"Health care professionals in the same situation should study this Supreme Court resolution in relation to their own cases."
Given my poor eyesight, I am always interested in anything to do with vision care and was intrigued by the case of ophthalmologist Mario Reyes, former head of the Ospital ng Maynila’s Opthalmology Department.
Reyes, a devout Roman Catholic, is known to express his religious faith by conducting medical missions. He provides cataract surgery that costs P50,000 per eye for free to indigent patients.
News reports from early 2018 show that he conducted several such missions in Cebu and Bohol, treating patients not only for cataract but also pterygium, glaucoma, and strabismus (crossed-eyes).
He combined the medical aspect with the religious through his involvement with Raise Me Up, a prayer counseling group, most of whose members are part of the Bukas-Loob sa Diyos community.
In 2014, Dr. Reyes was suspended by the Philippine Academy of Opthalmology for “uncoordinated missions” and other concerns related to his stint as chairman of the Department of Opthalmology of the Ospital ng Maynila.
PhilHealth, a government agency, adopted the ruling of PAO and through its Accreditation Department suspended Reyes’ accreditation as a health care professional effective Dec. 1, 2014 until Nov. 30, 2026.
Dr. Reyes asked the department as well as PhilHealth’s Board for a reconsideration of the 12-year suspension imposed but was denied both times. He then went to the Court of Appeals contending that according to law, any such suspension was illegal. He also said that PhilHealth should have given him the right to be heard.
The Court of Appeals dismissed his petition for review so Dr. Reyes elevated his concern to the Supreme Court.
In a resolution dated July 30, 2019, the SC declared that the imposition by PhilHealth of a 12-year suspension on Reyes is illegal because PhilHealth made it solely on the basis of PAO’s suspension of Reyes as its member.
The SC resolution (http://sc.judiciary.gov.ph/6361/) starts thus:
“G.R. No. 241062 (Dr. Mario D. Reyes, M.D. v. Philippine Health Insurance Corporation). In this petition for review on certiorari filed by Dr. Mario D. Reyes, M.D. (Dr. Reyes), We remind Philippine Health Insurance Corporation (PhilHealth) that it cannot impose any penalty beyond what is provided for under the law.”
According to Reyes’ counsel Atty. Saul Hofileña Jr., the resolution also states that the PAO does not determine who may practice medicine, but rather it is the government, specifically the Board of Medical Examiners.
Hofileña quoted the SC resolution that “there was no showing that Dr. Reyes’ certificate of registration to practice medicine was suspended or revoked by the Board of Medical Examiners.” The said Board is the only body that can determine whether a physician may practice medicine or not.
Hofileña added that PhilHealth should not have taken “the recommendations of medical organizations blindly since such recommendations may only be the result of enmity or ill-will.”
Hofileña said further that the ‘findings’ of the Philippine Academy of Ophthalmology “were made without giving Dr. Mario Reyes the opportunity to explain his side. In other words, the entire proceedings were bereft of due process.”
This Supreme Court ruling is one of a series of setbacks that has plagued the PhilHealth under the current administration. The agency was under scrutiny in recent months for the alleged overpayments on PhilHealth claims totaling P154 billion over the past six years, particularly in relation to “ghost” dialysis claims.
No less than President Rodrigo Duterte himself expressed his displeasure over the alleged misuse of public funds, in June ordering the National Bureau of Investigation to conduct probes on those involved in the filing of fraudulent claims.
On Aug. 14, the Senate held a hearing to investigate alleged corruption in PhilHealth and the Department of Health.
Going back to the case of Reyes, the SC resolution is a victory for him in that PhilHealth was sternly reminded that they may not impose penalties such as suspension that are not in accordance with the law, and that they should not base suspensions on the decisions of private organizations, especially if the individual is not sanctioned in any way by the Board of Medical Examiners.
Health care professionals in the same situation should study this SC resolution in relation to their own cases.
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