SIXTEENTH CONGRESS OF THE )

REPUBLIC OF THE PHILIPPINES )

First Regular Session ) '13 JUL -1 P3 :23

SENATE
S. No. 151
Introduced by SENATOR PIA S. CAYETANO

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EXPLANATORY NOTE

Section 15 Article II of the Constitution provides that "(t)he State shall

protect and promote the right to health of the people and instill health
consciousness." In addition, Section 11 of Article 12 states that "(t)he State shall
adopt an integrated and comprehensive approach to health and development
which shall endeavor to make essential goods, health and other social.services
'
available to the people at affordable costs."

To give substance and spirit to the above constitutional precepts, the bill
seeks to provide a "Magna Carta of Patients Rights and Obligations". Under this
proposal, the duties and responsibilities of the government vis-a-vis the people's
concomitant rights and obligations are stressed in order to give them decent,
humane and quality health care.

The proposed measure provides for individual and societal rights, as well
as obligations of patients, health care practitioners and health care institutions.

The bill also proposes a grievance mechanism wherein any complaint

arising from violations of any of the rights of patients shall first be submitted for
mediation.

...£L
Premises considered, immediate passage of this bill is earnestly sou9ht.

TANO
SIXTEENTH CONGRESS OF THE .§-ermh>
tl}fl,;, of tl1 )i-,cr,lnij
REPUBLIC OF TH'E PHILIPPINES
First Regular Session

·13 JUL -1 P 3 :23

SENATE
151
Introduced by SENATOR PIA S. CAYETANO

AN ACT
PROCLAIMING THE RIGHTS AND OBLIGATIONS OF PATIENTS, PROVIDING A
GRIEVANCE MECHANISM THEREOF AND FOR OTHER PURPOSES

Be enacted by the Senate and House of Representatives of the Philippines in

Congress assembled:
SECTION 1. Short Title. - This Act shall be known as the "Magna Carta of

Patient's Rights and Obligations of 201a."

SEC. 2. Declaration of Policy. - It is hereby declared the policy of the State

to promote the right to health of the people and instill health consciousness among

them, It shall likewise protect and enhance the right of all people to human _dignity

thereby establishing the Magna Carta of Patient's Rights and Obligations in order to

ensure a decent, humane and quality Health Care for all patients and Health Care

Providers.

SEC. 3. Definition of Terms. - As used in this Act, the following terms

shall

be defined as follows:

a. Emergency Patient - one who is in immediate threat of dying or losing life

or limb;

b. Health Care - measures taken by a Health Care Provider or in a Health

Care Institution in order to determine a patient's state of health or to

restore or maintain it;

,
c, Health Care Institution - a site devoted primarily to the maintenance and

·operation of facilities for the prevention, diagnosis, treatment and care of

individuals suffering from illness, disease, injury or deformity if in need of

medical and nursing care;

 d. Health Care Provider - any physician, dentist, nurse, pharmacist or

paramedic and other supporting health personnel, including, but not

limited to, dental and ·medical technicians and technologists, nursing

aides, therapists, nutritionists trained in Health Care and/or duly

registered and licensed to practice in the Philippines as well as traditional

and alternative Health Care practitioner; and

e. Patient - a person who avails of the health and medical care services.

SEC. 4. Individual Rights of Patients. - The following individual rights of

Patients shall be respected by all those involved in the delivery of Health Care

services;

a. Right 'to Good Quality Health Care and Humane Treatment - Eve/y

person has a right to a continuity of good quality Health Care witho t

discrimination and within the limits of the resources, manpower and

competence available for health and medical care. In the course of such

care, his human dignity, convictions, integrity, individual needs and

cullure shall be respected.

If a Patient cannot immediately be given treatment that is medically

necessary, he shall be informed of the reason for the delay and be

treated in accordance with his best interests, Provided, that the treatment

applied shall be in accordance with generally accepted medical principles.

Emergency Patients shall be extended immediate medical care

and treatment without requiring, as a prerequisite thereof, any pecuniary

consideration.

b. Right to Dignity - The Patient's dignity, culture and value shall be

respected at all times in medical care and teaching. Likewise, terminally ill

patients shall be entitled to humane terminal care to make dying as

dignified and comfortable as possible.

c. Right to be Informed of His Rights and Obligations as a Patient -

Every person has the right to be informed of his rights and obligations

as·

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 a Patient. In line with this, the Department of Health, in coordination with

Health Care Providers, professional and civic groups, the media, health

insurance corporations, people's organizations and local government

organizations, shall launch and sustain a nationwide information and

education campaign to make known to the people their rights as Patients,

as provided in this Act. It sh,111 also be the duty of Health Care

Institutions to inform Patients of their rights as well as of the institution's

rules and regulations that apply to the conduct of the Patient while in the

care of such institution. These rights and rules and regulations shall be

posted in a bulletin board conspicuously placed in a Health Care

Institution.

d. Right to Choose His Physician / Health Institution - The Patient is free

to choose the services of a physician or health institution of his choice

except when he chooses to be confined in a charity ward. In this case,

the attending physician shall be the consultant under whose service the

patient was admitted as appearing in the Doctor's Order Sheet of the

Medical Record. The Patient shall have the right to seek a second opinion

and subsequent opinions, if necessary, from another physician-or health

institution, and to change his physician or health institution.

e. Right to Informed Consent -· The Patient has a right to self-

determination and to make free decisions regarding himself/herself.

However, the attending physician shall inform the Patient of t e

I
consequences of his/her decisions.

A Patient who is mentally competent and is of legal age, or in his

incapacity or age of minority, his legal representative, has a right to a

clear explanation, in layman's terms, of all proposed or contemplated

procedures, whether diagnostic or therapeutic, including the identity and

professional circumstances of the person or persons who will perform the

said procedure or procedures. The explanation shall include the amount

of information necessary and indispensable for him to intelligently give his

3
consent, including, but not limited to, the benefits, risk, side effects and

the probability of success or failure, as a possible consequence of said

proposed procedure or procedures, including the implications of

withholding consent. Ion the explanation, the comprehensive ability of the

patient shall also be considered, taking into account his level of

education, the dialect or language that he speaks and understands, and if

possible, with the use of anatomic sketch or any materials or visual aids

that may aid the Patient, or his legal representative, in fully understanding

the proposed procedure or procedures.

The right to informed consent shall likewise consider the

voluntariness in which the Patient or his/her legal representative has

given his/her consent, seeing to it that the Patient or his legal

representative was allowed to ask questions, or that he/she is given the

chance to consult his/her kin, or to seek another expert opinion. If the

Patient is unconscious or is unable to express his/her will, informed

consent must be obtained whenever possible from a legal representative,

Provided however, That when medical intervention is urgently needed,

the consent of the patient may be presumed, Provided further, That a

physician should always try to save the life of a Patient who is

unconscious due to suicide attempt.

In the case of a Patient who is legally incompetent or is a minor,

the consent of a legal representative is required, Provided however, That

the Patient must be involved in the decision making process to the fullest

extent allowed by his mental capacity. If the legally incompetent Patient

can make rational decisions, his/her decisions must be respected, and

he/she has the right to 'forbid disclosure of such information to his/her

legal representative.

If the patient's legal representative forbids treatment, but, in the

opinion of the physician, It is contrary to the patient's best interest, the

4
 physician may challenge this decision in court, Provided however That in
'
emergency cases, the physician shall act in the patient's best interest,

Provided further, That in emergency cases where there is no one who

can give consent on the patient's behalf, the physician can perform any

emergency diagnostic or treatment procedure in the best interest of the

patient.

f. Right to Refuse Diagnostic and Medical Treatment - The Patient has

the right to refuse diagn_ostic and medical treatment procedures,

provided that the following conditions are satisfied;

i. The Patient is of legal age and is mentally competent;

ii. The Patient is informed of the medical consequences of his/her

refusal;

iii. The Patient releases those involved in his care from any

obligation relative to the consequences of his/her decision; and

iv. The Patient's· refusal will not jeopardize public health and

safety.
g. Right to Refuse Participation in Medical Research - The Patient has
. I
the right ta be advised of plans to involve him/her in medical research thf t

may affect the care or treatment of his/her condition. Any proposed

research shall be performed only upon the written informed consent of the

Patient.

h. Right to Religious Belief and Assistance - The Patient has the right to

receive spiritual and moral comfort, including the help of a priest or

minister of his/her chosen religion. He/she also has the right to refuse

medical treatment or procedures which may be contrary to his religious

beliefs, subject to the limitations described in paragraph 6 of this Section.

i. Right To Privacy and Confidentiality - The patient has the right to

privacy and protection from unwarranted publicity. The right to privacy

shall include the patient's right not to be subjected to exposure, private or

5
public, either by photography, publications, video-taping, discussion, or by

any other means that would otherwise tend to reveal his person and

identity and the circumstances under which he was, he is, or he will be,

under medical or surgical care or treatment.

The Patient and his/her legal representative has the right to be

Informed by the physician or his/her legal representative of the patient's

continuing Health Care requirements following discharge, including

instructions about home medications, diet, physical activity and other

pertinent information.

All identifiable information about a patient's health status, medical

condition, diagnosis, prognosis and treatment, and all other information of

a personal kind, must be kept confidential even after death, Provided,

That descendants may have a right of access to information that will

infqrm them of their health risks.

All identifiable Patient data must also be protected. The protection

of the data must be appropriate as to the manner of its storage. Human

substance from which identifiable data can be derived must be likewise

protected.

Confidential information can be disclosed in the following cases:

i. When the patient's medical or physical condition is in

controversy in a court litigation and the court, in its discretion,

orders the patient to submit to physical or mental examination

of a physician;

ii. When public health or safety so demands;

iii. When the Patient, or in his incapacity, his/her legal

representative, expressly gives the consent;

iv. When the patient's medical or surgical condition is discuss!d

in a medical or scientific forum for expert discussion for

I
his/her benefit or for the advancement of science and

6
 medicine, Provided however, That the identity of the Patient

should not be revealed; and

v. When it is otherwise required by law.

j. Right to Disclosure of, and Access to, Information - In the course of

the patient's treatment and hospital care, the Patient or his/her legal

guardian has the right to be informed of the result of the evaluation of the

nature and extent of his/her disease. Any other additional or further

contemplated medical treatment on surgical procedure or procedures,

shall be disclosed and may only be performed with the written consent of

the patient.

The disclosure of information may be withheld if giving the

information to the Patient will cause mental suffering or further impair his

health, Provided, That such disclosure may be withheld or deferred to

some .future opportune time upon due consultation with the patient's

immediate family, Provided further, That such information must be giv!!n

in a way that is appropriate to the local culture and in a manner the

Patient can understand.

The Patient has the right to choose who he/she desires should be

informed on his behalf, Provided however, That the Patient also has the

right not to be informed on his explicit request, unless it is required for the

protection of another person's life.

The Patient has the right to be given, and examine, an itemized bill

for hospital and medical services rendered. He is entitled to a thorough

explanation of such bill.

k. Right to Correspondence and to Receive Visitors - The Patient has

the right to communicate with his/her relatives and other persons and to

receive visitors subject to reasonable limits prescribed by the rules and

regulations of the Health Care Institution.

7
I. Right to Medical Records - The Health Care Institution and the
'
physician shall ensure and safeguard the integrity and authenticity of the

medical records.

The Patient, upon his/her request, is entitled to a medical

certificate and clinical abstract. He/she has the right to view, and obtain

an explanation of, the contents of his/her medical records from the

attending physician, except for psychiatric notes and other incriminating

information obtained about a third party.

The Patient may also obtain from the Health Care Institution a

reproduction, at his/her expense, of his/her medical records, except for

the psychiatric notes and incriminating evidence referred to above,

Provided, That any relevant document that the Patient may require for

insurance claims shall be made available to him within a reasonable

period of time.

m, Right to Health Education " Every person has the right to health

education that will assist him in making informed choices about personal

health and about available health services. The education shall include

information about healthy lifestyles and about methods of prevention and

early detection of illnesses. The personal responsibility of everybody for

his own health should b stressed.

n. Right to Leave Against Medical Advise - The Patient has the right to

leave a hospital or any other Health Care Institution regardless of his

physical condition, Provided, That:

I

I. He/she is informed of the medical consequences of his/h$r

decision;

ii. He/she releases those involved in his/her care from any

obligation relative to the consequences of his/her decision;

and

iii. His/her decision will not prejudice public health and safety.

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 o. Right to Express Grievances. - Every Patient has the right to express

valid complaints and grievances about the care and services received

and to know the disposition of such complaints, in accordance with

Sections 7-8 of this Act.

SEC. 5. Societal Rights of Patients. - In addition to the Individual rights of

Patients, the Patient has likewise the following societal rights:

a. Right to Health - The Patient has the right to access quality Health Care

and physicians who are free to render clinical and ethical judgment

without interference or xternal pressure. He has likewise the right to

regain/and or acquire the highest attainable standard of health in a non-

l
discriminatory, gender sensitive and equal _manner which health

authorities and Health Care Providers must progressively contribute to

realize.

b. Right to Access to Quality Public Health Care - The Patient has the

right to a comprehensive and integrated Health Care delivery system with

the necessary manpower and facility resources. He shall also have the

right to a functioning public health and Health Care facilities, needed

programs, such as public health insurance, goods and services in

sufficient quantity. He shall likewise be provided with health facilities and

services with adequate provision for essential drugs, regular screening

programs, appropriate treatment of prevalent diseases, illnesses, injuries

and disabilities. Towards this end, the government shall approximate the

international standard allocation for the health sector as set by the World

Health Organization.

c. Right to a Healthy and Safe Workplace - The Patient as the right to a

healthy natural workplace environment with adequate supply of safe and

potable water and basic sanitation, industrial hygiene, prevention and

reduction of exposure to harmful substances, preventive measures for

occupational accidents and diseases, and an environment that

9
 discourages abuse of alcohol, tobacco and drug use, and the use of other

harmful substances,

d. Right to Medical Information and Education Programs - The Patient

has the right to medical information and education programs on

immunization; prevention, treatment and control of diseases; behavior

related concerns; and disaster relief and emergency situations during

epidemics and similar health hazards. The State shall endeavor to

provide these information through lectures, symposia, tri-media, posters

and the like.

e. Right to Participate in Policy Decisions - The Patient has the right to

participate in policy decisions relating to patient's right to health at the

community and national levels.

f. Right to Access to Health Facilities - The Patient has the right to be

admitted to primary, secondary, tertiary and other specialty hospitals

when appropriate and necessary.

g. Right to an Equitable and Economical Use of Resources - The

Patient has the right to an equitable and economical use of [esources

such that health institutions, projects and programs of the State are

equitably established and implemented in various regions of the country.

h. Right to Continuing Health Care - The Patient has the right to avail of,

or secure access to, programs that will ensure continuity of care in t e

form of hospice care, rehabilitation, chemotherapy, radiotherapy arid

other similar modalities.

i. Right to Be Provided Quality Health Care In Times of Insolvency -

The Patient has the right, at all times, to access quality medical care in

spite of insolvency. The State must provide for a system of payment to

Health Care Institutions and Providers for all the valid and necessary

medical expenses of the.poor and marginalized citizens.

1
 SEC. 6. The Obligations of Patients. - The Patient shall fulfill the following

obligations and responsibilities regarding his/her medical care and/or personal

behavior:

a. Know Rights - The Patient shall ensure that he knows and understands

what his/her rights as a Patient are and shall exercise those rights

responsibly and reasonably.

b. Provide Adequate, Accurate and Complete Information - The Patient

shall provide, to the best of his/her knowledge, adequate, accurate and

complete information about all matters pertaining to his/her health,

including medications and past or present medical problems, ailments,

medical history, consultation with other physicians, results of diagnostic

work-up and treatment, to his/her Health Care Provider.

c. Report Unexpected Health Changes - The Patient shall report

unexpected changes to his/her condition or symptoms, including pain, to

his/her Health Care Provider.

d. Understand the Purpose and Cost of Treatment - The Patient shall

ensure that he/she understands the purpose and cost of any proposed

treatment or procedure before deciding to accept it. He/she shall notify

his/her Health Care Provider if he/she does not understand any

information about the proposed care or treatment. The Patient shall insist

upon explanations until adequately informed and shall endeavor to make

all the necessary consultations before reaching a decision.

e. Accept the Consequences of Own Informed Consent - The Patient

shall accept all the consequences of his/her own informed consent. If

he/she refuses treatment or does not follow the instructions or advice of

the Health Care Provider, he/she must accept the consequences of such

decision and relieve the Health Care Provider of any liability as a result of

the exercise of his/her right to self-determination.

1
f. Sattla Financial Obligations. - The Patient shall ensure that the

financial obligations as a result of his/her Health Care are fulfilled as

promptly as possible. Otherwise, he/she shall make the appropriate

arrangements to settle unpaid hospital bills and/or professional fees in

accordance with Republic Act No. 9439. The patient must seek support

from the State in order to establish a system of payment to Health Care

Institutions and Providers.

g. Respect the Rights. of Health Care Providers, Health Care

Institutions and Other Patients - The Patient is obligated to give due

respect to the rights and well-being of Health Care Providers, Health Care

Institutions and other Patients. He shall act in a considerate and/or

cooperative manner and shall give respect to the rights and properties of

others. He shall follow the policies, rules and regulations, and procedures

of Health Care Institutions.

h. Obligation to Self - The Patient shall refrain from indulging in unhealthy

food consumption; addiction forming substance foods such as tobacco,

alcohol and drugs; lifestyles that have an adverse impact on health, such
, I
as sexual promiscuity and reckless activities; and contamination of t e
I

environment. The Patient is obligated to maintain a state of wellness.

i. Provide Adequate Health Information and Actively Participate in

His/Her Treatment. - The Patient shall ensure that he/she has adequate

health information that will allow him/her to actively participate in the

formulation of his/her diagnostic and treatment plans. When he/she signs

an informed consent, it is assumed that he has the necessary information.

J. Respect the Right to Privacy of Health Care Providers and

Institutions. - The Patient has the obligation to submit grievances to the

proper authorities or venue and not resort to unwarranted publicity in the

media. He/she shall not disclose to the public any alleged complaint

1
 against Health Care Providers and/or Institutions if ii has not been fully

decided by a court or administrative tribunal of prosper jurisdiction.

k. Exercise Fidelity on Privileged Communication - A patient-physician

relationship is a fiduciary one where mutual trust, respect and confidenbe

are expected, All communications are privileged and the patient' is

obliged not to breach this privileged communication especially if it

involves a third party.

I. Respect a Physician's Refusal to Treat Him - While the Patient has

the right to choose his/her physician, he/she is also obligated to respect

the physician's decision to choose whom he/she will treat.

m. Respect the Physician's Decision on Medical Reasons based on

His/Her Religious Beliefs - The Patient is obliged to respect the

physician's religious beliefs. If the Patient is a minor or is legally

incapacitated, his/her parents or legal representatives are obliged to

likewise respect the physician's decision on matters relating to medical

reasons despite their religious beliefs.

n. Ensure Integrity and Authenticity of Medical Records - The Patient is

obliged to ensure the integrity and authenticity of his/her medical records.

Any manner of alteration of his/her records is a criminal offense subject to

the provisions of the Revised Penal Code.

o. Participate in the Training of Competent Future Physicians - The

Patient is obligated to participate in the training of future physicians

provided that necessary information is provided to him/her and the

appropriate ethical considerations are observed.

p. Report Infractions and Exhaust Grievance Mechanism. - The Patient

shall immediately inform his/her Health Care Provider of any perceived or

alleged infraction of his/her rights as set forth in this Act through pro9er

channels in order to promote mutual trust, respect and confide ce

'
between the Provider and the and Patient. The Patient shall exhaust the

1
 grievance mechanism mediation provided in Sections 7-8 of this Act

before filing any administrative or legal action.

SEC. 7. Grievance Mechanism. - Any written complaint arising from

violation of any of the rights of patients shall first be submitted for mediation. There

shall be two (2) forms of mediation: the hospital-based mediation and the

barangay-based mediation.

The hospital-based mediation committee shall be composed of a physician

who shall be appointed by the hospital and shall act as chairperson and two other

(2) physicians recommended by the Philippine Medical Association local component

society and acceptable to both parties as members. The chairperson and the

members of the committee must be in good standing of the PMA and its local

component society.

The barangay-based mediation committee shall be composed of the local

health officer as chairperson. one from the religious or duly accredited people 1s

organization, and one from the PMA local component society who is a member In

good standing.

The mediation procedure shall not be adversarial in nature. The Patient and

the Health Care Provider shall be given the opportunity to discuss the complaint and

efforts shall be made for its amicable settlement No monetary compensation nor

legal counsels shall be involved at this stage.

The aggrieved party shall be given thirty (30) days from occurrence of the

incident to file his/her written complaint for mediation. Upon receipt of the written

complaint, the concerned mediation committee shall have ninety (90) days to

resolve the complaint.

A successful mediation shall bar the filing of any judicial or administrative

actions.

SEC. 8. Second-Tier Mediation. - When mediation fails or no agreement

is reached after the lapse of the ninety (90) day period, the mediation committee

1
 shall refer the complaint to the· PMA through its local component society for
'
appropriate administrative action.

The PMA local component society shall serve as the second tier mediation. It

shall be composed of the president of the local society as the presiding officer and

one representative from each of the following: component medical society, specialty

society corresponding to the case, the People's Health Watch or other civic

organizations, and a representative from the local religious organization. The PMA

component society shall render its decision within sixty (60) days from receipt of the

complaint.

In the event that the second tier medication fails, the case shall be

automatically referred to the PMA Commission on Ethics which shall likewise render

Its decision within sixty (60) days from receipt of the complaint.

Resort to mediation and referral to the PMA Commission on Ethics shall be a

condition precedent to the filing of a legal action in court.

All parties to the complaint shall be bound by the rules on confidentiality on

all levels of the mediation.

All minutes of the mediation proceedings shall not be disclosed to any party

unless authorized by the court of law. Any discussion held or admissions made

therein shall not be used for or against any party in subsequent or other

proceedings.

In the event there is compensation, it shall be limited to actual monetary loss

due to treatment related to physical injuries. It shall not cover for "pain and

suffering" or other explicit non-monetary loss. An award shall bar the patient from

filing any other legal actions.

SEC. 9. Prescriptive Period. - The time during which the case is submitted

for mediation shall toll the running of the prescriptive period for the filing of a civil or

criminal case under the Revised Penal Code or any administrative case under

existing laws.

1
 SEC.10. Inclusion In School Curriculum, Licensure Examinations and

Training. - The provisions of this Act shall be considered in the medical and

medical-related school curriculum and licensure examinations, including trainings

and seminars of traditional and alternative Health Care Providers or practitioners.

SEC, 11. Rules and Regulations. - The Secretary of Health, in consultation

with the Philippine Medical Association, the Philippine Hospital Association, the

Philippine Institute of Traditional and Alternative Health Care and other concerned

private agencies, non-governmental organization and people's organizations shall

promulgate such rules and regulations as may be necessary for its implementation

within One Hundred Eighty (180) days from the effectivity of this Act.

SEC. 12; Repealing Clause. - All Acts, Executive Orders, Rules and

Regulations, or parts thereof that are inconsistent with the provisions of this Act are

hereby repealed or modified accordingly.

SEC. 13. Effectlvity. - This Act shall take effect fifteen (15) days after the

date of its publication in at least two (2) major newspapers of general circulation.

Approved,