Hospital Liabilities

8/3/2019 Hospital Liabilities

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HOSPITAL LIABILITIES


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DEFINITION

HOSPITAL

An institution maintained for the reception, careand treatment of those in need of medical and

surgical attention.


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CLASSIFICATIONS OF HOSPITAL

Functional Classification:

Diagnostic Hospital

A hospital devoted solely to the diagnosis of disease, injury, deformity, or physical and mental

conditions. It may be provided with x-ray and

laboratory facilities for diagnostic purposes.

Surgical hospital

A hospital where operative procedures are

employed as a mode of treatment.


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Maternity hospital

A hospital established for the reception, care andtreatment of expectant mothers and care of the

newly-born infants.

Rehabilitation hospital

A hospital established to enhance return of a

disabled to his usual activities and adapts his

condition to a specific environment.


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Cosmetic hospital

A hospital for the improvement of the physical oraesthetic condition either by surgery of by

physical means.


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As to Control and Financial Support:

Public or government hospital

a hospital operated and maintained eitherpartially or wholly by the national, provincial,

municipal, or city government or other political

subdivision, or by any department, division, board

or other agency thereof.


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As to Control and Financial Support:

Private hospital

One which is privately owned, especiallyestablished and operated with funds raised or

contributed through donations, or private capital

or other means, by private individuals,

associations, corporation, religious organization,firm, company or joint stock association.


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Classification Based on the Size or Bed Capacity:

Determined By the Hospital Licensure Act.

For the purpose of determining the quantity andquality of facilities.

Including the staff and other personnel of a

hospital services.

Minimum standard requirements for a hospital of

25, 50, 100 and 450 bed capacity hospitals.


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Classification of a Hospital as to Whether it isTraining or Not:

Hospitals primary duty of reception, care and

treatment of patients Some hospitals are utilized for medical and

paramedical education.

Undergrad students are given training as a part of

their curriculum. Others may pursue further development of skill

and proficiency in the post-graduate level.


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A Hospital Cannot Practice Medicine:

The hospital merely agrees to care for the

patient by furnishing him withaccommodations and attendants including

nurses and interns.


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Reasons Why a Hospital Cannot Practice Medicine:

The practice of medicine by a hospital for profit

through employment of licensed physicians is not

in the interest of public safety, health and welfare

and therefore contrary to public policy. The

capacity of a hospital to practice medicine cannot

be subjected to government examinations todetermine whether it is qualified to diagnose,

treat or employ any form of treatment.


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Reasons Why a Hospital Cannot Practice

Medicine:

If a hospital will be allowed to practicemedicine, then the licensed physician

employed by the hospital will be merely

receiving orders from the corporate body or

its officers who are not licensed to practice

medicine.


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Duties of the Governing Board of a Hospital:

To determine the policies of the hospital in

relation to the community needs; To see to it that the proper professional

standards are maintained in the care of the

sick;


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Duties of the Governing Board of a Hospital:

To coordinate the professional interest of the

hospital with the administrative, financial andcommunity needs;

To direct the administrative personnel in order

to carry out the policies; and

To provide adequate financing to secure

sufficient income and to assure business-like

control of expenditures.


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REGULATION OF HOSPITALS

The Bureau of Medical Services (Bureau of

Health and Medical Services) as a licensing

agency and subject to the approval of the

Secretary of Health, shall promulgate rules

and regulations to implement the provisions

of this Act (RA 4226 or Hospital Licensure Act).


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RULES AND REGULATION IN A

HOSPITAL

The State Regulation of a hospital

Applicable to all hospital and embodied in the

Licensure Act together with its implementing rules

and regulations for its enforcement.

SelfRegulation of a Hospital

Regulation promulgated and enforced only within

a hospital for purposes of discipline, order,convenience, and for other reasons, the governing

board may so desire.


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DUTIES OF A HOSPITAL

To furnish a safe and well maintained building

and ground

To furnish adequate and safe equipments To exercise reasonable care in the selection of

the members of the hospital staff


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LIABILITY OF GOVERNMENT

HOSPITALS

A state cannot be sued except when itconsents. The immunity of the governmentfrom the official acts of its officers, agents and

employees is based on the old English maximthat The king could do no wrong

Following the doctrine of the immunity of thestate from suit, a public or governmenthospital cannot be sued inasmuch as it isowned and controlled by the government


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LIABILITY OF PRIVATE CHARITABLE

HOSPITALS

Charitable Hospital

Is established and maintained from donations,

contributions, philanthropic acts and pays no

dividend, has no capital stock, seek no profit, and

render hospital services gratuitously


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LIABILITY OF PRIVATE CHARITABLE

HOSPITALS

The test of a charitable hospital:

It is not the extent of the services rendered

Nor whether the patient pays more or less than

the cost of the services But whether those who operates it are doing so

for private profit, directly or indirectly.

To determine whether a hospital was established

for charity is the articles of incorporation and theconstitution and by-laws of the corporation whichestablished the hospital


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DOCTRINES OR THEORIES APPLIED TO

CHARITABLE HOSPITAL

Trust Fund Doctrine:

Voluntary non-profit or charitable hospitals derive supportfrom voluntarily contributions or donations

The contributors specifically mention that the purpose of

the money collected is for the reception, care andtreatment of charity patients.

The contributions are only held in trust by the governingbody of the hospital.

Diverting the trust fund for the payment of damage will be

utilizing the money not intended by the donor. If the endowment, contribution or donation is solely for the

charity patients, then there will be no fund available for thepayment of damages.


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CHARITABLE HOSPITAL

Implied Waiver Theory:

A patient who enters a private charity hospital,

knowing fully well that it is merely supported bybenevolent and humanitarian contributions,

waives his right to claim damages.


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CHARITABLE HOSPITAL

Public Policy Theory:

A private hospital for charity performs a quasi-publicfunction.

It renders service to the indigent patients withoutremuneration.

It is undertaking the obligation imposed upon the statefor the preservation of life and maintenance of healthof the people.

If a government hospital is immune from liability whileundertaking such obligation, for the same reason, theprivate hospital for charity must be given the sameimmunity also.


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CHARITABLE HOSPITAL

Independent Contractor Theory:

A patient who enters a private charitable hospital

does not have a contract with the hospital but

with the attending physician. The hospital has no capacity to supervise the

activities of the attending physician in themanagement of the patient.

It is but logical therefore that if the attendingphysician committed a wrongful act, he himselfmust be held liable and not the hospital.


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LIABILITIES OF A PRIVATE HOSPITAL

FOR PROFIT

A private hospital for profit may be held

vicariously liable for the negligent act of its

employees.

All other principles to determine the liability

of physicians may be applied to private

hospitals operating for profit


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LIABILITIES OF A HOSPITAL

Corporate Liabilities:

Arises from failure of the hospital to furnish

accommodations and facilities necessary tocarry out its purpose or to follow in a given

situation, the established standard of conduct to

which the corporation should conform.


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Corporate Liabilities:

Failure to furnish safe and well maintained buildings andground

Failure to furnish safe and reliable equipment includes:

a) Heaterb) Defective bed

c) Sideboard

d) Wheel chair

e) Electric appliance

f) Defective instrument

Failure to make careful selection, review, and supervision ofindependent physicians who are permitted to practice inthe hospital


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Nursing staff:

Duties and Responsibilities of a Nurse (R.A. 877 as

amended by RA 4704 and further amended by RA

6136)


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Kinds of Nurses:

STUDENT NURSE

Not an employee of the hospital

PROFESSIONAL NURSE

A licensed nurse in the service of a hospital is anemployee of the hospital.

She may, however, be a borrowed servant of a

physician when her activities are under his control.

The doctrine of vicarious liability may be applied forthe negligent act which caused injury to the patient


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Kinds of Nurses:

SPECIAL DUTY NURSE

A special duty nurse or private nurse is one whoexercises independent calling subject to the

control of no one in her work and who contracts

to work according to her own judgment.

A special duty nurse is an independent contractor. For any wrong act committed by her, she herself

must be held liable.


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Hospital liability for inadequate nursing

services:

A hospital is not only required to have qualified

and reliable nurses but also sufficient in number

to maintain adequate services to the patient.


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Medical Staff:

INTERNS

After completion of clinical clerkship, internship in any of

the hospitals approved by the Board of Medical Education,is required before a person may be qualified to take thefinal board examination.

The Board of Medical Education is empowered to certifythe hospitals which have complied with the minimum

physical requirements for the admission of interns. The quantity and quality of facilities will determine the

number of interns who may be allowed to undergo clinicaltraining in a hospital.


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Medical Staff:

RESIDENT PHYSICIANS

Unlike interns, they are medical graduates andduly authorized to practice medicine.

CONSULTANTS

Ethically, it is the duty of the attending physician

to solicit the services of another physician when

he encounters difficulty in diagnosing and treating

a case.


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ADMISSION AND EMERGENCY CASES

A hospital must have an admitting departmentor section.

Aplace which determines who are eligible for

admission, and the number and types ofpatients to be admitted depending upon thesize, organizational pattern, and capabilities ofthe personnel.

The policies on admission is defined by thegoverning board of the hospital.


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A person has no absolute right to be admittedin a hospital or to avail of hospital services.

The discretion to admit is vested on the

management or governing board.

The relationship between hospital and patientis contractual and the hospital has the right to

choose patients whom it wants to serve, inthe same manner that the patient has theright to choose the hospital.


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A government hospital has no absolute privilegeof choice of patients inasmuch as it is establishedand maintained by public funds.

Must open its door to all who seek its servicesand facilities and must be made available to allmedical practitioners and patients.

This is, however, limited by the facilities of the

hospital, number of beds available, and thecapacity of the technical staff to institutetreatment procedures with competence.


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A private hospital is given more power tochoose the physicians and patients it wants toserve.

The management usually adopts certainguidelines to be the bases of admission ofpatients.

The only limitation is that it must not beoppressive, discriminatory, illegal, or contraryto public policy.


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Some of the justifiable grounds to refuse

admission of patients:

In order for the patient to be able to collectdamages from the hospital it must be shown

that his non-admission is the proximate cause

of any aggravation of his condition.


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A hospital affiliated to a medical school may

have special beds for indigent patients and

may vary the cases to be admitted for

purposes of instruction.

Patients who seek admission in those special

beds impliedly waive their rights to privacy of

confidential communications.


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The reservation of a room or a bed in a hospital doesnot constitute a contract between the hospital and thepatient in a way that if the patient needs the room orbed, the hospital can be compelled to furnish himimmediately.

The order in the reservation must be observed withoutprejudice to the specific room or bed being reserved.

But, if the room or bed is available, the hospital has no

right, based on the order of priority, to arbitrarilyrefuse admission of the patient after the reservationhas been accepted.


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Attendance to Emergency Cases in Hospitals:

Facilities for medical practice, and in order to carry outthe legal obligation of physicians employed in theseinstitutions or authorized to practice therein in

attending to a patient in danger of death or isotherwise an emergency case, it becomes theresponsibility of hospital to provide facilities foremergency cases.

Therefore, all hospitals covered by the provisions of the

R.A. 4226 shall henceforth take steps to insure thatimmediate attention and proper treatment are given toall emergency cases.


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Attendance to Emergency Cases in Hospitals:

For the treatment of a particular emergency case, first-aidtreatment shall be resorted to and the patient shallthereafter be transferred to another hospital with

necessary facilities as soon as the condition of the patientpermits.

An emergency case as used in this Order means a patientwhose delay in treatment may cause loss of life or limb orpermanent residual damage.

If an emergency patient has been given the necessaryimmediate care and the threat to life and serious injuryhave simmered down, a private hospital is not obliged toadmit a patient if he cannot pay the required deposit.


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TRANSFER AND DISCHARGE OF

PATIENTS

The transfer of emergency patients from one

hospital or clinic to another can only be done

if the condition of emergency ceases to be a

threat to the life and that the transfer itself

will not impair the life and health of the

patient.

The transfer must be premised on the desireand consent of the patient.


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PATIENTS

The moment the patient is admitted in ahospital, there exists a contractual obligationfor the hospital to let the patient avail of the

services of the hospital until such time whenthe service is no longer necessary.

If the patient is not in a position to pay thenecessary bill, the hospital is not preventedfrom utilizing the court of law for the recoveryof the hospital bill.


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PATIENTS

If the attending physician, after evaluation of the

patients condition, considers that further

hospitalization is no longer indispensable, he may

order the discharge with or without condition.

The order must always be written in the clinical

record and may simply state may go home or

may provide certain advice or condition likeadvised to report after two weeks for check-up


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PATIENTS

A patient whos been given emergency

treatment may be transferred to another

hospital which has facilities to treat injury or

disease suffered by the patient upon the

request of the patient or relatives.

The physician attending to such emergency

may allow such transfer, if in his evaluation, itwill not endanger the life of the patient.


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PATIENTS

Discharge of patient in need of furtherhospitalization is unreasonable.

When a hospital undertakes to treat a person,

it must not act unreasonably in removing thatperson from the premises.

The patient must remain in the hospital and

treatment continued if it is foreseeable thatthe patients condition will be aggravated ifremoved from the hospital.


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REFUSAL OF PATIENT TO LEAVE THE

HOSPITAL

Refusal of the patient to remain in the hospital will notbe a lawful ground to detain him if he is of a soundmind and of legal age

The attending physician must appraise the patient ofthe potential untoward effects if he leaves the hospital.If after being told of the serious consequences, thepatient insists on leaving the hospital, the attendingphysician has no other recourse than to abide with the

patients wish, otherwise, he may be held criminallyliable for slight criminal detention (Art. 268, RevisedPenal Code)


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HOSPITAL

Preventing the patient from leaving the hospitalmeans detaining him or in any other manner,depriving him of his liberty

It is a violation of Sec. 6, Art. III of 1987 PhilippineConstitution which guarantees that The libertyof abode and of changing the same within thelimits prescribed by law shall not be impairedexcept upon lawful order of the court. Neither

shall the right to travel be impaired except in theinterest of national security, public safety, orpublic health, as may be provided by law.


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HOSPITAL

If the patient in spite of the advice not to leave the hospital insisted on

leaving, aside from the notation in the clinical record went home

against advice, the attending physician or nurse must let the patient

sign a release paper which contains among other things, the following:

That he vehemently wanted to leave the hospital (whether or nothe stated the reason for his desire)

That he was advised of the probable danger to his life or

impairment to his health if ever he does, in a clear, adequate and

understandable language

That in spite of the explanation of potential danger (immediate orremote) to him, he would still leave the hospital

That he holds the hospital or any member of its staff not

responsible criminally or civilly for whatever consequence to his

life and health as a result of his act


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HOSPITAL

If the patient refuses to sign the release form, then it is

recommended that the form be presented to the patient in

the presence of competent witnesses.

The statement Patient refused to sign may be written on the

release form, signed by the person who presented it and also

by the witnesses.

In some instances, the patient refuses to leave the hospital in

spite of the order for his discharge.

He may do so in a private hospital provided the corresponding

hospital bill is properly satisfied and with the consent of the

attending physician.

However, this will create a problem in the charity wards of

government hospitals.


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HOSPITAL

A patient may have fully recovered from his ailment or a

newly born child has long been on overdue stay in the nursery

or has been abandoned by the parents with unknown address

or has given a wrong address.

Medical and humanitarian reasons make it necessary to

discharge other patients who do not need further

hospitalization.

Patients with known addresses may be sent home through

the social service department of the hospital.

Infants and abandoned children may be referred to the DSWD

for custody, care and placement.


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HOSPITAL

Premature Discharge

The attending physician and the hospital may be held

liable to the patient if the latter is discharged from the

hospital in spite of the fact that further hospitalization is

still necessary.

Detention of a Patient for Non-payment of Bill

A patient cannot be detained in a hospital for non-

payment of the hospital bill.

If the patient cannot pay the hospital or physicians bill, the

law provides a remedy for them to pursue; that is, by filing

the necessary suit in court for the recovery of such fee or

bill.


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HOSPITAL

However, the hospital may legally detain a patient against his

will when he is a detained or convicted prisoner, or when the

patient is suffering from a very contagious disease wherein his

release will be prejudicial to public health, or when the

patient is mentally ill, that his release will endanger public

safety.


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HOSPITAL LIABILITY FOR INFECTION

A clinic or hospital may be held liable for failure to

afford patients with adequate protection against

infection.

Prevention of hospital acquired infection involve careof the physical plant, screening of personnel, care of

equipment, use of aseptic techniques, and use or reuse

of defective supplies.


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HOSPITAL LIABILITY FOR INFECTION

The risk of infection is common and there is no duty for

the hospital to warn the patient, but the hospital will

be held liable for the injury caused by the infection if

the patient can prove that it is caused by hospitalnegligence.

Infection caused by equipment and faulty technique

Contact with infected patient

Negligence of personnel and staff

Hospital personnel may be the source of infection

Documents

Hospital Liabilities