Monday, December 12, 2011

HOSPITAL ARREST (Anti-Detention Of Patients Act)

By Siesta-friendly

Like Mary and Joseph looking for a place to give birth, Eleanor and Edgar approached several government hospitals for Eleanor’s premature delivery.  And like Mary and Joseph who were several times turned away, Eleanor and Edgar “were refused admission for some reason or other. Some facilities claimed they did not have incubators for premature babies.”[1]

We still cannot understand how hospitals, especially government hospitals, continue to turn away people in need of medical help.  We do not think that’s mere ignorance of the almost 15-year old law that is Republic Act No. 8344 (“An Act Penalizing The Refusal Of Hospitals And Medical Clinics To Administer Appropriate Initial Medical Treatment And Support In Emergency Or Serious Cases …), we think its just the blatant disregard of it.

But that is not why we are making this post since we’ve already discussed RA 8344 previously - it’s because Eleanor and Edgar’s plight did not end upon the birth of their boy.  While Mary and Joseph were given gifts by wise men, Edgar and Eleanor were given a ransom demand by not so wise men. The hospital told them that they had to pay “more than P700,000 for the delivery and care of [their] premature baby.”[2] 

Eleanor is a golf caddie while Edgar is an unemployed former grass cutter.  So, from the time of their son’s birth on July 19, 2011 until November 25, 2011 – over 4 months - Baby John stayed inside the University of Perpetual Help - Dr. Jose Tamayo Medical Center in BiƱan (UPH), Laguna not because he was sick but because his parents couldn’t pay the (unbelievable) P700,000.00-plus hospital bill. 

Baby John was released only on November 25, 2011after media exposure of their story and after the couple’s appeal to the Department of Health (DOH).  Pursuant to R.A. 9439 (An Act Prohibiting The Detention Of Patients In Hospitals And Medical Clinics On Grounds Of Nonpayment Of Hospital Bills Or Medical Expenses)[3], Eleanor and Edgar “signed a promissory note undertaking to pay the hospital bill in monthly installments.”[4]

Illegal Hospital Detention

We don’t have to tell you that what UPH did was wrong, at least morally. But how wrong were they, legally?

Let’s start with Section 1 of RA 9439 which states:

It shall be unlawful for any hospital or medical clinic in the country to detain or to otherwise cause, directly or indirectly, the detention of patients who have fully or partially recovered or have been adequately attended to or who may have died, for reasons of nonpayment in part or in full of hospital bills or medical expenses.

The news reports do not contain any allegation that Baby John was being held by UPH because he was still sick.  Although, it was reported that for “four months [Eleanor] was not allowed to touch or hug her baby as hospital staff said he needed intensive care because, having weighed only 1.14 kilograms at birth, he had pneumonia and pulmonary problems.”[5] That excuse seems to be a defense against Eleanor’s claim of lack of contact with her baby than a defense in favor of the baby’s detention.

Section 2 further states:

Patients who have fully or partially recovered and who already wish to leave the hospital or medical clinic but are financially incapable to settle, in part or in full, their hospitalization expenses, including professional fees and medicines, shall be allowed to leave the hospital or medical clinic, with a right to demand the issuance of the corresponding medical certificate and other pertinent papers required for the release of the patient from the hospital or medical clinic upon the execution of a promissory note covering the unpaid obligation…

Promissory Note

Unfortunately, under the circumstances, hospitals/clinics are at best left with –

1)                  A promissory note required as follows - 

The promissory note shall be secured by either a mortgage or by a guarantee of a co-maker, who will be jointly and severally liable with the patient for the unpaid obligation. In the case of a deceased patient, the corresponding death certificate and other documents required for interment and other purposes shall be released to any of his surviving relatives requesting for the same. (Section 2)

In the case of a deceased patient, DOH Administrative Order No. 2008-0001 (Implementing Rules And Regulations of Republic Act No. 9439) [6] clarifies that any of the surviving relatives who refuse to execute a promissory note shall be allowed to claim the cadaver and can demand the issuance of death certificate and other pertinent documents for interment purposes, but documents for other purposes shall be released only after the execution of a promissory note. (Part V. A. Paragraph 3)

2)                  An assignment of proceeds, as follows:

DOH AO No. 2008-0001 adds that in the case of a deceased patient and in the event that the above-mentioned documents “will be needed for the purposes of getting the benefits from the SSS, GSIS, Philhealth, insurance policies or pre-need plans, the hospital may require the execution of an assignment of proceeds up to the extent of the hospital bills or medical expenses/hospitalization.” (Part V. A. Paragraph 2)

The only other protection for hospitals/clinics is that RA 9439 does not apply to patients who stayed in private rooms” (Section 2). So does that mean private room patients can be held by hospitals/clinics for ransom if they can’t pay?  Food for thought. 

Illegal Detention of Cadaver

Yet, despite the clear mandate of the RA 9439 and DOH AO No. 2008-0001, hospitals continue to find excuses to try and circumvent the law -

“To add insult to injury, the hospital put us through a terrible and humiliating ordeal before we were able to take my mother’s body for a proper funeral and burial. We were asked to provide collateral, postdated checks, OR/CR of vehicles or find a guarantor who will vouch for us.

Funeraria Paz arrived to take mama’s body but the hospital insisted that we needed to keep the body at Holy Trinity for “preservation” while we are negotiating the terms of the promissory note. They insisted that they weren’t holding my mom’s body, but repeatedly refused to release it. They advised us to keep the body at Holy Trinity for preservation in a fridge for a “minimal fee” of P4,000-5,000 per day.” – Account of Alva Marano-Alfonso detailing “what the Marano family went through when their beloved mother, Josephine, passed away last November 16 at age 56. The body was held for ten hours, pending down-payment of P200k. The title of their home is being demanded by the Paranaque Doctors’ Hospital as collateral — until their bills are fully settled.”[7]

DOH assistance

To help both the patients and the hospitals/clinics, the DOH is mandated to, “as far as practicable, assist patients in looking for financial assistance from government and non-government sources to settle the unpaid hospital bills or medical expenses / hospitalization expenses.  Toward this end, the DOH shall work closely with fincancial institutions like, but not limited to, [Philhealth], [PCSO], [PAGCOR], [LGUs], as well as Congress, to provide funds for this purpose. (Part V. B. Paragraph 1 c))

Although, in the case of Eleanor and Edgar, the DOH guaranteed P10,000.00 financial assistance and the PCSO guaranteed a P50,000.00 donation, the government should be made to guaranty more substantial financial assistance to indigent patients.

Liability of hospital/clinic

Any officer or employee of the hospital or medical clinic responsible for releasing patients, who violates the provisions of R.A. 9439 and its implementing rules and regulations shall be punished by a fine of not less than P20,000.00, but not more than P50,000.00, or imprisonment of not less than 1 month, but not more than 6 months, or both such fine and imprisonment, at the discretion of the proper court. (Section 3, RA 9439; Part V. B. Paragraph 3, DOH AO No. 2008-0001)

Business is business, true; but lives are lives – priceless and invaluable.  Lives are mothers, fathers, daughters, sons, relatives, friends, loved ones.  Business is just business. For a profession that deals with lives regularly and intimately, it is appalling that it should be health personnel who should treat people the worst if only to continue making money.



[1]  Alcantara, S. R. (2011, November 20). Baby john’s plight touches netizens. Retrieved from http://technology.inquirer.net/6299/baby-john’s-plight-touches-netizens/
[2]  Supra.
[3]  April 27, 2007.
[4]  Alcantara, S. R. (2011, December 4). ‘Hostage’ baby is finally home.  Retrieved from http://newsinfo.inquirer.net/104923/hostage-baby-is-finally-home
[5]  Supra.
[6]   January 7, 2008
[7]  Villanueva-Ong, Y.  (2011, December 6).  The high cost of dying.  Retrieved from http://www.philstar.com/Article.aspx?articleId=755429&publicationSubCategoryId=64

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6 comments:

Anonymous said...

"...RA 9439 does not apply to “patients who stayed in private rooms” (Section 2)". This should be on a case-to-case basis. My daughter had an immuno-compromised condition and was not allowed to be with other patients, hence she was forced to be in a private room.The hospital allowed us to leave only after signing a promissory note and leaving our laptop with them as collateral. I hope our legislators would do something about this and the health care system in the Philippines.

Anonymous said...

Yes it is correct, they are just implementing it to those who is not staying in private room, Why? what if there is no availability of non private room and the relatives was advised to be confined by the time of their arrival, so no choice just to take the private room, I am writing this comment, because my relatives undergone Whipples Operation wherein the doctors need to remove a tumor located in the pancreas it is defined as Pancreatic Reed Mass, it is a very serious matter and the patient need to be stayed in the ICU fro further medical assistance,the doctors said that this only takes for 1-3 months depending on the condition of the patient, if you are the patient do you want to stay together with other patient who might witnessed dressing your open wound in the stomach with the cut size of 12 inches horizontal and 12 inches vertical, even the relatives are not allowed to stay inside the room while in the process of dressing, imagine it is an open wound, are you going to take the risk that a lot of bacteria might incurred by the patient that might result to serious infection, especially in our case, before the operation we have not enough money to cover it, but we got no choice instead of losing your love once without giving him or her another chance to live, until the time that we ended up all of our savings, because he is staying in the hospital for more than a year, We are not rich, but lives is very important to us, and this is my question will the doctor allow him to stay in the non private room of his condition, We have already paid almost half of the total bill, Seriously the Government should revised the existing law...

The Legally Inclined said...

Anonymous,

Are you asking if the hospital can ask him to leave because he has only paid less than half of his bill? Then the answer is no pursuant to RA 8344 (“An Act Penalizing The Refusal Of Hospitals And Medical Clinics To Administer Appropriate Initial Medical Treatment And Support In Emergency Or Serious Cases, Amending For The Purpose Batas Pambansa Bilang 702, Otherwise Known As "An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases”). http://www.lawphil.net/statutes/repacts/ra1997/ra_8344_1997.html

Hope this helps.

We hope your relative recovers soon.

Sincerely,
TLI

Sara Jane Co said...

Im quite worried as to how the promissory note goes. I gave birth to my first child last friday, (nov.6,2015), in whixh my baby was only 34weeks and 6days old, but because she was a preterm baby, they had to put her in an incubator for a day for observtion but was transferred to a regular nursery bed the very next day. My husband and I are both unemployed for 6months now because of my sensitive and delicate pregnancy, my husband is forced to stay with me since there's no one else who can assist me in moving around. and ia just living with my both senior citizen parents. We had little savings left for daily expenses and is only enough for simple everyday life.

When i was brought to Dr. Jesus Delgado Memorial Hospital due to waterbreak, i wasnt supposed to be admitted at first because we dont have 8k to provide for a deposit. My husband then asked if caritas health shield (hmo) is accepted in their hospital, thank God they are, and so i was admitted.

Sara Jane Co said...

After 4hours of feeling hungry, dehydrated and chilly in the recovery room, i was then brought to the room, the room my husband admitted me with is the ward, where-in 6people share the same room. Finding out an hour later that my hmo would be able to cover the charges even if i choose a private room, i quickly said that it would be a delightful convenience to be transferred to a private room since this is my first birth experience, and that we might as well take advantage of the hmo coverage.

It was only on Nov. 9,2015 that I was visited by my ob-gyne for an I.E. and I was given instructions on my diet, how to clean the wound and such..she then left for rotation, when after 30mins, ahe came back running and told me that my hmo only provided her P6,600 and P4,000 something for her anesthesiologist. She then blatantly told me and my husband that those amount are just for gas, and that we need to call our hmo to provide her more. Moments later, he had her secretary called my room and told me that we still need to pay her P37,000 more.(unbelievable)

Sara Jane Co said...

I was admitted from Nov.6,2015 up until Nov.10,2015. The total hospital bill that I and my baby incurred during the 4days was P37,000++.. In which clearly stated on the breakdown of the bill that the professional fee of my ob-gyne and the anesthesiologist are already included. With the help of my hmo and philhealth, everything was settled but the misc fee which is around P1,500 in which we settled in cash payment. My baby would still need to board a few days more to finish her antibiotics. They assured me tht whatever my hmo was paying for my baby, and if the boarding and antibiotics are the same, it's all going to be covered, so i need nt worry anymore.

Everything is already settled in the billing department and we're just waiting for the nurse to give us the release form, which by thw way took her almost 2hours to sign it. We found out tht the reason they're delaying it is because my ob is waiting for her P37k. My husband and I was like 'where the heck are we going to get that??' We decided to call our ob and i had to literally beg for her to give us until the next day to atleast find money to pay her, not the whole amount, but at least a portion of it. Ofcourse she agreed and told us to write a.promissory note.

What i wrote in the promissory note is that we'll make all possible action to pay P17,000 by the nextday and the remaining P20,000 in installment form. Both my huaband and I signed the note and gave it to her secretary and have her signed our copy.

God did provide, through loaning from relatives and friends, we were able to come up with 20k. Just yesterday, Nov. 12, we were able to give my ob the 20k payment, the moment she receuved the paymemt, she then told us to wait. 20k was in a check form, and she had to encash the check so she can give us the 3k. Moments later, she called and told me that it was a crossed check and she had to wait until tuesday for the clearing. We then told her that we needed the 3k cash because we dont have any money left on us and that our baby is due to be released the next day. She then repeatedly answered ua rhat she doesnt have any money on her and that she needs to pick her daughter up in school already, so she has to go. We were left in the hospital hanging. We only have enough left for our fare going back home.

So today, my baby is due to be checking out, but we havent slept a bit because we are so stressed out finding money for the bills that we still need to settle for today. Aside from the pedia's pf P10,000, there are still other misc we had to pay, plus, whtver medicine and milk the doctor would be givin us to buy.

We tried every people we know, checked out every lender and loan there is, still an epic fail. The only money left in our pocket right now is P350.

If the promissory note doeant include patients on private room, does that mean that i wouldnt be able to get my baby out?? Will there be any way that we can loan from any LGU without payslips? We're considered both indigent now, and i dnt know where else we can get that big amount of money. I would appreciate if someone can help me out. Havent slept for two days now,all because of the bills piling up.. We're already drowning, why are the doctors still pushing us deeper???