Rejoinder To Playing Doctor
By Ben Hur P. Mobo, Jr., MD, MPH
I received interesting comments about my maiden column on the assault on Aklan public healthcare system. Some outrightly dismissed it as politically motivated as if by virtue of such slur it made the whole argument invalid. Others have correctly pointed out the ethical ramifications of individual and collective actions.
Let me conveniently ignore the former. It is my own way of not stooping down to utterly myopic, grossly naïve and outrightly laughable “rebuttal”. It is the punch Ali did not give Frazier on the latter’s way down. It would have been just inelegant.
Let me, then, focus on the ethical issue and its ramifications. First, doctors in the Philippines- - more so than doctors in the United States—are put on such high pedestal in the society. I would like to believe that we as a collective body of self-less intellectual professionals have rightfully earned such accolades. Many of us are the top of our classes in college and high school (hence the smart factor). We presumably worked hard and long, and—not exactly speaking from experience— may have lost budding relationships along the way (hence the self-less sacrifice factor). And many of us honestly want to change the world through good and decent deeds without becoming a lawyer or a traditional politician (hence the two factors combined).
We, doctors, hold an implicit sacred contract with our patients every time we engage in doctor-patient relationship. Intrinsic within it is the privileged information principle that allows our patients to open up freely without fearing that their medical information will be shared elsewhere. We share this privilege with only a handful of other professionals— father-confessors and lawyers for example. Indeed, being a doctor is a privilege. This is why, to me, a valid medical license is more than just a piece of paper you can purchase in any nook and corner in Recto.
Embedded also within the patient-doctor relationship are the patient’s rights (among others) to information disclosure, to choice of medical provider as well as to complaint and appeal processes. To borrow a popular comic book line: “With great powers come great responsibilities.” As much as we are put on high pedestal, we must also be held in higher standards. Patients should be able to question—in private and in public courts of opinion—what they perceive as medical malfeasance.
In the United Sates, the American Medical Association (AMA) has promulgated its Principles of Medical Ethics. Among the 9 principles are: 1) A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. 2) A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interest of the patients.
My quick Google search did not yield similar information from the Philippine constitution, the Philippine Regulatory Commission policy, or the Philippine College of Physicians. I am not saying that they do not exist; it is just that they were not available to me as of this writing. I would, therefore, like to make the assumption that such principles apply to Filipino physicians. As such, doctors have actually the moral and legal obligations to report unlawful practice of medicine. This, then, is a call directed at the Aklan Medical Society to take appropriate actions.
The extent of cases of and penalties surrounding unlicensed practice of medicine are rather broad and extensive. Some reported cases in the United States include: 1. Under the title “Man Charged with Impersonating Hospital Doctor” that was published on November 1, 1984, the prestigious New York Times reported “a 29-year-old hospital accountant was arrested yesterday in the emergency room of Lincoln Hospital in the Bronx, (New York) on charges of impersonating a physician and treating patients. He was caught after nurses had noticed his patient charts were not medically correct.”
2. Another case that appears as “Gerald Barnes (criminal)” in the Wikipedia website reported that the perpetrator “stole the identity of a licensed medical doctor for years until his negligence and lack of medical knowledge contributed to a death in December 1979”. He was later found guilty of manslaughter and practicing without a medical license. “After his release (for good behavior) and numerous later arrests for practicing without a license at 70 years old, he was arrested again, but this time for federal fraud charges (impersonating a doctor but this time as part of his job he did physical checkups on FBI agents, hence why it was upgraded to a Federal crime) and is now serving a 20 year sentence in a federal penitentiary.” 3. A woman from New Jersey was found guilty of Medicaid fraud. “She provided counseling services, wrote and altered prescriptions, although she is unlicensed to practice medicine, and caused bills to be submitted to the Medicaid Program for the services rendered (pharmacologic management) as if they had been rendered by a licensed practitioner.”
4. Another case was described in the web pages of the New York Office of Attorney General: “the Attorney General’s office announced the arrest of a New Jersey man on charges of Unlicensed Practice of Medicine for allegedly performing cosmetic surgery and other services to the public without a license.”
5. From the web pages of the Assistant District Attorney of Santa Clara, California: “A joint investigation by the California State Medical Board, the Santa Clara County District Attorney’s Office and the Department of Insurance, uncovered allegations that Nguyen Nhu Quang, who is not a licensed physician, performed breast implant surgery on a young female victim causing great bodily injury and disfigurement.”
To curb the unlicensed practice of medicine, various states have come up with varying degrees of penalty for such offense. The State of Florida statutes, for example, indicate the following sanctions and penalties for unlicensed practice of a health care profession: 1) May issue and deliver to such person and other individuals who aid and abet the unlicensed practice a notice to cease and desist from such violation; 2) May impose by citation and administrative penalty; 3) May seek the imposition of a civil penalty; and 4) In addition to the administrative and civil remedies, and in addition to the criminal violations and penalties listed in the individual health care practice acts, may file felony charges.
What specific Philippines laws were broken in this case? Which principles of medical ethics upheld by the Philippine College of Physicians were violated? I am not certain. The fact remains that with the triple appointments, the Aklan government has opened itself and its coffers to multitude of civil and criminal suits. To wit, a couple of weeks ago the (US) Veterans Affairs Secretary was forced to resign because of perceived inadequacies in healthcare provision among US veterans and because of the well-publicized molds at the Walter Reed Hospital. Such is the real ramification of chain of responsibility. (Ed’s Note: The author’s article, “Playing Doctor: Tonet Viray” was published in the editorial, Madyaas Pen, August 19 – 25, 2007 issue.) /MP
Let me conveniently ignore the former. It is my own way of not stooping down to utterly myopic, grossly naïve and outrightly laughable “rebuttal”. It is the punch Ali did not give Frazier on the latter’s way down. It would have been just inelegant.
Let me, then, focus on the ethical issue and its ramifications. First, doctors in the Philippines- - more so than doctors in the United States—are put on such high pedestal in the society. I would like to believe that we as a collective body of self-less intellectual professionals have rightfully earned such accolades. Many of us are the top of our classes in college and high school (hence the smart factor). We presumably worked hard and long, and—not exactly speaking from experience— may have lost budding relationships along the way (hence the self-less sacrifice factor). And many of us honestly want to change the world through good and decent deeds without becoming a lawyer or a traditional politician (hence the two factors combined).
We, doctors, hold an implicit sacred contract with our patients every time we engage in doctor-patient relationship. Intrinsic within it is the privileged information principle that allows our patients to open up freely without fearing that their medical information will be shared elsewhere. We share this privilege with only a handful of other professionals— father-confessors and lawyers for example. Indeed, being a doctor is a privilege. This is why, to me, a valid medical license is more than just a piece of paper you can purchase in any nook and corner in Recto.
Embedded also within the patient-doctor relationship are the patient’s rights (among others) to information disclosure, to choice of medical provider as well as to complaint and appeal processes. To borrow a popular comic book line: “With great powers come great responsibilities.” As much as we are put on high pedestal, we must also be held in higher standards. Patients should be able to question—in private and in public courts of opinion—what they perceive as medical malfeasance.
In the United Sates, the American Medical Association (AMA) has promulgated its Principles of Medical Ethics. Among the 9 principles are: 1) A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. 2) A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interest of the patients.
My quick Google search did not yield similar information from the Philippine constitution, the Philippine Regulatory Commission policy, or the Philippine College of Physicians. I am not saying that they do not exist; it is just that they were not available to me as of this writing. I would, therefore, like to make the assumption that such principles apply to Filipino physicians. As such, doctors have actually the moral and legal obligations to report unlawful practice of medicine. This, then, is a call directed at the Aklan Medical Society to take appropriate actions.
The extent of cases of and penalties surrounding unlicensed practice of medicine are rather broad and extensive. Some reported cases in the United States include: 1. Under the title “Man Charged with Impersonating Hospital Doctor” that was published on November 1, 1984, the prestigious New York Times reported “a 29-year-old hospital accountant was arrested yesterday in the emergency room of Lincoln Hospital in the Bronx, (New York) on charges of impersonating a physician and treating patients. He was caught after nurses had noticed his patient charts were not medically correct.”
2. Another case that appears as “Gerald Barnes (criminal)” in the Wikipedia website reported that the perpetrator “stole the identity of a licensed medical doctor for years until his negligence and lack of medical knowledge contributed to a death in December 1979”. He was later found guilty of manslaughter and practicing without a medical license. “After his release (for good behavior) and numerous later arrests for practicing without a license at 70 years old, he was arrested again, but this time for federal fraud charges (impersonating a doctor but this time as part of his job he did physical checkups on FBI agents, hence why it was upgraded to a Federal crime) and is now serving a 20 year sentence in a federal penitentiary.” 3. A woman from New Jersey was found guilty of Medicaid fraud. “She provided counseling services, wrote and altered prescriptions, although she is unlicensed to practice medicine, and caused bills to be submitted to the Medicaid Program for the services rendered (pharmacologic management) as if they had been rendered by a licensed practitioner.”
4. Another case was described in the web pages of the New York Office of Attorney General: “the Attorney General’s office announced the arrest of a New Jersey man on charges of Unlicensed Practice of Medicine for allegedly performing cosmetic surgery and other services to the public without a license.”
5. From the web pages of the Assistant District Attorney of Santa Clara, California: “A joint investigation by the California State Medical Board, the Santa Clara County District Attorney’s Office and the Department of Insurance, uncovered allegations that Nguyen Nhu Quang, who is not a licensed physician, performed breast implant surgery on a young female victim causing great bodily injury and disfigurement.”
To curb the unlicensed practice of medicine, various states have come up with varying degrees of penalty for such offense. The State of Florida statutes, for example, indicate the following sanctions and penalties for unlicensed practice of a health care profession: 1) May issue and deliver to such person and other individuals who aid and abet the unlicensed practice a notice to cease and desist from such violation; 2) May impose by citation and administrative penalty; 3) May seek the imposition of a civil penalty; and 4) In addition to the administrative and civil remedies, and in addition to the criminal violations and penalties listed in the individual health care practice acts, may file felony charges.
What specific Philippines laws were broken in this case? Which principles of medical ethics upheld by the Philippine College of Physicians were violated? I am not certain. The fact remains that with the triple appointments, the Aklan government has opened itself and its coffers to multitude of civil and criminal suits. To wit, a couple of weeks ago the (US) Veterans Affairs Secretary was forced to resign because of perceived inadequacies in healthcare provision among US veterans and because of the well-publicized molds at the Walter Reed Hospital. Such is the real ramification of chain of responsibility. (Ed’s Note: The author’s article, “Playing Doctor: Tonet Viray” was published in the editorial, Madyaas Pen, August 19 – 25, 2007 issue.) /MP
1 comment:
It is a loud silence we hear from both the Aklan LGUs and the Aklan Medical Society regarding this controversy of Tonet Viray as far as news found in this forum.
For us Aklanons out of Aklan, our main source of timely news is the Internet. Aklan LGUs and Aklan Medical Society are leaving it to ourselves to form conclusions about this issue. And if you ask me what this conclusion be, it is dependent on the amount of news and commentaries on differnet sides of the issue. So far, what I read in this forum is not favorable to the Aklan LGU and Aklan Medical Society. I have not seen their responses on this forum nor in any other online forum from Aklan. It seems they have not taken the move to air their side so far.
Let this be a lesson among Aklan politicians that the Internet is a potent forum to present their views and positions. Abdicating their chance may have tremendous ramifications in their 2010 plans.
For statistics, do these politicians know how many people of voting age have stated their location as Aklan in Friendster? Allow me to volunteer - more than 10,000. If all these are voting in Aklan and will vote based on what they read from the Internet, it is large enough vote to have a winning margin in governatorial or congressional election in Aklan.
Elmar M. Gomez
elmarmgomez2003@yahoo.com
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