Thursday, September 30, 2004

Madness? (the Philippine Medical Malpractice Bill)

An email came in from my Aunt who's a physician (an Alumna of UP Medicine, Class 1987). It's an article written by Dr. Minguita Padilla about the proposed Medical Malpractice Bill here in the Philippines. It has interesting points that our legislators should consider.


Dr. Minguita Padilla

Hardly a week passes by without news of the sorry state of our country’s healthcare system. Government health workers are shaving their heads in desperation, not just because of the pittance they get as wages, many of them barely breaching the poverty level, but also because they do not receive even the basic salary benefits due them. Government has slashed its health budget even further and now allocates a scandalous 35 centavos per Filipino for one of the most basic of human needs. At least 35 medical schools are on the brink of closure because of the large drop in enrollees while at least 2000 physicians are expected to leave the country for greener pastures this year alone. The lack of new doctors has reached such a proportion that even the most sought after training institutions such as the UP-PGH, which used to turn away so many applicants for residency, today cannot even fill up half of its available positions. The same is true for private training hospitals. Patients in government hospitals around the country are already feeling the effects of this alarming trend. Soon patients in private hospitals will feel it too.

This being the reality, one would think our legislators would be anxious to come up with laws that would encourage our health workers, especially our physicians, to stay. But no. For the very first public hearing of the Health Committee of the Senate scheduled on the morning of September 28, not one proposed bill seeks to address this pressing problem. On the contrary, almost all the proposals are punitive bills aimed at punishing our medical practitioners. And mind you, not just doctors but the entire spectrum of them. But even more absurd is the fact that many of these bills are rehashed bills that were trashed by previous congresses, including the last congress, because of the clear danger they posed to the life of our already moribund healthcare system. A stand-out among these rehashed bills is Senate Bill 1720 of Senator Sergio Osmena that not only seeks to criminalize “malpractice”, but would also force all physicians and dentists to have “mandatory malpractice insurance”. Well at least he makes no pretence about the real intention of his bill or who its ultimate beneficiaries would be.

Just how oppressive is this bill? If it were to be passed into law then for any “malpractice”, which by the bill’s definition includes even the most minor, unintentional injury; a health practitioner would loose his license AND be punished with prison terms AND fines far greater than those prescribed by our penal code for grave crimes such as treason, frustrated homicide with intent to kill, and even mutilation. The bill would open medical practitioners to harassment since anyone, even someone not related to the patient, can sue regardless of whether the patient sues or not. Even worse, the bill would even infringe on the right of patients and their families to forgive their doctor and for all concerned to move on since the bill provides that even express pardon by the patient and his family “will not be a legal impediment to the prosecution of the crime, nor will it extinguish the criminal action still pending, nor will it constitute a ground for remitting the penalty already imposed.” Even cold blooded murderers are entitled to forgiveness, are not medical practitioners, whose main purpose is to heal and serve, worthy of this? By no means is this the end of the bill’s atrocious provisions. Indeed, nowhere in the world is there a law against medical practitioners as harsh as this. Given the true state of our healthcare system, as well as the fact that our legal system already provides the means to sue medical practitioners, the insanity of this rehashed bill would be almost comical if it were not so tragic.

What has gotten into our honorable legislators? Is madness now such an epidemic in our government that our lawmakers believe creating an extremely hostile environment for our medical practitioners will help solve our pressing health problems? Is mandatory malpractice insurance the overwhelming cry of a country where at least 40% of people live in abject poverty, where many hospitals lack the most basic laboratory tests and where health workers have to make do with substandard equipment and insufficient medicines as they attempt to give our people some semblance of quality health care? Is an oppressive malpractice law the answer to the plight of millions of Filipinos who die each year without ever having been seen by a doctor simply because there is no one to be found?

Two years ago, a national witch hunt against doctors ensued because of rabid media support given to a malpractice bill with provisions identical to S.B. 1720, and we warned the public about the exodus of doctors and nurses that would ensue. Most thought we were bluffing. Today we are witnessing this prediction coming to pass, and the worse is yet to come.

We are growing tired of fighting and of being called self serving when all we really want is quality health care for our people. We are weary of having to explain the obvious dangers of a bill that, like the undead, is repeatedly killed but manages to come alive again in various forms and permutations. But no spin doctors for us. We cannot possibly compete at this front, and the truth should not require any spin. All we can do now is appeal to our patients and to media practitioners of goodwill, and let them in on the real score. We pray that they too will fight the good fight and oppose such bills, not so much for our sake, because we can always opt to leave, but especially for theirs. But if our legislators and our people cannot see what is already staring us all in the face, choosing instead to believe the deceptive voice of vested interest; then so be it. One day soon the concerned legislators and this bill’s supporters will find themselves somewhere in the Philippines in desperate need of a doctor, and find none, only an empty hospital. Then perhaps they will finally listen.

(Dr. Ma. Dominga “Minguita” B. Padilla is an ophthalmologist and one of five individuals recently awarded as a “Hero for Health” by the Department of Health and Pfizer Philippines for her pioneering work in eye banking that has restored sight to thousands of Filipinos throughout the country.)