Tarlac hospital doctors file case vs gov over ‘illegal acts’

 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