Written Report2

7/31/2019 Written Report2

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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

COLLEGE OF BUSINESSBACHELOR IN OFFICE ADMINISTRATION-

Major in Corporate Transcription

In partial fulfillment

For the requirements

In

Medical Procedures with Practicum and Laboratory

Submitted By:

Joziel Erica C. Roselo

Jenny L. CayonteMariel M. Granada

Anna Feliza N. Pascual

Noriezhen John BasilioFrances Guada JacintoCristelle Mendoza

Mary Rose S. Ticala

BOA CT 3-3D

Presented to:Ms. Jessie I. Quierrez

July 26, 2012


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Table of contents

Doctor and the law

I. Doctor as a complainantII. Doctor as a plaintiffIII. Doctor as witnessIV. Vocabulary WordsV. References


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DOCTOR AS A COMPLAINANT

Republic act 2382

ARTICLE III

THE BOARD OF MEDICAL EXAMINERS; REGISTRATION OF PHYSICIANS

Section 22.Administrative investigations. In addition to the functions provided

for in the preceding sections, the Board of Medical Examiners shall perform the

following duties: (1) to administer oath to physicians who qualified in the examination;

(2) to study the conditions affecting the practice of medicine in all parts of the

Philippines; (3) to exercise the powers conferred upon it by this article with the view of

maintaining the ethical and professional standards of the medical profession; (4) to

subpoena or subpoena duces tecum witnesses for all purposes required in the discharge of

its duties; and (5) to promulgate, with the approval of the Commissioner of Civil Service,

such rules and regulations as it may deem necessary for the performance of its duties in

harmony with the provisions of this Act and necessary for the proper practice of medicine

in the Philippines.

Administrative investigations may be conducted by not less than four members of

the Board of Medical Examiners; otherwise the proceedings shall be considered void.


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The existing rules of evidence shall be observed during all administrative investigations.

The Board may disapprove applications for examination or registration, reprimand erring

physicians, or suspend or revoke registration certificates, if the respondents are found

guilty after due investigations.

Section 23.Procedure and rules. Within five days after the filling of written

charges under oath, the respondent physician shall be furnished a copy thereof, without

requiring him or her to answer the same, and the Board shall conduct the investigation

within five days after the receipt of such copy by the respondent. The investigation shall

be completed as soon as practicable.

Section 24.Grounds for reprimand, suspension or revocation of registration

certificate. Any of the following shall be sufficient ground for reprimanding a physician,

or for suspending or revoking a certificate of registration as physician:

(1) Conviction by a court of competent jurisdiction of any criminal offense

involving moral turpitude;

(2) Immoral or dishonorable conduct;

(3) Insanity;

(4) Fraud in the acquisition of the certificate of registration;

(5) Gross negligence, ignorance or incompetence in the practice of his or her

profession resulting in an injury to or death of the patient;


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(6) Addiction to alcoholic beverages or to any habit forming drug rendering him

or her incompetent to practice his or her profession, or to any form of gambling;

(7) False or extravagant or unethical advertisements wherein other things than his

name, profession, limitation of practice, clinic hours, office and home address, are

mentioned.

(8) Performance of or aiding in any criminal abortion;

(9) Knowingly issuing any false medical certificate;

(10) Issuing any statement or spreading any news or rumor which is derogatory to

the character and reputation of another physician without justifiable motive;

(11) Aiding or acting as a dummy of an unqualified or unregistered person to

practice medicine;

(12) Violation of any provision of the Code of Ethics as approved by the

Philippine Medical Association.

Refusal of a physician to attend a patient in danger of death is not a sufficient

ground for revocation or suspension of his registration certificate if there is a risk to the

physician's life.

Section 25.Rights of respondents. The respondent physician shall be entitled to

be represented by counsel or be heard by himself or herself, to have a speedy and public


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hearing, to confront and to cross-examine witnesses against him or her, and to all other

rights guaranteed by the Constitution and provided for in the Rules of Court.

Section 26.Appeal from judgment. The decision of the Board of Medical

Examiners shall automatically become final thirty days after the date of its promulgation

unless the respondent, during the same period, has appealed to the Commissioner of Civil

Service and later to the Office of the President of the Philippines. If the final decision is

not satisfactory, the respondent may ask for a review of the case, or may file in court a

petition for certiorari.

Section 27.Reinstatement. After two years, the Board may order the

reinstatement of any physicians whose certificate of registration has been revoked, if the

respondent has acted in an exemplary manner in the community wherein he resides and

has not committed any illegal, immoral or dishonorable act.

Article IV PENAL AND OTHER PROVISIONS

Section 28.Penalties. Any person found guilty of "illegal practice of medicine"

shall be punished by a fine of not less than one thousand pesos nor more than ten

thousand pesos with subsidiary imprisonment in case of insolvency, or by imprisonment

of not less than one year nor more than five years, or by both such fine and

imprisonment, in the discretion of the court.

Section 29.Injunctions. The Board of Medical Examiners may file an action to

enjoin any person illegally practicing medicine from the performance of any act

constituting practice of medicine if the case so warrants until the necessary certificate


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therefore is secured. Any such person who, after having been so enjoined, continues in

the illegal practice of medicine shall be punished for contempt of court. The said

injunction shall not relieve the person practicing medicine without certificate of

registration from criminal prosecution and punishment as provided in the preceding

section.

Section 30.Appropriation. To carry out the provisions of this Act, there is hereby

appropriated, out of any funds in the National Treasury not otherwise appropriated, the

sum of twenty thousand pesos.

Section 31.Repealing clause. All Acts, executive orders, administrative orders,

rules and regulations, or parts thereof inconsistent with the provisions of this Act are

repealed or modified accordingly.

Section 32.Effectivity. This Act shall take effect upon its approval: Provided,

That if it is approved during the time when examinations for physicians are held, it shall

take effect immediately after the said examinations: Provided, further, That section six of

this Act shall take effect at the beginning of the academic year nineteen hundred sixty to

nineteen hundred sixty-one, and the first paragraph of section seven shall take effect four

years thereafter.

Approved: July 1959


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misconduct was dropped. However, the case went to trial on the other two charges. A

unanimous jury verdict for the defense was returned.

Dr. Bursztajn testified for the defense as an expert witness in forensic psychiatry, medical

decision making, and informed consent. His testimony included:

a constructive use of decision analysis to retrace the decision-making process engaged in

by the physician and patient and thereby to counter the hindsight bias introduced by the

plaintiff;

a forensic analysis of the informed-consent process engaged in by the physician and

patient, which provided a psychological autopsy of the decision.

Specifically, Dr. Bursztajn testified:

that the physician and patient had appropriately considered the risks and benefits of four

possible courses of action: medical treatment, psychiatric treatment, surgery, and no

treatment;

that the patient had been competent to give informed consent and had in fact done so;

that the physician's actions met the standard of care in the areas of medical decision

making and informed consent and were responsive to the patient's wishes as expressed at

the time;


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Article II Section 12 of the 1987 Philippine Constitution

The State recognizes the sanctity of family life and shall protect and strengthen the

family as a basic autonomous social institution. It shall equally protect the life of the

mother and the life of the unborn from conception.

The act is criminalized by the Revised Penal Code of the Philippines, which was enacted

in 1930 and remains in effect today. Articles 256, 258 and 259 of the Code mandate

imprisonment for the woman who undergoes the abortion, as well as for any person who

assists in the procedure, even if they be the woman's parents, a physician or

midwife. Article 258 further imposes a higher prison term on the woman or her parents if

the abortion is undertaken "in order to conceal [the woman's] dishonor".

There is no law in the Philippines that expressly authorizes abortions in order to save the

woman's life; and the general provisions which do penalize abortion make no

qualifications if the woman's life is endangered. It may be argued that an abortion to save

the mother's life could be classified as a justifying circumstance (duress as opposed

to self-defense) that would bar criminal prosecution under the Revised Penal Code.

However, this has yet to be adjudicated by the Philippine Supreme Court.

Proposals to liberalize Philippine abortion laws have been opposed by the Catholic

Church, and its opposition has considerable influence in the predominantly Catholic

country. However, the constitutionality of abortion restrictions has yet to be challenged

before the Philippine Supreme Court.
http://en.wikipedia.org/wiki/Revised_Penal_Code_of_the_Philippineshttp://en.wikipedia.org/wiki/Duresshttp://en.wikipedia.org/wiki/Self-defense_(theory)http://en.wikipedia.org/wiki/Supreme_Courthttp://en.wikipedia.org/wiki/Roman_Catholic_Churchhttp://en.wikipedia.org/wiki/Roman_Catholic_Churchhttp://en.wikipedia.org/wiki/Supreme_Court_of_the_Philippineshttp://en.wikipedia.org/wiki/Supreme_Court_of_the_Philippineshttp://en.wikipedia.org/wiki/Roman_Catholic_Churchhttp://en.wikipedia.org/wiki/Roman_Catholic_Churchhttp://en.wikipedia.org/wiki/Supreme_Courthttp://en.wikipedia.org/wiki/Self-defense_(theory)http://en.wikipedia.org/wiki/Duresshttp://en.wikipedia.org/wiki/Revised_Penal_Code_of_the_Philippines


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DOCTOR AS A WITNESS

The Different Capacities in Which the Doctor Maybe Called To Testify

There are three sets of circumstances under which a doctor may be called as a

witness, and the rights, privileges and duties of the doctor will be found to vary:

1. Where the doctor is possessed of information relevant to some issue on the case, which

information he/she acquired in order than a professional capacity.

2. Where the doctor has treated a patient and he is called upon to testify as to the physical

condition of the patient, treatment administered, etc.

3. Where the doctor has never treated the person whose bodily condition is in issue but is

called as an expert to assist the court in arriving at a determination of a scientific fact as

to the bodily condition of such person, the expectation to his recovery, etc.

Role of a medical expert witness

*The medical expert offers an opinion on the facts of the case.

This can be based on written notes and documents, or through an examination of the

patient. The medical expert is not the treating doctor.

*While their opinion is provided at the request of one or other of the parties

involved in the claim, the duty of the medical expert witness is to assist the court rather

than the party who instructs them.


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They can be summoon by both parties but their opinion must not be biased because their

main objective is to give essential information that can help the court to clarify the case.

*The medical experts report or comments must be independent, objective and

unbiased.

The doctors expertise helps the court decide the matter before it, and may be used to

diminish the other sides case. It can lead to appearing as a witness in court and having

the opinion tested by cross examination.

*The role can vary from considering a breach of duty in a clinical negligence

claim, offering opinions on liability and causation, to examining a claimant and

discussing their treatment and what could be offered.

*A medical expert witness should not be confused with a professional witness.

The former provides an expert medical opinion on a case, whereas the latter is requested

to testify solely on the observed facts of a case.

VOL. XXXVIII, No. 3 The Doctor on the Witness Stand 99

4. Our general trend has been tight abdominal closure wherever possible and the routine

use of sulfonamides intra abdominally. Recently, however, we have had reasons to

modify this procedure.8


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5. Whenever it seems that drains must of necessity be used our results would indicate

that cigarette drains are to be preferred.

6. Non-surgical intervention in generalized peritonitis and drainage without removal of

the appendix in abscess formation seem to be expedient according to our series, as well

as others.

7. Where there have been acute complications the appendicitis was considered and

treated as a primary factor, the complication being treated along with the appendicitis.

EVERY practicing physician in this state is a potential witness and is subject to

subpoena before its judiciary tribunals. Whether he likes it or not, sooner or later he will

be hauled into court to give testimony in connection with some case he had examined or

treated. Some doctors dread the ordeal, a great many resent the imposition and

practically all do their best to discourage the parties in litigation from calling them to the

witness stand.

However, if serious consideration is given this matter, it becomes quite obvious that

there is no reason for dreading it or calling it an ordeal.

Furthermore, it is the doctor's moral 'obligation to his patient to willingly and cheerfully

p: esent all the facts in a case to enable his injured patient to obtain what he is legally

entitled to under the law. It is unethical and even immoral for the doctor to attempt to

evade his duty in connection with a contested case in which he was the attending

physician.


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The reason the average doctor assumes an antagonistic attitude toward medical

testimony is because he so frequently becomes the object of a100 JOURNAL OF THE

NATIONAL MEDICAL ASSOCIATION MAY, 1946 vicious attack on cross-

examination by an arrogant and impertinent lawyer. I have seen and heard medical

witnesses attacked as to their knowledge, ability, honesty, partiality and credibility. I

have seen them at times present such a sorry spectacle that I have almost been ashamed

of being one myself.

How is the average doctor to fulfill his duties to his patients and at the same time escape

the indignities and discomfiture on cross-examination?

How is he to impress the court and jury with his honesty and impartiality? How is he to

discourage the unjustified innuendos and cruel insinuations and at the same time help his

patient and justice?

The answer is "Be prepared".

Keep careful records-most cases are tried long after the injury took place and the course

of treatment terminated. In such cases the doctor will have more or less forgotten the

subject matter of his testimony as the trial approaches. No court or jury would expect a

doctor to rely entirely upon his memory for the recital of all the facts: n a given case

unless it were of an extremely unusual or outstanding character. Since the average case

is not outstanding and since he treats a good many other cases, he has to rely on his

records or memoranda to refresh his-memory. It is best if they are in his own

handwriting or dictated by him; however, there is no legal limitation as to the type or


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character of evidence that may be used to refresh the memory of a witness. "Anything

which will refresh the recollection of a witness may be looked at by him for that

purpose, although in itself it is not evidential." (Hinkelsman v. Pasteelnick Atl. 441.)

CONTENTS OF RECORDS

1. Detailed history of the occurrence and mechanics of the injury.

2. Where and under what circumstances first examination was made.

3. Chief complaints or subjective symp.oms.

4. Physical examination and objective findings.

5. Persons present at time of examination.

6. Clinical progress notes, with special attention to pain and suffering.

7. X-rays and laboratory findings.

8. Pre-existing ailments or congenital anomalies.

9. Consultations-when, where and for what purposes.

10. Medical fees-amount collected and balance due.

11. Permanency of injuries and future effects.


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Although physicians and surgeons in general are experts, and their opinions are

admissible in evidence upon questions embraced in the practice of their professions, yet it

is inadvisable for them to render an opinion as to the permanency of injury or disease

without mature deliberation or medical consultation. The practice of insurance companies

in submitting forms including a question as to permanency of the injury very frequently

results in embarrassment for the attending physicians on the witness stand. This practice

although not intended for such purpose, takes advantage of the weakness of human nature

and personal egotism on the part of the physicians in obtaining in the hurried report an

ultimate disability in a given accidental injury. The nature pride in his professional ability

at times impel him to prognosticate little or no permanent incapacity in spite of the fact

that by the very nature of the injury considerable permanent damage I bound to result in

spite of the best of treatment This results in embarrassment because when the doctor goes

over the injured carefully and find the residual damage and testifies to same, he I

immediately confronted by his old report station no permanent disability will result from

the injury.

I remember hearing one doctor testify in behalf of the patient with a lung injury to the

effect that he would perform a lobectomy without permanent disability in spite of

infection and pleural and pulmonary destruction.

In any case involving serious injury it is advisable for the general practitioner to have the

benefit of a consultation for his own as well as the patient's protection. This will be of

benefit in instituting proper treatment, clarifying the pathology and indicating the nature


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of an extent of permanent injury, thus avoiding embarrassing questions on the witness

stand.

To avoid discomfiture on the witness stand, the general practitioner who had been in

charge of litigated traumatic case and who wishes to give opinion evidence should keep

abreast of the medical literature and familiarize himself at least with the normal anatomy

and physio'ogy of the

VOL. XXXVIII, No. 3 The Doctor on the Witness Stand 101 human body. This is

particularly true of osteology and kinesiology. He should not only be familiar with the

various types of motion in each individual joint, but also what muscles or group of

muscles perform the various motions and what nerve or nerves control them. If limitation

of motion is found he should be able to describe its average extent and degree of

deviation from the normal.

As a rule the amount of incapacity is determined by a comparison with the opposite

normal mate. However, very frequently this method is not available because of the

absence or a previous injury to the mate. Furthermore some motions such as

hyperextension of the spine have no mate for comparison. It is essential, therefore, for the

medical witness to know the neutral position and normal range of motion of the various

joints, and by measuring the degree of motion in the case at issue figure out the amount

or percentage of deviation.


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The prevailing impression is that the criterion of disability in joint injuries is the amount

of restriction of motion. It is erroneous because very frequently severe and permanent

disability results from excessive or abnormal motion. An injury to the crucial or lateral

ligaments of the knee joint may result in a greater range of motion in the horizontal axis

or may cause abnormal lateral mobility with consequent instability. An injury to the ankle

may not restrict dorsi and plantar flexion but may give abnormal inversion or eversion in

the upper ankle joint. In all of these instances there is considerable disability without

involving restriction of motion.

I feel that no doctor should attempt to go on the witness stand and render opinion

evidence without thoroughly believing in his own interpretation of his findings in spite of

what other expert opinion may be. Furthermore, every medical witness should be ready

and willing to demonstrate his findings outside the courtroom should he be called upon to

do so. This procedure is at times permissible and advisable because of the diametrically

opposite opinion by doctors of the opposing parties. It is well to bear this in mind when

examining the injured and note such findings as are demonstrable to a lay witness. These

include atrophy, shortening, curvature and any loses.

SUMMARY

1. Fulfill your obligation to your patient by testifying in his behalf.

2. Avoid embarrassment and discomfiture on the witness stand by acting in a dignified

manner. being prepared and giving an honest and impartial opinion.


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3. Do not submit hasty reports without due deliberation; do not pass on permanent

disability prematurely.

4. Obtain all possible aid in arriving at an accurate diagnosis and instituting adequate

treatment; these include x-rays and laboratory findings.

5. Obtain the services of a consultant whenever the injury appears serious or permanent

incapacity probable.

6. Above all keep detailed and accurate records and bring them to court when called upon

to testify.


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VOCABULARY WORDS:

CERTIORARI- writ of superior court to call up the records of an inferior court or body

acting in a quasi-judicial capacity.

WRIT- is a formal written order issued by a body with administrative or judicial jurisdiction; in

modern usage, this body is generally a court. Warrants, prerogative writs and subpoenas are

common types of writs but there are many others.

SUBPOENA- a writ commanding a person designated in it to appear in court under a penalty for

failure.

SUBPOENA DUCES TECUM- a writ commanding a person to produce in court certain

designated documents or evidence.


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REFERENCES:

http://www.lectlaw.com/files/med35.htm

http://www.forensic-psych.com/articles/casePlaintiffvDoctor.php

http://en.wikipedia.org/wiki/Abortion

http://www.hospitaldr.co.uk/guidance/how-to-become-a-medical-expert-witness

1. Thorek, Max: Surgical Errors and Safeguards, ed. 4,

Philadelphia, J. B. Lippincott Company, 1943.

2. Goodman, Max and' Silverman, Irving: Acute Appendicitis in Patients with the

Common Contagious

Disease, New England J. of Med., 228:533-542

(April 29) 1943.

3. Husband, C. W. and Schmitt, N. L.: Torsion of the

Gallbladder Associated with Acute Appendicitis, J.

of International College of Surgeons, 8:348-50

(July-August) 1945.

4. Coleman, W. G.: Appendiceal Coprolith Simulating

Ureteral Calculus, J. of International College of

Surgeons, 8:397-401 (Sept.-Oct.) 1945.

5. Graves, Gutrie Zoeklee: Errors in the Diagnosis of

Acute Appendicitis, International Surgical Digest,

40:135-137 (Sept.) 1945.


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6. King, H. Jackson: The Problem of Acute Appendicitis, A Survey covering four years,

The Amer. J. of

Surgery, New Series, 49:104-111 (July-Sept.) 1940.

7. Ochsner, Alton and Johnston, J. Harvey: Appendiceal Peritonitis, International

Surgical Digest, 40:

131-135 (Sept.) 1945.

8. Herbert, Peter A. and Scaricaciottoli, Thomas M.:

Diffuse Hepatic Necrosis Caused by Sulfadiazine,

Archives of Pathology, 40:94-98 (Aug.) 1945. Abstracted (With reference to a similar

case) Jefferson, Nelson C.: J. N. M. A., this issue.

9. The Doctor as a witness by John E. Tracy, A.B., LL.D, Ann Harbor, Michigan.

10. The Doctor as a witness by John E. Tracy, A.B., LL.D, Ann Harbor, Michigan.

11. Know your rights and how to make them work for you: Readers Digest P. 180 -183

12. Professional Nusing in the Philippines (Eleventh Edition): Ronald M. Venzon, RN, MAN; Lydia M.

Venzon, RN, MAN Ph.D, FPCHA P. 194-198

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