Physician Act of 2012

Jose Y. Cueto Jr., MD, FPCS, MHPEd Member

Professional Regulatory Board of Medicine

Philippine College of Physicians 43rd Annual Convention

Physician Act Versions

House of Representatives • HBN 100 (Rep. Garin) • HBN 1616 (Rep. Binay) • HBN 5067 (Rep. Maranon)

Senate • SBN 46 (Sen. Lacson) • SBN 1173 (Sen. Pimentel) • SBN 1226 (Sen. Enrile) • SBN 2456 (Sen. Zubiri) • SBN 2669 (Sen. Drilon) • SBN 3137 (Sen. Trillanes(

Pending Bills from 15th Congress

House of Representatives • Committee adopted House

Bill 6538 • Authors: Rep. Janette Garin and 15 Co-authors • Approved

Senate • Committee adopted Senate

Bill 3137 • Submitted Feb. 27, 2012 • Authors: Sen. Antonio

Trillanes and Sen. Franklin Drilon

• Sponsored on the floor by Sen. Trillanes

• Period of Interpellation

Amendments to RA 2382, the Medical Act of 1959

Related to: I. Medical Education II. Licensure Examinations III. Regulation of the Practice of Medicine IV. Integration of the Profession V. CME

Generic Rule of the PRC

Earlier Versions Inclusion of: • PMA • Integrated PMA

Final Version • PRC moved for deletion of

names of private organizations in all regulatory laws

• Medicine: Accredited

Integrated Professional Organization (AIPO)

I. Amendments: Medical Education Art. I. Sec. 3. Objectives

RA 2382 1. Standardization and regulation of medical education 2. Examination for registration of physicians 3. Supervision, control and regulation of the practice of medicine

HBN 6538/SBN 3137 1. Standardization, upgrading

and regulation 4. Integration of the profession into one national organization/APO 5. Promotion of competence, moral values and professional attitudes of physicians

I. Amendments: Medical Education Members, Council of Medical Education

HBN 6538 • Chair, CHED • Secretary, DOH • Chair, PRBOM • President, AIPO • President, APMC

SBN 3137 • Chair, CHED • Secretary, DOH • Chair, PRBOM • President, AIPO • President, APMC • President, PHA • Dean, UP-NTTC-HP

Amendments: Medical Education Minimum Required Course

RA 2382 (1959) 1. Medical Course • At least 4 years • Internship

SBN 3137 1. Medical Course • 5 years inclusive of clerkship

and internship

HBN 6538 1. Medical Course • At least 4 years • Internship

Amendments: Medical Education

RA 2382 (1959) 2. Admission requirements • Bachelor’s degree • Certificate of eligibility • Good moral character • Birth certificate

HBN 6538 / SBN 3137 2. Admission requirements Added • Proof of successfully passing

the NMAT

II. Amendments: Licensure Examinations

RA 2382 Board of Medicine • Six members Qualifications • Natural-born citizen • Duly registered physician • Practice for 10 years • Good moral character /

recognized standing in medical profession

• Not a member of faculty

HBN 6538 / SBN 3137 Board of Medicine • Chair, Vice-chair, 5 members Qualifications: Add • Resident for at least 10

consecutive years • Bona fide member of AIPO • At least 40 years old • Has not been convicted of

criminal offense • Experience of at least 5/2 years as

faculty • Not connected with review center

Licensure Examinations

RA 2382 • Number of subjects: 12

• Rating: 75%/50%

• Scope of examination: Prelim, Final, Complete

• Refresher course after 3 failures

HBN 6538 / SBN 3137 • Number of subjects: 12 / 13 • Added: Neurology Psychiatry • Rating: 75%/50%

• Scope of examination: No

prelim/Final

• No provision for refresher course

Proposals from PRBOM/CHED-TCME

• If refresher course is removed, then a limit on allowed number of attempts/takes to 6-8 times has been proposed

• Provision for one-time re-examination for

those with average 75% or higher, but with grade below 50% in a number of subjects (Incorporated in Sec. 23, Art. IV, HBN 6538)

III. Amendments: Art. V. Regulation of the Practice of Medicine (SBN 3137)

Sec. 27. Acts Constituting the Practice of Medicine

(4) Using or affixing “MD” with his/her name in the practice of the medical profession or in written/oral communications (also in HBN 6538)

(5) Conducting formal medical classes in medical schools, seminars, lectures, symposia and the like

Amendments Art. V. Regulation of the Practice of Medicine

Sec. 27/28. Disciplinary Sanctions The Board shall have the power, upon proper

notice and hearing, to suspend from the practice of profession or revoke the certificate of registration of a physician, or issue a reprimand or cancel the special temporary permit to a foreign physician for any of the following grounds/causes:

Amendments Art. V. Regulation of the Practice of Medicine

Sec. 27/28. Disciplinary Sanctions (Grounds for reprimand, suspension, revocation)

(g) Making or causing to be made false, misleading, extravagant or unethical advertisements wherein things other than his name, profession, limitation of practice, clinic hours, office and home address are mentioned

Amendments Art. V. Regulation of the Practice of Medicine

Sec. 27/28. Disciplinary Sanctions (Grounds for reprimand, suspension, revocation)

(i) Making any fraudulent claims with government or private health insurance

(k) Performing any act constituting the practice of an area of medical specialization without fulfilling the specialization requirements prescribed by the Board of Medicine

Implication

• Physicians performing specialty procedures • Need to meet specialization requirements • Prescribed by the BOARD of Medicine

Art. V, Sec. 28 (SBN 3137)

(l) Knowingly aiding or subjecting oneself to be a patient of any person who is unqualified or unregistered to practice medicine or an area of medical specialization, except in aid of training of a medical student…….

• That this provision shall not apply when an act constituting the practice of medicine or an area of medical specialization is performed in a hospital, clinic or medical center as an accredited practitioner of such hospital, clinic or medical center

• For this purpose, all hospitals, clinics and medical centers are hereby required to furnish the appropriate regional office of the DOH a list of all medical practitioners duly accredited to practice within their respective institutions every three months

Art. VI. Penal Provisions, Section 39

Penalties: (a) imprisonment of 1-5 years (b) fine of 200,000-500,000 pesos (c) both Conditions: 1. Practice w/o valid cert. of registration and

prof. ID or special temp. permit 2. Using cert. of registration/ID issued to

another 3. Using false/forged docs to obtain cert/ID

Article VI, Section 39

4. Impersonating any bona fide registrant 5. Abetting or assisting in the illegal practice by a

person who is not lawfully qualified to practice medicine or any area of medical specialization

6. Engaging in the practice of medicine w/o cert. of reg.

7. Attempting to use a revoked or suspended cert. of reg or STP

Article VI, Section 39

8. Using/advertising title or description conveying that he/she is registered physician when he/she is not

9. Conveying impression to the public that

he/she is a specialist in an area of medical specialization when he/she is not

Article V, Section 39

10. (a) Section 28, (i) false med cert / fraudulent claims (j) performing criminal abortion (k) performing an act w/o specialization req (l) complicated

Article V, Section 39

10. (b) when death occurs as a result of the commission of the prohibited act in paragraph (k) performing an act without fulfilling specialization requirements, Sec. 28, the offense shall be considered as qualified violation of this Act

• Punishable by life imprisonment • Fine of 500,000 to 2M pesos

IV. Integration of the Medical Profession

Article V. Sec. 35: Integration of the Profession The profession shall be integrated into one

national Accredited Professional Organization (APO) of Physicians to be duly recognized and accredited by the Board and the Commission

Earlier Bills

• Used Integrated PMA (IPMA) • Regulatory Laws: prohibit incorporation of

specific names of organizations (possibility of cancellation of accreditation)

• Lifespan of Law: 50 years • Use of generic terms • Changed to Accredited Integrated Professional

Organization (AIPO) in later versions of the bill

Provision

Article V. Sec. 35: Integration of the Profession The profession shall be integrated into one

national Accredited Professional Organization (APO) of Physicians to be duly recognized by the Board and the Commission

Mechanics

• Bill LAW • Formulate an IRR • Contain the procedures, rules and regulations

• Who formulates?

Scenarios

1. Organizations apply for recognition; selection by PRBOM; recommends to PRC for final approval

Question: existing organization? or form a new organization?

Model: Integration of Lawyers

Supreme Court

Commission on Integration

Philippine Bar Association

Integrated Bar of the Philippines

Integration of Physicians Professional Regulation

Commission

Professional Regulatory Board of Medicine

Accredited Professional Organization

Accredited Integrated Professional Organization

Recommended Changes

• Organizational structure • Improved representation • Election procedures • Rules and regulations • New constitution and by-laws

Disciplinary Sanctions

Article V. Sec. 29. The Board shall have the power to suspend from the practice of profession, or revoke the certificate of registration or issue a reprimand….

(o) Willful failure or refusal to be a member of the Integrated Accredited Professional Organization for physicians (expulsion or termination of membership therefrom)

V. CME (SBN 3137)

Art. V. Sec. 36. Mandatory Continuing Medical Education

The Board shall implement a mandatory continuing medical education among practicing physicians in consonance with the guidelines of the CPE as shall hereafter be promulgated by the Commission

V. CME (HBN 6538))

Art. V. Sec. 35. Mandatory Continuing Medical Education

The Board shall implement through the integrated and accredited professional organization of physicians a mandatory continuing medical education among practicing physicians in consonance with the guidelines of the CPE as shall hereafter be promulgated by the Commission.

Summary: PRBOM Proposals

1. Medical course: at least 4 years 2. Retain 12 subjects/clusters 3. Teaching: does not constitute practice of

medicine

PRBOM Proposals

Art. III. Sec. 10 Powers and Duties of the PRBOM • Proposal: Add to page 5, line 27, letter (a) Supervise

and regulate the practice of medicine in the Philippines by classifying and determining categories of physicians and the requirements for each category, defining their scope of practice, overseeing specialization and certification of specialists, and establishing a registry of specialists

PRBOM Proposals

Art. V. Sec. 28 Disciplinary Sanctions (m) Violation of any provision of the Code of

Ethics for Physicians as prescribed by the Integrated APO of Physicians and adopted and promulgated by the Board, subject to approval by the Commission

Delete: as prescribed by the Integrated APO of Physicians and adopted and promulgated

PRBOM Proposals

Art. V. Sec. 28 Disciplinary Sanctions (m) Violation of any provision of the Code of

Ethics for Physicians as prescribed by the Board, subject to approval by the Commission

Most Difficult

1. The specialization requirement

2. The penal provisions

3. The integration of the profession

Bicameral Conference

• In the presence of certain differences Objective: • To reconcile conflicting provisions of the

versions of the Lower House and Senate

Problem

• Advice from Chief of Staff, Sen. Trillanes • Keep proposals for modification to a

manageable minimum (3-5) • If there will be too many major changes, it’s as

if a new version is being made; difficult to reconcile versions in bicameral conference; difficult to pass (another round of new questions)

What to expect 16th Congress

• Proposal for the re-filing of the professional regulatory bills from the 15th Congress

• Final approval • Submission to the Office of the President for

his signature • Crafting of the IRR • Full implementation

THANK YOU