Patient you cannot refuse

Atty. Rodel V. Capule M.D., FPCP*

IV

*Dr. R.V. Capule is an attorney specializing in medical malpractice,
physical injuries and food torts. He is a law professor of Legal Medicine at
Arellano University School of Law and a consultant in Legal Medicine at
Manila Adventist Medical Center and Makati Medical Center.
In the olden times, a physician is free to choose
his own patient or exercise his right to refuse a
patient for any reason or for no reason at all.
Nowadays, there are laws or consensual contracts that
mandate a physician to treat a patient in a given
circumstance, and refusing such patient may create
liability.
Under the law
1
a physician cannot refuse to
render immediate emergency medical assistance to
patients who are in danger of dying and/or who
may have suffered serious physical injuries. The law
only contemplates patients who are brought to the
emergency room or a clinic. If the patient is not in
danger of dying or only sustained less serious or slight
physical injuries, then the law will not apply. Refusal
to render treatment for non-payment of deposit or
advance payment is also sanctioned by the law.
2
The Code of Ethics of the Philippine Medical
Association further provides that [a] physician should
be free to choose patients.
3
Nonetheless, the code
expressly provided an exception in choosing patients,
thus, [in] an emergency, provided there is no risk
to his or her safety, a physician should administer at
least first aid treatment and then refer the patient to
the primary physician and/or to a more competent
health provider and appropriate facility if necessary.
4

A physician cannot refuse to render at least first aid
treatment provided it will not endanger his personal
safety. In the same tenor, the Medical Act of 1959
5

can revoke or suspend the license of a physician if
he refused to attend a patient in danger of death
without any risk to his life. Both the Code of Ethics
and the Medical Act of 1959 impose a duty not to
refuse a patient with emergency medical condition or
a patient in danger of death as long as rendering
treatment will not cause harm to a physician.
Conversely, if treating such patient will endanger the
life of the physician, law and ethics will not sanction
refusal to treat.
Interestingly, some contractual obligations can
curtail a physicians right to choose patients. When
a corporation or any establishment enters into a
retainership agreement with a physician, in reality
such corporation or establishment is simply securing
the future services of the physician. In other words,
the physician is already consenting to treat future
patients provided for in the retainership agreement.
He cannot just refuse to treat that patient unless
for cause. Company physicians, school physicians,
Philhealth professional healthcare providers and HMO
healthcare providers, to name a few, are bound to
treat patients provided for by their contracts. Under
this circumstance, a physician is already bound by
a physician-patient relationship with a future patient.
Knowingly or otherwise, a physician has abdicated his
right to choose patients.
It would be best to remember that the obligatory
nature of the medical profession arises when a
physician 1) voluntarily holds himself out in the
community as a practicing physician and the person
is in need of urgent medical care and 2) has entered
into an expressed contract to render service.
6
Lastly, can one refuse a previously disruptive or
uncooperative patient? How about a patient who has
not paid his obligation from his previous consultation
or admission? These situations should be treated with
caution. Under the spells of illness doctrine, the
consensual contract between the patient and physician
will be valid only during the existence of the disease
which prompted the consultation. In other words, for
every subsequent illness a new contract is required.
This applies both to in-patient or out-patient treatment.
If consultations are made during the existence of a
physician-patient relationship, refusal to treat might
be interpreted as abandonment. The moment the
previous physician-patient relationship or the retainership
agreement has ended, refusing to treat a disruptive
patient or a non-paying patient will not create any
liability, unless such patient is in danger of dying at
the time of consultation.
References
1. R. A. 6615 An act Requiring Government and Private
Hospitals and Clinics to Extend Medical Assistance in
Emergency Cases
2. R.A. 8344 An Act Prohibiting the Demand of Deposits or
Advance Payments
3. Section 2 Article II
4. Section 3 Article II
5. Section 24 R.A. 2382
6. Can I Refuse Patients?, Legal Prescription for Doctors;
Phil. J. Internal Medicine, 42; July-August, 2004
Legal Prescription Philippine Journal of Internal Medicine