Revised Implementing Rules and Regulations of Republic Act No. 8316

June 29, 2016

DOH ADMINISTRATIVE ORDER NO. 2016-0027

 

I. Rationale/Background

On February 5, 1973 by virtue of Department Order No. 60-B series 1973, Cotabato Hospital was given an authorized bed capacity of 200. The said Department Order changed its name from Cotabato Hospital to Cotabato Regional Hospital (CRH) in accordance with the Philippine Hospital Development Program of the Department of Health. Further, pursuant to Section 16 of Republic Act No. 4226 (Hospital Licensure Act) Cotabato Regional Hospital (CRH) was classified as a General Hospital, Teaching and Training, and under the service category of a Tertiary Hospital.

Being the only tertiary hospital in Region XII, the Cotabato Regional Hospital served as the end referral hospital for all cases that required higher level of treatment. It served not only Region XII but the Autonomous Region in Muslim Mindanao (ARMM) as well. As a teaching and training hospital, the four major departments: Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Surgery have accredited residency training programs by the accrediting board of their respective societies.

On June 30, 1997, without the President's signature, Republic Act No. 8316 lapsed into law, upgrading CRH to a medical center and correspondingly increased its bed capacity to four hundred (400) beds. The said law has not been fully implemented because despite of its actual implementing beds of 400, budget allocated to Cotabato Regional and Medical Center (CRMC) for Maintenance and Other Operating Expenses (MOOE) and Personnel Services (PS), had remained for that of a two hundred (200)-bed hospital.

Based on the hospital statistical report, the hospital's actual occupancy rates for the years 2013, 2014, and 2015 are 136.06%, 140.40%, and 162.55%, respectively or an average of 146.33% in the last three (3) years. The ratio of hospital bed per population in Region XII is 1 hospital bed to 10,345 (1:10,345) population which is beyond the ideal ratio of 1 hospital bed to 1,000 (1:1,000) population.

In the Philippine Hospital Development Plan 2000, the CRMC was identified to be developed into a Trauma and Cancer Center. For the past three years from 2013 to 2015, the trauma cases have averaged 4,890 per year with vehicular accidents specially that of two-wheeled vehicle being consistently in the Top 10 Cases of Morbidity and Mortality followed by gunshot wounds, electrocution, and burns. Cancer cases have consistently increased through the years from 1,336 in 2013 to 1,497 in 2014 and 1,534 in 2015; the top 10 morbidities being cancers of lung, breast, colon/rectum, cervix, leukemia, stomach, thyroid, ovary, prostate, and corpus uteri. Most of these cases have to be referred to Davao City or to a health care facility chosen by the patient due to absence of a radiation facility in CRMC. It is in the above light that these Rules and Regulations are issued to fully implement RA 8316. DETACa

II. Objective

This Administrative Order sets the revised Implementing Rules and Regulations of Republic Act No. 8316 otherwise known as "An act upgrading the Cotabato Regional Hospital in Cotabato City into a Medical Center to be known as the Cotabato Regional and Medical Center, and Appropriating Funds Therefor."

III. Scope

These Rules and Regulations discussed in this Administrative Order shall only pertain to Republic Act No. 8316.

IV. Definition of Terms/Acronyms

1. Act — refers here to Republic Act No. 8316 entitled "An Act Upgrading the Cotabato Regional Hospital in Cotabato City into a Medical Center to be known as the Cotabato Regional and Medical Center, and Appropriating Funds Therefor".

2. AO 2012-0012-A — refers to the amended Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines dated September 3, 2015.

3. Bed Capacity — refers to the number of beds made available for inpatient care.

4. Bed Occupancy Rate (BOR) — is the ratio of actual inpatient service days for a given period to the declared bed capacity of the hospital for the same period.

5. CRMC — refers to Cotabato Regional and Medical Center.

6. Level 3 Hospital — as classified in Administrative Order No. 2012-0012-A dated September 3, 2015.

7. Medical Center — the highest tertiary level hospital with teaching, training, and research functions. It provides for highly specialized care and diagnostic services. It has more specialty services and should have specialized units which are organ/disease specific.

8. Referral Hospital — refers to a health care institution capable of accepting referrals from lower level hospitals and render general and specialized health care services.

9. Regional Hospital — a higher level tertiary referral hospital with teaching, training, and research functions. It shall have specialty and sub-specialty services in the four (4) major departments and provide basic diagnostic and ancillary procedures. The catchment population is at least 500,000.

V. Policies and Guidelines

A. General Policies

The CRMC shall provide a tertiary level of promotive, curative, preventive, rehabilitative health care services, and research. It shall be fully equipped with state-of-the-art equipment and facilities, complemented by adequately trained and competent health human resources as appropriate for a licensed Level 3 health care facility.

Furthermore, the CRMC shall strengthen its existing services (Internal Medicine, Pediatrics, Surgery, Obstetrics-Gynecology, Emergency Medicine, Rehabilitation Medicine, Anesthesiology, Pathology and Laboratory Medicine, Radiology and Imaging Services, Mental Health, Oncology and their sub-specialties and Orthopedics) and aim for the improvement of its service capability and capacity while continually serving as a referral hospital, complementing the services of local government health care facilities in the province and the region. The increase in bed capacity shall be consistent with the Development Plan of the Cotabato Regional and Medical Center to be a Trauma and Cancer Center.

B. Implementing Mechanisms

In support of the implementation of Republic Act No. 8316, the following guidelines shall be implemented:

1. Expansion of Services

The CRMC shall operate as a 400-bed Level 3 hospital with additional services such as TB Center for TB-DOTS and Programmatic Management of Drug-Resistant Tuberculosis (PMDT), Center for Emerging and Re-emerging Diseases, Cancer and Nuclear Medicine Center, Trauma Center, and Regional Reference Laboratory for Central Mindanao complemented by adequately trained health human resources.

Structural reorganization with additional services shall be established based on the Hospital Development Plan.

2. Health Human Resource

In case of detailed employees and/or deployment of staff as a result of the DOH Rationalization Plan, the CRMC shall continue to honor the positions, security of tenure, and other rights of its human resource complement. The hospital shall evaluate the existing health human resource complement, reclassify and/or propose upgrading of positions, promote professional development and hire additional staff to comply and conform to the DOH standards, purpose and intent of Republic Act No. 8316.

The CRMC has implemented the increase in its health personnel based on the recommended staffing pattern for a 400 bed capacity hospital following the DBM-DOH Joint Circular No. 2013-01, "Revised Organizational Structure and Staffing Standards of Government Hospitals, CY 2013 Edition" dated September 23, 2013.

3. Assets and Liabilities

All assets, movable and immovable, and records of the CRMC as well as its liabilities and obligations shall be properly updated and shall be accounted for in accordance with existing policies and guidelines.

4. Equipment

The CRMC shall make an inventory of the existing hospital equipment and undertake upgrading to conform to DOH minimum standards of a Level 3 hospital as provided for under AO No. 2012-0012-A. Additional equipment and facilities that will complement the expansion of services such as but not limited to laboratory, additional radiology and imaging, radiation equipment shall be procured with the support of the DOH.

5. Infrastructure

The CRMC shall implement and seek the support of DOH for the construction/repair/renovation of physical infrastructure to conform to all existing laws and licensing standards and current international standards for hospital buildings in line with Hospital Safe from Disasters Program, among others.

6. Systems Development

The CRMC shall develop and sustain the standards of hospital operations including ISO 9001:2008 standards to provide Continuing Quality Improvement (CQI) in patient care and safety for patients, health workers and clientele of the hospital. It shall implement an electronic information system conforming to the basic requirements of the Integrated Hospital Operations and Management Program (IHOMP).

7. Quality Management

The CRMC Management shall enhance and implement Continuing Quality Improvement Program, Patient Safety, standards on the Manuals of Hospital Operations and Management issued by the Health Facility Development Bureau (HFDB), other policies and standards provided by the DOH, Health Facilities and Services Regulatory Bureau (HFSRB), Food and Drug Administration (FDA), the Philippine Health Insurance Corporation (PhilHealth) and other standards provided by international health organizations which are supportive of existing local and national standards.

The CRMC shall implement the quality management system conformance with ISO 9001:2008 certification standards.aDSIHc

VI. Implementing Structure

1. Administrative Control

The Medical Center Chief of CRMC shall be accountable and responsible for the operations and management relative to the increase in bed capacity, upgrading of service capability and implementation of all the other provisions of the Act.

The DOH, through Regional Office XII (SOCCSKSARGEN) shall have oversight jurisdiction over the hospital operations. It shall monitor the implementation of the Act and may recommend further necessary upgrading guided by this Administrative Order.

Further, the Health Facility Development Bureau (HFDB) shall provide the needed technical assistance in line with the hospital upgrading, development, and capacity building.

2. Sourcing and Use of Funds

The amount necessary to carry out the provisions of Republic Act No. 8316 shall be sourced out accordingly:

2.1. Capital investment for infrastructure and equipment shall be sourced from the DOH General Appropriations Act (GAA), hospital income which includes PhilHealth payments, public-private partnership and other modes of financing scheme subject to prevailing government rules and regulations;

2.2. The additional Maintenance and Other Operating Expenses (MOOE) resulting from the hospital expansion shall be sourced from the GAA, hospital income, PhilHealth payments, public-private partnership and/or other modes of financing scheme;

2.3. Personnel Services (PS) to carry out the full implementation of the staffing pattern of 400 beds in compliance with DOH-DBM Joint Circular 2013-01 dated September 23, 2013 and other related issuances shall be sourced out from GAA and other sources; and

2.4. Release of funds from the DOH shall be approved by the appropriate authority.

VII. Repealing/Separability Clause

Administrative Order No. 13-A s. 1998 dated September 15, 1998 and provisions of previous issuances that are inconsistent or contrary to the provisions of this Order are hereby rescinded.

If any provision of this Order is declared unauthorized or rendered invalid by any court of law or competent authority, those provisions not affected thereby shall remain valid and effective.

VIII. Effectivity

This Order shall take effect fifteen (15) days after publication in the Official Gazette or in a newspaper of general circulation.

(SGD.) JANETTE P. LORETO-GARIN, MD, MBA-HSecretary of Health