involving human
experimentation: Provided, further, That the Department of Health shall safeguard
the continuing training and education of future health care providerfpractitioner to
ensure the development of the health care delivery in the country: Provided,
furthermore, That the patient involved in the human experimentation shall be made
aware of the provisions of the Declaration of Helsinki and its respective guidelines.

11) Right to Correspondence and to Receive Visitors. - The patient has
the right to communicate with relatives and other persons and to receive visitors
‘subject to reasonable limits prescribed by the rules and regulations of the health care
institution,

12) Right to Express Grievances. - The patient has the right to express
complaints and grievances about the care and services received without fear of
discrimination or reprisal and to know about the disposition of such complaints. Such
a system shall afford all parties concerned with the opportunity to settle amicably all
grievances.

13) 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.
The Department of Health, in coordination with health care providers, professional
and civic groups, the media, health insurance corporations, people's organizations,
focal government organizations, shail {aunch and sustain a nationwide information:
and education campaign to make known to people their rights as patients, as
declared in this Act Such rights and obligations of patients shall be posted in a
bulletin board conspicuously placed in a health care institution.

It shall be the duty of health care institutions to inform 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.


Sec. 5. Societal Rights of Patients. — in addition to the individual rights of
patients, the patient has likewise their societal rights. Following are the societal rights
of patients:

1) Right to Health. - The patient has 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 practitioner must progressively
contribute to realize.

2) Right to Access to Quality Public Health Care. - The patient has the
right of functioning public health and health care facilities, goods and services and
programs needed and sufficient quantity. They shall likewise be provided with health
facilties and services with adequate provision of essential drugs, regular screening
Program, appropriate treatment of prevalent diseases, illnesses, injuries and
disabilities, including provision of public health insurance. Towards this end, the
goverment shall, as far as practicable, approximate the international standard
allocation for the health sector as set by the World Health Organization

3) Right to 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 use, drug
use and other harmful substances

4) Right to Prevention and Education Programs. ~ The patient has the
right to prevention and education programs on immunization, on the prevention,
treatment and control of diseases, for behavior-related concems, for disaster relief
and emergency situations during epidemics and similar health hazards.

5) 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.

Title IV: Declaration of Obligations

Sec. 6. The Obligation of Patients. — Patients shall at all times fulfill their
obligations and responsibilities regarding medical care and their personal behavior.

1) Know Rights. - The patient shall ensure that he/she knows and
understands what the patients’ rights are and shall exercise those rights responsibly
and reasonably.

2) Provide Accurate and Complete Information. — The patient shall
provide, to the best of his knowledge, accurate and complete information about all
matters pertaining to his/her health, including medications and past or present
medical problems to his/her health care provider.

3) Report Unexpected Health Changes. — It shall be the duty of every
Patient to report unexpected changes to his/her condition or symptoms, including
pain, to a member of the health care team


4) Understand 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 the health care provider or
practitioner if he/she does not understand any information about his/her care or
treatment. The patient shall insist upon explanations until adequately informed and
consult with all relevant persons before reaching a decision.

5) Accept Consequences of Own Informed Consent. - The patient shall
accept all the consequences of the patient's own informed consent. If he/she refuses
treatment or do not follow the instructions or advice of the health care provider or
practitioner, he/she must accept the consequences of his/her decision and thus
relieve the health care provider or practitioner of any liability.

6) Settle Financial Obligations. - The patient shall ensure that financial
obligations of his/her health care are fulfilled as promptly as possible, otherwise,
helshe shall make appropriate arrangements to settle unpaid bills in the hospital
and/or professional fees of the health care provider through post-dated checks or
promissory notes or any similar medium.

7) Relation to Others. — The patient shall so conduct himself or herself so as
Not to interfere with the well-being or rights of other patients or providers of health
care. Helshe shall act in a considerate and cooperative manner, respect the rights
and property of others and follow the policies and procedures of the health care
establishment.

8) Exhaust Grievance Mechanism. - The patient shall first exhaust the
grievance mechanism provided in this Act before filing any administrative or legal
action.

Title V: Grievance Mechanism

‘Sec. 7. Mediation. — Any written complaint arising from violation of any of the
right of patients under Section 4 of this Act shall first be submitted for mediation
There shall be two (2) forms of mediation, namely: hospital-based mediation and
non-hospital-based mediation.

The Hospital-based mediation shall be composed of a grievance officer
appointed and designated permanently by the hospital who shall act as Chairperson
and two (2) physicians agreed upon by both parties, as members.

For the Non-Hospital-based Mediation, it shall be composed of the Local
Health Officer as Chairperson and the Barangay Human Rights Action Officer and
representative each from the Philippine Medical Association, the Council of Health
Practitioner Association and the Philippine Institute of Traditional and Altemative
Health Care, and the designated people's organization, as members.

For this purpose, the Department of Health shall ensure the establishment of
these grievance mechanisms and issue the necessary rules and regulations for its
proper operation.


‘The hearing procedure shall not be adversarial in nature. The patient and the
health care provider or practitioner shall be given the opportunity to discuss the
cause of complaint and effort shall be made for its settlement. No monetary
compensation shall be involved during this stage and neither shall a legal counsel be
present. The parties to the complaint shall be bound by the rules on confidentiality.

The aggrieved party shail be given thirty (30) days from occurrence of incident
to file his er written compiaint to the appropriate grievance mechanism level.

Upon receipt of written complaint, the Chairperson shall give notice to the
respondent. Upon receipt of the written complaint and due notice to the respondent,
the Mediation Committee shall be given thirty (30) days to resolve the said
complaint. Otherwise, the complainant shall have the option proceed to the no-fault
arbitration process or file appropriate administrative and legal action under existing
Jaws.

Sec. 8. No-fauit Arbitration Process. — if and when the complaint is not
fesolved through mediation within the prescribed period, the complainant has the
option to file a case for settlement at the no-fault arbitration process. However, only
complaints arising from treatment causing physical injuries shall proceed to this
arbitration process.

A NoFaut Arbitration Committee shall be established in every health care
institution. The Committee shall be composed of five (5) member-peer review of
physicians. The complainant and the health care provider shall each be duly
represented in the Committee.

The Committee shall base its decision on documentary evidence including
depositions. Within thirty (30) days from receipt of the complaint, the Committee shall
ender a decision

Compensation shall be limited to actual monetary loss. It shall not cover for
“pain and suffering” or other explicitly non-monetary losses. A no-fault award shall
bar the patient from further seeking damages in any judicial or administrative
proceedings.

‘A Health-Provider Compensation Fund shall be established in all health
facilities by health provider associations/organizations or when not possible, through
the Philippine Health Insurance Corporation, The funding shall come from
assessments paid by the health care providers. For this purpose, the Philippine
Health insurance Corporation shall ensure the establishment of this Fund and issue
the necessary rules and guidelines for its proper operation.

Sec. 9. Prescriptive Period. - The time during which the case is submited
for mediation shail 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.

Title Vi: Miscellaneous Provisions


Sec. 10. inclusion In School Curriculum, Licensure Examinations and
Training. — The provisions of this Act shail be included in the medical and medical-
related school curriculum and licensure examinations, including trainings and
‘seminars of traditional and altemative 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 Altemative Health Care, Philippine Health
Insurance Corporation and concemed private agencies, the People’s Health Watch,
other non-govemmental organizations and concemed 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 The
Implementing Rules and Regulations of this Act shall identify specific conditions
under which the individual rights of patients, as stipulated in Subsections 3, 6, 7 and
9 of Section 4 hereof, may be curtained or suspended in the interest of public health
and safety.

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.

Sec. 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,