In the Philippines, the practice of "hospital detention" or the withholding of vital documents—specifically death certificates—due to non-payment of medical expenses is a recurring issue. While hospitals have a right to be compensated for their services, Philippine law explicitly prohibits using the release of a deceased person's remains or documents as leverage for debt collection.
The Legal Framework: Republic Act No. 9439
The primary legislation governing this issue is Republic Act No. 9439, also known as "An Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of Non-Payment of Hospital Bills or Medical Expenses."
1. Scope of the Law
The law applies to both public and private hospitals. However, it distinguishes between the types of accommodations:
- Fully Covered: Patients who stayed in "ward" accommodations are protected by the law.
- Excluded: Patients who stayed in private rooms are generally excluded from the protective provisions of RA 9439 regarding the release of documents, although human rights and civil codes still apply to the release of the body itself.
2. The Prohibition on Withholding Documents
Under RA 9439 and its Implementing Rules and Regulations (IRR), it is illegal for a hospital to withhold the death certificate and other relevant medical documents necessary for the release of the body or for burial purposes.
The law states that a patient (or their heirs/guardians) who is unable to pay the hospital bills has the right to leave the hospital or have the remains of the deceased released upon the execution of a Promissory Note.
The Mechanism for Release: Promissory Notes
To facilitate the release of the death certificate despite an outstanding balance, the following conditions must be met:
- Execution of a Promissory Note: The surviving relatives or guardians must sign a promissory note for the unpaid balance.
- Security: The note must be secured by either a mortgage or by a guarantee of a co-maker who is jointly and severally liable for the debt.
- Prohibition on Detention: Once these documents are executed, the hospital is legally mandated to release the deceased and the corresponding death certificate.
Legal Remedies and Actions
If a hospital refuses to release a death certificate despite the offer of a promissory note, the aggrieved party can pursue several legal avenues:
1. Criminal Action
RA 9439 imposes criminal liability on hospital administrators or employees who violate its provisions.
- Penalties: Violators may face a fine of not less than ₱20,000.00 but not more than ₱50,000.00, or imprisonment of not less than one month but not more than six months, or both, at the discretion of the court.
2. Administrative Action
A formal complaint can be filed with the Department of Health (DOH) through the Health Facilities and Services Regulatory Bureau (HFSRB).
- The DOH has the authority to investigate the hospital and, if found guilty of "hospital detention" or withholding documents, can suspend or revoke the hospital’s license to operate.
3. Special Civil Action: Petition for Mandamus
If the hospital refuses to perform its ministerial duty (the issuance of a death certificate required by law), the relatives may file a Petition for Mandamus.
- Mandamus is a court order compelling a corporation or board to perform an act which the law specifically enjoins as a duty resulting from an office, trust, or station.
4. Civil Action for Damages
Under the Civil Code of the Philippines, the heirs can sue the hospital for damages (Moral, Exemplary, and Actual).
- Article 19: Every person must, in the exercise of his rights and in the performance of his duties, act with justice, give everyone his due, and observe honesty and good faith.
- Article 21: Any person who willfully causes loss or injury to another in a manner that is contrary to morals, good customs or public policy shall compensate the latter for the damage.
Relevant DOH Issuances
The DOH has reinforced these laws through various Administrative Orders (e.g., DOH AO No. 2008-0001). These orders clarify that:
- Hospitals cannot refuse to issue the Certificate of Death (for registration) even if the bill is unpaid.
- The "Death Certificate" is a prerequisite for burial under the Code on Sanitation of the Philippines (PD 856). Withholding it effectively prevents the lawful burial of the deceased, which can be argued as a violation of public policy and sanitary laws.
Summary of Rights
| Issue | Legal Status |
|---|---|
| Withholding the Body | Strictly prohibited under RA 9439 for all patients. |
| Withholding Death Certificate | Prohibited if a secured Promissory Note is provided (specifically for ward patients). |
| Requirement for Burial | A Death Certificate is legally required; hospitals cannot obstruct the burial process. |
| Hospital’s Right | Hospitals retain the right to sue for collection of sum of money in civil court. |
In the eyes of Philippine law, the debt is a civil obligation, whereas the release of a body and its death certificate is a matter of human dignity and public health. One cannot be used as a ransom for the other.