LEGAL ASPECTS OF NURSING

Responsibility and Accountability

When nurses undertake to practice

their profession, they are held responsible
and accountable for the quality of
performance of their duties.

Professional Negligence

Refers to the commission or omission

of an act, pursuant to a duty, that a
reasonably prudent person in the same or
similar circumstance would or would not
do, and acting or the non-acting of which
is the proximate cause of injury to another
person or his property.

Elements of negligence
1. existence of a duty on the part of
the person charged to use due care
under circumstances.
2. failure to meet the standard of
care.
 3. the foreseeability of harm resulting
from failure to meet the standard
4. the fact that the breach of this
standard resulted in an injury to
the plaintiff.

Examples of Negligence
1. Failure to report observations to
attending physicians.
2. Failure to exercise the degree of
diligence, which the circumstances
of the particular case demands.
3. Mistaken identity
4. Wrong medicine, wrong
concentration, wrong route, wrong
dose.
5. Defects in the equipment such as
stretchers and wheelchair that can
lead to falls.
6. Administration of medicine without
doctor’s prescription.

Doctrine of Res Ipsa Loquitor “The Thing

Speaks for Itself”

Examples
 1. Wrong site injection leading to
sciatic nerve paralysis
2. Burn area due to spilled hot water
bag or improvised hot water bag

Malpractice

Refers to improper or unskillful care of

a patient by a nurse.

Examples
1. Insertion of urinary catheter
causing damage to urinary sphincter
2. Failure to properly monitor patient,
resulting in aspiration pneumonia
and death
3. Fall during transfer of patient

Doctrine of Force Majeure

Means an irresistible force, one that is

unforeseen or inevitable.

Nurses who fail to render service

during floods, fire, earthquakes and
accidents are not held negligent.
Doctrine of Respondeat Superior. “Let the
Master answer for the acts of the
subordinate.”

The liability is expanded to include the

superior (doctors, hospitals, chief,
head) as well as the nurse performing
the negligent act.

Examples
1. The hospital will be held liable, if,
in an effort to cut down on
expenses decides to hire
underboard nurses or any non-
registered health care providers.
2. The surgeon will be held
responsible in a case where
visceral pack or an instruments is left
in a patient’s abdomen.

Incompetence

It is the lack of ability, legal

qualifications or fitness to discharge the
required duty.
Liability of Nurses for the Work of Nursing
Aides

Nurses should not delegate their

functions to nursing aides since the
Philippine Nursing Act specifies the
scope of nursing practice of professional
nurses.

Liability for the Work of Nursing Students

Under the Philippine Nursing Act of

2002 RA 9173, nursing students do
not perform professional nursing
duties.

They are to be supervised by their

clinical instructors, in order that the
errors committed by nursing students will
be avoided, the following measures
should be taken:
1. Nursing students should always be
under the supervision of their
clinical instructors.
 2. They should be given assignments
that are at their level of training,
experience, and competency.
3. They should be closely supervised
if they are performing procedures
for the first time.
4. They should be oriented to the
policies of the nursing unit.
5. Their performance should be
assessed frequently to determine
their strengths and weaknesses.
6. Frequent conferences with the
students will reveal their problems
which they may want to bring to
the attention of their C.I. or vice
versa.

Intravenous Therapy and Legal

Implications

Based on the Philippine Nursing Act of

1991 Section 28 which states that “in
the administration of intravenous
injections, special training shall be
required according to protocol
established”.
 Therefore nurses have to undertake a
certified training IV Therapy as
developed by ANSAP.

Telephone Orders

Telephone orders should be done in

emergency cases only.

The nurse should read back such order

to the physician to make certain the order
has been correctly written.

Such order should be signed by the

physician on his next visit within 24
hours.

The nurse should sign the name of the

physician per her own and note the time
the order was received.

Charting Done by Nursing Students

When a nurse or a clinical instructor

countersigns the charting of a nursing
student he attests that he has personal
knowledge of information and that such is
accurate and authentic.

Tort: A legal Wrong

1. Assault - is the imminent threat

of harmful or offensive bodily
contact.

Battery - is an intentional,
unconsented
touching of another
person.

• A patient refuses an injection

and the nurse gives it anyway,
the nurse can be charged for
battery.
• A patient who gets injured
while being restrained may
cause the nurse to be liable for
assault and battery.

2. False Imprisonment or Illegal

Detention - the unjustifiable
 detention of a person without legal
warrant.

• A hospital can be charged of

false imprisonment if they
refuse to allow the patient to
leave after a discharge order.

3. Invasion of Right to Privacy and

Breach of Confidentiality

• Divulge information from a

patient’s chart to improper
sources, the nurse can be liable
of breach of confidentiality.
• A nurse permits a non-
professional person to view a
woman in labor inside the
delivery room.

4. Defamation - character
assassination, be it written or
spoken.

4.1 Slander - oral defamation

4.2 Libel - written defamation
Crimes, Misdemeanors, and Felonies

Crimes. It is an act committed or

omitted in
violation of the law.

Felony. It is committed with deceit

and fault. A
deceit exists when the act
is
performed with deliberate
intent and
there is fault when the
wrongful acts
result from imprudence, or
lack of
skill or foresight.

Examples: rape, murder,

drug-related
crimes, theft

Criminal negligence may be

classified into
 reckless imprudence and simple
imprudence.

Reckless imprudence occurs

when a person does an act
or fails to do it voluntarily but
without malice, from which material
damage results immediately.

Simple imprudence occurs

when the person or nurse did
not use precaution and the
damage was not immediate or
impending danger was not evident or
manifested.

Criminal intent is the state of mind

of a
person at the time the criminal act
is
committed, that is he knows that
an act is not lawful and still
decided to do it anyway.

Misdemeanor. Is a general name for

criminal
 offense which does not in law amount
to
felony. Punishment is usually fine or
imprisonment of less than one year.

Conspiracy to commit a crime: When

two or more persons agree to commit
a felony and decide to do it. Persons
who commit felonies are either
principals, accomplices or accessories.

Principals - are those who take a

direct part in
the execution of the act.

Accomplices - are those persons who

cooperate in
the execution of the offense

Accessories - are those who, having

knowledge
of the commission of
the crime,
take part or assisting
the crime
 by concealing the
crime.

Classes of Felonies
1. According to the degree of the acts of
execution
1.1 consummated, when the elements
(time, place, how) of felony are
well-planned prior to its
execution.
1.2 frustrated, when the elements are
present however its execution
failed.
1.3 attempted, when the offender
commences the act but does not
perform all the acts which
shall produce the felony by reason
of some cause or accident.

2. According to the degree of punishment

2.1 grave felonies, are those to which
the law attaches the capital
punishment (death,
imprisonment from 6 years and 1 day,
fine of not exceeding 6,000
pesos).
 2.2 less grave felonies, are those to
which
the law punishes with correctional
imprisonment from 1 day to 6
years and, fine of not exceeding
6,000 pesos but not less than 200
pesos.
2.3 light felonies, are punishable only
when they have been
consummated.

Circumstances affecting criminal

liability.
1. Justifying Circumstances.
1.1 when one acts in defense of
his life or
rights.

2. Exempting Circumstances.
2.1 insane person
2.2 person under 15 years old
2.3 any person who acts under
irresistible force, and
uncontrollable fear
 3. Mitigating Circumstances (a
situation which lessens the
offense)
3.1 no intention
3.2 the offender is under 18 or over
70
years old
3.3 presence of provocation or
threat
3.4 the offender is suffering from
severe illness

4. Aggravating Circumstances (a
situation / act making the crime
worse)
4.1 taking advantage of his public
position
4.2 when the crime is committed
with insult to public
authorities
4.3 the crime is committed in a
place of worship
4.4 when the crime is committed
during misfortune and
calamities
 4.5 premeditated crime or after an
unlawful entry
4.6 fraud or disguise

5. Alternative Circumstances, are

those which must be taken into
consideration as
aggravating or mitigating according
to the offender’s relation to
complainant, degree of instruction
and education.

Lack of education is not mitigating

in: rape, abduction, arson,
treason, seduction, acts of
lasciviousness (lying on top of the
complainant, embracing
and kissing her, mashing her
breasts, inserting his hand
inside her panty and touching her
sexual organ) and heinous
crimes.

Moral Turpitude
It is the gross disregarding of moral
standards expected of a human being
while doing some activity or crime.
Example: raping a person in front of
her parents or husband.

Murder. Unlawful killing of a person.

Examples:
* Death resulting from
abortion
* Euthanasia

Abortion. Expulsion of the fetus

before the age
of viability.

Infanticide. Killing of a child less

than 3 days
old.

Parricide. Killing one’s father, mother

or child whether
legitimate or illegitimate or any
of his descendants.

Robbery. Taking of the property from

another person.
Points to Observe in Order to Avoid
Criminal Liability
1. Be familiar with the Philippine Nursing
Law.
2. At the start of employment, get a copy
of your job description, agency rules,
regulations and policies.
3. Upgrade your skills and competence.
4. Accept only such responsibility that is
within the scope of your employment and
your job description.
5. Do not delegate your responsibility to
others.
6. Determine whether your subordinates
are competent in the work you are
assigning them.
7. Consult for problems.
8. Verify orders that are not clear.
9. Keep the value and necessity of
keeping accurate and adequate
records.
10.Patients are entitled to an informed
consent.

Sources of Law
Law - ordinance of reason promulgated for
the common good by one who
has legitimate authority. It
consists of enforced rules under
which a society is governed.

Types of Law
1. Public Law - a bill or joint
resolution (other than for
amendments to the Constitution)
passed by both Houses of Congress
and approved by the President.

Branches
1.1 Felonies
1.2 Misdemeanor

2. Private/Civil Law - a body of laws

regulating relations between
individuals or between individuals
and corporations concerning
property rights, personal dignity
and freedom, and personal injury.

3. Contract Law - that branch of

jurisprudence that studies the
 rights and obligations of parties
entering into contracts.

4. Tort - court cases that seek

compensation for damages..

Criminal Law
Involves the state imposing
sanctions for crimes
committed by individuals so that
society can achieve justice and a
peaceable social order.

Administrative Law
Refers to the body of law which
regulates bureaucratic managerial
procedures and defines the
powers of administrative
agencies.

Characteristics of a Law
1. Authority or the right to declare
that the rule exists.
2. The rule is pronounced or
expressed and that its source can
be identified.
 3. A right to enforce the same must
be provided.

The Controlling Authority of a Law:

The
Government

Pronouncement of the Law: Must be

declared in writing

Good Samaritan Law

A rule that exempts from liability a
person (such as an off-duty
physician/nurse) who voluntarily
renders aid to another in imminent
danger but negligently causes injury
while rendering the
aid.

This rule is to protect those who come

to the aid of others for no other reason
than kindness.

Nurse-Attorney Relationship

Licensure (discussed in RA 9173)

Laws, Resolutions, Proclamations and
Executive
Orders Affecting the Practice of
Nursing in the Philippines

RA 877 An act regulating the practice

of nursing profession in the
Philippines

RA 4704 June 18, 1966

An act amending certain
sections of RA 877 also known as
the “Philippine Nursing Law”.

RA 6136 August 31, 1970

An act amending subparagraph
seven of RA 877 (application and
execution of legal orders).

RA 7164 Philippine Nursing Act of 1991

RA 6511 An act amending RA 465 which

standardized the examination and
registration fees charged
by the various Board of Examiners.
PRC Memorandum No. 90 – 11. Dated
August 20, 1990, provided the new
rates for examination and registration.

LOI No. 1000 March 20, 1980 Pres.

Ferdinand Marcos
required that members of
accredited professional
organizations shall be given
priority in the hiring of employees in
the government service and
in the engagement
of professional services.

RA 1612 Privilege Tax Law – Professional

Tax
Payment

RA 7392 June 18, 1960

Amended RA 2644 known as
Midwifery Law

RA 2382 The Philippine Medical Act

RA 5181 This act prescribes permanent
residence and reciprocity as
qualifications for any
examination or registration for the
practice of any profession in the
Philippines

RA 6425 Dangerous Drug Act

RA 3573 in 1929 declared that all

communicable diseases shall
be reported to the nearest
health station and that any person
may be inoculated, administered
or injected with prophylactic
preparations.

RA 1082 Approved on June 1954 and

amended by RA 1891 on June 22,
1957 provides for the
creation of RHUs.

RA 1891 an act amending some

provisions in RA 1082
RA 4073 liberalizes the treatment of
leprosy.

PD 996 requires compulsory

immunization for all children
below eight years old against
communicable Diseases.

PD 825 provides penalty for improper

disposal of garbage and
other forms of uncleanliness.

PD 856 “Code of Sanitation” which

provides for control of all
factors in man’s environment
that affect health.

PD 148 amending RA 679 (Woman and

Child Labor Law), states that the
employable age shall be 16
years.

RA 6365 established a National Policy on

Population and created the
Commission on Population.
PD 791 the revised Population Act.

PD 166 amending PD 791 which

strengthens family planning
programs through participation of
private organizations and individuals in
the formulation and
implementation of the
program planning policies.

General Order No. 18 enjoins all

citizens of the Philippines to
promote the concept of family
welfare, responsible parenthood and
family planning.

LOI No. 47 directs all schools of

medicine, nursing, midwifery
and allied medical professions
and social work to prepare, plan and
implement the
integration of family
planning in their curricula.

Dept of Labor Order No. 7 requires all

industrial establishments to
provide family
planning services.

PD 48 limits paid maternity leave

privileges to four children.

PD 69 limits the number of children to

four for tax exemption purposes.

PD 965 requires that couples intending

to get married must first
undergo a family planning and
responsible parenthood instruction prior
to the issuance of a marriage
license.

RA 1054 requires the owner, lessee or

operator of any company and
establishment to furnish free
emergency, medical and dental
attendance to his workers.

RA 4226 Hospital Licensure Act

PD 442 Labor Code of the Philippines

PD 603 Child and Youth Welfare Code

PD 651 decrees the registration of birth

of a child within 30 days with the
Civil Registrar

ILO Convention149 provides for the

improvement of life
and work conditions of nursing
personnel.

PD 1519 gives Medicare benefits to all

government employees
regardless of status of
appointment.

PD 1636 requires compulsory

membership in the GSIS or
SSS Retirement Plan

PD 626 Employee Compensation and

State
Insurance Fund

RA 6675 Generic Act of 1988

RA 6758 standardizes the salaries of
government employees which
include the nursing
personnel

RA 7160 The Local Government Code

RA 7305 The Magna Carta for Health

Workers

RA 7600 Rooming-in and Breastfeeding

Act

RA 7432 Senior Citizen’s Act

PD 223 creating the Professional

Regulation Commission
(Board of Nursing) and
prescribing its powers and functions.

PD 541 allows former Filipino

professionals to practice
their respective profession in the
Philippines. Balikbayans may practice
their profession during the period
of their stay in the country.
Pronouncements
Nurses’ Week - Last week of
October

National Cancer
Consciousness
Week - Second week
of January

International
Women’s Day - March 8

World Health Day - April 7

Earth Day - April 2

National Health
Worker’s Day - May 7

World Red Cross

Day - May 8

International Nurse’s
Day - May 12
World Diabetes Day - June 27

World AIDS Day - December 1

World Breastfeeding
Day - August 1

International Day
For Drug Abuse
and Child Trafficking - January 2