Medical Action Group, Inc. (MAG)

Medicines priced within the Filipinos reach

2008-08-13T21:47:00.000-07:00

After years of waiting for the passage of the much-contended legislation, the debacle over the Cheaper Medicines Bill hounds the public even after its celebrated passage in June of 2008.

More than a roller coaster ride

To say that the campaign to pass the Cheaper Medicines Bill was difficult is a complete understatement.

The legislation with its noble purpose to ensure affordable medicines to Filipinos had gone through various controversies before it gained the passage it rightfully deserved.

In the 13^th Congress, the Cheaper Medicines Bill as it was popularly known, initially sought to amend the Philippine patent law to make room for flexibilities provided under the World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (WTO-TRIPS).

Flexibilities under the IP amendments include parallel importation of drugs with patent protection without the consent of the patent holder. It also provides flexibilities for the issuance of license to the government or any third party, which can manufacture patented medicines in the event of a national emergency, disaster or any similar emergencies, further limiting the criteria for granting patents to drugs and medicines. This then allows the early working of a generic drug application even before the patent protection of its originator drug expires.

The Cheaper Medicines Bill then was not a popular legislation even among legislators in both the Senate and House of Representatives because of the technical issues surrounding intellectual property rights. It remained unpopular until a major turning point presented itself in the form of a note.

In February 21, 2007, days before the Congress closed its session for a much-awaited recess, lawyers from a prominent law firm trooped to the session hall of the House of Representatives to monitor and lobby against the bill’s passage. A few minutes later, Congressman Ferjernel Biron went ballistic and confronted the lawyers; apparently, one of the lawyers has passed a note to Congressman Teddy Boy Locsin bearing the message, “We desperately need someone to question the quorum now. Can you do it?”. The note also requested Congressman Locsin to call Mr. Leo Wassmer, vice-president and Chief Executive Officer of the Pharmaceutical Healthcare Association of the Philippines (PHAP). Chaos soon followed the commotion as Congressman Locsin threw the lawyers out of the session hall with the media at their tracks.

After a series of statements identifying the lawyers as representatives of the Pharmaceutical Healthcare Association of the Philippines (PHAP) and later the denouncement of the lobbying act by the civil society as a desperate attempt to control the inevitable end in the patent regime of the pharmaceutical industry, the Cheaper Medicines Bill became a symbolic legislation. The Bill became an essential weapon in the waging war between patients’ rights and patent rights.

Soon after the incident, it gradually became evident that the bill will not pass in time for the closing of the 13^th Congress. Nevertheless, what the public lost during the end of thirteenth congress, it gained in the opening of the next congress. The bill gained enough publicity to solicit support from legislators in both chambers. Before the committee hearings were even conducted, majority of the house representatives have signed the pending legislation as authors and co-authors.

Complications ensued after various legislators filed their own version of the Cheaper Medicines bill. After several public hearings and consultations, salient points of the bill included more than just the Intellectual Property Code amendments. The bill contained amendments to the Generics Act and pharmacy law. The establishment of a drug price regulation was also included along with a provision to strengthen the Bureau of Food and Drugs (BFAD).

Seemingly repeating history, the House version of the bill again faced contention with some of its provision ruffling feathers within and beyond the halls of the lower house. The Drug Price Regulation vs. Intellectual Property Code amendments debate was consistently drowning all other issues on the Cheaper Medicines bill in the first stages of the hearings by the House Committee on Trade and Industry. Legislators sponsoring the provision were vicious in their critique of the IP amendments with allegations centering on the premise that the IP amendments will not really translate into affordable medicines.

The Philippine Medical Association (PMA) meanwhile, were passionate about a certain provision on the amendments to the Generics Act. The amended provision mandates for prescribing in drugs in its generic name only, no brand name shall appear in any part of the prescription pad. This provision seeks to promote the use of generic drugs at the same time prevent multinational pharmaceutical companies from using the prescription pads as a marketing tool for their branded drugs. The PMA went as far as threatening to conduct a nationwide Hospital Holiday, a boycott in which hospitals will refuse to accept patients once every week except for emergency cases. PMA conducted a nationwide motorcade to signify the doctors’ opposition against the “Generics-only” Prescription. PMA’s steadfast supporter was Senator Pia Cayetano, which during the bicameral deliberations was adamant about including the provision and moved to scrap the Generics only prescription from the final Bicameral version of the bill.

The Department of Health after a much-publicized show of support for the generics only prescription retracted their recommendation with statements saying that 54% of Filipinos are already purchasing Generic medicines. Thus, the need to amend this specific provision no longer merits the urgency that it has been provided before.

In the midst of allegations against the generic name only prescription and even generic drug itself, the public health advocates remain steadfast in their stance, challenging the PMA to renounce their profit-oriented view of prescribing in the drug’s brand name so that they can put the patients’ best interest in mind.

The Office of the President saw the debate over whether to drop the generic name only prescription or not as the sole hindrance to the passage of such a noble legislation. Thus, in May of 2008, President Gloria Macapagal Arroyo publicly appealed to the Bicameral Committee members to drop the said provision to be able to pass a more important piece of legislation.

With that statement, the provision was indeed scrapped. Several advocate legislators have committed to soon raise the generics name only prescription in an omnibus bill amending the Generics Act.

After the controversies hounding the public health legislation, President Gloria Macapagal Arroyo finally signed the Cheaper Medicines Law, last June 6 of this year which in its final form is officially referred to as the Universally Accessible Cheaper and Quality Medicines Act of 2008.

Salient points of the law

The Cheaper Medicines Law contains various mechanisms that seek to make medicines affordable and accessible to the public. The Amendments to the Intellectual Property Code of the Philippines, Generics Act, Pharmacy law, and provisions on Drug Price Regulation, Non-Discriminatory Clause, Strengthening of the Bureau of Food and Drugs, composes the newly enacted legislation.

Intellectual Property Rights vs. Public Health

Multinational companies have exerted extreme pressures to the WTO to be able to protect their Intellectual Property Rights. Since the DOHA declaration on TRIPS and Public Health came into force, only a number of countries have adopted the flexibilities provided under TRIPS.

Chapter 2 of the Cheaper Medicines Law contains amendments to the Philippine patent law to incorporate the said flexibilities in the Intellectual Property Code of the Philippines.

The law provides for stricter patentability criteria for drugs and medicines in the market. Sec. 5 emphasizes that the mere discovery of a new form or property of a drug will not be considered patentable unless it has been proven to enhance the efficacy of the said drug. This section seeks to prevent multinational companies from abusing the patent law in a patenting strategy called Evergreening. In the application of the Evergreening strategy, Multinational Pharmaceutical companies introduce new additions to existing substances of drugs and medicines to gain extension of the patent protection of a certain drug.

Parallel Importation allows the importation for resale of patented medicines introduced anywhere in the world. Sec. 72.1 states that the right to parallel import drugs and medicines is provided to any available government agency or any private third party.

Sec. 72.4 meanwhile pertains to the right to avail of the early working provision stated in the law. The provision seeks to provide for early processing of generic medicines application to prepare for the originator’s patent expiration. This will increase the access to generic medicines of the public immediately after the patent of a drug or medicine expires.

Sec. 74 and Sec. 93 discuss the Government Use provision and Grounds for Compulsory Licensing. Both sections identify concrete cases in which the government (Sec. 74) or any third party licensed by the IPO (Sec. 93) can use the invention without the consent of the patent holder. The patent of an invention may be exploited in cases of national emergency and other instances of extreme urgency, there is public-non commercial use without satisfactory reason, and when a judicial or administrative body has determined that the use of the product is anti-competitive. When a demand for a patented product in the country is not being met to an adequate extent and on reasonable terms based on findings of the Department of Health Secretary, the said product may be subject to government use or compulsory license among others.

Civil Action for Infringement under Sec. 76 of the Intellectual Property Code may not apply in instances covered by provisions pertaining to the Limitations of patent rights, Government Use, Compulsory Licensing, and the Procedures on Issuance of a Special Compulsory License under the TRIPS Agreement.

The law remains explicit in the protection against possible infringement of trademarks and trade names of imported or sold drugs and medicines under the Section 72.1 of the law.

The chapter further discusses the period of filing and requirement to obtain a License on for filing of compulsory licenses, and Rights conferred by the patent holder on registered marks.

What’s in a name?

The Generics act amendments became a much contended provision for the section mandating every health professional to prescribe in only the generic name of the drug, completely scrapping the brand names from the prescription pads. The generics-only prescription (formerly under Sec. 6. b) seeks to increase the use as well as promote the affordable generic drugs in the market.

The much-contented provision - the generics name only prescription was dropped in the last stages for the legislative process. The generics act amendments retained the original provision of Section 6.(b) stating the responsibility of all health practitioners to write prescriptions using the generics name with the brand name included if so desired.

To promote the use of generic drugs, Section 5 was amended to strengthen the provision that requires the DOH to publish annually the generic names and its corresponding brand names of all drugs and medicines in the county in acceptable means of public dissemination.

Every generic drug will now bear the message, “This product has the same therapeutic efficacy as any other generic product of the same name. Signed: BFAD” in its labels and packaging.

Under the Cheaper Medicines law, every local manufacturing company operating in the Philippines shall now be mandated to produce, distribute and made widely available to the public an unbranded generic equivalent of their branded drug.

Individuals violating provisions in the Generics Act will now be faced with harsher penalties. Violating parties of Sec. 6 (a) and (b) will have increased penalty fines. Second conviction will incur a penalty of not less than ten thousand persos (Php 10,000.00) and not exceeding twenty five thousand pesos (Php 25,000.00). Third offense penalizes violators of a fine not less than twenty five thousand pesos (Php 25,000.00) but not exceeding fifty thousand pesos (Php 50,000.00) and suspension of his license for 60 days at the discretion of the court. The fourth conviction entails a more grave penalty of fine not less that one hundred pesos (Php 100,000.00) and suspension of his license to practice his profession for one year or longer.

Meanwhile, a penalty of a fine not less than one hundred thousand pesos (Php 100,000.00) and suspension or revocation of license to operate of drug establishments or outlets awaits any juridical person that may violate provisions under Sec. 6 (c), 6 (d), 7 or 8. Officers directly responsible for the violation will be fined with at least forty thousand pesos (Php 40, 000.00) and suspension or revocation of license to practice profession.

The Secretary of Health may also impose administrative sanctions such as suspension or cancellation of license to operate and may even recommend suspension of license to practice profession to the erring parties.

In search for accountability

The Drug price regulation mechanism ranks among the provisions that were gruesomely tackled by legislators in both chambers. The concept of a drug regulatory mechanism took several forms. The former house version of the Cheaper Medicines law was initially a regulatory board composed of representatives from government agencies and civil society. Drug Price Regulation in the senate bill meanwhile grants the authority to regulate drug prices issued by the president only upon the recommendation of an advisory council.

The deliberations gave rise to arguments on who shall be held accountable for regulating drug prices. Senator Mar Roxas defended his position stating that a provision as controversial as the drug price regulation must have a face, an individual to be held accountable for. Accountability in this mechanism will not be efficiently projected if the provision would establish a drug price regulatory board.

Discussions on which form of drug price regulation should be legislated dragged for months. The issue was finally resolved during the Bicameral proceedings. With the senate version being adopted and the house version’s powers and structure included in the law.

Under the Drug Price Regulation, the President of the Philippines may now issue maximum retail prices for drugs and medicines based on recommendations by DOH.

Drugs and medicines that are subject for drug price regulation includes those indicated for treatment of chronic illnesses and life threatening conditions, drugs and medicines indicated for pregnancy and prevention of diseases, anesthetic agents, and intravenous fluids. Drugs and medicines listed in the Philippine National Drug Formulary Essential Drug List and other medicines that the DOH deems necessary to subject to price regulation.

Sec. 24 of RA 9502 protects the public from price manipulation of drugs and medicines. Under this section, price manipulation such as hoarding, profiteering or illegal combination, or forming cartel is considered illegal. The subsequent section discusses penalties for violating parties. A penalty of imprisonment for a period of not less than five (5) years nor more than fifteen (15) years or payment or fines not less than one hundred thousand pesos (Php 100,000.00) nor more than ten million pesos (Php 10,000,000.00). Suspension or revocation of license to operate for both professional and business license will also be ordered depending on the court’s discretion.

Drugs and medicines subject to drug price regulation is also mandated to display the retail and maximum price in the labels of the product with the phrase, “Retail price not to exceed” and “Under drug price regulation” on a red strip. Every manufacturer, importer or trader shall issue a price list with the corresponding retail prices, maximum retail prices and other information to wholesalers, distributors and retailers and to the Secretary of the Department of Health as well.

Monitoring and reporting function was similarly given priority on this Chapter. Sec. 27 refers to the responsibility of the local government units and the Department of Trade and Industry to submit quarterly price monitoring reports to the DOH. Sec. 28 discusses the need to conduct independent periodic surveys as well as studies of the selling prices of all drugs and medicines, emphasizing the role of DTI to provide independent reports to the DOH.

The Department of Health in turn shall be submitting their bi-annual monitoring report of its performance in implementing the provisions in the act. The reports shall be submitted to the President and similarly published in a newspaper of general circulation. A report should also be submitted to both the House of Representatives and the Senate within the opening of the regular session.

The issuance of a drug price regulation order with the corresponding conditions for implementation by the President should be published in at least two (2) newspapers of general circulation Drug outlets must also post a clear copy of the order of the President.

Reclaiming the public’s trust

The debate over the generics vs. branded drugs usage has shifted to BFAD’s apparent lack of capacity to fulfill it mandate to ensure safe and good quality of food, drugs and cosmetics to protect the interest of the people.

As the attacks unleashed against the generics drugs on quality issues continued, so have the issues against BFAD. The raging onslaught centered mainly on BFAD’s previous lapses of monitoring and regulation of drugs in the market. Their capacity was again brought in question when provisions that would require efficient and adequate expertise from a drug regulatory authority were proposed. This provision includes the generics name only prescription, the influx of parallel imported drugs and others.

In the attempt to provide BFAD with such efficiency and expertise, a provision was provided under Republic Act 9502. Section 31 seeks to strengthen the BFAD by allowing retaining the fees, fines, royalties and other charges incurred from its services. Such retained will be used in its operations such as upgrading of facilities, equipment outlay, human resource development, and expansion among others.

In five years, BFAD is mandated to determine if the fees and charges are indeed sufficient to meet the needs of the bureau. Should the retained fees do meet the budgetary requirements of BFAD, the agency will continue to retain its generated funds but will cease to receive any funding from the annual budget of the national government. Should the retained fees be insufficient for the operations of BFAD, they will still continue to retain the fees awhile receiving the annual budget allocation from the national government until such time when the BFAD director and the DOH Secretary certifies that the accumulated retained fund is enough for the agency’s financial needs. A yearly performance report will also be submitted to the Quality Affordable Medicines Oversight Committee.

To increase the quality assurance of drugs and medicines, BFAD will now undertake steps to ensure that drugs sold in the nation will have conformed to international standards for the content, purity, and quality of pharmaceutical products.

Over the Counter Drugs in Convenience Stores

Amendments to the Pharmacy law will now allow Over-the-Counter Drugs to be sold in supermarkets, convenience stores, and other retail establishments. Pharmaceutical companies, importers, distributors, wholesalers will only sell drugs and medicines to retail drug outlets, hospital pharmacies, and other drug wholesalers if they are under the supervision of a registered pharmacist. While for supermarkets and other retail establishments, they must first be duly licensed by BFAD.

Discrimination among drugs and medicines

The law also prevents discrimination among drugs and medicines. Under the non-discriminatory clause, it will be illegal for any drug retail outlet to refuse to carry, either by sale or by consignment any parallel imported drugs and medicines. These products will be displayed with equal prominence in the retail outlet’s shelves.

Chapter 5 also prohibits entities in the drug supply chain (Manufacturers, Importers, Traders, Distributors, and wholesalers) to refuse to sell to any wholesalers and retailers without sufficient and justifiable reason.

Corresponding penalties will be imposed for violations of this chapter, from fines of not less than Php 100, 000.00 to Php 500, 000.00. For succeeding offenses, fines will not be less than Php 500,000.00 to Php 1, 000, 000.00 and a possible suspension or revocation of its license to operate, business or professional licenses.

Ensuring the law’s effective implementation

A Congressional Oversight Committee with the title “Quality Affordable Medicines Oversight Committee will be established and will compose five members from the Senate, five members from the House of Representatives and will be jointly chaired by the Senate and House Committee on Trade and Industry. Vice Chair post meanwhile, will be held by the Chairpersons of the Senate and House Committee on Health

Moving beyond the Cheaper Medicines bill

Affordability and Accessibility issues are what the Cheaper Medicines Law sought to address. However, the problems on broader Access to Medicines of Filipinos are beyond what the law provides. Other mechanisms provided under the World Health Organization’s recommendations for increased access to medicines should similarly be in place. The WHO Access to Medicines framework recommends four strategies of improving access. Rational Use, is the selection of medicines suitable to the country’s health needs; Affordable pricing seeks to lower drug prices through an efficient generics policy and cost-containment measures; Sustainable Financing includes ensuring that essential medicines are under social health insurance, while a Reliable Supply and Management system includes a coordinated medicines management system, and the application of transparent and good procurement process for the procurement of medicines among others.

With the lobbying work finally concluded, the real test of achieving access to affordable medicines begins with the law’s implementation. Public health advocates have traversed this path even before a legislation addressing the high prices of medicines was even foreseen. Many have seen beautifully crafted legislations eventually becoming a loss for the state’s lack of political will for its implementation.

The Department of Health and the Intellectual Property Office, the two implementing agencies of the law, have initially called for submissions of the positions of stakeholders in the drafting of the implementing rules and regulations. It is in this crucial stage that public, especially that of the civil society, should maintain a watchful eye towards the crafting of the law’s implementing rules.

The true test of an effective legislation is in its crafting, implementation, political will of the state, vigilant monitoring of the civil society among others. It is with public’s greatest hopes that the bill will not suffer the same fate as those legislations that came before the Cheaper Medicines Law – an unrecognized piece of legislation gathering dust in the archives of the Philippine Congress.

Medicines priced within the Filipinos reach

2008-08-13T21:41:00.000-07:00

After years of waiting for the passage of the much-contended legislation, the debacle over the Cheaper Medicines Bill hounds the public even after its celebrated passage in June of 2008.

More than a roller coaster ride

To say that the campaign to pass the Cheaper Medicines Bill was difficult is a complete understatement.

The legislation with its noble purpose to ensure affordable medicines to Filipinos had gone through various controversies before it gained the passage it rightfully deserved.

With that statement, the provision was indeed scrapped. Several advocate legislators have committed to soon raise the generics name only prescription in an omnibus bill amending the Generics Act.

Salient points of the law

Intellectual Property Rights vs. Public Health

Chapter 2 of the Cheaper Medicines Law contains amendments to the Philippine patent law to incorporate the said flexibilities in the Intellectual Property Code of the Philippines.

The law remains explicit in the protection against possible infringement of trademarks and trade names of imported or sold drugs and medicines under the Section 72.1 of the law.

The chapter further discusses the period of filing and requirement to obtain a License on for filing of compulsory licenses, and Rights conferred by the patent holder on registered marks.

What’s in a name?

Every generic drug will now bear the message, “This product has the same therapeutic efficacy as any other generic product of the same name. Signed: BFAD” in its labels and packaging.

In search for accountability

Under the Drug Price Regulation, the President of the Philippines may now issue maximum retail prices for drugs and medicines based on recommendations by DOH.

Reclaiming the public’s trust

Over the Counter Drugs in Convenience Stores

Discrimination among drugs and medicines

Ensuring the law’s effective implementation

Moving beyond the Cheaper Medicines bill

Healthcare Gone Awry. Dissecting the Hospital Detention Law

2007-10-23T21:39:00.000-07:00

The Right to Health of everyone is guaranteed both in international conventions and domestic laws.

The 1987 Philippine Constitution under Article 13, Section 11 states, “There shall be priority for the needs of the under-privileged, sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers.”

The United Nations International Covenant on Economic, Social and Cultural Rights (UN-ICESCR) also stressed the right to health of everyone. Article 12.2-D emphasized, “The creation of conditions which would assure to all medical service and medical attention in the event of sickness”.

However in spite of these state guarantees and conventions, quality and affordable healthcare remain elusive for Filipinos.

The unfortunate, impoverished people

Suffering from prolonged labor, Marites was admitted in Bukidnon Provincial Hospital in Maramag on the 12^th of July in 2007. She was then pregnant with her 7^th child.

With her husband afflicted with Malaria, Marites was left with 6 children to feed, a Php 4, 750.00 unpaid hospital bill and a newly born baby detained with her at the provincial hospital’s abandoned out-patient department. Without sufficient finances to settle hospital obligations, Marites and her baby still remain admitted almost a month after she was hospitalized.

Marites was just among the 18 patients who lay languishing in carton mats in a ward resembling an unsanitized and cramped detention ward in the Bukidnon Provincial Hospital in August of 2007. Bukidnon patients were constantly anxious of acquiring other diseases during their stay in the filthy hospital ward. Detained patients for almost three months have reportedly tried to escape the hospital premises for lack of adequate food and nourishment provided by the hospital.

The Hospital Detention Law

To address the recurring cases of patients held in hospitals for lack of sufficient funds, a legislative measure was enacted in April 27 of 2007, declaring the act of detaining patients in hospitals illegal.

Under the Republic Act No. 9439, popularly known as the Hospital Detention Law, patients without the financial capacity to settle their hospital obligations but has fully or partially recovered are allowed to leave the hospital or medical clinic upon the accomplishment of a promissory note.

The promissory note covering the patient’s hospital expenses should be guaranteed by a mortgage or a co-maker who will be similarly held liable for the unpaid hospital dues.

A patient also has the right to demand for his/her medical certificate as well as other papers necessary for his/her release from the said medical facility. In case of deceased patients, the corresponding certificates and other documents shall be similarly released to the patients’ relatives.

Failure to adhere to the Hospital Detention Law would entail fines amounting of not less than twenty thousand pesos (P20, 000.00), but not more than fifty thousand pesos (P50, 000.00). The violating party may also be imprisoned by not less than one month, but not more than six months. Both fine and imprisonment may also be applied depending on the discretion of the proper court.

The Hospital Detention Law, however, does not apply to patients who opted for private rooms, thus prioritizing indigent patients.

Profits vs Public Service

As the Hospital Detention Law gained praise for its pro-poor principles, its passage threatened hospital owners as well as doctors and nurses. The Private Hospitals Association of the Philippines (PHAP) began publicly airing their opposition to the law.

PHAP argued that without the payments from hospital fees, the funds of hospitals will not suffice for medicine and equipment expenses as well as the salaries of hospital employees. The group added that the hospital’s lack of fund sources will lead to closures of hospitals and will further drive health professionals to work abroad wherein better compensation and benefit packages awaits them.

Rustico Jimenez, spokesperson of PHAP, even cited that many hospitals are burdened with unpaid bills, adding that, among the patients who secured promissory notes, only one out of 10 of them honored the promissory agreements. Meanwhile in their desperation, other patients resort to providing fictitious names and addresses to avoid their unpaid obligations.

With these arguments, PHAP threatened to conduct a nationwide Hospital Holiday in which PHAP member hospitals will close down two to three times a month except for the emergency ward. The Hospital Holiday will continue until 2008 or until the law is amended or a reasonable Implementing Rules and Regulations (IRR) are formulated. Among the 300 member hospitals of PHAP include St. Luke’s Medial Center, Asian Hospital, University of Santo Tomas (UST) Hospital, Medical City, and the Makati Medical Center.

The Department of Health (DOH) responded to the appeals of PHAP to consider the private hospital’s interest in the issue. DOH in the person of Undersecretary Alexander Padilla invited PHAP in the formulation of the Implementing Rules and Regulations of the Hospital Detention Law.

PHAP relented and postponed its planned Hospital Holiday but after the initial crafting of the IRR, the group renewed its call for the hospital boycott saying, the IRR was not sufficiently drafted to protect the interest of the private hospitals.

During the Hospital Holiday debates, DOH Secretary Francisco Duque III contested the arguments of the possible decrease in the private hospitals’ profits, saying that these hospitals are actually receiving sufficient funds from PhilHealth, 70% of PhilHealth reimbursements go to private hospitals, and a meager 30% was reimbursed to government hospitals.

Last priority

According to the National Statistical Coordination Board (NCSB), 24 out of 100 Filipino families have not earned enough to fulfill their basic food and non-food needs in 2003. Unemployment rates also remained high according to the National Statistics Office, with 2.8 Million Filipinos unemployed as of July this year.

With not enough earnings to spend for basic necessities, healthcare remained the least of the Filipinos’ priorities.

In 1999, the Department of Health reported that cases of under medication (antibiotics) or over-medication on cheap preparations were already prevalent. The World Health Organization meanwhile attested in their World Drug Situation in 2000, that less than 30% of Filipinos have regular access to medicines. 40% have never seen a doctor.

In 2006, a meager 2.9 percent are being spent on medical care by a Filipino family. Their expenditures on health care reflected that 24.1 percent alone was spent on hospital room charges in 2001. 21.7 percent were used for other medical charges such as the doctor’s fees.

With the poverty plaguing Filipinos around the nation, to trust in the government’s health care aid is the second most logical recourse. The state however, has again failed in this aspect.

The state’s lack of political and moral will to address the issue of healthcare remains evident in the 2007 National Budget. The state’s budget for health in 2007 was only 1.28 % of the National Budget compared to the 8% allocation for national defense and 21% for debt service.

In fact in the WHO World Health Statistics 2007, the Philippines received a low rank of 153^rd out of 192 countries in the government’s health spending as a share of a country’s total spending on health.

Thus it is no longer surprising that in a study conducted by the World Bank in 2001, Data showed that Filipino patients prefer private hospitals more than the government health services. According to the Filipino Report Card of Pro-Poor services, patients utilize the private hospitals and clinics the most in the Philippines and across the regions (46%-59%). Government hospitals ranked second with 30%-45% nationwide and in NCR and Luzon.

In spite of their financial limitations, Filipino families continue to demand for quality and satisfactory health care services. A demand which is far from being met by the government with the meager health budget allocation each year; A need for better and affordable healthcare in which the private hospitals are more than willing to supply.

In the guise of healthcare reform

While sincerely attempting to resolve the accessibility and affordability issues of health care, the passage of the Hospital Detention Law, has just merely transferred the state’s obligations to the private sector.

Instead of creating an environment in which healthcare is accessible and affordable such as allocating sufficient health budget to address the health care needs of the public, the government has preferred to prioritize expenditures for national defense and debt servicing.

Patients are then forced to make out-of-pocket payments, driving them to the mercy of private hospitals that are charging fees beyond the patients’ financial means.

Private hospitals, meanwhile, are far from being unscathed. In their desire for earning more profits, they have managed to neglect the individuals they have sworn to protect and care for. Thus healthcare in the private sector are oftentimes based on the financial capacity of the patient.

While the blatant profiteering of private hospitals at the expense of the poor Filipino patients is by itself condemnable, their arguments, however are not. The threat of hospital closures as well as the possible increase in the migration of health professionals cannot simply be disregarded.

In 2003, two hundred hospitals have closed down and eight hundred have partly closed due to the lack of health workers. The Philippines to date is the number one exporter of nurses around the world. An estimated 85% of Filipino nurses are working abroad. The Professional Regulation Commission in 2004 reported that 8, 931 nurses leave the country each year. The large international demand for nurses triggered the doctors to become nurses as well. The medicine enrollees have decreased by 33% in 2004.

If the government is truly sincere in its efforts to address the cases of hospital detention in the country, the passage of a law prohibiting such cases will never be enough.

Until the widespread poverty continues to ail the Filipinos; Until the government truly recognizes its right to health obligation to its people; Until comprehensive and systematic reforms in the various aspects of the healthcare system in the Philippines are implemented, the passage of the Hospital Detention Law will only remain a symbolic gesture of the state’s attempt to fulfill its Right to Health obligations to the Filipinos.

Cheaper Medicines Bill: Isang Hakbang Tungo sa Makatarungang Presyo ng Gamot

2007-07-28T05:59:00.000-07:00

Isang hapon matapos ang pamimigay ng mga lobbying paraphernalia sa loob ng Kongreso, lumapit sa akin ang isa sa mga lola na kasapi ng aming multi-sectoral network.

“Sana ipasa na nila ngayon ang bill natin, makunsensya naman sila.”

Natigilan ako at nag-isip kung paano ko sasagutin ang kanyang komento. Nagkasya na lamang ako sa pagsasabing, "Sana nga po‚ Nay.“

Ika-5 na ito ng Hunyo, isang araw bago tuluyang magtapos ang ika-13 na Kongreso. Tulad ng ibang mga panukalang batas na nalimot at naiwang nakabinbin sa mababang kapulungan, ang House Bill No. 6035 o mas nakilala bilang Cheaper Medicines Bill, ay mistulang mababaon din kasama nang kasaysayan ng ika-13 Kongreso.

At hindi nga ako nag-kamali. Isang buwan at mahigit matapos ang hindi pag pasa ng Cheaper Medicines Bill, mainit pa rin ang talakayan kung bakit nga ba ang isang panukalang batas, na bukod sa benepisyong pampubliko ay Certified Urgent din ni Pangulong Gloria Macapagal Arroyo ay hindi nakapasa sa mababang kapulungan.

Kalagayan ng Gamot sa Pilipinas

Ayon sa World Health Organization (WHO) Health Development Report ng 2000, ang Pilipinas sa kasalukuyan ay pang-126 sa 191 na bansa sa antas ng kalusugan. 40% ng mga Pilipino ay hindi nakaka-konsulta sa mga duktor tuwing sila ay nagkaka-sakit.

Sa buong Asya, pangalawa ang Pilipinas sa kataasan ng presyo ng gamot. Ayon sa WHO - The World Drug Situation, wala sa 30% ng ating mamamayan ang may regular na kakayahan na makabili at makakuha ng kinakailang gamot. Dahil dito, napipilitan ang karamihan ng mga Pilipino na mag-under medicate ng kanilang mga gamot o mag over-medicate naman sa mga mumurahing alternatibo upang matugunan kanilang mga karamdaman.

Isa sa mga pangunahing dahilan sa hindi-makatarungang presyo ng gamot ay ang kontrol ng mga Multinational Pharmaceutical Companies sa ating industriya. Ang kabuuang merkado ng gamot sa Pilipinas ay kumikita ng halos 94.8 bilyong piso sa bawat taon. 81.2% dito ay mula sa bentahan ng mga drugstores.

Ang industriya ng parmasyotika sa Pilipinas ay dominado ng iilan. Sa paggawa pa lamang ng gamot, halos 80% ng toll manufacturing sa mga kompanyang parmasyotika ay ginagawa ng Interphil Laboratories. Ang wholesale distribution naman, halos 80% ay hawak ng Metro Drug/Zuellig Pharma, itinuturing na sister company ng Interphil Laboratories. Sa pag-bebenta ng gamot na tingi o retail, mahigit sa 60% ay mula sa Mercury Drug na may mahigit sa 600 outlets sa buong bansa.

Upang mapanatili ng mga malalaking kumpanya ng parmasyotika ang kanilang kontrol sa merkado, naging gawain na ang pang-aabuso sa sistema ng patent sa bansa. Sa ilalim ng World Trade Organization – Trade Related Aspects on Intellectual Property Rights (WTO-TRIPS), ang patent ng isang produkto ay may karampatang proteksyon na tumatagal ng 20 taon o higit pa. Dahil wala pa sa merkado ang generic na gamot nito, kontrolado ng iisang kumpanya lamang ang nasabing merkado sa loob ng 20 taon. Sa pagtagal ng proteskyon sa patent, tumatagal din ang monopolyo ng mga Multinational Drug Corporations sa industriya. Kasabay ng pagtagal ng kanilang monopolyo ay ang paglaki ng kanilang taunang kita.

Sa pagtatapos ng patent ng isang gamot, nag–hahain muli ng panibagong aplikasyon ang mga kumpanyang ito upang mapahaba ang proteksyon sa kanilang produkto. Kalimitan ay nagdadagdag lamang ng ilang mga sangkap at substances ang mga ito upang masabi na ang kanilang gamot ay bagong imbensyon at mayroong bagong lunas. Madalas, sila ay nagagawaran ng panibagong proteksyon sa kanilang patent. Kilala ang ganito pang-aabuso bilang “Evergreening”.

Bukod sa pang-aabuso sa patent system, isa rin sa pamamaraan ng pagpapanatili ng kontrol sa merkado ay ang panggigipit sa mga maliit na lokal ng kumpanya ng gamot na nagnanais gumawa at mag-benta ng murang generic na gamot.

Sa pamamagitan ng pag-hahabla sa korte, pananakot tulad ng pagpapadala ng mga sulat kalakip ang kanilang mga babala at iba pang mga paraan, kalimita’y hindi na nakaka-sabay sa kumpetisyon ang mga maliliit na kumpanya ng generic na gamot. Kaya’t maaring pataasin ng mga malalaking kompanyang parmasyotika ang presyo ng gamot sa Pilipinas.

Ang House Bill 6035 at ang Intellectual Property Code

Ang House Bill No. 6035 ay isang panukalang batas na naglalayong amyendahan ang Intellectual Property Code (IPC) ng Pilipinas upang maging mas sensitibo sa pangangailangang pangkalusugan ng mga Pilipino.

Kabilang sa mga nais amyendahan sa IPC ay ang Sec. 22, na nagsasaad ng mga produkto at substances na hindi saklaw ng patent, Sec. 72 na nagbibigay ng limitasyon ng mga karapatan sa patent, Sec.74 na nagtatakda ng karapatan ng isang bansa sa paggamit ng patented na produkto at Sec. 147 na nabibigay proteskyon sa trademark ng isang patented na produkto.

Nakasaad sa Sec. 3 ng Cheaper Medicines Bill ang Non-Patentable Inventions, Parallel Importation, Early Working Provisions at ang Government Use.

Ang layunin ng probisyon ng Non-patentable inventions ay upang maiwasan ang Evergreening. Hindi ituturing na patentable ang isang bagong natuklasan na substansya o gamit ng isang patented na produkto maliban na lamang kung ito ay matutuklasan na may bagong lunas o therapeutic value o di kaya’y mapapatunayang isang bagong imbensyon. Ito ay upang maiwasan ang pagpapahaba ng proteksyon ng patent ng isang gamot.

Sa Parallel Importation naman, ang isang kumpanya ay pinapayagan mag-angkat ng isang produktong may patent sa kanyang bansa kahit walang pahintulot ng patent holder nito. Makakatulong ang probisyong ito sa pag-papababa ng presyo ng gamot lalo na kung ang nag-aangkat na bansa ay may pangngailangang magbenta ng mas abot-kayang gamot sa bansa nito. Ang gamot na binili ng nasabing kumpanya sa mas mababang halaga ay maaring ma-import sa kanyang bansa upang maipagbili sa merkado sa mas mababang presyo.

Ang Early Working Provision, na kilala rin bilang Bolar Provision, ay magbibigay ng karapatan sa mga kumpanya ng generics upang maghain ng aplikasyon para sa paggawa at pagbenta sa isang patented na gamot bago pa matapos ang patent protection nito. Sa Pilipinas, ang proseso ng aplikasyon upang gumawa at mag-benta ng generic na gamot ay tumatagal ng 18 hanggang 60 buwan na mas makakapagpahaba ng kontrol ng mga malalaking kumpanya ng gamot. Sa Early Working Provision, maaring maipag-bibili agad ang generic na beryson ng isang gamot matapos ang proteksyon nito sa patent.

Sa probisyong Government Use, pinapalakas ang karapatan ng pamahalaan na gumawa at mag-benta ng mga patented na gamot kahit walang pahintulot ng may-ari nito. Maari din itong magbigay ng mga lisensya sa ibang mga kumpanya upang makagawa at makapg-benta ng mga generic na gamot sa mga sitwasyon tulad ng epidemya at iba pang maaring ituring na national emergencies.

Bukod sa mga probisyong mag-aamyenda ng Intellectual Property Code, may mga ilang naidagdag sa orihinal na HB 6035. Ang pagtatayo ng Drug Price Regulatory Board, Oversight Committee at ang Non-Discriminatory Clause ay mga probisyong isinama sa HB 6035 nuong ang nasabing panukala ay dumaan sa Period of Ammendments.

Ngunit ang ilan sa mga naidagdag na probisyong tulad ng pagtatayo ng Drug Price Regulatory Board bilang isang mekanismo ng pagpapababa ng presyo ng gamot ay naglunsad ng iba’t ibang komento. Pangunahing argumento dito ay ang kawalan ng transparency ng mga malalaking kumpanya ng gamot sa kanilang mga gastos sa paggawa at pag-bebenta ng gamot. Maraming mga katanungan hinggil sa kanilang pagiging tapat sa mga isinasaad na halaga at gastos ng kanilang operasyon. Hangga’t hindi transparent ang mga kumpanyang ito sa kanilang gastos, hindi epektibong maitatakda ng Drug Price Regulatory Board ang regulasyon sa presyo ng mga gamot.

Ang pagpasa ng panukalang batas na ito ay maglulunsad ng masiglang kumpetisyon sa pambansang industriya ng gamot, mabibigyan ng pagkakataon ang mga lokal na kumpanya ng generic na gamot na makasabay sa kumpetisyon ng mga malalaking korporasyon ng parmasyotika. Ang pag-aamyenda sa Patent Laws ng isang bansa ay isa sa mga tinuturing na epektibong mekanismo upang mapababa ang presyo ng gamot.

Deliberasyon sa Mababang Kapulungan

Ang pagpasa ng isang panukalang batas na nagnanais maging makatarungan ang presyo ng gamot ay isang masalimuot na pakikibaka.Iba’t Ibang uri ng pamumulitika at panggigipit ang inabot ng Cheaper Medicines Bill hanggang sa tuluyang hindi ito maipasa.

Isa sa mga pangunahing naging sanhi ng hindi pag-usad nito ay ang kawalan ng Quorum sa kongreso. Mistulang hindi naging prioridad ng mga mambabatas ang pagdalo sa mga sesyon kaya’t ang mga mahahalagang panukalang batas ay hindi napagtutuunan ng nararapat na pansin.

Sinamantala naman ito ng mga Multinational Drug Corporations na tutol sa pagpasa ng Cheaper Medicines Bill. Dahil sa inabot na ang panukala ng ilang buwan bago magsara ang ika-13 Kongreso, ang kailangan na lamang gawin ng mga kumpanyang ito ay i-delay ang pagpasa ng bill hanggang sa tuluyang nang matapos ang deliberasyon. Kasama ang kanilang mga bayad na kongresista, inipit ang Cheaper Medicines Bill sa bawat sesyon nito, ang pag-question ng quorum ay ginamit ring paraan upang matapos ang deliberasyon ng nasabing panukala.

Napatunayan ang ganitong sabwatan at pagdikta ng mga Multinational Drug Corporations nang pinalabas ang mga kinatawan ng Pfizer, GlaxoSmithKline at ng Pharmaceutical and Healthcare Association of the Philippines (PHAP) sa loob ng session hall ng Kongreso dahil sa pag-aabot ng isang sulat kay Rep. Teddy Boy Locsin na nagsasad ng mensaheng, “We desperately need someone to question the quorum now. Can you do it? Please Call Leo Wassmer (Chief Executive Officer ng PHAP) at this number ________”. Ang unethical lobbying na ito ay naganap sa huling araw ng Special Session ng Kongreso nuong buwan ng Pebrero. Inabot ng iba’t ibang uri ng pambabatikos mula sa mga kongresista at iba’t ibang health rights advoactes ang insidenteng ito.

Kung susuriin, ang kawalan ng political will ng Kongreso at ng Malacañang ang kumitil sa Cheaper Medicines Bill. Bagama’t ito ay Certified Urgent Bill ng Pangulong Arroyo, nauna pang naipasa ng mga kongresista ang Human Security Act (Anti-Terror Bill) at ang PAGCOR Franchise Extension Bill, mga batas na may pulitikal at personal na ganansya ang mga kongresista. Nagpapatunay lamang na ang kalusugan ng mga Pilipino ay hindi prioridad ng pamahalaan.

Ilang araw mula ng magtapos ang ika-13 Kongreso, sinubukan ng ilang mga kongresista at senador na magtawag ng isang special session upang maipasa ang lahat ng mga mahahalagang panukalang batas na naiwan sa kongreso subalit hindi ito pinakinggan ng administrasyong Arroyo. Ayon sa mga pahayagan, binanggit ng political adviser na si Gabriel Claudio na kailangang masigurado muna ng mababang kapulungan ang quorum bago gumawa ng karampatang aksyon ang Malacañang.

Binaling naman ng mababang kapulungan ang hindi pagpasa ng bill kay Senator Mar Roxas, ang pangunahing may-akda ng Senate Version ng HB No. 6035. Inakusahan nila Rep. Ferjernel Biron at Rep. Janette Garin si Sen. Roxas nang hindi pagtanggap sa bersyon ng kamara dahil sa probisyon na Price Regulation. Giit pa nila, hindi makakapag-pababa ng presyo ng gamot ang bersyon ni Sen. Roxas. Nagbigay din ng pasaring na mayroong isang bilyong piso na lobby money na inilabas ang mga Multinational Drug Corporations upang hindi maipasa ang bill. Pinabulaanan ni Sen. Roxas ang ganitong mga alegasyon, aniya gumagawa na lamang ng dahilan ang mga kongresistang ito upang hindi masisi sa hindi pagpasa ng HB No. 6035.

Ang Senate Bill No. 2263, ang bersyon ng Cheaper Medicines Bill sa Senado, ay naipasa sa Third Reading nuong nakaraang Enero taong kasalukuyan samantalang ang House Bill No. 6035 ay naiwang nakabinbin sa Second Reading.

Cheaper Medicines matapos ang ika-13 Kongreso

Matapos ang mainit na bangayan, pamumulitika at publicity na nakamit ng Cheaper Medicines Bill, muling nadinig ang iba’t ibang pangako ng mga pulitiko.

Maging si Pangulong Arroyo ay hindi nagpahuli. Sa kanyang nakalipas na State of the Nation Address, umapila ito sa kongreso at maging sa publiko na tulungan sina Senador Mar Roxas, Rep. Ferjernel Biron at Rep. Teddy Boy Locsin upang mabigyan ng abot-kayang alternatibo na gamot ang mga mamamayan. Ito ay sa pamamagitan ng pagsasabatas ng Cheaper Medicines Bill na, aniya, halos naipasa nuong Hunyo.

Ilang araw din simula ng magbukas ang ika-14 na Kongreso, mayroong nang walong panukalang batas na nagnanais mapababa ang presyo ng gamot, Nagkahain na ang mga ito sa mababang kapulungan. Nagkaroon na ng iba’t ibang anyo at iba’t ibang pangalan ang nuo’y House Bill No. 6035 – ang panukalang batas na mag aamyenda sa Intellectual Property Code ng Pilipinas.

Sa pagbubukas ng panibagong kongreso, sumagi sa aking isip ang naisagot ko sa aming nakatatandang kasapi, isang araw bago tuluyang matapos ang ika-14 na kongreso. Marami akong iniisip na dapat naisagot sa kanya. Gusto kong ipaliwanag ang matinding pulitika na pumatay sa isang napakagandang panukala. Gusto kong ipaliwanag ang garapalang korupsyon na namamayani sa hanay ng mga naihalal na kongresista. Gusto kong sabihin na walang maasahan ang mga Pilipino hanggat nanatiling ganid sa salapi ang mga pinagkatiwalaang kinatawan sa kongreso.

Nagkasya na lamang ako sa pagsasabing, “Sana nga po‚ Nay”

Dahil sa kabila ng matinding dismaya, nangibabaw pa rin ang pagnanasang makita ang araw na wala nang Pilipinong mamamatay dahil sa kawalan ng kakayahang makabili ng gamot.

Profit-Driven Hospitals and Doctors forget Hippocratic Oath

2007-07-05T03:41:00.000-07:00

PRESS RELEASE
26 May 2007

“The Hospital Holiday threat posed by the Private Hospitals Association of the Philippines (PHAP) reduced private hospitals and doctors into mere businessmen who put profit first before public health forgetting their sworn oath to save and protect their patient’s lives from harm and injustice. The statement is a clear indication that private hospitals have become profit oriented – standing to gain from the ailments of its patients.” Edeliza Hernandez, Executive Director of Medical Action Group (MAG) said.

In protest of Republic Act 9439 of the Hospital Detention Law, PHAP threatened to conduct a Hospital Holiday in which hospitals, except the Emergency ward will temporarily close down from once to three times each month until December should the private hospitals negotiation with the Department of Health failed. The Law seeks to ban hospitals from releasing patients on the grounds of non-payment of hospital bills.

“The fears expressed by PHAP over RA 9349’s impact over the private hospitals funds and the Filipino doctors migration are still presumptions. RA 9349 does not cover patients with private rooms, signifying that the law seeks to protect the poor patients confined in the charity ward. For most private hospitals, the cases of admission of poor patients in the charity ward are very few. Private hospitals profit comes from its well-off patients rather than the poor ones.” Hernandez furthered.

Hernandez added that the government should increase its subsidies on public government hospitals such as the Philippine General Hospital to improve its quality of service and accommodate the increasing number of poor patients in need of medical assistance. Tax Incentives for private hospitals must likewise be considered.

RA 9439 or the Hospital Detention Law prohibits hospitals from detaining patients because of non-payment of hospital bills. Patients will sign a promisory note secured by a mortgage or by a guarantee from a co-maker which will be similarly liable for the unpaid hospital expenses.

“We are appealing to the Department of Health to remain firm in its stance in dealing with the private hospitals demands. DOH should protect public health amidst the pressure exerted by the Private Hospitals Association of the Philippines.” Hernandez concluded.

The Medical Action Group, Inc. (MAG) is a non-government organization composed of doctors and health professionals committed to advancing the People’s Right to Health.

GMA's State of Mental Illness

2007-07-05T03:38:00.000-07:00

PRESS RELEASE
8 December 2006

"Suffering from paranoia and illusions of grandeur, the Medical Action Group recommends President Gloria Macapagal Arroyo’s immediate resignation and continuous bed rest.” Edeliza Hernandez, Executive Director of Medical Action Group said.

The Medical Action Group, Inc. (MAG) declared its diagnosis of Pres. Arroyo’s state of mental health, claiming that aside from GMA’s poor health condition, She is apparently suffering from mental instability which renders her unfit and incapable of continuing the duty of running the nation.

MAG’s findings are based on the following symptoms evidently present in GMA’s actions: GMA’s consistent declaration of herself as the legitimate president of the country in spite of the persisting Hello Garci Tape controversy; her constant assurance of respecting human rights while simultaneously eliminating her political enemies and detractors; GMA’s incessant illusions of persecution from her alleged enemies of the state to the extent of branding prominent individuals of insurgency and rebellion; and her claims of leading the Filipino people out of the poverty in which she herself has instigated.

Hernadez added, “It is time for GMA to address the issue of her mental health, such symptoms are severe and must be immediately attended for proper medical attention. For the meantime, we advise her to refrain from making decisions and judgements involving the nation’s economy and welfare.”

Medical Action Group, Inc. (MAG) is a non-government health organization composed of medical professionals advocating for the advancement of health and human rights in the nation.

Some Degree of Negligence

2007-07-05T03:33:00.000-07:00

PRESS RELEASE
23 November 2006

In a Press Conference held early this week, Health Secretary Francisco Duque III stated that the factors which affected the seven neonatal sepsis deaths at the Rizal Medical Center (RMC) “strongly point to some degree of negligence”. He added that early onset newborn sepsis which resulted to the infants’ deaths “could not have been hospital acquired, the infection was really from the mothers.”

According to the joint medical team assigned to investigate the RMC neonatal sepsis case, the infants’ deaths were an “outbreak of highly fatal early onset newborn sepsis.’ He added that “mother-to-child transmission had occurred even before delivery.”

“Some ‘Degree of Negligence’ is not even an adequate description of what transpired in the delivery room of Rizal Medical Center (RMC) on the day of Oct. 4 , 2006. We are outraged by the attempts of the Department of Health to minimize the gravity of the neonatal sepsis deaths at the RMC.” Medical Action Group (MAG) Executive Director, Edeliza Hernandez said.

Hernandez added that although it is possible that the disease was incurred during the pre-natal stage of pregnancy, The question posed should not be who is the culprit behind the deaths, but rather are the Department of Health and Rizal Medical center , adequately equipped with the knowledge and facilities to prevent, treat and contain the disease?

MAG also criticized the DOH for the apparent inadequacy in dealing with government and private hospital’s issues particularly in the RMC case saying, “As a health authority, DOH has the obligation and responsibility to regulate and monitor hospital standards. Why did DOH chose to keep silent when records showed that as early as last year, RMC’s cases of neonatal disease were alarmingly increasing?”

From January to October 2006 alone, data showed that 69 babies died at the Rizal Medical Center while 47 infants perished in the previous year. RMC’s cases of infants acquiring neonatal sepsis increased from 83 babies to 127 this year as based on the findings of the DOH joint medical team.

“The DOH executive committee’s consideration to extend the leave of absence or merely transfer the RMC officials to another institution will not resolve the issue. This move will merely serve as an evidence of DOH’s failure to penalize and impose sanctions to hospitals violating the patient’s rights to adequate health service. The Department should prioritize the indemnification of the victims’ families, not the whims of influential hospital administrators and officials.” Hernandez firmly stated.

In response to RMC’s statements that typhoon Milenyo remained one of the factors that affected the extent of the hospital’s service, Hernandez laments, “For a true health professional committed to the principles of the health industry, there is no excuse for providing the standard, if not the best possible treatment for patients. Not even a typhoon can hamper a medical professional’s oath of service.”