The 2009 Philippine Blog Awards

Saturday, June 27, 2009

FAMILY FIX: Hospitals Keeping Patients Until Bills Are paid

As a lawyer and a Filipino lawyer that is, who does not need to specialize and whose legal practice is a self imposed limitation, I feel that I should have a working knowledge of just about anything that anyone like family, friends, colleagues, employers or clients, would be very interested to know (as it affects them somehow) and would expect me to know the answers right at my finger tips when they ask. I guess one of those questions would relate to hospitals and hospital bills since everyone, in one way or another, has been or has a family member or friends who have been to the hospital and faced the million dollar pressure of being made to pay the bills before being discharge.

Recently one of my friends suffered from a seizure and was brought to a well known hospital in Makati on an emergency. The confinement lasted for two (2) days and the doctor recommended discharge. When the family was settling the medical bills (which is horrendously high at that), there was some problem with her HMO that would take time before it gets resolved. Since the family did not have the amount ready on the day of her release, she was held hostage, and was not allowed to leave the hospital (accumulating more bills for every day of stay, of course) until her family could finally raise the money to settle the bills. Sad huh. Sadder is the fact that this was not the first time I hear this story. She is just among the hundred clients who bombarded me with questions like: is it legal for the hospital to prevent the patients' discharge until full payment of the bill? what does the law say?

Ouchhh.. I'll tell you the law and leave it to you to answer the other question of whether the hospital has the right to prevent discharge of patients until they can pay the bill.

The applicable laws are – Republic Act No. 4226 or An Act Requiring the Licensure of All Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency”, Administrative Order No. 70 – A, Series of 2002 or the Revised Rules and Regulations Governing The Registration, Licensure and Operation of Hospitals And Other Health Facilities in the Philippines and Republic Act No. 8344 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”.

Combined review and interpretation of the above mentioned laws dealing with the regulation of all government and private hospitals and other health facilities reveal that the following acts by any individual, corporation, association, or organization operating a hospital, or persons under their authority are considered violations of the Hospital Licensure Act or the rules and regulations issued in pursuance thereto and are thus considered prohibited acts:

1. Refusal to Discharge Patients or their relatives, to release cadavers and to issue a duly accomplished death certificate for non payment of hospital bills (A.O. No. 70-A in relation to R.A. 4226)
2. Refusal to admit patients for lack of capacity to pay (A.O No. 70-A in relation to R.A. 4226)
3. In emergency or serious cases, requesting, soliciting, demanding, or accepting any deposit or any form of advance payment as a pre-requisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability. (R.A. 8344)

Any individual, corporation, association, or organization can file charges or complaints against any hospital or other health facility, or any of its personnel, who has violated or is violating the provisions of R.A. 4226 or of Admin. Order No. 70-A (No. 1 and 2) and if upon investigation and hearing, the hospital or other health facility concerned, or any of its personnel is found violating the provisions, the Director of the Bureau of Health Facilities and Services shall suspend the license for a definite or indefinite period of time, or revoke the license without prejudice to taking the case to judicial authorities for criminal action.

For commission of No. 3, the official, medical practitioner or employee of the hospital or medical clinic, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four months, or a fine of not more than One Hundred Thousand Pesos (P100,000.00) or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than One Hundred Thousand Pesos (P100,000.00), but not more than Five Hundred Thousand Pesos (P500,000.00) or both at the discretion of the court.

From the foregoing findings, we can conclude that hospital laws, rules and regulations, if properly implemented and followed, are enough to ensure the rights of all people to quality health services. However, the actual practice by these hospitals and health facilities run counter to the very purpose of the regulation. I was able to obtain Hospital Information Sheet from three Private Hospitals. Sadly, not one of the Public Hospitals have this Information Sheet (well maybe because the services in these Public Hospitals are free –of-charge). Although, the sampling is too small to arrive at a fair conclusion, still I am of the opinion that requiring the patients to settle their bills or make arrangements for the payment thereof before discharge (or holding them hostage until the bill is paid) seemed to be an establish policy of all private hospitals. Whether this policy (in several versions and wordings) is violative of the hospital law and rules and regulations is something that would require investigation in case -to -case basis.
Sample of the policy on discharge/deposits and payment of bills are as follows:


Credit and Collection Department (CCD) provides patient with a notice for initial/additional deposits and a running bill or a partial bill. We advise that you make arrangements to pay regularly in order that the bill does not accumulate. The balance of accounts if any should be paid upon discharge. Professional fees of your Attending Physician are billed separately and must be paid in cash at the Cashier.”

Non-emergency patients are required to put up a deposit based on room rate and initial diagnosis of the Admitting Physician. Please maintain at all times through out the hospitalization a balance equivalent to the deposit made or as required by the Billing Section for the provision of medications from our Pharmacy and Laboratory examination and other procedures the Physician may require to be done on the patient. Statement of account will be forwarded to you every two (2) days to keep you posted on your existing balance. Failure to comply with the above requirements will mean:

1. Curtailment of credit privileges on medicines, supplies and other procedures except in case of emergency;
2. Transfer to lower room rate
3. Transfer to the Clinical division

A discharge slip will be given to you upon Doctor’s order authorizing your discharge before 3:00P.M. CUT-OFF TIME is at 12 noon and 12 midnight. Please vacate the room at 1:00 P.M. in order to avoid addition room charge.

Tuesday, June 16, 2009

IMMIGRATION ISSUES: Processing Special WorkPermit at BID

Last Monday, I was at the Bureau of Immigration in Manila to apply for accreditation for my new law office, to file two (2) applications for Special Work Permit for my Mongolian clients who are in the Philippines for a one-month fixed period employment as MTC Mongolian Language Interpreters and visit some old friends who are still working at the Bureau. Many things have changed over the years, since I was working there last. There is much order in the manner by which applications and extension of stay are being done. Accompanied by my brother Mike as the law office paralegal, we were able to make the extension and file the applications in a few hours. I was also told that the approval will come in two days.

Under the guidelines issued by the Philippine Department of Foreign Affairs, Mongolian nationals are considered as "unrestricted" nationals. As such, they do not need to obtain entry or 9(a) visas prior to entering the country. Upon arrival in the Philippines, the "unrestricted" foreign nationals will be given 9(a) visas valid for 21 days (shorter for some foreign nationals) which can be extended, if necessary, during their stay in the Philippines.

Aside from the 9(a) visa, the Language Interpreters/translators, whether restricted or unrestricted, must also have with them upon arrival (a) a passport valid for not less than six months beyond their contemplated period of stay, and (b) a valid return ticket.

Immediately upon the arrival and before the start of the orientation, and thereafter the training program, the interpreters/translators are required to obtain the proper work visa because they will be performing work in the Philippines. The interpreters/translators are employed on a one-time basis and will stay in the Philippines for a period of only four weeks. Under the circumstances, it would be sufficient for the teachers/translators to obtain a Special Work Permit ("SWP") valid for three months (and renewable for another three months) from the Bureau of Immigration in connection with the pilot training program. The emplyer is the local petitioner of the SWP applications.

The requirements that must be submitted in connection with an application for an SWP are as follows:

a) Letter-Request by petitioning company (duly notarized);
b) Photocopy of the pertinent pages of the passport and the authorized stay;
c) Signed bio-data/curriculum vitae;
d) Photocopy of SEC Certificate of Registration, By-Laws and Articles of
Incorporation of the petitioning company;
e) Contract of Employment/Appointment Letter; and
f) As per M. O. No. ELM-083, where the applicant shall receive compensation
from Philippine sources, there shall be submitted an Affidavit of
Undertaking to Withhold and Remit to the Bureau of Internal Revenue taxes
due on all income.

The processing period to obtain an SWP is around one week from the submission of the complete documentary requirements; while the estimated government fees are approximately PhP6,000.00 per application.