Monday, April 10, 2006

PHILIPPINE HEALTH CARE IN CRISIS PART IV: A MEDICAL MALPRACTICE CASE IN THE PHILIPPINES

[This post is intended as a parallel to the post below (PHILIPPINE HEALTH CARE IN CRISIS PART III: WHY MEDICAL MALPRACTICE WILL NOT WORK IN THE PHILIPPINES). But, because of limitations of the blogspot format (no complaints, mind you), I am posting this in an over/under fashion with the former]

It is now after passage of the Philippine Medical Liabilities Act of 2006. A patient sues say a plastic surgeon because of a poor tummy tuck result. A case is filed at the City Prosecutor’s Office who decides on the merits of the case. On the question of community standards of care, all kinds of “experts” will be presented – from the faith healer in Carcar to the iris scanners at the mall to the cosmetic surgery experts in Manila. Fund transfers start flying all over within the framework of “preliminary hearing”. The plaintiff pays more and the case gets accepted for litigation.

The case is now raffled off to a RTC judge. (In this system, the judge is a one-man-act, no 12-man jury here. He will referee the proceding and decide at the end). The judge will look at the merits of the case, sees the high stakes in it and certifies it as meritorious. The merits of the case from both sides will be officially reviewed by the judge and a settlement conference is scheduled. Now, fund transfers fly in a higher level. No settlement is reached so the case goes to trial.

Trial time. Trial is basically a parade of testimonial “experts” including the faith healer from Carcar, fighting to probe to the judge that yes/no the plastic surgeon met the community standard of care. Why did the judge accept the faith healer as an “expert” witness? Heck, he goes there himself for his cysts, diabetes and “high blood” (in a recent Pulse Asia survey, more than 60% of people chose faith healer over doctor).

For the poor plastic surgeon, the final blow was this high-paid cosmetic surgery “expert” from Manila who never spent a day of training in plastic surgery, who testifies that the services and result were below community standards of care. Why does the judge judge (no typo here) accept this “expert”? Heck, he sees and listen to him/her every morning on national TV.

After 1 year of the trial process – delays, postponements, conflicts with the judge’s docket schedule (read: there are other more promisingly lucrative cases), it’s decision time. Some heretofore unknown person approaches the plastic surgeon’s main counsel and says: “The judge will hand down his decision tomorrow. If you have 2 million pesos, he will give it to you”. This information is relayed to the plastic surgeon who asks: “Why should we do that when the trial clearly shows that I am innocent?” (As if the trial really counts!) This in turn is relayed to the fixer verbatim. The message back to the plastic surgeon: “…then he will give it to the other side”.

Two million is two million. The plastic surgeon pinned some hopes on the slim chance that the judge has got some righteousness in him.

The following day, decision time at the RTC: “Guilty!”

The plastic surgeon loses his license to practice medicine and goes to jail to start life among murderers, rapists, child molesters, drug addicts, carnappers, swindlers and kidnappers (notice: no big time smugglers, drug lords and government grafters and corrupters here).

Friday, March 31, 2006

PHILIPPINE HEALTH CARE IN CRISIS PART III: WHY MEDICAL MALPRACTICE WILL NOT WORK IN THE PHILIPPINES

As mentioned in the blog below, the Philippine society is not mature enough to handle medical malpractice. Here is a brief glimpse at a medical malpractice case in the USA:

A patient sues say a plastic surgeon because of a poor tummy tuck result. The case will get filed in a municipal level trial court as a civil case, meaning the reward is money, plain and simple. (There will be no talk about fines, imprisonment and loss of license). The facts of the case will then get submitted to the judge who will decide whether or not there is merit.

When the judge deems the case meritorious, a preliminary hearing is scheduled (in his sala, not the prosecutor's office). At the hearing both sides present their evidences. The most important for the plaintiff is the sworn testimony, via legal deposition, of an expert witness, a physician, attesting to the poor quality of the job the plastic surgeon performed. On the other hand, the plastic surgeon's side present evidences, the most important of which is a sworn testimony of an expert witness, a physician, testifying to the fact that the accused plastic surgeon's job meets community standard of care.

The judge then advises both sides to find a settlement (always a certain amount of dollar). When the two cannot come up with a settlement agreement, the judge then schedules a jury trial. (The judge in the USA is considered not wise enough to decide on guilt or innocence. He/she passes the buck to 12 people in the community picked at random).

The judge's job from here on is to administer the case in court acting as a referee, controlling mainly the lawyers from both sides, and to be sure that the jury is instructed well on the rules of evidences and the gravity of jury tampering (members of the jury cannot communicate in any shape or form with any member of either side while the case is going on, and for a period of time afterwards).

Then after all the arguments are presented (usually one to two weeks), the jury goes into conference ("jury seclusion") and fight among themselves to come up with a common decision. When the decision is guilty, they decide how much the reward is, based on previous manifestations of the plaintiff.

If the jury verdict is "innocent", end of case. If the verdict is "guilty", the defendant plastic surgeon may file reconsideration, appeals, etc. just like here.

Again, I said earlier that this takes a mature society for this to work.

What will happen here?

[Next issue: A MEDICAL MALPRACTICE CASE IN THE PHILIPPINES]

Saturday, March 25, 2006

PHILIPPINE HEALTH CARE IN CRISIS PART II: CONGRESS CONTINUES TO PUSH FOR MEDICAL MALPRACTICE BILL - BOYS PLAYING WITH FIRE

[ Philippine Health Care in Crisis Part I has already been posted in another section of Lapu-Lapu Times]

On the news talk show the other day, Rep. Biazon continues to push for the Medical Malpractice Bill. Congress has been trying this for the last 5 years. Lately, it has tried to sugar-coat this with a new title "The Medical Liability Bill" - Boys playing with fire!

Medical Malpractice is workable only in a mature society…and barely so. In the USA, the only country with an existing malpractice litigation climate, the component states are struggling to find ways to tone down malpractice.

Here’s the irony. “Malpractice Bill” in the States means striking down malpractice litigation whereas in the Philippines “Malpractice Bill” means setting up a system to promote malpractice litigation – complete opposites.

In the States, malpractice litigation is a civil case. In the Philippines, congress is talking about criminal case. (Sometimes, it makes me wonder whether the lawmakers and judicial players know the difference between civil and criminal cases).

Think about this. Health delivery crisis has been brewing in the States due to the malpractice crisis. Segments of society do not have access to proper medical care because doctors refuse to provide them for fear of being sued and get slapped with a monetary reward (which is why in the States, malpractice insurance is mandatory).

The Philippine Medical Malpractice Bill is pushing for punitive damages as well as civil damages. On top of monetary awards, the Philippine physicians will be facing jail sentence (6 years imprisonment) and loss of license to practice.

Philippines, think about this. You are in the midst of a health care crisis. Big segments of your society do not have access to proper medical care. You have district hospitals sharing one lonely doctor between themselves. Because of economic realities, doctors are studying to be nurses with the hope of a better life abroad. Your nurses, medical technologists and physical therapists are leaving for abroad.

Wake up!! Think instead of improving the livelihood of the medical professionals.

[Next post: WHY MEDICAL MALPRACTICE WILL NOT WORK IN THE PHILIPPINES]

Monday, March 06, 2006

QUALITY OF EDUCATION: ON A STEEP SLOPE TO THE BOTTOM

Reported today:
  • Only 42% of graduating high school students pass the National Language Proficiency Test.
  • Education-wise, graduating high school students are in the 2nd year high school level; and graduating elementary (6th grade) students are in grade 3 level

According to Senator Angara, Chairman of the Senate Committee on Education, this is due to decreasing annual budget of the Department of Education in the face of expanding number of students - a truly dangerous combination.

Nobody mentioned the number #1 cause - the Principle of Progressive Advancement. Sometime in the 80's the Department of Education issued a policy that nobody fails in school. A boon for parents (no extra expense for a repeated year) and teachers (pass and be rid of the "problem pupil"). And the pupils - no need to study and do homework, lakwatsa lang, watch TV, cut classes, do the cheap rugby or sometimes shabu, etc.

This in all likelihood started the steep downward slide. The past few years, more than 60% of graduating elementary school students cannot pass the high school readiness test. About 3 years ago, then Secretary of Education de Jesus, tried to do something about this by instituting the "Bridge Program" - those who cannot pass the high school readiness test would go to a remedial program - for free! And only when they successfully complete this will they be allowed in first year high school.

The teachers and parents mob ganged up on him, the government deserted him, and he was gone in a few months.

Forget about coup d' etat, military mutiny, destabilization, lack of moral ascendancy, graft and corruption, election rigging, landslides, etc. - education is the most serious problem facing the country today.

Wednesday, February 08, 2006

MILO'S NEWSCLIPS: THE ABORTION PILL

The death of more than 70 people in the Ultra stampede dominates Philippines news in the last several days. The basic blame is poverty. The Ibon Foundation has pegged the highest recorded number yet - 90% incidence. Some people attribute this to overpopulation. Here we go again (please refer to my blog on the population issue).

This brings us to one of Milo's newsclips titled: "Remove Abbott's control of abortion drug, urges Liberal". A debate is raging in Australia regarding RU486, the abortion pill. I don't think that will ever happen here in the Philippines. RU486 will not reach first base here.

Sunday, December 25, 2005

CHRISTMAS EXPOSES THE DICHOTOMY IN PHILIPPINE SOCIETY

Leading up to the 25th, news accounts and television/radio interviews of vendors and retailers invariably ends up in the lament of how slow it is this Christmas season. People are so hard up that plainly, they're not buying. This is the same thing that people here in Lapu-Lapu complain about.

The Department of Labor has been flooded by complaints of companies not giving their 13th month pay (bonus) as mandated by law. Workers in different government agencies are demonstrating, decrying the fact that the bonus that Malacanang promised is nowhere in sight.

Then, there's the news of the Christmas party for Malacanang employees. Everybody is donating his/her PHP5,000 bonus to the party. Lucky people!!

Saturday, December 24, 2005

HOLIDAY SEASON 2005

Lapu-Lapu Times wishes you
Happy Holidays!