Strengthening the Protection of Patients Against Hospital Detention

Sentate TWENTIETH CONGRESS OF THE Office of the fortretary REPUBLIC OF THE PHILIPPINES First Regular Session NOV 12 P3:40 SENATE RECEIVED BY: 1511 S. No. (In Substitution of Senate Bill Nos. 217 and 960) Prepared and submitted jointly by the Committees on Health and Demography, Social Justice, Welfare and Rural Development, and Finance, with Senators Hontiveros, Estrada and Tulfo (E.) as authors thereof AN ACT STRENGTHENING THE PROTECTION OF PATIENTS AGAINST HOSPITAL DETENTION ON GROUNDS OF NONPAYMENT OF HOSPITAL BILLS OR MEDICAL EXPENSES AND PROVIDING STIFFER PENALTIES FOR VIOLATIONS THEREOF, AMENDING FOR THE PURPOSE REPUBLIC ACT 9439 ENTITLED "AN ACT PROHIBITING THE DETENTION OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS ON GROUNDS OF NONPAYMENT OF HOSPITAL BILLS OR MEDICAL EXPENSES Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:

SECTION 1. Sections 1, 2, and 3 of Republic Act 9439, entitled "An Act

2 Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of 3 Nonpayment of Hospital Bills or Medical Expenses", ", are hereby amended to read as follows: "SECTION 1. It shall be unlawful for any hospital or medical clinic, OR ANY OTHER SIMILAR FACILITY, 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 non-payment, in part or in full, of hospital bills, medical expenses, OR PROFESSIONAL FEES. IT SHALL ALSO BE UNLAWFUL TO DETAIN THE RELATIVES, REPRESENTATIVES, OR CARERS OF SUCH PATIENTS, AS WELL AS TO THE NEWBORN CHILD IN THE CASE

OF MATERNITY PATIENTS, IN EXCHANGE FOR THE PATIENT TO BE ALLOWED TO LEAVE THE HOSPITAL, MEDICAL CLINIC, OR ANY OTHER SIMILAR FACILITY. PATIENTS WHO STAYED IN PRIVATE ROOMS SHALL NOT BE COVERED BY THIS ACT, UNLESS THE SAID PATIENT, NOTWITHSTANDING ONE'S EXPRESSED DESIRE TO BE ADMITTED TO A NON-PRIVATE ROOM, WAS ADMITTED TO A PRIVATE ROOM FOR THE FOLLOWING REASONS: (A) NO NON- PRIVATE ROOM IN THE HOSPITAL, MEDICAL CLINIC, OR ANY OTHER SIMILAR FACILITY, WAS AVAILABLE AND THE PATIENT WAS COMPELLED TO BE ADMITTED THERETO DUE TO THE URGENCY OF THE CASE; AND (B) THE PHYSICIAN OR OTHER MEDICAL PROFESSIONALS OF THE HOSPITAL, MEDICAL CLINIC, OR ANY OTHER SIMILAR FACILITY, DEEMED IT TO BE IN THE BEST INTEREST OF THE PATIENT TO BE ADMITTED TO A PRIVATE ROOM FOR PURPOSES OF INTENSIVE CARE, ISOLATION, QUARANTINE, OR OTHER COMPELLING CIRCUMSTANCES."

SEC. 2. Patients who have fully or partially recovered and who

[already] wish to leave the hospital, [or] medical clinic, OR ANY OTHER SIMILAR FACILITY, but are financially incapable [to settle] OF SETTLING, in part or in full, their hospitalization expenses, including professional fees and medicines, shall be allowed to leave the hospital or medical clinic, with [al THE right to demand the IMMEDIATE issuance of the corresponding medical certificate, DISCHARGE SUMMARY, and other pertinent papers required for [the] THEIR release, [of the patient from the hospital or medical clinic] upon the execution of a promissory note covering the unpaid obligation: PROVIDED, THAT, NO PROMISSORY NOTE SHALL BE REQUIRED ON INDIGENT SENIOR CITIZENS WHO HAVE BEEN ENDORSED BY THE MEDICAL SOCIAL SERVICES OFFICE OF THE HOSPITAL, MEDICAL CLINIC, OR ANY SIMILAR FACILITY,

TO THE DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT: PROVIDED, FURTHER, THAT, THOSE PATIENTS WHO ARE PARTIALLY RECOVERED SHALL SIGN A WAIVER OR UNDERTAKING THAT THEY ARE ASSUMING THE RISK OF THE CONSEQUENCES FOR REQUESTING FOR DISCHARGE DESPITE HAVING NOT FULLY RECOVERED. 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.] ANY OR A COMBINATION OF THE FOLLOWING: (A) A MORTGAGE OVER REAL OR PERSONAL PROPERTY OF THE PATIENT, A RELATIVE, OR A CO-MAKER, WITHOUT NEED OF PUBLIC AUCTION, IN ACCORDANCE WITH REPUBLIC ACT NO. 11057, OTHERWISE KNOWN AS THE "PERSONAL PROPERTY SECURITY ACT"; (B) A GUARANTEE OF A CO-MAKER WHO SHALL BE JOINTLY AND SEVERALLY LIABLE WITH THE PATIENT FOR THE UNPAID OBLIGATION; (C) A DEED OF ASSIGNMENT OF THE LOAN PROCEEDS OR BENEFITS ENTITLEMENT FROM THE SOCIAL SECURITY SYSTEM (SSS) OR THE GOVERNMENT SERVICE INSURANCE SYSTEM (GSIS), IN CASE THE PATIENT IS AN ACTIVE MEMBER THEREOF; (D) A GUARANTEE LETTER FROM THE PHILIPPINE CHARITY SWEEPSTAKES OFFICE (PCSO); AND (E) IN THE CASE OF INDIGENT AND FINANCIALLY- INCAPACITATED PATIENTS, A GUARANTEE LETTER FROM THE DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT (DSWD) OR THE DEPARTMENT OF HEALTH (DOH). IN ALL CASES, THE MEDICAL CERTIFICATE, DISCHARGE SUMMARY, PRESCRIPTIONS, AND OTHER DOCUMENTS NECESSARY FOR THE PROCESSING OF CLAIMS OR BENEFITS

SHALL BE ISSUED WITHOUT DELAY AND WITHOUT REQUIRING FULL OR PARTIAL PAYMENT. 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: Provided, however, That patients who stayed in private rooms shall not be covered by this Act] CADAVER SHALL BE IMMEDIATELY RELEASED TO THE SURVIVING RELATIVES. THE CORRESPONDING DEATH CERTIFICATE AND OTHER DOCUMENTS REQUIRED FOR INTERMENT, BENEFIT CLAIMS, OR LEGAL PROCEEDINGS SHALL BE ISSUED PROMPTLY AND WITHOUT DELAY: PROVIDED, HOWEVER, THAT, FOR PURPOSES OF PRIVATE INSURANCE CLAIMS OR SETTLEMENT OF ESTATE, A SECURED PROMISSORY NOTE OR A DEED OF ASSIGNMENT OF PROCEEDS MAY BE REQUIRED PRIOR TO THE ISSUANCE OF RELEVANT DOCUMENTS: PROVIDED, FINALLY, THAT A DEED OF ASSIGNMENT OF BENEFITS ENTITLEMENT FROM THE SSS OR GSIS, IF THE DECEASED WAS A MEMBER THEREOF, OR A GUARANTEE LETTER FROM THE DSWD, IF THE DECEASED WAS AN INDIGENT, MAY BE ACCEPTED IN LIEU OF A PROMISSORY NOTE."

SEC. 3. Any officer or employee of the hospital, [or] medical

clinic, OR ANY OTHER SIMILAR FACILITY, responsible for [releasing] THE DISCHARGE OF patients OR THE RELEASE OF CADAVERS, who violates the provisions of this Act, shall [be punished by a fine of not less than Twenty thousand pesos (P20,000.00), but not more than Fifty thousand pesos (P50,000.00), or imprisonment of not less than one month, but not more than six months, or both such fine and imprisonment, at the discretion of the proper courti, 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 (4)

MONTHS, OR A FINE OF NOT LESS THAN ONE HUNDRED THOUSAND PESOS (P100,000.00), BUT NOT MORE THAN THREE HUNDRED THOUSAND PESOS (P300,000.00), OR BOTH, AT THE DISCRETION OF THE COURT. IF THE 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 FORMULATION AND 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 FIVE HUNDRED THOUSAND PESOS (P500,000.00), BUT NOT MORE THAN ONE MILLION PESOS (P1,000,000.00), OR BOTH, AT THE DISCRETION OF THE COURT. UPON THE COMMISSION OF THREE (3) REPEATED VIOLATIONS UNDER SUCH POLICY OR INSTRUCTION, THE LICENSE TO OPERATE OF SUCH HEALTH FACILITY SHALL BE REVOKED BY THE DOH."

SEC. 2. Access to Government Medical Assistance Programs. - The DOH shall

ensure that patients covered under this Act shall have access to the medical assistance programs of the government to cover unpaid promissory notes issued by indigent and financially-incapacitated patients, subject to existing guidelines.

SEC. 3. Patient Grievance and Discharge Protocol. - The DOH shall establish

a grievance and redress mechanism for patients and their families who are unlawfully detained in hospitals, medical clinics, or similar facilities, due to non-payment, IN PART OF IN FULL, OF HOSPITAL BILLS, MEDICAL EXPENSES, OR PROFESSIONAL FEES. All hospitals and medical facilities shall adopt standard patient discharge protocols, which shall include: (a) Immediate release of required medical documents; (b) Posting of patients' rights under this Act in conspicuous areas; and

(c) Referral to the hospital's medical social service office for indigent or financially-incapacitated patients.

SEC. 4. Implementing Rules and Regulations. - The DOH, jointly with the

4 DSWD, PhilHealth, GSIS, SSS, and the PCSO, shall, within six (6) months from the 5 effectivity of this Act, promulgate the rules and regulations necessary for the proper implementation of this Act.

SEC. 5. Separability Clause. - If any provision of this Act is declared

unconstitutional or invalid, other provisions not otherwise affected shall remain in full force and effect.

SEC. 6. Repealing Clause. - All laws, decrees, executive orders, rules and

regulations or parts thereof which are inconsistent with this Act are hereby repealed or amended accordingly.

SEC. 7. Effectivity Clause. - This Act shall take effect upon its publication in

the Official Gazette or in a newspaper of general circulation. Approved,