A ‘tipping point’ at Tarlac Provincial Hospital

(Conclusion)

Doctors and nonmedical workers at the Tarlac Provincial Hospital (TPH) got a big surprise they never expected since first week of May this year when their PhilHealth-pooled professional fees (PFs) have been withheld, allegedly with the instructions of Tarlac Gov. Vic Yap.

The TPH doctors and workers, led by anesthesiologist Dr. Nitz De Paño, are making a courageous stand to fight for what they believe is a violation of their rights. They’re not only fighting for themselves, but for the rights of all government health workers, Dr. De Paño told me in her e-mail.

This is not only an isolated problem, localized to TPH, Dr. De Paño said. They’re fighting for what could become a problem in all government hospitals throughout the country, which have been devolved to the local government unit (LGU) from the Department of Health (DOH) since 1991.

Incentive for hard work

The TPH doctors are standing their ground and resisting the revision of the 70:30-percent division scheme of PhilHealth funds paid for case-rate services rendered to patients admitted and treated in their hospital. The 30 percent is supposed to be pooled and divided equitably to the medical and nonmedical personnel of all government hospitals as an incentive for all the hard work they’ve done.

But in the case of TPH, the doctors think that the provincial government considers it their prerogative how they should distribute the PF-allocated funds.

“After a series of revisions—where initially, he (Governor Yap) wants to give only a very small percent for distribution—now, in effect, he wants it (the pooled PF funds) to be under the control of a management committee (ManCom), whose members will be appointed by his office and/or the chief of hospital,” Dr. De Paño said.

To get guidance on this conflict, Dr. De Paño and her TPH coworkers wrote to PhilHealth main office; and in a legal opinion dated June 25, 2015, lawyer Edgar Julio Asuncion, PhilHealth senior vice president and chief legal executive, wrote: “ … it clearly states … all hospitals, whether national or devolved, are covered by the policies, rules and regulations issued by DOH and PhilHealth, insofar as distribution of pooled PFs (70:30-percent sharing) is concerned. Although there is no dispute that… local government units have administrative control and supervision over devolved hospitals pursuant to the Local Government Code of 1991.”

Professional fees

I find this to be an equivocal statement which was probably intended to be Solomonic, but it does not give clear, absolute instructions on how the funds they (PhilHealth) gave are supposed to be divided. If 30 percent of the case-rate fees given by PhilHealth to the hospital is really intended as professional fees for services rendered by the doctors and other hospital workers, then they belong to the hospital personnel, and the LGU official and hospital administrators have no authority to reallocate them for some other purpose.

Despite everything, the TPH doctors and their coworkers should still give Governor Yap the benefit of the doubt that he’s trying to find a win-win solution to this problem, which apparently he unwittingly created. Several weeks into the controversy, he has instructed the chief of hospital to sit down with the doctors and coworkers to come up with a mutually acceptable agreement. “We got lucky since the (new) guidelines were put on hold,” said Dr. De Paño.

Governor Yap also subsequently announced that he is allowing the newly appointed chief of hospital to release the pooled PFs from March 16 to June 30, 2015, which the hospital has already received from PhilHealth; and the division will be based on the old or previously practiced 70:30-percent division scheme.

But that’s how far the TPH doctors’ and coworkers’ luck got.

PFs remain withheld

The pooled PFs, up to this writing, remained withheld. Dr. De Paño also decries what they see as plain and simple harassment of those who are standing for the doctors’ cause. Even the regular salaries of first-year residents (Medical Officers I) were also withheld, and were released only after they filed a civil service complaint.

“The rank and file have suffered tremendously since this (the PhilHealth incentive) was withheld around enrollment time. Some were not able to enroll their children and some had their ATMs pawned for cash,” said Dr. De Paño.

Contractual consultants, who are siding with the doctors, have also been terminated by nonrenewal of their contracts; when prior to this conflict, contractual consultants were automatically renewed for the past 20 years.

All department chairpersons were forced to submit a “courtesy” resignation within 48 hours. Except for one, they are opposed to the new PF guidelines.

Human rights violation

Dr. De Paño said that no resident physician is allowed “to lie down or rest even for awhile” during his/her 24 hours of duty. Keys to their quarters at the ER were allegedly confiscated.

Oh my, this has gone a bit too far already. If true, this is certainly a human rights violation. No human should be made to work straight for 24 hours without allowing them some periods of rest in between. This is not only detrimental to their health, but it can also compromise their judgment in evaluating their patients and deciding what is the best treatment for these patients, especially in cases of emergency.

“Residents were told to sign the agreement, so their contract can be renewed, or their salaries released. Nurses, janitors, aides and other nonmedical personnel were forced to sign under threat of their employment,” said Dr. De Paño.

The TPH workers have already elevated their predicament to PhilHealth, the DOH, the Philippine Medical Association (PMA) and other medical societies.

“We have exhausted all avenues to be heard, but unfortunately we are still at an impasse,” said Dr. De Paño.

Country’s unsung heroes

As of this writing, the TPH doctors and nonmedical personnel do not see yet the light at the end of the tunnel. Hopefully, from where the provincial government of Tarlac stands, the governor and his administrators can see the light better and appreciate the great sacrifices government physicians and workers do. They’re among the unsung heroes of our country.

While many of us bask in the recognition and praises heaped on our accomplishments, and enjoy the generous economic incentives that come with them, the government physicians and workers toil for a small fraction of what they could get had they been in private or corporate practice.

A governor or mayor is not expected to extol them to high heavens, but the least they could do is show our government doctors and health workers a bit of appreciation and respect.

I hear that Gov. Vic Yap is a just and reasonable person. I’m sure he’ll find it in his heart to understand the plight of the medical and nonmedical workers at the Tarlac Provincial Hospital.