Republic of the Philippines

HOUSE OF REPRESENTATIVES

Quezon City

EIGHTEENTH CONGRESS
Third Regular Session

HOUSE BILL No. 9894

RECEIVED
= DATESuly 29, 2021

* TIME 12:18pm *
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Introduced By Representative ALLAN BENEDICT S. REYES

EXPLANATORY NOTE

The Philippines experienced a second wave of COVID-19 infections during the second
quarter of 2021. The country was said to have recorded an average of more than 10,400
daily cases since the start of April which is nearly double the level in March and far above the
213 per day in April 2020 and 2,169 in the second half of last year.’

Because of this, intensive-care units in the Manila area were reported to be at 84%
capacity, while 70% of COVID-19 ward beds and 63% of isolation beds were full as of April
19, 2021.2

Hundreds of patients continued to suffer while waiting for admission in hospitals
overwhelmed by the surge in coronavirus cases. According to the data from Philippine
College of Emergency Medicine (PCEM) as of April 12, 2021, at least 310 COVID-19 patients
needing hospital care were still then waiting for beds across all fourteen (14) of its training
institutions in Metro Manila Last April 28, there were 30 hospitals that were classified as
critical while 21 hospitals were listed under the high-risk status.

‘As hospitals in Metro Manila reach capacity from a new surge of COVID-19 cases,
increasingly desperate Filipinos were reported to have been “stocking up on oxygen tanks
and touting unapproved medications amid fears the health care system may collapse.”*
Meanwhile, patients lucky enough to be admitted in hospitals unnecessarily crowded in
‘emergency rooms, the area which is supposedly staffed and equipped for the reception and
treatment of persons requiring immediate medical care. Hospital emergency departments
(EDs) were among the first to feel the wave of patients seeking care in high level facilities.

+ Philippine esp stmggle to cope as more severe COVID-9 wave its avaiable a

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Thus, occupancy in EDs was then described as “a sensitive number that could also help to
reflect three (3) things in the state of the health system: demand of patients seeking care,
supply or space in other parts of hospital where patients need to be admitted, and efficiency
of referral systems among hospitals."”

However, the health care utilization rate in Metro Manila that the public gets to know
only takes into account “ward beds, isolation beds, and intensive care unit (ICU) beds
dedicated to COVID-19 patients.”* This is why, as noted by PCEM President Dr. Pauline
Convocar, “when they say the system is overwhelmed, the numbers do not show yet in the
dashboards at 80-100% health care utilization rate, when the EDs are already operating at
110-150% occupancy rate with boarding of days to weeks."?

As of writing, DOH is said to be "studying how best to come up with standard reporting
methods of bed occupancy in emergency departments across the Philippines."!°Among the
challenges in doing this according to the DOH, was changing “modules” it used when
inputting data into its system used by hospitals to report statistics and used by officials to
track and share the healthcare utilization rate.""

Under Department of Health (DOH) Administrative Order No. 2020-016, public
hospitals are directed to allocate at least 30% of its total bed capacity for COVID-19 cases,
while private hospitals should allot at least 20%. This leaves public and private hospitals with
allocation for other non-COVID 19 cases at significantly reduced levels. For instance,
specialty hospitals attached to the DOH operating as Government-Owned and Controlled
Corporations (GOCCs) namely, the National Kidney and Transplant Institute, Philippine Heart
Center, Philippine Children's Medical Center and Lung Center of the Philippines, were also
mandated to comply with this allocation requirement, thereby, veering them away from
treating particular types of illness or particular conditions requiring a range of treatment or
from attending to patients suffering from diseases of a particular organ or group of organs.

While we need to know the official records for COVID-19 cases, it must be stressed
that it is equally important to know the figures for non-COVID-19 cases, especially in the
emergency rooms of hospitals. As the DOH observed, “[wle also need to know the base
requirement — how many beds in emergency department have been declared. for COVID,
how many for non-COVID, how many have you extended where you might have a tent for
triaging and all."?? In addition to bed capacity, official reports must also take into consideration
the overall service capability, available equipment and manpower complement of each
hospital.

Overall, by ensuring that our health care system is only operating at ideal levels, all
Filipinos can be assured that these important institutions continue to systematically deliver

7 Over 300 COVID-19 patients wait days for admission in Metro Manila hospitals available at
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w DOH to include emergency department occupancy in public COVID-19 tracker available at
ach (ast accessed 23 May 2021).

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8 DOH to include emergency department occupancy in public COVID-19 tracker available at
teacker (last accessed 23 May 2021).

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high quality health services while our medical frontliners are still able to provide satisfactory
treatment and patient care without compromising their own health and safety.

In view of the foregoing, passage of this bill is earnestly sought.
J Ww
HON. ALLAN BENEDICT S. REYES ‘4 f

Representative
3 District, Quezon City

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Do

Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
Third Regular Session

HOUSE BILL NO. 9894

Introduced By Representative ALLAN BENEDICT S. REYES

AN ACT CLASSIFYING AND ASSIGNING LEVELS TO ALL HOSPITAL EMERGENCY
ROOMS BASED ON THEIR BED OCCUPANCY, SERVICE CAPABILITY, MEDICAL
EQUIPMENT, AND MANPOWER COMPLEMENT AND APPROPRIATING FUNDS

THEREFOR
Be it enacted by the Senate and House of Representatives of the Philippines in
Congress assembled
1 SECTION 1. Short Title. - This Act shall be known as the “Emergency Room
2. Classification Act of 2021.”
3
4 SECTION 2. Coverage. ~ This Act shall apply to all hospitals in the Philippines,
5 both public and private, and regardless of classification.
6
7 SECTION 3. Definition of Terms. - For the purposes of this, the following definitions
8 shall apply:
9
10 a, Bed Occupancy Rate (BOR): The percentage of in-patient beds in the Emergency
i Room occupied over a given period of time. It is a measure of the intensity of
12 hospital resources as to number of beds, particularly in the Emergency Room,
3 utilized by in-patients, computed as follows:
14
15 BOR = Total Inpatient bed days / (licensed Authorized Bed Capacity in
16 the Emergency Room) X 100"?
17
18 _b. Service Capability: capabilities needed to support board certified/eligible medical
19 specialists and other licensed physicians rendering services in, but not limited to,
20 the following:"*
21 a. Clinical Services (Family Medicine, Pediatrics, Internal Medicine, Obstetrics
22 and Gynecology, Surgery)
23 b. Emergency Services
24 c. Outpatient Services
25 4. Ancillary and Support Services such as, clinical laboratory, imaging facility
26 and pharmacy
27

® DOH Hospitals Profile available at huyps//loh gov ph/sites def iles/publications/DOL Hospitals:

Profile O plf (ast accessed 22 May 2021).
Ia.

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c. Equipment Use Rate: the percentage of medical equipment in the Emergency
Room used over a given period of time. It is a measure of the intensity of hospital

equipment, particularly in the Emergency Room, utlized by in-patients, computed
as follows:

EUR = Equipment in use / Equipment in Emergency Room Inventory X

|. Manpower Utilization Rate: the percentage of identified manpower assigned in
the Emergency Room utilized over a given period of time. It is a measure of the
intensity of hospital manpower complementresources, particularly in the
Emergency Room, utilized by in-patients, computed as follows:

MUR = Required Medical Personnel attending to in-patients in the
Emergency Room / Total Number of Medical Personnel assigned to the
Emergency Room X 100

SECTION 4. Mandatory Reporting. All hospitals are mandated to report to the

Department of Health (DOH) and update their Emergency Room Classification, based on
the following:

1. Bed Occupancy Rate (BOR);

2. Service Capability;

3. Equipment Use Rate (EUR); and
4. Manpower Utilization Rate (MUR)

SECTION 5. Emergency Room Classifications - Following the reports from
hospitals as mandated by Section 4 of this Act, Emergency Rooms of hospitals shall be
classified by the DOH based on the following levels:

1. Critical level: Emergency Room reached BOR, EUR or MUR of more than 85
percent (85%);

2. High risk level: Emergency Room reached BOR, EUR or MUR of 70 percent
but not more than 85 percent (70% to 85%);

3, Moderate level: Emergency Room reached BOR, EUR or MUR of 60 percent
but not more than 70 percent (60% to 70%); and

4. Safe level: Emergency Room BOR, EUR or MUR is less than 60 percent
(60%)

SECTION 6. Implementing Rules and Regulations. - Within sixty (60) days from the
promulgation of this Act, the necessary rules and regulations for the proper implementation
of its provisions shall be formulated by the Department of Health (DOH) in coordination
with all the stakeholders and covered establishments and institutions.

SECTION 7. Repealing Clause. - All laws, executive orders, administrative orders,
tules, regulations, decrees, and other issuances or parts thereof, which are inconsistent
with the provisions of this Act are hereby revoked, repealed, or modified accordingly.

SECTION 8. Separability Clause. - If any provision of this Act is held
unconstitutional or invalid, the other provisions not affected thereby shall continue in

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operation and remain in full force and effect.

SECTION 9. Effectivity Clause. — This Act shall take effect fifteen (15) days after
its publication in a newspaper of general circulation or the Official Gazette.

Approved,

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