Saturday, December 27, 2008

IRR PATIENT ANTI-DETENTION LAW

ADMINISTRATIVE ORDER NO. 2008 - 0001

SUBJECT: Implementing Rules and Requlations of Republic Act No.

9439, otherwise known as "An Act Prohibitinq the Detention

of Patients in Hospitals and Medical Clinics on Grounds of --

Nonpavment of Hospital Bills or Medical Expenses".


I. Rationale:

The passage of Republic Act (R.A.) No. 9439, otherwise known as "An Act

Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of

Nonpayment of Hospital Bills or Medical Expenses", addresses the problem involving

some hospitals and medical clinics that refuse to discharge patients due to the

latter's inability to pay their hospital bills or medical expenses by encouraging them

to employ appropriate payment schemes. It also emphasizes the responsibility of

patients to honor their obligation with the hospital or medical clinic to pay their bills.

Section 4 of R. A. No. 9439 authorizes the Department of Health (DOH) to

promulgate the necessary rules and regulations.

II. Objective:

This Administrative Order sets the implementing rules and regulations to carry

out the provisions of R. A. No. 9439, otherwise known as "An Act Prohibiting the

Detention of Patients in Hospitalsand Medical Clinics on Grounds of Nonpayment of

Hospital Bills or Medical Expenses".

Ill. Scope:

This Administrative Order applies to patients admitted in government and

private hospitals and medical clinics, except those who stay in private rooms.

IV. Definition of Terms:

For purposes of R. A. No. 9439 and its implementing rules and regulations, the

following definitions are provided:

A. Co-Maker - a person, natural or juridical, who binds himself jointly and

severally to pay the unpaid hospital bills or medical expenses1

hospitalization expenses of the patient.

B. Complaint - a sworn written statement of ultimate facts, filed by the patient,

charging the official or employee of the hospital or medical clinic with any

violation of R. A.. No. 9439 and its implementing rules and regulations.

C. Detention - an act of restraining a person from leaving the hospital

premises for nonpayment of hospital bills or medical expenses in part or in

full.

D. Guarantee - an expressed assurance by the co-maker to the hospital or

medical clinic that certain facts or conditions are true and/or will happen.

The hospital or medical clinic is permitted to rely on that assurance and

seek appropriate action if it is not true and/or followed.

E. Hospital - a health facility for the diagnosis, treatment and other forms of

health care of individuals suffering from deformity, disease, illness or injury,

or in need of surgical, obstetrical, medical or nursing care. It is an institution

where there are installed bassinets or beds for 24-hour use or longer by

patients in the management of deformities, diseases, injuries, abnormal

physical and mental conditions, and maternity cases.

F. Hospital Bills or Medical Expenses1 Hospitalization Expenses - costs of

diagnosis, treatment and other forms of health care of patients, which

include, but not limited to, doctor's fees, amount owing for clinical and

ancillary services rendered, charges for room, meals, medical supplies,

drugs and medicines, and payments for use of equipment.

G. Medical Clinic - a health facility that satisfies the above definition of a

hospital but uses the phrase "medical clinic" in its business name.

H. Mortgage - a method of using real property (land) or personal property

(other physical possessions) as security for the payment of a debt.

I. Officer or Employee of a hospital or medical clinic - a person acting in

behalf of a hospital or medical clinic responsible for releasing patients in

accordance with written policies and procedures of the hospital or medical

clinic.

J. Patient - for the purposes of R. A. No. 9439 and these implementing rules

and regulations, a person who is already admitted and availed of health

care services in a hospital or medical clinic.

K. Private Room - a single occupancy room or a ward type room divided by

either a permanent or semi-permanent partition (except curtains) not to

exceed 4 patients per room who are admitted for diagnosis, treatment and

other forms of health care maintenance.

L. Promissory Note - an unconditional promise in writing made by the patient

and/or his/ her next of kin to the hospital or medical clinic, engaging to pay

on demand, or at a fixed or determinable future time, a sum certain in

money to order or to bearer.

V. Policies and Guidelines:

A. General Policies:

1. Patients, except those who stay in private rooms, who are partially or

fully recovered and who wish to leave the hospital or medical clinic but

are incapable to pay, in part or in full, their hospital bills or medical

expenses/ hospitalization expenses shall be allowed to leave the

hospital or medical clinic and shall be issued the corresponding medical

certificate and other pertinent documents for their release from the

hospital or medical clinic upon execution of a promissory note covering

the unpaid obligations. The promissory note shall be secured by either a

mortgage, or a guarantee of a co-maker who shall be jointly and

severally liable for the unpaid obligations.

In the case of a deceased patient, any of his1 her surviving relatives shall

be issued the corresponding death certificate and other pertinent

documents for interment purpose only. For other purposes, such

documents shall be issued only upon execution of a promissory note

covering the unpaid obligations by any of the surviving relatives. The

promissory note shall be secured by either a mortgage, or a guarantee

of a co-maker who shall be jointly and severally liable for the unpaid

obligations. In the event the documents will be needed for purposes of

getting the benefits from the Social Security System. Government

Service lnsurance System, Philippine Health lnsurance Corporation,

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 expensed hospitalization expenses.

3. In the case of a deceased patient, any of his/ her 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. Documents for other

purposes shall be released only after execution of a promissory note.

4. Any hospital or medical clinic detaining or causing, directly or indirectly,

the detention of patient for reason of nonpayment, in part or in full, of

hospital bills or medical expenses/ hospitalization expenses shall be

held accountable for such unlawful act. Detention occurs when all of the

following are present:

a) The patient who is partially or fully recovered has expressed his1 her

intention to leave the hospital or medical clinic, or the attending

physician has issued a discharge order;

b) The patient is not confined in a private room and is financially

incapable to settle in part or in full the corresponding hospital bills or

medical expenses1 hospitalization expenses;

c) Patient has executed a promissory note covering the unpaid hospital

bills or medical expenses1 hospitalization expenses; and

d) The officer or employee of the hospital or medical clinic responsible

for releasing the patient has restrained him from leaving the hospital

premises.

5. In the case of a deceased patient, any hospital or medical clinic refusing

to release the cadaver for reason of nonpayment, in part or in full, of

hospital bills or medical expenses1 hospitalization expenses shall be

held accountable for such unlawful act. Detention occurs when all of the

following are present:

a) The medical officer has made the pronouncement of death;

b) Any of the surviving relatives is incapable to pay the corresponding

hospital bills or medical expenses/ hospitalization expenses;

c) Any of the surviving relatives has executed a promissory note

covering the unpaid hospital bills or medical expenses1

hospitalization expenses; and

d) The officer or employee of the hospital or medical clinic responsible

for releasing the deceased patient has refused to release the

cadaver and/ or relevant documents.

B. Specific Guidelines:

1. Classification, Admission and Discharge of Patients

To minimize, if not prevent, incidence of patients being unable to pay,

and hospitals or medical clinics detaining patients for reason of

nonpayment of hospital bills or medical expenses1 hospitalization

expenses, patients and hospitals or medical clinics alike may institute

and observe the following:

a) Government hospitals or medical clinics shall classify patients in

terms of their capacity to pay according to the guidelines set by the

DOH in Administrative Order No. 51-A s. 2000: Implementing

Guidelines on Classification of Patients and on Availment of Medical

Social Services in Government Hospitals, dated October 12, 2001.

b) Private hospitals or medical clinics shall have written policies and

procedures to classify patients in terms of their capacity to pay. For

this purpose, private hospitals or medical clinics may refer to A0 No.

51 -A S. 2000.

c) The DOH, government and private hospitals or medical clinics shall,

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 financial

institutions like, but not limited to, Philippine Health Insurance

Corporation, Philippine Charity Sweepstakes Office, Philippine

Amusement and Gaming Corporation, Local Government Units, as

well as ,Congress, to provide funds for this purpose.

d) All hospitals or medical clinics shall establish billing and collection

procedures subject to current accounting and auditing rules and

regulations.

e) All hospitals or medical clinics shall have written policies and

procedures for admitting and releasing patients, including identifying

the officer/s or employeels responsible for releasing patients.

2. Execution of Promissory Note

a) Except those who stay in private rooms, patients who are partially or

fully recovered and who wish to leave the hospital or medical clinic

but are incapable to pay, in part or in full, their hospital bills or

medical expenses/ hospitalization expenses are obliged to execute a

promissory note secured by either a mortgage, or a guarantee of a

co-maker.

b) In the case of a deceased patient, any of his surviving relatives is

obliged to execute a promissory note secured by either a mortgage,

or a guarantee of a co-maker.

c) Hospitals or medical clinics shall have written policies and

procedures for execution of promissory notes secured by either a

mortgage, or a guarantee of a co-maker.

3. Penalty

Any officer or employee of a hospital or medical clinic responsible for

releasing patients who has been found to commit any violation of R.A.

No. 9439 and its implementing rules and regulations shall be punished

by either a fine of not less than Twenty Thousand Pesos (P20,OOO) but

not more than Fifty Thousand Pesos (P50,000), or imprisonment of not

less than One (1) Month but not more than Six (6) months, or both such

fine and imprisonment, at the discretion of the proper court.

VI. Repealing1 Separability Clause:

Provisions from previous issuances that are inconsistent or contrary to the

provisions of this Order are hereby rescinded and modified accordingly.

If any provision of this Order is declared unauthorized or rendered invalid by

any court of law or competent authority, those provisions not affected thereby shall

remain valid and effective.

R. A. No. 9439 repeals or amends the pertinent provisions of the Revised Penal

Code, particularly Articles 267, 268 and 270, decrees, orders, rules and regulations

inconsistent with the same, in so far as the same involves hospitals or medical

clinics, medical practitioners, and their staff and employees.

VII. Effectivity:

This Order shall take effect fifteen (15) days after publication in a newspaper of general circulation.


FRANCISCO T. DUQUE Ill, M.D., M.Sc.

Secretary of Health

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