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[ G.R. No. 234448, November 06, 2018 ]

PRIVATE HOSPITALS ASSOCIATION OF PHILIPPINES v. SALVADOR MEDIALDEA +

PRIVATE HOSPITALS ASSOCIATION OF THE PHILIPPINES, INC. (PHAPI) REPRESENTED BY ITS PRESIDENT, DR. RUSTICO JIMENEZ, PETITIONER, VS. HON. SALVADOR MEDIALDEA, EXECUTIVE SECRETARY, AND THE ACTING SECRETARY OF DEPARTMENT OF HEALTH, RESPONDENTS.

DECISION

TIJAM, J.:

On grounds of denial of substantive due process, repugnancy to the constitutional presumption of innocence, violation of the equal protection and involuntary servitude clauses, petitioner Private Hospitals Association of the Philippines, Inc., (PHAPi) - an organization of privately-owned clinics, hospitals, and other health facilities - seeks to declare as unconstitutional and void the duty imposed upon hospitals, medical practitioners and employees to prevent actual death or injury under Section 1; the penal provisions under Section 4; the presumption of liability clause under Section 5; and the reimbursement and tax deduction clause under Sections 7 and 8, all of Republic Act (R.A.) No. 10932^[1] otherwise known as an Act Strengthening the Anti-Hospital Deposit Law.

The Antecedents

In 1984, Batas Pambansa (BP) Bilang 702 entitled An Act Prohibiting the Demand of Deposits or Advance Payments for the Confinement or Treatment of Patients in Hospitals and Medical Clinics in Certain Cases was enacted. BP 702 was described as a landmark legislative measure that aimed to stop the practice of hospitals and medical clinics of asking for deposits or advance payments for treatment or confinement of patients in emergency and serious cases.^[2]

Essentially, BP 702 makes it unlawful for any director, manager or any other officer of a hospital or medical clinic to demand any deposit or any other form of advance payment for confinement or treatment in such hospital or medical clinic in emergency or serious cases.^[3] BP 702 penalizes such erring director, manager or any other officer of a hospital or medical clinic with a fine of not less than one thousand pesos but not more than two thousand pesos or imprisonment for not less than fifteen days but not more than thirty days, or both such fine and imprisonment.^[4]

On August 25, 1997, BP 702 was amended by R.A. No. 8344.^[5] R.A. No. 8344 makes it unlawful not only to demand, but also to request, solicit, and accept any deposit or advance payment as a prerequisite for confinement or medical treatment in emergency or serious cases. R.A. No. 8344 further makes the refusal to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability unlawful. In case the hospital or the medical clinic has no adequate medical capabilities, R.A. No. 8344 outlines the procedure for the transfer of the patient to a facility where appropriate care can be given.^[6] Under a new provision, R.A. No. 8344 allows the transfer of the patient to an appropriate hospital consistent with the latter's needs after the hospital or medical clinic has administered medical treatment and support.^[7]

R.A. No. 8344 also provides the following governing definitions for purposes of the law:

(a) Emergency - a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient.

(b) Serious case - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient.

(c) Confinement - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic.

(d) Hospital - a facility devoted primarily to the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients.

(e) Emergency treatment and support - any medical or surgical measure within the capability of the hospital or medical clinic that is administered by qualified health care professionals to prevent the death or permanent disability of a patient.

(f) Medical clinic - a place in which patients can avail of medical consultation or treatment on an outpatient basis.

(g) Permanent disability - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No. 442; as amended, otherwise known as the Labor Code of the Philippines.

(h) Stabilize - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer.

R.A. No. 8344 also increased the penalties prescribed under BP 702 to imprisonment of not less than six months and one day but not more than two years and four months, or a fine of not less than twenty thousand pesos, but not more than one hundred thousand pesos, or both at the discretion of the court. However, if the violation was committed pursuant to an established hospital or clinic policy or upon the instruction of its management, the director or officer responsible for the formulation and implementation of such policy shall suffer imprisonment of four to six years, or a fine of not less than one hundred thousand pesos, but not more than five hundred thousand pesos, or both, at the court's discretion.^[8]

Sensing the need to curb the still prevalent practice of refusing to provide initial medical treatment and support in emergency or serious cases without the corresponding deposit or advance payment, House Bill No. 5159^[9] was submitted by the House Committee on Health which seeks to increase the penalties for violation of BP 702 as amended by R.A. No. 8344; expand the definition of "emergency care" to include women in active labor and at the risk of miscarriage or fetal distress; include reimbursement from the Philippine Health Insurance Corporation (PhilHealth) for the expenses advanced by hospitals and medical facilities in treating poor and indigent patients; and mandate the Philippine Charity Sweepstakes Office (PCSO) to provide assistance to poor and marginalized patients on emergency treatment in hospitals.^[10]

This development met similar support from the Senate through Senate Bill No. 1353^[11] submitted by its Committees on Health and Demography, Justice and Human Rights, and Ways and Means. Similar to its lower house counterpart, Senate Bill No. 1353 aims to increase the penalties for violation of the law; define "basic emergency care"; and include PhilHealth reimbursement of basic emergency care incurred by the hospital or medical clinic. However, peculiar to the Senate version is the presumption of liability imposed against the hospital, medical clinic, and the involved official, medical practitioner, or employee in the event of death, permanent disability, serious impairment of the health condition of the patient, or injury to or loss of the unborn child proceeding from the denial of admission to the health facility pursuant to a policy or practice of demanding deposits or advance payments for confinement or treatment.

A consolidation of Senate Bill No. 1353 and House Bill No. 5159 gave birth to R.A. No. 10932 which was signed into law on August 3, 2017.

Thus, as it presently stands, R.A. No. 10932 makes it unlawful to request, solicit, demand or accept deposit or advance payment as a prerequisite not only for confinement or medical treatment but also for administering basic emergency care.^[12] It expands the scope of "basic emergency care" to include medical procedures and treatment administered to a woman in active labor.^[13]

In case a transfer to another hospital is deemed appropriate, R.A. No. 10932 further mandates the local government unit where the hospital or medical clinic is located to allow free use of its emergency medical vehicle. Moreover, all hospitals are required to post a notice indicating its classification level and the list of medical services it is authorized to perform.^[14]

R.A. No. 10932 also introduces the creation of a Health Facilities Oversight Board (Board) where complaints against health facilities for violations of the law shall be initially filed. The Board is given the power to investigate, adjudicate and impose administrative sanctions including the revocation of the health facility's license.^[15]

Further to the matter of penalties, R.A. No. 10932 imposes upon an erring official, medical practitioner or employee of the hospital or medical clinic the penalty of imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than P100,000.00, but not more than P300,000.00, or both at the court's discretion. However, when the violation was made pursuant to an established hospital policy or upon instructions of its management, the penalties are increased as against the director or officer formulating and implementing such policy to four (4) years to six (6) years, or a fine of not less than P500,000.00, but not more than P1,000,000.00, or both, without prejudice to an award for damages.^[16]

In addition, R.A. No. 10932 introduces the three-strike rule, or when upon 3 repeated violations committed pursuant .to an established policy or upon instruction of the management, the health facility's license to operate shall be revoked by the Department of Health (DOH). The law also makes the president, chairman, board of directors, or trustees and other officers of the health facility solidarily liable for damages.^[17]

Apart from the foregoing, R.A. No. 10932 presumes liability against the hospital, medical clinic, and the official, medical practitioner, or employee involved, in the event of death, permanent disability, serious impairment or permanent injury to or loss of an unborn child, proceeding from the denial of admission to a health facility pursuant to a policy of requiring deposits or advance payments for confinement or treatment.^[18]

R.A. No. 10932 also mandates that the PhilHealth reimburse the cost of the basic emergency care and transportation services rendered by the hospital or medical clinic to poor and indigent patients and that the PCSO provide medical assistance for the basic emergency care needs of the poor and marginalized groups. Expenses incurred in giving basic emergency care to poor and indigent patients not reimbursed by PhilHealth are allowed to be treated as tax deductions.^[19]

Meanwhile, pending resolution of the instant petition or on April 4, 2018, the DOH issued Administrative Order No. 2018-0012 implementing R.A. No. 10932.

The Arguments for the Petitioner

Petitioner claims locus standi to file the present Petition for Certiorari and Prohibition as it stands to be directly injured by the implementation of R.A. No. 10932 insofar as the law regulates the conduct of its members and places the latter's management and staff at the risk of administrative, civil, and criminal sanctions.^[20] At any event, petitioner claims that the issues herein presented specifically on the denial of due process and to equal protection of laws are of transcendental importance that should allow the present petition to prosper despite the absence of direct injury.^[21]

Petitioner further claims that the issues raised in the instant petition are ripe for adjudication given the imminent threat of the imposition of the unconstitutional duties and the corresponding unconstitutional sanctions under R.A. No. 10932 against petitioner's members with the impending approval of the rules implementing R.A. No. 10932.^[22] Petitioner also argues that an allegation that R.A. No. 10932 infringes upon the constitutional rights to due process, equal protection of laws and the presumption of innocence, is sufficient to invoke the Court's power of review.^[23]

Claiming exception to the doctrine of hierarchy of courts, petitioner also advances the view that direct resort to the Court is justified given the genuine issues of constitutionality posed by the present petition.^[24]

Going into the merits of the petition, petitioner seeks to strike down as unconstitutional R.A. No. 10932 for being unduly oppressive and thus violative of substantive due process. Elaborating, petitioner argues that Section 1 of BP 702 as amended by R.A. No. 8344 and R.A. No. 10932 imposes upon the proprietor, president, director, manager or any other officer, medical practitioner or employee of a health care institution the duty to administer basic emergency care or medical treatment and support as dictated by good practice of medicine to prevent death, or permanent disability, or in the case of a pregnant woman, permanent injury or loss of her unborn child, or non-institutional delivery in emergency or serious cases.^[25]

Petitioner argues that "basic emergency care" and "emergency treatment and support" as defined under R.A. No. 10932 imposes upon the physician, the hospital, its management and staff the untenable duties to actually prevent death, permanent disability, permanent injury to or loss of an unborn baby or its non-institutional delivery and to sufficiently address an emergency situation and in case of a woman in active labor, to ensure the safe delivery of the baby.^[26] Echoing Lucas, et al. v. Dr. Tuaño,^[27] petitioner emphasizes that a physician is not an insurer of the good result of treatment.^[28] Petitioner thus argues that the duty imposed by R.A. No. 10932, being predicated on the achievement of an end that is impossible to guarantee, amounts to a denial of due process.^[29]

Further, petitioner aims to strike down the fines imposed under Section 4 for being unjust, excessive, and oppressive as they are not commensurate to the act or omission that is being penalized.^[30] Petitioner also questions the solidary liability for damages under Section 4 insofar as it generally makes "other officers" of the health facility solidarily liable with the president, chairman, members of the board of directors or trustees.^[31]

The presumption of liability spelled under Section 5 of R.A. No. 10932 is also being assailed for being repugnant to the constitutional presumption of innocence. It is the contention of petitioner that the presumption of liability clause allows for a presumption of generalized liability, i.e., administrative, civil and criminal, upon the occurrence of death, permanent disability and serious impairment of the health condition of the patient or her unborn child after the denial of the patient's admission due to a hospital policy of demanding deposits or advance payments.^[32]

Also, petitioner emphasizes that the presumption of liability clause necessarily presumes that there is, at all times, a causal connection between the injury and the acts or omissions complained of.^[33] Expounding on this argument, petitioner argues that the offense defined under R.A. No. 10932 involves medical malpractice. As such, the causation between the injury and the medical action are determinable only through the technical and scientific competence of physicians and thus, cannot be presumed by law.^[34]

Finally, petitioner seeks to strike down as unconstitutional the exclusion of the basic emergency care of patients not classified as poor, indigent or marginalized from PhilHealth reimbursement, PCSO assistance and tax deductibility under Sections 7 and 8 of R.A. No. 10932 for being violative of the equal protection clause.

Illustrating its argument, petitioner contends that these provisions would allow a hospital who treats a poor patient to receive PhilHealth reimbursement, PCSO assistance and tax deduction, and yet the hospital who treats a patient not classified as poor, indigent or marginalized will not be allowed a similar PhilHealth reimbursement, PCSO assistance and tax deduction.^[35] It is likewise the view of petitioner that the law, insofar as it obliges hospitals, its staff and management to render services to patients not classified as poor, indigent, or marginalized without the corresponding reimbursement, assistance and tax deduction, amounts to involuntary servitude.^[36]

The Arguments for the Respondents

Respondents Hon. Salvador Medialdea, Executive Secretary, and the Acting Secretary of Department of Health, through the Office of the Solicitor General (OSG), seek to dismiss the instant petition for being procedurally infirm on the ground that certiorari and prohibition are proper only against judicial, quasi-judicial, or ministerial act. Like so, respondents seek a dismissal of the petition for lack of a justiciable controversy in the absence of an actual governmental act which directly causes or will imminently cause injury to the alleged right of petitioner.^[37] Respondents also attacks petitioner's standing to file the present petition for lack of personal stake in the outcome of the controversy, it being neither a hospital or health facility itself.^[38] Further, respondents assert that the issues raised by petitioner being speculative are not matters of transcendental importance that would justify a disregard of the rule on locus standi and the doctrine of hierarchy of courts.^[39]

Contrary to petitioner's claims, respondents contend that R.A. No. 10932 does not impose upon the hospital, medical facility, its staff or management the duty to guarantee that death, permanent loss or injury is prevented, neither does it penalize the failure of the physician or the hospital staff to prevent such occurrences. Rather, respondents argue that what R.A. No. 10932 prohibits is the act of requesting any form of advance payment as a prerequisite for administering basic emergency care or medical treatment, or the act of refusing to administer such as dictated by good practice to prevent death, permanent loss or injury.^[40]

Also, respondents maintain that the fines imposed under R.A. No. 10932 are reasonable, and that in any case, the determination of the propriety of fines for violation of offenses lies within the discretion of the legislature.^[41] Respondents add that neither is the solidary liability imposed by law unreasonable because such arises only from the participatory acts of the directors and officers who are responsible for the formulation and implementation of policies contrary to the mandates of R.A. No. 10932 and pertains only to damages which may be awarded to the patient-complainant.^[42]

Respondents likewise defend the validity of the presumption of liability clause on the argument that the liability therein mentioned pertains to the liability for the death, permanent disability, serious impairment, injury or loss of the unborn child and that such presumption arises only upon prior proof that there was denial of admission to the health facility and that such denial was made pursuant to a policy of demanding deposits for confinement or treatment.^[43]

Addressing the supposed violation of the equal protection clause, respondents maintain that patients classified as "poor", "indigent", or "marginalized" substantially differ from those who are not categorized as such, hence the provision on PhilHealth reimbursement, PCSO assistance and tax deduction must be upheld in the face of the equal protection challenge.^[44]

Issues

Before the Court addresses the questions of constitutionality raised against certain provisions of R.A. No. 10932, it is imperative to first determine whether the Court, in fact, can discharge its power of judicial review. This is, in turn, determined by addressing the following issues: (a) are petitions for certiorari and prohibition proper to assail the constitutionality of R.A. No. 10932; (b) is direct resort to the Court proper; (c) has petitioner, as an association of privately-owned hospitals, clinics and other health facilities, the requisite legal standing; and (c) is the petition ripe for adjudication.

Ruling of the Court

We dismiss the petition. While the remedies of certiorari and prohibition are proper legal vehicles to assail the constitutionality of a law, the requirements for the exercise of the Court's judicial review even under its expanded jurisdiction must nevertheless first be satisfied.

Propriety of Certiorari and Prohibition

Petitioner seeks to declare as unconstitutional certain provisions of R.A. No. 10932 and for this purpose, availed of the remedy of certiorari and prohibition. Respondents counter that certiorari and prohibition are available only against judicial, quasi-judicial or ministerial functions and not against legislative acts, as in the instant case.

The rule is settled that the allegations in the complaint and the character of the relief sought determine the nature of the action and the court that has jurisdiction over it.^[45] The present petition specifically alleges that R.A. No. 10932 is unconstitutional for being violative of substantive due process, the presumption of innocence, and the equal protection of laws and as such, seeks that the enforcement and implementation thereof be prohibited.

Under Rule 65 of the Rules of Court, the ground for review in certiorari and prohibition is grave abuse of discretion, and there is grave abuse of discretion when an act is done contrary to the Constitution, the law or jurisprudence or executed whimsically, capriciously or arbitrarily, out of malice, ill will or personal bias.^[46] Petitions for certiorari and prohibition are thus appropriate remedies to raise constitutional questions.^[47]

Grave abuse of discretion as a ground for review does not only appear under Rule 65 of the Rules of Court but also under Section 1,^[48] Article VIII of the Constitution defining judicial power. As constitutionally defined, judicial power includes not only the duty to settle actual controversies involving rights which are legally demandable and enforceable, but also, the duty to determine whether or not there has been grave abuse of discretion amounting to lack or excess of jurisdiction on the part of any branch or instrumentality of the government. Such innovation under the 1987 Constitution later on became known as the Court's "traditional jurisdiction" and "expanded jurisdiction," respectively.^[49]

Given the commonality of the ground of grave abuse of discretion, the Court has allowed the use of a Rule 65 petition to invoke this Court's expanded jurisdiction.^[50]

As expressly granted by the Constitution, the Court's expanded jurisdiction when invoked permits a review of acts not only by a tribunal, board or officer exercising judicial, quasi-judicial or ministerial functions, but also by any branch or instrumentality of the Government. "Any branch or instrumentality of the Government" necessarily includes the legislative and the executive, even if they are not exercising judicial, quasi-judicial or ministerial functions.^[51]

In Pedro Agcaoili, Jr., et al. v. The Honorable Representative Rodolfo C. Fariñas, et al.,^[52] we affirmed the availability of the extraordinary writs for determining and correcting grave abuse of discretion amounting to lack or excess of jurisdiction on the part of the legislative and executive branches following Judge Villanueva v. Judicial and Bar Council,^[53] as follows:

With respect to the Court, however, the remedies of certiorari and prohibition are necessarily broader in scope and reach, and the writ of certiorari or prohibition may be issued to correct errors of jurisdiction committed not only by a tribunal, corporation, board or officer exercising judicial, quasi-judicial or ministerial functions but also to set right, undo and restrain any act of grave abuse of discretion amounting to lack or excess of jurisdiction by any branch or instrumentality of the Government, even if the latter does not exercise judicial, quasi-judicial or ministerial functions. This application is expressly authorized by the text of the second paragraph of Section 1, supra.

Thus, petitions for certiorari and prohibition are appropriate remedies to raise constitutional issues and to review and/or prohibit or nullify the acts of legislative and executive officials.^[54] (Citation omitted and emphasis ours)

Accordingly, we held as proper remedies the writs of certiorari and prohibition in Samahan ng mga Progresibong Kabataan (SPARK), et al. v. Quezon City, as represented by Mayor Herbert Bautista, et al.,^[55] assailing the constitutionality of curfew ordinances and in Agcaoili questioning the contempt powers of the Congress in the exercise of its power of inquiry in aid of legislation. Following this trend in jurisprudence, petitioner therefore correctly availed of certiorari and prohibition under Rule 65 of the Rules of Court to assail the constitutionality of R.A. No. 10932 and enjoin its enforcement, notwithstanding that these governmental actions do not involve the exercise of judicial, quasi-judicial or ministerial functions.

Direct Resort to the Court

Jurisdiction over petitions for certiorari and prohibition are shared by this Court, the Court of Appeals, the Sandiganbayan and the Regional Trial Courts.^[56] Since the remedies of certiorari and prohibition are available to assail the constitutionality of a law, the question as to which court should the petition be properly filed consequently arises given that the hierarchy of courts "also serves as a general determinant of the appropriate forum for petitions for the extraordinary writs."^[57]

Respondents argue that direct resort to this Court is unjustified and thus violates the doctrine of hierarchy of courts.

Under the doctrine of hierarchy of courts, "recourse must first be made to the lower-ranked court exercising concurrent jurisdiction with a higher court."^[58] As a rule, "direct recourse to this Court is improper because the Supreme Court is a court of last resort and must remain to be so in order for it to satisfactorily perform its constitutional functions, thereby allowing it to devote its time and attention to matters within its exclusive jurisdiction and preventing the overcrowding of its docket."^[59]

Nevertheless, we cautioned in The Diocese of Bacolod, et al. v. COMELEC, et al.,^[60] that the Supreme Court's role to interpret the Constitution and act in order to protect constitutional rights when these become exigent is never meant to be emasculated by the doctrine of hierarchy of courts. As such, this Court possesses full discretionary authority to assume jurisdiction over extraordinary actions for certiorari filed directly before it for exceptionally compelling reasons, or if warranted by the nature of the issues clearly and specifically raised in the petition.^[61]

As developed by case law, the instances when direct resort to this Court is allowed are enumerated in The Diocese of Bacolod^[62] as follows: (a) when there are genuine issues of constitutionality that must be addressed at the most immediate time;^[63] (b) when the issues involved are of transcendental importance;^[64] (c) in cases of first impression;^[65] (d) the constitutional issues raised are better decided by the Supreme Court;^[66] (e) the time element or exigency in certain situations;^[67] (f) the filed petition reviews an act of a constitutional organ;^[68] (g) when there is no other plain, speedy, and adequate remedy in the ordinary course of law;^[69] (h) the petition includes questions that are dictated by public welfare and the advancement of public policy, or demanded by the broader interest of justice, or the orders complained of were found to be patent nullities, or the appeal was considered as clearly an inappropriate remedy.^[70]

The present petition, while directed against an act of a co-equal branch of the government and concerns a legislative measure directly affecting the health and well-being of the people, actually presents no prima facie challenge, as hereunder expounded, as to be so exceptionally compelling to justify direct resort to this Court.

Requisites of Judicial Review

Notwithstanding the propriety of the legal vehicle employed, the Court cannot exercise its power of judicial review, even under its expanded jurisdiction, when the requisites for the exercise thereof are not satisfied.

"The power of judicial review is the power of the courts to test the validity of executive and legislative acts for their conformity with the Constitution."^[71] When exercised, the judiciary does not arrogate upon it a position superior to that of the other branches of the government but merely upholds the supremacy of the Constitution.

In Congressman Garcia v. The Executive Secretary,^[72] the Court held that, for a proper exercise of its power of review, certain requisites must be satisfied, namely:

(1) an actual case or controversy calling for the exercise of judicial power; (2) the person challenging the act must have standing to challenge; he must have a personal and substantial interest in the case such that he has sustained, or will sustain, direct injury as a result of its enforcement; (3) the question of constitutionality must be raised at the earliest possible opportunity; and (4) the issue of constitutionality must be the very lis mota of the case.^[73]

Arguing the absence of the first and second requisites, respondents seek an outright dismissal of the instant petition. We agree.

Actual Case or Controversy

"[A]n actual case or controversy is one which involves a conflict of legal rights, an assertion of opposite legal claims, susceptible of judicial resolution as distinguished from a hypothetical or abstract difference or dispute."^[74] To be justiciable, the case or controversy must present a contrariety of legal rights that can be interpreted and enforced on the basis of existing law and jurisprudence. Regardless of whether the Court's power of review is invoked under the traditional or expanded concept, the presence of an actual case or controversy remains a requisite before judicial power is exercised.^[75] However, when the Court's expanded jurisdiction is invoked, the requirement of an actual case or controversy is satisfied upon a prima facie showing of grave abuse of discretion in the assailed governmental act.^[76] Alexander A. Padilla, et al. v. Congress of the Philippines^[77] emphasized that for the Court to exercise its power of judicial review and give due course to a petition for certiorari, the petitioners should set forth their material allegations to make out a prima facie case for certiorari.

Interrelated with the requirement of an actual case or controversy is the requirement of ripeness. Consistently, a question is considered ripe for adjudication when the act being challenged has had a direct adverse effect on the individual or entity challenging it. The question of ripeness asks whether a case involves contingent events that may not occur as anticipated and whether there is actual injury to the party being suit.^[78] Thus, it is required that an act had been accomplished or performed by either branch of the government and that there is an immediate or threatened injury to the petitioner as a result of the challenged action before courts may interfere.^[79] In Province of North Cotabato, et al. v. Gov't. of the Rep. Of the Phils. Peace Panel on Ancestral Domain (GRP), et al.,^[80] we held that "[w]hen an act of a branch of government is seriously alleged to have infringed the Constitution, it becomes not only the right but in fact the duty of the judiciary to settle the dispute."^[81]

The allegations set forth in the petition failed to meet the requirement of a prima facie showing of grave abuse of discretion on the part of the Congress relative to the provisions of R.A. No. 10932. While R.A. No. 10932 and its implementing rules are accomplished acts of a co-equal branch of the government, the petition is unfortunately bereft of any allegation that petitioner, nor any of its members, had thereby suffered an actual or direct injury as a result of a discretion gravely abused. In the absence of an actual and direct injury, any pronouncement by the Court would be purely advisory or sheer legal opinion, in view of the mere hypothetical scenarios which the instant petition presents.

The challenged law also enjoys the presumption of constitutionality which the Court, at the first instance, cannot disturb in the absence of a prima facie showing of grave abuse of discretion and, upon delving into the merits, in the absence of a clearest showing that there was indeed an infraction of the Constitution.^[82] If the Court were to invalidate the questioned law on the basis of conjectures and suppositions, then it would be unduly treading questions of policy and wisdom not only of the legislature that passed it, but also of the executive which approved it.^[83]

Legal Standing

Closely related to the constitutional mandate that the Court settle only actual cases or controversies is the requirement of legal standing. Invariably, legal standing or locus standi is defined as a personal and substantial interest in a case such that the party has sustained or will sustain direct injury as a result of the governmental act that is being challenged.^[84]

As a rule, a party is allowed to raise a constitutional question when (1) he can show that he will personally suffer some actual or threatened injury because of the allegedly illegal conduct of the government; (2) the injury is fairly traceable to the challenged action; and (3) the injury is likely to be redressed by a favorable action.^[85]

Sans doubt, R.A. No. 10932 governs the conduct of hospitals, medical facilities, medical practitioners and employees inasmuch as the law imposes upon the latter certain obligations and imposes corresponding sanctions in case of violation. However, petitioner itself, is not a hospital, a medical facility, a medical practitioner or employee, but an association thereof.

Section 1,^[86] Rule 3 of the Rules of Court provides that juridical persons authorized by law may be parties in a civil action. In turn, Article 44^[87] of the Civil Code enumerates the juridical persons having capacity to sue which includes corporations, partnerships and associations for private interest or purpose to which the law grants a juridical personality, separate and distinct from that of each shareholder, partner or member. Section 4,^[88] Rule 8 of the Rules of Court mandates that "[f]acts showing the capacity of a party to sue or be sued or the authority of a party to sue or be sued in a representative capacity or the legal existence of an organized association of persons that is made a party, must be averred."

Thus, while juridical persons, like an association, are endowed with the capacity to sue or be sued, it must demonstrate substantial interest that it has sustained or will sustain direct injury. Assuming a hospital is found liable for violating the provisions of R.A. No. 10932, the liability or direct injury inures not to the petitioner association itself but to the member-hospital.

To be sure, the rule on standing admits of recognized exceptions: the over breadth doctrine, taxpayer suits, third party standing and the doctrine of transcendental importance.^[89] To fall under the third party exception, an association filing a case on behalf of its members must not only show that it stands to suffer direct injury, but also that it has been duly authorized.by its members to represent them or sue in their behalf.^[90]

In this case, while petitioner successfully averred that it is a non stock, non-profit organization, existing under the laws of the Philippines and identified its members being the sole national organization of purely privately owned clinics, hospitals or other health facilities in the Philippines, dedicated to the management and concerns of private hospitals in the country,^[91] it failed to demonstrate that ample authority had been extended to it by its members to file the instant petition.

The attached Board Resolutions^[92] and Secretary's Certificate^[93] merely state that the "members of the [petitioner], view [R.A. No. 10932] as [unconstitutional] with respect to its penal provisions or Section 4 thereof, the same being oppressive and confiscatory; and with respect to its provision on 'Presumption of Liability' or Section 5 thereof, which is utterly against the Constitutional provision on 'Presumption of Innocence'" without authorizing petitioner to file the necessary petition to question the constitutionality of the law before any court. Petitioner therefore cannot benefit from the third party exception to the requirement of locus standi.

In view of the foregoing limitations, there is no reason for the Court to take cognizance of the present petition.

WHEREFORE, the Petition is DISMISSED.

SO ORDERED.

Carpio, (Senior Associate Justice), Peralta, Bersamin, Jardeleza, A. Reyes, Jr., and Hernando, JJ., concur.
Del Castillo, J., on official leave.
Perlas-Bernabe, J., Please see Concurring Opinion.
Leonen, J., See separate concurring opinion.
Caguioa, J., See separate concurring.
Gesmundo, J., on official leave.
J. Reyes, Jr., J., on official leave.

NOTICE OF JUDGMENT

Sirs/Mesdames:

Please take notice that on November 6, 2018 a Decision, copy attached herewith, was rendered by the Supreme Court in the above-entitled case, the original of which was received by this Office on December 12, 2018 at 3:10 p.m.

	Very truly yours,

	(SGD)
	EDGAR O. ARICHETA
	Clerk of Court

x x x x

SEC. 3. After the hospital or medical clinic mentioned above shall have administered medical treatment and support, it may cause the transfer of the patient to an appropriate hospital consistent with the needs of the patient, preferably to a government hospital, specially in the case of poor or indigent patients.

^[8] Section 2. Section 2 of Batas Pambansa Bilang 702 is hereby deleted and in place thereof, new sections 2, 3 and 4 are added, to read as follows:

x x x x

SEC. 4. Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of this Act shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than Twenty thousand pesos (P20,000.00), but not more than One hundred thousand pesos (P100,000.00) or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than One hundred thousand pesos (P100,000.00), but not more than Five hundred thousand pesos (P500,000.00) or both, at the discretion of the court.

^[9] AN ACT STRENGTHENING THE PROVISION OF EMERGENCY HEALTH CARE SERVICE TO PATIENTS, FURTHER AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, AS AMENDED, ENTITLED "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCED PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES."

^[10] See Fact Sheet of House Bill No. 5159.

^[11] AN ACT INCREASING THE PENALTIES FOR THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES" AS AMENDED BY REPUBLIC ACT NO. 8344, AND FOR OTHER PURPOSES.

^[12] Section 1. Section 1 of Batas Pambansa Bilang 702, as amended, is hereby further amended to read as follows:

Sec. 1. In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for administering basic emergency care to any patient, confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death, or permanent disability, or in the case of a pregnant woman, permanent injury or loss of her unborn child, or noninstitutional delivery: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act.

^[13] Section 2. Section 2 of the same Act, as amended, is hereby further amended to read as follows:

"Sec. 2. For purposes of this Act, the following definitions shall govern:

"x x x x

"(i) 'Basic emergency care' - the response to a situation where there is urgently required medical care and attention, and shall include procedures required for initial diagnosis, use of equipment and supplies in sufficiently addressing the emergency situation, considering the welfare of the patient. It also includes the necessary medical procedures and treatment administered to a woman in active labor to ensure the safe delivery of the newborn.

"(j) 'Noninstitutional delivery' - the delivery of a newborn while in transit, outside of a health facility, after an initial consultation was done with a health facility."

^[14] SEC. 3. Section 3 of the same Act, as amended, is hereby further amended to read as follows:

"SEC. 3. After the hospital or medical clinic mentioned above shall have administered medical treatment and support, it may cause the transfer of the patient to an appropriate hospital consistent with the needs of the patient, especially in the case of poor or indigent patients.

Where there is no ambulance available for use by the hospital or medical clinic for the emergency transfer of the patient to a facility where the appropriate care shall be given, the local government unit (LGU) where the hospital or medical clinic is located must allow the free use of its emergency vehicle to transport the patient to the hospital or medical clinic where a continuation of care shall be given. The hospital or medical clinic must provide a staff nurse with advanced cardiovascular life support (ACLS) certification or its equivalent to accompany the patient in the emergency vehicle.

All hospitals are required to post at their entrance a notice indicating the classification level of the hospital as licensed by the Department of Health (DOH) and the list of medical services that the hospital is authorized to perform."

^[15] SEC. 5. New Sections 5, 6, 7 and 8 shall be inserted after Section 4 of Batas Pambansa bilang 702, as amended, to read as follows:

x x x x

SEC. 6. Health Facilities Oversight Board. - All complaints for violations of this Act against health facilities shall be filed initially with the Health Facilities Oversight Board under the Health Facilities and Services Regulatory Bureau (HFSRB) of the [DOH]. The Board shall be composed of a DOH representative with a minimum rank of director to serve as Chair, a representative from the Philippine Health Insurance Corporation (PhilHealth), a representative from the Philippine Medical Association (PMA), a representative from private health institutions and three (3) representatives from non-government organizations (NGOs) advocating for patient's rights and public health, one of whom should be a licensed physician.

The Board shall investigate the claim of the patient and after adjudication, impose administrative sanctions in accordance with this Act including the revocation of the health facility's license. On the basis of its own findings, the Board shall also facilitate the filing of the criminal case in the proper courts. This is without prejudice to the right of the patient-complainant to directly institute criminal proceedings in the courts.

^[16] SEC. 4. section 4 of the same Act, as amended, is hereby further amended to read as follows:

SEC. 4. Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of this Act shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than One hundred thousand pesos (P100,000.00), but not more than Three hundred thousand pesos (P300,000.00 or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than Five hundred thousand pesos (P500,000.00), but not more than One million pesos (P1,000,000.00) or both, at the discretion of the court, without prejudice to damages that may be awarded to the patient-complainant: Provided, further, That upon three (3) repeated violations committed pursuant to an established policy of the hospital or clinic or upon the instruction of its management, the health facility's license to operate shall be revoked by the DOH. The president, chairman, board of directors. or trustees, and other officers of the health facility shall be solidarily liable for damages that may be awarded by the court to the patient-complainant.

^[17] Id.

^[18] SEC. 5. New Sections 5, 6, 7 and 8 shall be inserted after section 4 of Batas Pambansa bilang 702, as amended, to read as follows:

SEC. 5. Presumption of Liability. - In the event of death, permanent disability, serious impairment of the health condition of the patient-complainant, or in the case of a pregnant woman, permanent injury or loss of her unborn child, proceeding from the denial of his or her admission to a health facility pursuant to a policy or practice of demanding deposits or advance payments for confinement or treatment, a presumption of liability shall arise against the hospital, medical clinic, and the official, medical practitioner, or employee involved.

^[19] SEC. 5. New Sections 5, 6, 7 and 8 shall be inse1ted after section 4 of Batas Pambansa bilang 702, as amended, to read as follows:

x x x x

SEC. 7. PhilHealth Reimbursement of Basic Emergency Care. - PhilHealth shall reimburse the cost of basic emergency care and transportation services incurred by the hospital or medical clinic for the emergency medical services given to poor and indigent patients. Furthermore, the Philippine Charity Sweepstakes Office (PCSO) shall provide medical assistance for the basic emergency care needs of the poor and marginalized groups.

^[20] Rollo, p. 8.

^[21] Id.

^[22] Id. at 10.

^[23] Id. at 10-11.

^[24] Id. at 11.

^[25] Id. at 13-14.

^[26] Id. at 14.

^[27] 604 Phil. 98 (2009).

^[28] Id. at 125.

^[29] Rollo, p. 16.

^[30] Id.

^[31] Id. at 18.

^[32] Id. at 20.

^[33] Id.

^[34] Id.

^[35] Id. at 22.

^[36] Id.

^[37] Id. at 55.

^[38] Id. at 56.

^[39] Id. at 58-59.

^[40] Id. at 61.

^[41] Id. at 68.

^[42] Id. at 71.

^[43] Id. at 72.

^[44] Id. at 73-74.

^[45] Hon. Ermita v. Hon. Aldecoa-Delorino, 666 Phil. 122, 132 (2011).

^[46] Ocampo, et al. v. Rear Admiral Enriquez, et al., 798 Phil. 227, 294 (2016).

^[47] Francisco, Jr., et al. v. Toll Regulatory Board, et al., 648 Phil. 54, 86 (2010).

^[48] Section 1. The judicial power shall be vested in the Supreme Court and in such lower courts as may be established by law.

Judicial power includes the duty of the courts of justice to settle actual controversies involving rights which are legally demandable and enforceable, and to determine whether or not there has been a grave abuse of discretion amounting to lack or excess of jurisdiction on the part of any branch or instrumentality of the Government.

^[49] See Francisco, Jr. v. The House of Representatives, 460 Phil. 830, 883, 909-910 (2003).

^[50] Association of Medical Clinics for Overseas Workers, Inc. (AMCOW) v. GCC Approved Medical Centers Association, Inc., et al., 802 Phil. 116, 139 (2016).

^[51] Araullo, et al. v. President Benigno S.C. Aquino III, et al., 737 Phil. 457, 531 (2014).

^[52] G.R. No. 232395, July 3, 2018.

^[53] 757 Phil. 534 (2015).

^[54] Id. at 544, citing Araullo, et al. v. President Benigno S.C. Aquino III, et al., supra at 531.

^[55] G.R. No. 225442, August 8, 2017.

^[56] Section 4 of Rule 65 provides:

SEC. 4. When and where petition filed. - The petition shall be filed not later than sixty (60) days from notice of the judgment, order or resolution. In case a motion for reconsideration or new trial is timely filed, whether such motion is required or not, the sixty (60) day period shall be counted from notice of the denial of the said motion.

The petition shall be filed in the Supreme Court or, if it relates to the acts or omissions of a lower court or of a corporation, board, officer or person, in the Regional Trial Court exercising jurisdiction over the territorial area as defined by the Supreme Court. It may also be filed in the Court of Appeals whether or not the same is in aid of its appellate jurisdiction, or in the Sandiganbayan if it is in aid of its appellate jurisdiction. If it involves the acts or missions of a quasi-judicial agency, unless otherwise provided by law or these rules, the petition shall be filed in and cognizable only by the Court of Appeals.

No extension of time to file the petition shall be granted except for compelling reason and in no case exceeding fifteen (15) days.

^[57] Chamber of Real Estate and Builders Assn., Inc. (CREBA) v. Sec. of Agrarian Reform, 635 Phil. 283, 300 (2010), citing Heirs of Bertuldo Hinog v. Hon. Melicor, 495 Phil. 422, 432 (2005).

^[58] Arroyo v. DOJ, et al., 695 Phil. 302, 334 (2012).

^[59] Dy v. Judge Bibat-Palamos, et al., 717 Phil. 776, 782 (2013).

^[60] 751 Phil. 301 (2015).

^[61] Id. at 330-331.

^[62] Supra note 60.

^[63] Id. at 331.

^[64] Id. at 332.

^[65] Id.

^[66] Id. at 333.

^[67] Id.

^[68] Id. at 334.

^[69] Id.

^[70] Id. at 334-335.

^[71] Congressman Garcia v. The Executive Secretary, et al., 602 Phil. 64, 73 (2009).

^[72] 602 Phil. 64 (2009).

^[73] Id. at 73.

^[74] Hon. Exec. Sec. Belgica, et al. v. Ochoa, Jr., et al., 721 Phil. 416, 519 (2013).

^[75] Samahan ng mga Progresibong Kabataan (SPARK), et al., v. Quezon City, as represented by Mayor Herbert Bautista, et al., supra note 55.

^[76] Id.

^[77] G.R. No. 231671, July 25, 2017.

^[78] Lawyers Against Monopoly and Poverty (LAMP), et al. v. The Secretary of Budget and Management, et al., 686 Phil. 357, 369 (2012).

^[79] Philippine Constitution Association (PHILCONSA) v. Philippine Government (GPH), G.R. No. 218406, November 29, 2016, 811 SCRA 284, 297.

^[80] 589 Phil. 387 (2008).

^[81] Id. at 486.

^[82] See Hon. Drilon v. Mayor Lim, 305 Phil. 146, 150 (1994).

^[83] ABAKADA GURO Party List (formerly AASJS), et al. v. Hon Purisima, et al., 584 Phil. 246, 268 (2008).

^[84] Anak Mindanao Party-List Group v. Exec. Sec. Ermita, 558 Phil. 338, 350 (2007).

^[85] Tolentino v. Commission on Elections, 465 Phil. 385, 402 (2004).

^[86] SECTION 1. Who may be parties; plaintiff and defendant. - Only natural or juridical persons, or entities authorized by law may be parties in a civil action. The term "plaintiff" may refer to the claiming party, the counter-claimant, the cross-claimant, or the third (fourth, etc.) - party plaintiff. The term "defendant" may refer to the original defending party, the defendant in a counterclaim, the cross-defendant, or the third (fourth, etc.) - party defendant.

^[87] Art. 44. The following are juridical persons:

(1) The State and its political subdivisions;

(2) Other corporations, institutions and entities for public interest or purpose, created by law; their personality begins as soon as they have been constituted according to law;

(3) Corporations, partnerships and associations for private interest or purpose to which the law grants a juridical personality, separate and distinct from that of each shareholder, partner or member.

^[88] Sec. 4. Capacity. - Facts showing the capacity of a party to sue or be sued or the authority of a party to sue or be sued in a representative capacity or the legal existence of an organized association of person that is made a party, must be averred. A party desiring to raise an issue as to the legal existence of any party or the capacity of any party to sue or be sued in a representative capacity, shall do so by specific denial, which shall include such supporting particulars as are peculiarly within the pleader's knowledge.

^[89] White Light Corp., et al. v. City of Manila, 596 Phil. 444, 456 (2009).

^[90] Pharmaceutical and Health Care Assoc. of the Phils. v. Health Sec. Duque III, 561 Phil. 386, 396 (2007).

^[91] Rollo, pp. 4-5.

^[92] Id. at 33-34 and 36-37.

^[93] Id. at 35.

CONCURRING OPINION

PERLAS-BERNABE, J.:

I concur.

The present Petition for Certiorari and Prohibition filed by petitioner Private Hospitals Association of the Philippines, Inc. (PHAPi) should be dismissed due to its lack of legal standing, and the absence of an actual case or controversy.

The power of judicial review is the power of the courts to test the validity of the executive and legislative acts if they conform to the Constitution. Through such power, the judiciary enforces and upholds the supremacy of the Constitution. However, for a court to exercise this power, certain requirements must first be met, namely:

(1)
an actual case or controversy calling for the exercise of judicial power;

(2)
the person challenging the act must have "standing" to challenge; he must have a personal and substantial interest in the case such that he has sustained, or will sustain, direct injury as a result of its enforcement;

(3)

the question of constitutionality must be raised at the earliest possible opportunity; and

(4)
the issue of constitutionality must be the very lis mota of the case.^[1]

In this case, PHAPi is not a hospital or medical clinic, but only an association of - as its name denotes - private hospitals. As such, PHAPi is not directly subject to the provisions of Republic Act No. (RA) 10932,^[2] and consequently, does not stand to suffer a real and apparent threat or injury so as to demonstrate its locus standi to file this petition. To be sure, while it claims that it represents the interests of its member hospitals, records are bereft of any showing that it was specifically authorized to file this case on their behalf. Hence, PHAPi's conveyed interests, through the distinct manner of argumentation in the petition, can only be attributed as its own.

Furthermore, there appears to be no actual justiciable controversy that would sanction a review of the assailed provisions of RA 10932. Among others, PHAPi does not allege that any of its represented hospitals employs the deposit policy prohibited under RA 10932. Neither does PHAPi claim that a patient was refused admission by virtue of such policy nor was it shown that a claim has been filed based on the said law. As jurisprudence states, the need to prove an actual justiciable controversy is not merely an idle procedural requirement, but a clear safeguard to ensure that the courts do not unduly intrude into the areas specifically reserved to the other branches of government.^[3] The Court's exercise of judicial review on a hypothetical and theoretical situation runs the danger of it prematurely supplanting the wisdom of Congress with its own.

ACCORDINGLY, I vote to DISMISS the petition.

^[1] Garcia v. Executive Secretary, 602 Phil. 64,73 (2009).

^[2] Entitled "AN ACT STRENGTHENING THE ANTI-HOSPITAL DEPOSIT LAW BY INCREASING THE PENALTIES FOR THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS 'AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES,' AS AMENDED BY REPUBLIC ACT NO. 8344, AND FOR OTHER PURPOSES," approved on August 3, 2017.

^[3] See Philippine Constitution Association v. Philippine Government, G.R. Nos. 218406, 218761, 204355, 318407, and 204354, November 29, 2016, 811 SCRA 284, 296-297.

CONCURRING OPINION

LEONEN, J.:

I concur with the ponencia and add the following observations.

In this Petition for Certiorari and Prohibition under Rule 65 of the Rules of Court, petitioner Private Hospitals Association of the Philippines, Inc. (PHAPi), represented by its President, Dr. Rustico Jimenez, seeks to question the constitutionality of particular provisions of Republic Act No. 10932, otherwise known as the Act Strengthening the Anti-Hospital Deposit Law by Increasing Penalties for Refusal of Hospitals and Clinics to Administer Medical Treatment in Emergency or Serious Cases.

Petitioner asserts that the case is ripe for adjudication considering that there is an imminent threat that unconstitutional obligations and sanctions will be imposed on its members because of the impending approval of the implementing rules of Republic Act No. 10932.^[1] It also claims that it has the required locus standi because it stands to be directly injured by the implementation of Republic Act No. 10932, considering that its members' management and staff are placed at the risk of administrative, civil, and criminal liabilities.^[2] It further argues that in any case, the absence of a direct injury should not bar this Court from taking cognizance of this case as it raises issues that are of transcendental importance, particularly on denial of due process, equal protection of laws, and presumption of innocence.^[3]

The ponencia notes that the requisites for this Court's exercise of the power of judicial review is not present in this case.^[4] It found that there is no actual case or controversy, and that petitioner does not have the required locus standi to file the petition.

It discusses that the requirement of an actual case or controversy is satisfied upon a prima facie showing of grave abuse of discretion in the governmental act. Likewise, a case is ripe for adjudication if there is an act of the government and an immediate or threatened injury to petitioner as a result of the act.^[5]

The ponencia found that petitioner failed to meet the requirement. It notes that there is no allegation that petitioner or its members have suffered an actual or direct injury from any grave abuse of discretion. It found that the absence of the injury will render this Court's opinion as merely advisory.^[6]

The ponencia further points out that the law is presumed constitutional and this cannot be overturned in the absence of any showing of grave abuse of discretion or any infraction of the Constitution.^[7] It posits that it would be delving into questions of policy and wisdom of the executive and legislative departments if it invalidated the law based on conjectures and suppositions.^[8]

As to locus standi, the ponencia notes that Republic Act No. 10932 covers hospitals, medical facilities, medical practitioners, and employees, but not associations.^[9] Thus, in this case, the association is not the one who will be held liable for any violation of Republic Act No. 10932.^[10]

Furthermore, while an association has the capacity to sue or be sued, it must still show a substantial interest such that it has sustained or will sustain a direct injury.^[11] While third-party standing may be invoked as an exception to the rule, the ponencia notes that petitioner failed to demonstrate that it had been authorized by its members to file the instant case.^[12]

Thus, it did not take cognizance of the present petition.

I concur. This case is indeed not ripe for judicial review.

Canonical for the exercise of judicial review when the constitutionality of a law is being questioned are these requirements: first, there must be an actual case or controversy involving legal rights that are capable of judicial determination; second, the parties raising the issue must have locus standi; third, the constitutionality of the law must be raised at the earliest opportunity; and fourth, resolving the issue on constitutionality must be essential to the disposition of the case.^[13]

I

There is no actual case or controversy in the case at bar.

The requirement for an actual case or controversy is fundamental. This is based on Article VIII, Section 1 of the 1987 Constitution:

Section 1. The judicial power shall be vested in one Supreme Court and in such lower courts as may be established by law.

Judicial power includes the duty of the courts of justice to settle actual controversies involving rights which are legally demandabie and enforceable, and to determine whether or not there has been a grave abuse of discretion amounting to lack or excess of jurisdiction on the part of any branch or instrumentality of the Government. (Emphasis supplied)

An actual case or controversy means that there are conflicting legal rights, such that the legal claim of one party is opposed to the legal claim of another, and it is capable of being resolved by the courts.^[14] It is necessary that the conflicting legal rights must be real and concrete, not merely hypothetical or conjectural.^[15]

It is well-established in this jurisdiction that . . . for a court to exercise its power of adjudication, there must be an actual case or controversy — one which involves a conflict of legal rights, an assertion of opposite legal claims susceptible of judicial resolution; . . . In other words, the pleadings must show an active antagonistic assertion of a legal right, on the one hand, and a denial thereof on the other; that is, it must concern a real and not a merely theoretical question or issue. There ought to be an actual and substantial controversy admitting of specific relief through a decree conclusive in nature, as distinguished from an opinion advising what the law would be upon a hypothetical state of facts.^[16] (Citations omitted)

Thus, there must first be a real and material act affecting another, which one party asserts is done within the bounds allowed by law, but which another contends is injurious to his or her right. If there is yet no such act, or when such acts are merely conjecture, there is no actual case or controversy. In case of a governmental act, the party asserting its unconstitutionality must allege the actual act performed by the government that caused it the injury.

In Lozano v. Nograles,^[17] this Court explained:

An aspect of the "case-or-controversy" requirement is the requisite of "ripeness". In the United States, courts are centrally concerned with whether a case involves uncertain contingent future events that may not occur as anticipated, or indeed may not occur at all. Another approach is the evaluation of the twofold aspect of ripeness: first, the fitness of the issues for judicial decision; and second, the hardship to the parties entailed by withholding court consideration. In our jurisdiction, the issue of ripeness is generally treated in terms of actual injury to the plaintiff. Hence, a question is ripe for adjudication when the act being challenged has had a direct adverse effect on the individual challenging it. An alternative road to review similarly taken would be to determine whether an action has already been accomplished or performed by a branch of government before the courts may step in.^[18] (Emphasis supplied, citations omitted)

The requirement of an actual case or controversy is rooted on the respect for the separation of powers of the three branches of the government. Courts cannot supplant the discretionary acts of the legislative or the executive branch on the premise that they know of a wiser, more just, or expedient policy or course of action.^[19] They may only act in case the other branches acted outside the bounds of their powers or with grave abuse of discretion amounting to lack or excess of jurisdiction.

The other reason for requiring an actual case or controversy is to maintain the significance of this Court's role in making "final and binding construction[s] of law."^[20] Courts do not render mere advisory opinions. Judicial decisions are part of the legal system,^[21] and thus, have binding effects on actual persons, places, and things. Ruling on hypothetical situations with no bearing on any matter will weaken the import of this Court's issuances. In Belgica, et al. v. Ochoa:^[22]

Basic in litigation raising constitutional issues is the requirement that there must be an actual case or controversy. This Court cannot render an advisory opinion. We assume that the Constitution binds all other constitutional departments, instrumentalities, and organs. We are aware that in the exercise of their various powers, they do interpret the text of the Constitution in the light of contemporary needs that they should address. A policy that reduces this Court to an adviser for official acts by the other departments that have not yet been done would unnecessarily tax our resources. It is inconsistent with our role as final arbiter and adjudicator and weakens the entire system of the Rule of Law. Our power of judicial review is a duty to make a final and binding construction of law. This power should generally be reserved when the departments have exhausted any and all acts that would remedy any perceived violation of right. The rationale that defines the extent of our doctrines laying down exceptions to our rules on justiciability are clear: Not only should the pleadings show a convincing violation of a right, but the impact should be shown to be so grave, imminent, and irreparable that any delayed exercise of judicial review or deference would undermine fundamental principles that should be enjoyed by the party complaining or the constituents that they legitimately represent.

The requirement of an "actual case," thus, means that the case before this Court "involves a conflict of legal rights, an assertion of opposite legal claims susceptible of judicial resolution; the case must not be moot or academic based on extra-legal or other similar considerations not cognizable by a court of justice." Furthermore, "the controversy needs to be definite and concrete, bearing upon the legal relations of parties who are pitted against each other due to their adverse legal interests." Thus, the adverse position of the parties must be sufficient enough for the case to be pleaded and for this Court to be able to provide the parties the proper relief/s prayed for.

The requirement of an 'actual case' will ensure that this Court will not issue advisory opinions. It prevents us from using the immense power of judicial review absent a party that can sufficiently argue from a standpoint with real and substantial interests.^[23] (Citations omitted)

Moreover, hypothetical or conjectural situations illicitly widen the courts' discretion such that future parties who present claims on the law being interpreted may be unduly affected by the limitations set, without affording them the opportunity to be heard, thus:^[24]

An advisory opinion is one where the factual setting is conjectural or hypothetical. In such cases, the conflict will not have sufficient concreteness or adversariness so as to constrain the discretion of this Court. After all, legal arguments from concretely lived facts are chosen narrowly by the parties. Those who bring theoretical cases will have no such limits. They can argue up to the level of absurdity. They will bind the future parties who may have more motives to choose specific legal arguments. In other words, for there to be a real conflict between the parties, there must exist actual facts from which courts can properly determine whether there has been a breach of constitutional text.^[25] (Emphasis in the original)

Thus, in cases where the constitutionality of a law is being questioned, it is not enough that the law or the regulation has been passed or is in effect. To rule on the constitutionality of provisions in the law without an actual case is to decide only the basis of the mere enactment of the statute. This amounts to a ruling on the wisdom of the policy imposed by the Congress on the subject matter of the law.

In Southern Hemisphere Engagement Network, Inc. v. Anti-Terrorism Council,^[26] this Court ruled that it is not enough that there is & possibility of abuse of the questioned enactment. There must first be an actual act of abuse.

In Republic of the Philippines v. Herminio Harry Roque, et al.,^[27] this Court said that the parties presented no actual case or controversy because they did not show any government action implementing the questioned statute against them.

In Philippine Bus Operators Association of the Philippines v. Department of Labor and Employment,^[28] this Court ruled that it is not enough that the issuances may result in a diminution of the bus drivers and conductors' income, considering that the allegations are based on speculation.

In Philippine Press Institute, Inc. v. Commission on Elections,^[29] the petitioner in that case did not assert a specific act committed against it by the Commission on Elections in enforcing or implementing the questioned law. This Court found that there was no actual case or controversy.

An allegation of grave abuse of discretion amounting to lack or excess of jurisdiction is insufficient.^[30] If there is no exercise of discretion, it could not have been gravely abused.

In the case at bar, petitioner failed to show that any violation of its rights was committed as a consequence of the enactment of Republic Act No. 10932. The law itself has not been enforced against petitioner or its members. In fact, petitioner's allegation is that there is a risk or a threat that its members will be obligated and sanctioned by the enactment of the law. Thus, there is yet no act committed by petitioner showing any breach of the statute, and there is yet no act of enforcement or sanction against it. There is no injury yet suffered by petitioner. The sanctions they alleged are still in the realm of imagination.

II

I also agree that petitioner failed to show that it has the required locus standi to file the petition.

As an association which represents private hospitals, petitioner is a third party to the instant case. Thus, before it may file the petition, it must show that it is compliant with the requisites for third-party standing.

Another requisite for this Court's exercise of judicial review is that the party filing must have locus standi or legal standing to file the suit, thus:

Legal standing or locus standi is the "right of appearance in a court of justice on a given question." To possess legal standing, parties must show "a personal and substantial interest in the case such that [they have] sustained or will sustain direct injury as a result of the governmental act that is being challenged." The requirement of direct injury guarantees that the party who brings suit has such personal stake in the outcome of the controversy and, in effect, assures "that concrete adverseness which sharpens the presentation of issues upon which the court depends for illumination of difficult constitutional questions."

. . . .

Whether a suit is public or private, the parties must have "a present substantial interest," not a "mere expectancy or a future, contingent, subordinate, or consequential interest." Those who bring the suit must possess their own right to the relief sought.^[31] (Citations omitted)

The party filing must show that it has a substantial interest in the case such that it was or will be directly affected or injured by the challenged governmental act.

However, this Court has given leeway to petitions filed by parties who have no personal or substantial interest in the challenged governmental act but nonetheless raise "constitutional issue[s] of critical significance."^[32]

The substantiality and directness of the injury is reckoned from the point of view of petitioner. Thus, this Court has allowed suits to be filed by taxpayers in cases where there is a claim of an unconstitutional tax measure or illegal disbursement of public funds. Cases filed by voters who show an obvious interest in the validity of the questioned election law have been allowed. Courts have likewise taken cognizance of cases filed by legislators in petitions where they claim that their prerogative as legislators have been infringed upon.^[33]

In a very limited subset of cases, this Court has allowed a party to bring a suit on behalf of another. However, for this Court to accept that the third party has the standing to file the case, the following requisites must be present: first, the party filing the suit "must have suffered an 'injury-in-fact', thus [has] a "sufficiently concrete interest" in the outcome of the issue in dispute; [second, he or she] must have a close relation to the third party; and [third, the third party is prevented by] some hindrance . . . to protect his or her own interest."^[34]

Associations have been able to file petitions on behalf of its members on the basis of third-party standing.

In Pharmaceutical and Health Care Association of the Philippines v. Secretary of Health,^[35] this Court found that an association "has the legal personality to represent its members because the results of the case will affect their vital interests,"^[36] thus:

This [modern] view fuses the legal identity of an association with that of its members. An association has standing to file suit for its workers despite its lack of direct interest if its members are affected by the action. An organization has standing to assert the concerns of its constituents.

. . . .

. . . We note that, under its Articles of Incorporation, the respondent was organized . . . to act as the representative of any individual, company, entity or association on matters related to the manpower recruitment industry, and to perform other acts and activities necessary to accomplish the purposes embodied therein. The respondent is, thus, the appropriate party to assert the rights of its members, because it and its members are in every practical sense identical . . . The respondent [association] is but the medium through which its individual members seek to make more effective the expression of their voices and the redress of their grievances.^[37] (Citation omitted)

However, associations must sufficiently establish who their members are, that their members authorized them to sue on their behalf, and that they would be directly injured by the challenged governmental acts.^[38]

In Philippine Bus Operators Association of the Philippines vs. Department of Labor and Employment,^[39] this Court did not allow the association to represent its members because it failed to establish the presence of these requirements. There was no evidence of board resolutions or articles of incorporation showing that it was authorized to file the petition. It noted that some of the associations even had their certificates of incorporation revoked by the Securities and Exchange Commission. This Court ruled that it was not enough that they alleged that they were an association that represented members who would be directly injured by the implementation of a law, thus:

The associations in Pharmaceutical and Health Care Association of the Philippines, Holy Spirit Homeowners Association, Inc., and The Executive Secretary were allowed to sue on behalf of their members because they sufficiently established who their members were, that their members authorized the associations to sue on their behalf, and that the members would be directly injured by the challenged governmental acts.

The liberality of this Court to grant standing for associations or corporations whose members are those who suffer direct and substantial injury depends on a few factors.

In all these cases, there must be an actual controversy. Furthermore, there should also be a clear and convincing demonstration of special reasons why the truly injured parties may not be able to sue.

Alternatively, there must be a similarly clear and convincing demonstration that the representation of the association is more efficient for the petitioners to bring. They must further show that it is more efficient for this Court to hear only one voice from the association.

In other words, the association should show special reasons for bringing the action themselves rather than as a class suit, allowed when the subject matter of the controversy is one of common or general interest to many persons. In a class suit, a number of the members of the class are permitted to sue and to defend for the benefit of all the members so long as they are sufficiently numerous and representative of the class to which they belong.

In some circumstances similar to those in White Light, the third parties represented by the petitioner would have special and legitimate reasons why they may not bring the action themselves. Understandably, the cost to patrons in the White Light case to bring the action themselves—i.e., the amount they would pay for the lease of the motels—will be too small compared with the cost of the suit. But viewed in another way, whoever among the patrons files the case even for its transcendental interest endows benefits on a substantial number of interested parties without recovering their costs. This is the free rider problem in economics. It is a negative externality which operates as a disincentive to sue and assert a transcendental right.^[40]

In Executive Secretary v. The Hon. Court of Appeals,^[41] the Asian Recruitment Council Philippine Chapter, Inc. was found to have standing to file the petition for declaratory relief on behalf of its member recruitment agencies because it proved through board resolutions that it was authorized to sue on the behalf of its members. It was able to show that it was the medium used by the members to effectively communicate their grievances.

Allegations of transcendental importance are not enough to allow exceptions to locus standi.

In Francisco v. House of Representatives,^[42] this Court enumerated factors that determine if an issue is of transcendental importance.

There being no doctrinal definition of transcendental importance, the following determinants formulated by former Supreme Court Justice Florentino P. Feliciano are instructive: (1) the character of the funds or other assets involved in the case; (2) the presence of a clear case of disregard of a constitutional or statutory prohibition by the public respondent agency or instrumentality of the government; and (3) the lack of any other party with a more direct and specific interest in raising the questions being raised.^[43] (Citations omitted)

Moreover, there must also be a showing of a "clear or imminent threat to fundamental rights" and of "proper parties suffering real, actual or more imminent injury,"^[44] thus:

In addition to an actual controversy, special reasons to represent, and disincentives for the injured party to bring the suit themselves, there must be a showing of the transcendent nature of the right involved.

Only constitutional rights shared by many and requiring a grounded level of urgency can be transcendent. For instance, in The Association of Small Landowners in the Philippines, Inc. v. Secretary of Agrarian Reform, the association was allowed to file on behalf of its members considering the importance of the issue involved, i.e., the constitutionality of agrarian reform measures, specifically, of then newly enacted Comprehensive Agrarian Reform Law.

This Court is not a forum to appeal political and policy choices made by the Executive, Legislative, and other constitutional agencies and organs. This Court dilutes its role in a democracy if it is asked to substitute its political wisdom for the wisdom of accountable and representative bodies where there is no unmistakable democratic deficit. It cannot lose this place in the constitutional order. Petitioners' invocation of our jurisdiction and the justiciability of their claims must be presented with rigor. Transcendental interest is not a talisman to blur the lines of authority drawn by our most fundamental law.

. . . .

Again, the reasons cited—the "far-reaching consequences" and "wide area of coverage and extent of effect" of Department Order No. 118-12 and Memorandum Circular No. 2012-001—are reasons not transcendent considering that most administrative issuances of the national government are of wide coverage. These reasons are not special reasons for this Court to brush aside the requirement of legal standing.^[45] (Citations omitted)

The petitioner was unable to prove that it was authorized by its members to file the instant case through board resolutions or through its articles of incorporation; I find, thus, that petitioner does not have the required standing to file the petition.

ACCORDINGLY, I VOTE to DISMISS the Petition.

^[1] Ponencia, p. 7.

^[2] Id.

^[3] Id.

^[4] Id. at 14.

^[5] Id. at 15.

^[6] Id.

^[7] Id.

^[8] Id. at 16.

^[9] Id.

^[10] Id. at 17.

^[11] Id. at 16-17.

^[12] Id. at 17.

^[13] Levy Macasiano v. National Housing Authority, 296 Phil. 56, 63-64 (1993) [Per C.J. Davide, Jr., En Banc].

^[14] Information Technology Foundation of the Philippines v. COMELEC, 499 Phil. 281, 304 (2005) [Per C.J. Panganiban, En Banc].

^[15] Id. See also Southern Hemisphere Engagement Network v. Anti-Terrorism Council, 646 Phil. 452, 479 (2010) [Per J. Carpio-Morales, En Banc].

^[16] Information Technology Foundation of the Philippines v. COMELEC, 499 Phil. 281, 304 (2005) [Per C.J. Panganiban, En Banc].

^[17] 607 Phil. 334 (2009) [Per C.J. Puno, En Banc].

^[18] Id. at 341.

^[19] See Angara v. Electoral Commission, 63 Phil. 139 (1936) [Per J. Laurel, En Banc]; Garcia v. Executive Secretary, 602 Phil. 64 (2009) [Per J. Brion, En Banc].

^[20] Concurring Opinion of J. Leonen in Belgica v. Ochoa, 721 Phil. 416, 661 (2013) [Per J. Perlas-Bernabe, En Banc].

^[21] CIVIL CODE, art. 8.

^[22] 721 Phil. 416 (2013) [Per J. Perlas-Bernabe, En Banc].

^[23] Id. at 661-662.

^[24] Philippine Bus Operators Association of the Philippines, et al. vs. Department of Labor and Employment, G.R. No. 202275, July 17, 2018 [Per J. Leonen, En Banc].

^[25] Id. at 25.

^[26] 646 Phil. 452 (2010) [Per J. Carpio-Morales].

^[27] 718 Phil. 294 (2013) [Per J. Perlas-Bernabe, En Banc].

^[28] G.R. No. 202275, July 17, 2018 [Per J. Leonen, En Banc].

^[29] Philippine Press Institute, Inc. v. Commission on Elections, 314 Phil. 131 (1995) [Per J. Feliciano, En Banc].

^[30] See Dissenting Opinion of J. Leonen in Spouses Imbong v. Ochoa, Jr., 732 Phil. 1, 554-666 (2014) [Per J. Mendoza, En Banc].

^[31] Philippine Bus Operators Association of the Philippines, et al. vs. Department of Labor and Employment, G.R. No. 202275, July 17, 2018 27-28 [Per J. Leonen, En Banc].

^[32] Funa v. Villar, 686 Phil. 571, 585 (2012) [Per J. Velasco, Jr., En Banc].

^[33] See Funa v. Villar, 686 Phil. 571 (2012) [Per J. Velasco, Jr., En Banc].

^[34] White Light Corp., et al. v. City of Manila, 596 Phil. 444, 456 (2009) [Per J. Tinga, En Banc].

^[35] 561 Phil. 386 (2007) [Per J. Austria-Martinez, En Banc].

^[36] Id. at 396.

^[37] Id. at 395-396.

^[38] Philippine Bus Operators Association of the Philippines, et al. vs. Department of Labor and Employment, G.R. No. 202275, July 17, 2018 32 [Per J. Leonen, En Banc].

^[39] G.R. No. 202275, July 17, 2018 [Per J. Leonen, En Banc].

^[40] Id. at 32-33.

^[41] 473 Phil. 27 (2004) [Per J. Callejo, Sr., Second Division].

^[42] 460 Phil. 830 (2003) [Per J. Carpio-Morales, En Banc].

^[43] Id. at 899.

^[44] In Re Supreme Court Judicial Independence v. Judiciary Development Fund, 751 Phil. 30, 44 (2015) [Per J. Leonen, En Banc].

^[45] Philippine Bus Operators Association of the Philippines, et al. vs. Department of Labor and Employment, G.R. No. 202275, July 17, 2018 33-34 [Per J. Leonen, En Banc].

SEPARATE CONCURRING OPINION

CAGUIOA, J.:

The instant Petition for Certiorari (Petition) filed by Private Hospitals Association of the Philippines, Inc. (PHAPi) assails the constitutionality of select provisions of Republic Act No. 10932^[1] (RA 10932), or the Act Strengthening the Anti-Hospital Deposit Law, i.e., Sections 1, 4, 5, 7, and 8 of the said law.

I concur with the ponencia that the instant Petition should be dismissed at the first instance because it does not present an actual case or controversy calling for the exercise of judicial power, and the petitioner has no personal and substantial interest in the case such that it has sustained, or will sustain, direct injury as a result of its enforcement.

In asking the Court to declare certain provisions of RA 10932 as unconstitutional for supposedly contravening the Constitution, the petitioner invokes the Court's power of judicial review under Section 4(2), Article VIII of the Constitution.^[2] The power of judicial review refers to the power of the courts to test the validity of executive and legislative acts for their conformity with the Constitution.^[3] Through such power, the judiciary enforces and upholds the supremacy of the Constitution.^[4] For the Court to exercise this power, it is indispensable that certain requirements must first be met, namely:

(1)
an actual case or controversy calling for the exercise of judicial power;

(2)
the person challenging the act must have standing to challenge; he must have a personal and substantial interest in the case such that he has sustained, or will sustain, direct injury as a result of its enforcement;

(3)

the question of constitutionality must be raised at the earliest possible opportunity; and

(4)
the issue of constitutionality must be the very lis mota of the case.^[5]

The Petition here fails the first two (2) requisites.

There is no actual case or controversy calling for the Court's exercise of judicial power.

An "actual case or controversy" is one which involves a conflict of legal rights, an assertion of opposite legal claims, susceptible of judicial resolution as distinguished from a hypothetical or abstract difference or dispute.^[6] There must be a contrariety of legal rights that can be interpreted and enforced on the basis of existing law and jurisprudence.^[7]

Related to the requisite of an actual case or controversy is the requisite of "ripeness," which means that something had then been accomplished or performed by either branch before a court may come into the picture, and the petitioner must allege the existence of an immediate or threatened injury to itself as a result of the challenged action.^[8]

Otherwise stated, an actual case or controversy means an existing case or controversy that is appropriate or ripe for determination, not conjectural or anticipatory.^[9]

The Petition here does not allege that any medical institution or practitioner has actually been held liable under RA 10932. Nor is there even an assertion that an existing action has been filed against any medical institution or practitioner who violated RA 10932. As well, there is likewise no assertion that any medical institution or practitioner has actually committed any act violative of RA 10932 that makes such institution or person susceptible to the liabilities imposed under the said law.

In short, it is apparent that the instant Petition was filed merely in anticipation of a possible breach or infraction of the law. To emphasize, an actual case or controversy which justifies the Court's exercise of its judicial review power necessitates an existing case or controversy that is appropriate or ripe for determination, and not merely an anticipatory controversy.

The petitioner has no locus standi to question the constitutionality of RA 10932.

That is not all. Again, in order for the Court to exercise its power of judicial review, the person or entity challenging the act must have standing to challenge — he must have a personal and substantial interest in the case such that he has sustained, or will sustain, direct injury as a result of its enforcement.

Defined as a right of appearance in a court of justice on a given question, locus standi requires that a party alleges such personal stake in the outcome of the controversy as to assure that concrete adverseness which sharpens the presentation of issues upon which the court depends for illumination of difficult constitutional questions.^[10] Unless a person has sustained or is in imminent danger of sustaining an injury as a result of an act complained of, such proper party has no standing.^[11]

Applying the foregoing in the instant case, it is crystal clear that petitioner PHAPi has no legal standing to question the constitutionality of RA 10932 — as it does not stand to sustain any damage or injury of a direct and personal nature in the implementation of RA 10932.

Under RA 10932, only officials, medical practitioners, and/or medical institutions that actually demand/accept any form of advance payment as a prerequisite for confinement/medical treatment of a patient in emergency situations or refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death/permanent disability are subjected to potential liability under the law.

Emphasis must be placed on the fact that petitioner PHAPi is not a medical institution that administers medical treatment, being an association with a completely separate juridical personality from its members. With petitioner PHAPi being a juridical person endowed with a distinct personality of its own, it is clear that any potential liability that may be imposed upon any of the petitioner's member hospitals, clinics, and facilities will NOT be a liability of petitioner PHAPi.

Restating the obvious, petitioner PHAPi will sustain no direct and personal injury from the implementation of RA 10932; it has no personal stake in the issues raised in the Petition. Hence, the requisite of locus standi is completely lacking, warranting the outright dismissal of the instant Petition.

Section 1 of RA 10932 is not violative of the Constitution.

Nevertheless, even if the abovementioned matters were to be swept aside for the sake of liberality, the instant Petition should nonetheless be dismissed as it is bereft of substantive merit.

The petitioner argues that Section 1^[12] of RA 10932 transgresses the Constitution because it purportedly imposes upon medical institutions and medical practitioners the untenable and impossible duty of actually preventing the death or permanent disability of a patient, or, in the case of a pregnant woman, permanent injury or loss of her unborn child, or non-institutional delivery. The petitioner posits the view that the aforementioned provision of the law is violative of due process as it goes against the jurisprudential doctrine that a physician is not an insurer of the good result of treatment.^[13]

The petitioner's interpretation of RA 10932 is mistaken.

The essence of RA 10932 is to prohibit medical institutions/practitioners from requesting or accepting any deposit or any other form of payment as a prerequisite for administering basic emergency care, confinement, or medical treatment of a patient, or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death, or permanent disability, or, in the case of a pregnant woman, permanent injury or loss of her unborn child, or non-institutional delivery, only in emergency or serious cases and only if the medical institution or practitioner has adequate medical capabilities to administer treatment.

By reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer.^[14]

Hence, contrary to the specious interpretation of the petitioner, Section 1 of RA 10932 does not mandate whatsoever that physicians be insurers of the good result of treatment. The law merely imposes on medical institutions/practitioners the strict duty to administer basic emergency care, as defined under the law, only with respect to persons in emergency or serious situations, and when the medical institutions/practitioners have the capability to administer such treatment.

Further, Section 4 of RA 10932 is also not violative of the Constitution.

The petitioner likewise argues that the fines and penalties imposed under Section 4^[15] of RA 10932 are constitutionally infirm becafuse they are supposedly unjust, excessive, and oppressive; the penalties set by the law are allegedly not commensurate to the act or omission being penalized.

This argument deserves scant consideration.

The penalties as prescribed by statute are essentially and exclusively legislative; the courts should not encroach on the prerogative of the lawmaking body.^[16] As pronounced by the Court early on in United States v. Borromeo,^[17] the fixing of penalties for the violation of statutes is primarily a legislative function, and the courts hesitate to interfere, unless the fine provided for is so far excessive as to shock the sense of mankind.

In any case, the stern fines and penalties provided by Section 4 of RA 10932 are not at all unjust, excessive, and oppressive, considering that the violation of the law does not entail mere damage to property. The observance of RA 10932 may very well determine whether a patient experiencing an emergency health situation will survive or perish. The grave consequences involved cannot be overstated; a patient's life hangs in the balance. Further, the legislature's desire to impose strict penalties upon violators of RA 10932 is in fealty to the constitutional mandate that the State shall protect and promote the right to health of the people.^[18]

Hence, the petitioner's attempt to assail the constitutionality of Section 4 of RA 10932 must also fall.

Furthermore, Section 5 of RA 10932 likewise does not violate the Constitution.

Section 5 of RA 10932 (Presumption of Liability Clause) states:

SEC. 5. Presumption of Liability. — In the event of death, permanent disability, serious impairment of the health condition of the patient-complainant, or in the case of a pregnant woman, permanent injury or loss of her unborn child, proceeding from the denial of his or her admission to a health facility pursuant to a policy or practice of demanding deposits or advance payments for confinement or treatment, a presumption of liability shall arise against the hospital, medical clinic, and the official, medical practitioner, or employee involved.

The petitioner finds Section 5, which makes the erring medical institution and/or practitioner prima facie liable for medical malpractice, unconstitutional on the notion that, in medical malpractice cases, the plaintiff must prove that the medical practitioner failed to do what a reasonably prudent doctor would have done or did what a reasonably prudent doctor would not have done. The petitioner adds that medical malpractice must be proven with reasonable medical probability based on competent expert testimony and that proximate cause of injury/death must be established.

These arguments are mistaken.

Under Section 5 of RA 10932, the presumption of liability on the part of the medical practitioner/institution arises only when death, permanent disability, serious impairment of the health condition of the patient-complainant, or, in the case of a pregnant woman, permanent injury or loss of her unborn child, occurs after the denial by the medical institution/practitioner of the emergency patient's admission to the health facility during an emergency/serious situation, pursuant to an established policy/practice of demanding deposits/advance payments for confinement or treatment.

In the context of medical malpractice, Section 5 creates a presumption of negligence on the part of the medical institution/practitioner when the latter commits a violation of law, i.e., the act of denying the emergency patient's admission to the health facility during an emergency/serious situation pursuant to an established policy/practice of demanding deposits/advance payments for confinement or treatment, which RA 10932 considers a violation of law.

The presumption of negligence when a statutory duty has been violated.

While the petitioner posits the view that this is unconstitutional because the plaintiff, in medical malpractice cases, must first prove that negligence was indeed committed, it should be noted that under Philippine law, the violation of a statutory duty may be treated either as a circumstance which establishes a presumption of negligence, negligence per se, or a circumstance which should be considered together with other circumstances as evidence of negligence.^[19]

The Court held in F.F. Cruz and Co., Inc. v. Court of Appeals^[20] that the failure of the therein petitioner to construct a firewall in accordance with certain city ordinances in itself sufficed to support a finding of negligence.

In Cipriano v. Court of Appeals,^[21] finding that the failure of the therein petitioner to register and insure his auto rustproofing shop in accordance with Presidential Decree No. 1572 constituted negligence per se, the Court held that "[t]here is thus a statutory duty imposed on petitioner and it is for his failure to comply with this duty that he was guilty of negligence rendering him liable for damages to private respondent."^[22]

Hence, creating a presumption of negligence based on the violation of a statutory duty is not legally infirm.

The violation of a statutory duty as the proximate cause of an injury

The petitioner also faults Section 5 of RA 10932 for supposedly presuming that the illegal act of the medical institution/practitioner, i.e., denying the emergency patient's admission to the health facility during an emergency/serious situation pursuant to an established policy/practice of demanding deposits/advance payments for confinement or treatment, is the proximate cause of the injury or death of the patient. The petitioner argues that in medical malpractice cases, the act or omission complained of must be established as the proximate cause of the injury or death.

In this respect, the pronouncement of the Court in Teague v. Fernandez,^[23] is instructive:

"x x x [I]f the very injury has happened which was intended to be prevented by the statute, it has been held that violation of the statute will be deemed to be the proximate cause of the injury." x x x

"The generally accepted view is that violation of a statutory duty constitutes negligence, negligence as a matter of law, or, according to the decisions on the question, negligence per se, for the reason that non-observance of what the legislature has prescribed as a suitable precaution is failure to observe that care which an ordinarily prudent man would observe, and, when the state regards certain acts as so liable to injure others as to justify their absolute prohibition, doing the forbidden act is a breach of duty with respect to those who may be injured thereby; or, as it has been otherwise expressed, when the standard of care is fixed by law, failure to conform to such standard is negligence, negligence per se or negligence in and of itself, in the absence of a legal excuse. According to this view it is immaterial, where a statute has been violated, whether the act or omission constituting such violation would have been regarded as negligence in the absence of any statute on the subject or whether there was, as a matter of fact, any reason to anticipate that injury would result from such violation. x x x"^[24] (Italics in the original omitted; emphasis, italics and underscoring supplied)

Otherwise stated, when a statute is created in order to prevent a certain injury, and such injury occurs when the statute is violated, then the violation of the statute will be deemed to be the proximate cause of the injury.

Applying the foregoing in the instant case, since Section 5 of RA 10932 contemplates a situation wherein death, permanent disability, serious impairment of the health condition of the patient-complainant, etc. occurs, which are the very injuries intended to be prevented by the introduction of RA 10932, then the acts violative of RA 10932 will be presumed to be the proximate cause of the death or serious injury.

In any case, the Presumption of Liability Clause does not create a conclusive presumption that the defendant is automatically guilty of medical malpractice. What the provision merely does is to shift the burden to the defendant to prove that there was another act or event that was the proximate cause of the death/injury.

The presumption of liability recognized under Philippine Law

Under various legal provisions and established legal doctrines, it is well recognized that liability may, at certain times, be disputably presumed when certain acts have been committed or when a certain set of conditions is present which has a reasonable or rational connection with the fact presumed.

For instance, the doctrine of res ipsa loquitur is well-recognized in this jurisdiction, wherein in a situation in which the thing causing the injury complained of is shown to be under the management of the defendant or his servants and the accident is such as in the ordinary course of things does not happen if those who have its management or control use proper care, it is presumed, in the absence of sufficient explanation by the defendant, that the accident arose from want of care of the latter.^[25]

As another example, Article 1387 of the Civil Code provides that alienation of property for valuable consideration made by a person against whom an unsatisfied judgment is outstanding raises a presumption of fraud.^[26]

Similarly, under Article 1265 of the Civil Code, whenever a thing is lost in the possession of the debtor, it shall be presumed that the loss was due to his fault, unless there is proof to the contrary, and without prejudice to the provisions of Article 1165.

With respect to common carriers, Article 1735 of the Civil Code states that if goods under the care of common carriers are lost, destroyed or deteriorated, then the common carriers are presumed to have been at fault or to have acted negligently. In relation to the foregoing, Article 1752 of the Civil Code even dictates that despite the presence of an agreement limiting the liability of the common carrier in the vigilance over the goods, the common carrier is nevertheless disputably presumed to have been negligent in case of their loss, destruction or deterioration.

In the same way, according to Article 1756 of the Civil Code, in case of death of or injuries to passengers, common carriers are presumed to have been at fault or to have acted negligently, unless they prove that they observed extraordinary diligence.

With respect to motor vehicle mishaps, Article 2185 of the Civil Code provides that unless there is proof to the contrary, it is presumed that a person driving a motor vehicle has been negligent if at the time of the mishap, he/she was violating any traffic regulation.

Moreover, under Article 2188 of the Civil Code, there is prima facie presumption of negligence on the part of the defendant if the death or injury results from his possession of dangerous weapons or substances, such as firearms and poison, except when the possession or use thereof is indispensable in his occupation or business.

In addition, and as already explained above, it is a settled rule that when a statute is created in order to prevent a certain injury, and such injury occurred when the statute was violated, the violation of the statute will be deemed to be the proximate cause of the injury.^[27] Jurisprudence has also recognized that the violation of a statutory duty may be treated either as a circumstance which establishes a presumption of negligence, negligence per se, or a circumstance which should be considered together with other circumstances as evidence of negligence.^[28]

In fact, under Section 3(b), Rule 131 of the Rules of Court, the disputable presumption that an unlawful act was done with an unlawful intent is sufficient, unless satisfactorily contradicted.

Hence, considering the foregoing provisions of law and established doctrines in jurisprudence providing for the presumption of liability, the Presumption of Liability Clause under Section 5 of RA 10932 is not at all a novel provision of law.

Similar to the abovementioned provisions and doctrines on the presumption of liability, Section 5 merely creates a disputable presumption of liability over the death or injury of a patient on the part of the medical practitioner and/or institution in a situation wherein a violation of a statutory duty is committed, in which such violation has, at the very least, a reasonable and rational connection to the death or injury that occurred.

The Presumption of Liability Clause does not violate the constitutional presumption of innocence.

The notion of presuming liability has been so accepted in Philippine law that it has even found application with respect to the more stringent and rigid concept of criminal liability.

The Court has previously upheld the constitutionality of penal statutes that provide for a prima facie evidence of guilt, shifting the burden of proof to the accused, despite the elementary rule that the prosecution has the burden of establishing proof beyond reasonable doubt. Hence, neither can the argument be made that the Presumption of Liability Clause infringes on the constitutional right to be presumed innocent.

To illustrate, under Article 217 of the Revised Penal Code, the failure of a public officer to have duly forthcoming public funds or property with which he is chargeable, upon demand by any duly authorized officer, shall be prima facie evidence that he has put such missing funds or property to personal use.

Also, under Article 315, paragraph 2(d) of the Revised Penal Code, as amended by RA 4885, the drawer of a check is given three (3) days to make good the said check by depositing the necessary funds to cover the amount thereof; otherwise, a, prima facie presumption will arise as to the existence of fraud, which is an element of the crime of estafa.

In Bañares v. Court of Appeals,^[29] citing People v. Mingoa,^[30] the Court held that, contrary to petitioner PHAPi's theory on the supposed infringement of the constitutional presumption of innocence, there is no constitutional objection to a law providing that the presumption of innocence may be overcome by a contrary presumption founded upon the experience of human conduct:

There is, of course, no constitutional objection to a law providing that the presumption of innocence may be overcome by a contrary presumption founded upon the experience of human conduct, and enacting what evidence shall be sufficient to overcome such presumption of innocence. The legislature may provide for prima facie evidence of guilt of the accused and shift the burden of proof provided there be a rational connection between the facts proved and the ultimate fact presumed so that the inference of the one from proof of the others is not unreasonable and arbitrary because of lack of connection between the two in common experience.^[31] (Emphasis and underscoring supplied)

Applying the foregoing to the Presumption of Liability Clause, considering that it envisions a situation wherein a person who is in extremely urgent need of medical attention is denied treatment by a medical institution/practitioner due to an illegal policy or practice of demanding deposits/advance payments for confinement or treatment, and such person dies or is seriously injured immediately thereafter, there is undoubtedly a reasonable connection between the illegal act committed and the ultimate fact presumed, i.e., liability for the death or injury of the emergency patient.

Such connection is not unreasonable and arbitrary, considering that death or serious injury would be the rational and logical outcome/consequence when a person experiencing an extremely urgent medical situation was not given timely medical attention due to a policy or practice expressly prohibited by law.

Finally, Sections 7 and 8 of RA 10932 do not violate the Constitution.

Lastly, the petitioner seeks to declare Sections 7 and 8^[32] of RA 10932 unconstitutional because the said provisions, which provide that PhilHealth reimbursement, Philippine Charity Sweepstakes Office assistance, and tax deductions shall only cover basic emergency care provided to poor, indigent, or marginalized patients, supposedly violate the equal protection clause.

The equal protection clause does not call for absolute equality. What it simply requires is equality among equals as determined according to a valid classification. Indeed, the equal protection clause permits classification.^[33]

Such classification, however, to be valid must pass the test of reasonableness. The test has four requisites: (1) The classification rests on substantial distinctions; (2) It is germane to the purpose of the law; (3) It is not limited to existing conditions only; and (4) It applies equally to all members of the same class.^[34]

First, a belabored discussion is not needed to explain that there are substantial distinctions as to the medical treatment of poor, indigent, and marginalized patients and that of patients who can very well afford medical treatment. It is self-explanatory that poor, indigent, and marginalized patients are differently situated as compared to affluent and well-off patients who have the means to avail themselves of medical treatment. Further, the special treatment of poor, indigent, and marginalized patients under RA 10932 is very much germane to the purpose of the law. In fact, the 1987 Constitution itself mandates that the State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost, wherein there shall be priority for the needs of the underprivileged sick, elderly, disabled, women, and children.^[35] Lastly, it is not limited to existing conditions only and that the questioned proviso .is equally apply to all members of the same class.

Given the foregoing reasons, I concur with the ponencia and vote to DISMISS the instant Petition.

^[1] AN ACT STRENGTHENING THE ANTI-HOSPITAL DEPOSIT LAW BY INCREASING THE PENALTIES FOR THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BLLANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES", AS AMENDED BY REPUBLIC ACT NO. 8344, AND FOR OTHER PURPOSES.

^[2] See Garcia v. The Executive Secretary, 602 Phil. 64, 73 (2009).

^[3] Id. at 73.

^[4] Id.

^[5] Francisco, Jr. v. The House of Representatives, 460 Phil. 830, 892 (2003).

^[6] Ocampo v. Enriquez, 798 Phil. 227, 288 (2016).

^[7] Id. at 288.

^[8] Id.

^[9] Board ofOptometry v. Colet, 328 Phil. 1187, 1206 (1996).

^[10] Ocampo v. Enriquez, supra note 6, at 289-290.

^[11] Id. at 290.

^[12] SECTION 1. In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for administering basic emergency care to any patient, confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death, or permanent disability, or in the case of a pregnant woman, permanent injury or loss of her unborn child, or noninstitutional delivery: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act.

^[13] See Lucas v. Tuaño, 604 Phil. 98, 125 (2009).

^[14] RA 10932, Sec. 1.

^[15] SEC. 4. Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of this Act shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than One hundred thousand pesos (P100,000.00), but not more than Three hundred thousand pesos (P300,000.00) or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than Five hundred thousand pesos (P500,000.00), but not more than One million pesos (P1,000,000.00) or both, at the discretion of the court, without prejudice to damages that may be awarded to the patient-complainant: Provided, further, That upon three (3) repeated violations committed pursuant to an established policy of the hospital or clinic or upon the instruction of its management, the health facility's license to operate shall be revoked by the DOH. The president, chairman, board of directors, or trustees, and other officers of the health facility shall be solidarily liable for damages that may be awarded by the court to the patient-complainant.

^[16] People v. Millora, 252 Phil. 105, 122 (1989).

^[17] 23 Phil. 279, 289 (1912).

^[18] 1987 CONSTITUTION, Art. II, Sec. 15.

^[19] See Añonuevo v. Court of Appeals, 483 Phil. 756, 766-767 (2004).

^[20] 247-A Phil. 51, 56 (1988).

^[21] 331 Phil. 1019 (1996).

^[22] Id. at 1027.

^[23] 151-A Phil. 648 (1973).

^[24] Id. at 652.

^[25] Spouses Africa v. Caltex (Phil.), Inc., 123 Phil. 272, 281-282 (1966).

^[26] See Ramos v. Cho Chun Chac, 54 Phil. 713, 715 (1930).

^[27] Teague v. Fernandez, supra note 23, at 652.

^[28] Añonuevo v. Court of Appeals, supra note 19.

^[29] 271 Phil. 886 (1991).

^[30] 92 Phil. 856, 858-859 (1953).

^[31] Bañares v. Court of Appeals, supra note 29, at 897.

^[32] SEC. 7. PhilHealth Reimbursement of Basic Emergency Care. — PhilHealth shall reimburse the cost of basic emergency care and transportation services incurred by the hospital or medical clinic for the emergency medical services given to poor and indigent patients. Furthermore, the Philippine Charity Sweepstakes Office (PCSO) shall provide medical assistance for the basic emergency care needs of the poor and marginalized groups.

SEC. 8. Tax Deductions. — Other expenses incurred by the hospital or medical clinic in providing basic emergency care to poor and indigent patients not reimbursed by PhilHealth shall be tax deductible.

^[33] Biraogo v. The Philippine Truth Commission of 2010, 651 Phil. 374, 459 (2010).

^[34] Id. at 459.

^[35] 1987 CONSTITUTION, Art. XIII, Sec. 11.

(1)	an actual case or controversy calling for the exercise of judicial power;

(2)	the person challenging the act must have "standing" to challenge; he must have a personal and substantial interest in the case such that he has sustained, or will sustain, direct injury as a result of its enforcement;

(3)	the question of constitutionality must be raised at the earliest possible opportunity; and

(4)	the issue of constitutionality must be the very lis mota of the case.^[1]

EN BANC

[ G.R. No. 234448, November 06, 2018 ]

PRIVATE HOSPITALS ASSOCIATION OF PHILIPPINES v. SALVADOR MEDIALDEA +

PRIVATE HOSPITALS ASSOCIATION OF THE PHILIPPINES, INC. (PHAPI) REPRESENTED BY ITS PRESIDENT, DR. RUSTICO JIMENEZ, PETITIONER, VS. HON. SALVADOR MEDIALDEA, EXECUTIVE SECRETARY, AND THE ACTING SECRETARY OF DEPARTMENT OF HEALTH, RESPONDENTS.DECISION

PRIVATE HOSPITALS ASSOCIATION OF THE PHILIPPINES, INC. (PHAPI) REPRESENTED BY ITS PRESIDENT, DR. RUSTICO JIMENEZ, PETITIONER, VS. HON. SALVADOR MEDIALDEA, EXECUTIVE SECRETARY, AND THE ACTING SECRETARY OF DEPARTMENT OF HEALTH, RESPONDENTS.

DECISION