TPH head, cashier, PhilHealth also respondents
TARLAC CITY — Doctors and personnel of the
Tarlac Provincial Hospital urged the Regional Trial Court, National Capital
Judicial Region to issue temporary
restraining order against the provincial government from enforcing a memorandum
the latter made which they said, illegally deprived them of shares and benefits
accrued from medical services they rendered.
Petitioners included doctors Antonita M. De
Pano, Yamani B. Chan, Myra G. Villaroman, Harrier C. Sulit, Prospero T. Ong
Jr., Cristina D. Pascual, NonatoJowinSison, Ramon Aviguetero, Marlo B. Manzano
representing around 60 TPH doctors and personnel.
Respondents in the civil case for declaratory
relief with prayer for issuance of TRO and writ of preliminary injunction were
Gov. Victor Yap and Leonardo Mangahas Jr., officer in charge of TPH including
hospital cashier Julio Pacelo.
Also named public respondent was Philippine
Health Insurance Corp (PhilHealth) represented by its president and CEO
Alexander A. Padilla.
Petitioners furnished a copy of their
pleading to the Northern Philippine Times, saying “payment for professional
services rendered by them were not subject to any regulation, limitation, or
re-distribution by respondents or by the Provincial Government of Tarlac except
when the same is in accordance with existing policies and practices of
PhilHealth before the issuance of the “guidelines setting the mechanism on the
distribution of service payment derived from PHIC” dated June 29, 2015 made by
the provincial government” which they said, didn't have legal basis.
Petitioners said respondents had no basis or
authority to refuse immediate payment and release of professional fees due
them.
They said the “complaint is of common and
general interest to the medical and non-medical staff of the Tarlac Provincial
Hospital. The persons affected are so numerous, numbering more than persons in
all that it is impracticable to join all as parties.”
In their petition, they said Yap, as
provincial governor was being impleaded to stop “issuing, and attempting to
forcibly impose, implement, and enforce the guidelines.”
They said Mangahas Jr. was “attempting to
forcibly impose, implement, and enforce the guidelines even to the extent of
forcing them (TPH employees) to tender their resignations for their opposition
to it.
Pacelo, they said, “refused to release since
January or June 2015 their just share in the professional fees paid by the
PhilHealth for the professional medical services already rendered by them. It
is further asserted that his actions are also upon the instructions or
directives of respondents Yap and Mangahas Jr. for the purpose of coercing and
forcing the petitioners to accede to, accept, and conform with the
“guidelines”.
In including PhilHealth as respondent, petitioners said it
is “impleaded as a necessary party considering that its regulations and
issuances pertaining to the professional fees due and payable to the
petitioners are being disregarded and discarded by respondents through their
enactment and forcible imposition of the guidelines”.
Petitioners said, “By law, all hospitals are
under the control and supervision of the Department of Health (DOH), especially
with respect to the services offered by the hospital and the clinical practice
guidelines and processes. In accordance with Republic Act No. 10606, otherwise
known as the “National Health Insurance Act of 2013”, all hospitals are
committed to achieving universal health care. In view thereof, it is the
manifest intent of the law that all individuals who are treated at hospitals,
whether national or devolved, are
covered by the PhilHealth.
“For this reason, the professional fees and
salaries of doctors and non-medical staff are governed by R.A. 10606, which
amended R.A. 7875 (the National Health Insurance Act of 1995), its Implementing
Rules and Regulations, as well as by the other issuances, policies, and
regulations of the DOH and of PhilHealth.
“Based on DOH Administrative Order No. 42 s.
2001, otherwise known as “Guidelines for sourcing, pooling, and distribution of
Medicare “common funds” in Department of Health hospitals, it is provided, among others, that “All DOH
retained and renationalized hospitals shall create a “common fund” where the
professional fees (PF) for services rendered to Medicare patients shall be
pooled and distributed among hospital workers”. This is applicable to all
hospital workers, whether full-time, part-time, permanent, temporary, casual,
contractual, or from the medical pool, whether medical or non-medical.
“Under Section 44 of the Revised Implementing
Rules and Regulations of R.A. 10606: All payments for professional services
rendered by salaried public providers shall be retained by the health facility
in which services are rendered and be pooled and distributed among health
personnel. Charges paid to public facilities shall be retained by the
individual facility in which services were
rendered and for which payment was made. Such revenues shall be used to
primarily defray operating costs other than salaries, to maintain or improve
the quality of service in the public sector”.
Finally, under PhilHealth Circular No. 35 s.
2013, otherwise known as the “ACR Policy No. 2
Implementing Guidelines on Medical and Procedure Case Rates, it is
clearly provided Professional Fees shall be distributed by the HCI within 30
calendar days from the date of receipt of reimbursement. Policies and
procedures on the distribution of PF shall be drafted and enforced by the HCI
based on the agreements between the HCI and the professionals. Reports of
noncompliance to this provision shall be forwarded to the PRO Health Care
Delivery Management Division (HCDMD) and shall be included as a violation of
the HCI to the Health Care Provider Performance Commitment.”
Petitioners said the government HCI shall
facilitate the payment of the pooled PF share to the health personnel. The
payment of the pooled PF shall be subject to existing rules on pooling by the
Department of Health (DOH)”
“In accordance with the foregoing rules and
regulations, the professional fees paid or reimbursed to the health care institution
(HCI) are pooled by the HCI and thereafter divided on a 70% SHARE going to the
HCI and the remaining 30% SHARE distributed to the doctors and non-medical
personnel for services rendered.
With respect to the 30% SHARE distributed to
the doctors and non-medical personnel, the same is further divided between the
medical and non-medical personnel on an equal basis. Thus, of the pooled
professional fees, 50% is distributed among the doctors and the remaining 50%
given to non-medical personnel.
They said “Despite the existence of clear and
established laws and regulations on the pooling and distribution of the 30%
SHARE that doctors and non-medical personnel like the petitioners are entitled,
even mandated, to receive, respondents Yap, without any prior consultation with
the petitioners unilaterally issued and enacted the “Guidelines Setting the
Mechanism on the Distribution of Service Payment Derived from PHIC” dated June
29, 2015.”
“While the above-cited laws and issuances
allow for the execution of agreements between the petitioners and Tarlac Provincial Hospital, which is the HCI
in this case, no such agreement has ever been discussed or negotiated, much
less finalized and duly executed between the petitioners and respondents.”
“Even more reprehensible is the fact that in
an effort to forcibly impose the “guidelines,”
the respondents have been employing unwarranted and unlawful acts of
coercion against the petitioners. These ignominious acts include the refusal to
release the salaries and the pooled professional fees of the petitioners as
well as forcing the petitioners to resign from their positions in the Tarlac
Provincial Hospital.”
They said “There is no legal basis for the
respondents to enact or to enforce the “guidelines.”” There is no law, regulation,
or issuance by the DOH or by PhilHealth which allows for such enactment and
issuance.
“Respondents
actions cannot be justified simply based on the self-serving assertion
that the Tarlac Provincial Hospital is a devolved hospital which, under Republic
Act No. 7160 (the “Local Government Code of 1991”) would be under the
administrative control and supervision of respondents Yap for the simple reason
that there are already clearly enacted guidelines pertaining to the manner in
which the share of the petitioners in the pooled professional fees should be
distributed. As such, the authority of respondents Yap cannot be validly argued
to sanction or justify his unilateral, unwarranted, and illegal deprivation of
the livelihood and professional fees due to the petitioners.
“In addition to engaging in the above illegal
acts, the respondents are also in continuing, contumacious, and direct
violation of their legal obligation to distribute the pooled professional fees
to the petitioners. The refusal of respondents to release and distribute both
the salaries and the pooled professional fees of the petitioners constitutes
refusal by the HCI to abide by its commitments as a PhilHealth accredited HCI.
In essence, petitioners said, the
“guidelines” were illegal and the Court should declare it so.
They asked the Court to cause immediate
release of their benefits and professional fees and restrain respondents from
enforcing the “guidelines.”
Petitioners said “It should not be overlooked
that in addition to other sources of revenue or appropriation, the Tarlac
Provincial Hospital receives a 70% share in professional fees that are paid or
remitted to it by PhilHealth. As such, there is no danger or prejudice to
viability or operations of the Tarlac Provincial Hospital or to any of the
respondents if the provisional remedies herein prayed for are granted.”
Petitioners were represented by law office of
Luis K. Kokin Jr. and associates.
Earlier petitioners filed a complaint
addressed to Civil Service Commission Sec. Francisco T. Duque urging him to
investigate the matter and Dr. Mangahas Jr. for his alleged illegal acts
related to the issue. Alfred Dizon
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