Major health associations have condemned former journalist and columnist Ramon Tulfo for what they describe as the “unjust” public shaming of a Philippine Heart Center (PHC) surgeon in a viral Facebook post over alleged exorbitant professional fees.
Tulfo’s post, uploaded on August 8 and now with over 28,000 reactions, 7,300 comments, and 7,700 shares, singled out PHC specialist Dr. Ramon Ribu. He claimed Ribu charged his friend’s mother ₱85,000 in professional fees, raising her hospital bill to ₱110,000 and preventing her discharge.
“It’s not even major surgery, just at the leg. How come the payment to hospitals and doctors are that high? Have mercy, Doc!,” Tulfo said in Filipino.
The Philippine Medical Association (PMA) issued a statement Monday, condemning the public naming of the surgeon. “Each doctor has the right to determine the worth of his services rendered guided by a common relative value scale followed in the Philippines. Based on accounts on services rendered to the patient mentioned in the case, the hospital charges and professional fees were within acceptable limits of ethical practice,” the statement read.
“We therefore condemn the post to malign a physician who performed his duty well. He was singled out despite the fact that there were several medical specialists who handled this very complex case,” the PMA added. The group also said Tulfo’s ₱85,000 figure was inaccurate and that doctors had agreed to accept a guarantee letter for payment.
The Philippine College of Surgeons (PCS), the Philippine Association of Thoracic, Cardiac and Vascular Surgeons Inc. (Patacsi), and the Philippine Wound Care Society (PWCS) issued a joint statement echoing the PMA’s condemnation. They criticized the “public shaming of our fellows or any member of the medical profession,” stressing that Tulfo’s post “negatively” portrayed a surgeon “based on unverified and unfounded claims.”
Tulfo Stands Firm
Despite the backlash, Tulfo defended his post in a DZMM interview Monday, arguing that doctors in government hospitals should show more compassion to indigent patients.
“Alam mo kailangan ding maibunyag ‘yung kanilang paniningil ng malalaking professional fee sa mahihirap. Ang sinasabi nila espesyalista sila, sayang ang pinag-aralan nila. E di ba meron din naman medical ethics? Na kapag mahirap ‘yung pasyente mo, maging considerate ka naman. Kawawa naman ‘yung mga tao,” he said in a DZMM interview.
[TRANSLATION: You know, their charging of huge professional fees to the poor also needs to be exposed. They say they’re specialists and that their education should not go to waste. But isn’t there also medical ethics? That if your patient is poor, you should be considerate. People are suffering.]
Tulfo alleged the patient, a diabetic woman with a persistent leg wound, still had a ₱139,000 hospital balance despite receiving significant financial assistance — ₱100,000 from his brother Sen. Erwin Tulfo, ₱50,000 from Caridad Tulfo Foundation, ₱100,000 from a friend, ₱75,000 from the Malasakit Center, and ₱25,000 from Rep. Miro Quimbo.
Told that PMA had debunked the ₱85,000 fee, Tulfo shot back: “Nag sisingungaling ‘yung isa sa kanila.” [TRANSLATION: One of them is lying.] He insisted he could raise the remaining balance if the professional fee was waived.
PMA Explains PHC’s Setup
In an exclusive interview with Joyful Wellness, PMA President Dr. Hector Santos Jr. clarified on Thursday some points on the state of the Philippine Heart Center (PHC).
“Doctors’ bills may contribute to the inability for them to settle their hospital bills. However, first to make it clear PHC is not just a “government hospital”,” said Santos.
“It has both a Clinical division (government supported fees) and the Private division which allows admission of Private patients handled by PHC consultants.”
He also explained that not all PHC consultants are salaried government employees, and many are accredited consultants authorized to admit private patients and set their own fees upon admission.
How Professional Fees are Set
Santos outlined the factors influencing a doctor’s professional fee, including specialization, subspecialization, case complexity, treatment length, equipment use, and the type of hospital or room.
“Higher professional fees charged for more difficult cases and long-standing treatment also entails higher professional fees,” he said, adding that specialists called in from outside may charge more to cover travel expenses.
“Doctors often follow an acceptable relative value for their consultations and professional fees. Only the attending doctor can determine what he feels is worthy of his provided services,” the PMA president emphasized.
PMA also noted that hospital charges are separate from doctors’ professional fees, and in many cases, promissory notes are accepted so patients can be discharged even without immediate payment of the fee.
However, PMA clarified that hospital charges are separate from doctors’ professional fees.
“As I said often, the hospital charges are given priority to be paid and promissory note accepted for profession fees of doctors only because the doctors already want the patient to be discharged.”
In the PHC case, Santos said the patient was admitted as a private-paying patient in a private room and was aware she would be treated by private doctors. He also criticized “patronage politics,” where patients seek guarantee letters from politicians and then “publicly shame doctors and health workers if they are not given extra amenity or courtesy discount.”
What the Law Says
The long-standing problem of patients unable to settle hospital bills sits against the backdrop of Republic Act No. 9439 (Anti-Hospital Detention Law), enacted in 2007 under former President Gloria Macapagal Arroyo to bar public and private hospitals from detaining patients cleared for discharge or withholding remains solely over unpaid bills.
The law allows patients to leave upon signing a promissory note secured by a mortgage or co-maker while bodies and death certificates must be released regardless of payment. Violators face fines of ₱20,000 to ₱50,000, jail terms of one to six months, or both.
In addition, the Department of Health (DOH) rules since 2008 require hospitals to post patient rights, use standard promissory note formats, and report their use.
But the enforcement, however, remains patchy: over 1,250 complaints of illegal detention were filed with the DOH from 2021 to mid-2024, often involving private hospitals. Legal grey areas persist, as “detention” under the law applies only after a discharge order and signed promissory note, leaving pre-discharge billing disputes, like in the PHC case, outside its direct scope.
Because of this, Congress now seeks tougher sanctions.
House Bill 11329 proposes fines up to ₱500,000, prison terms of up to six years, license revocation, acceptance of GSIS, SSS, and PhilHealth guarantee letters, and a 24-hour release mandate for the remains of Muslims and indigenous peoples. House Bill 1138 would likewise raise penalties and establish an Anti-Hospital Detention Assistance Fund for indigent patients. Lawmakers say current penalties are too weak to deter violations, especially in high-end hospitals.
Policy Reforms Urged
To address disputes over hospital and doctors’ fees, PMA is pushing for stronger implementation of the PhilHealth insurance program. Santos said that if the law is applied properly, it could reduce patients’ out-of-pocket expenses and ensure fair compensation for physicians.
“Implement the PhilHealth insurance program. The law in place if implemented properly could help serve the community from these problems,” he said, explaining that “doctors implement the primary care part of the PhilHealth law but government on their part should increase the benefits received from this National Insurance Program so there will be lesser out of pocket payment from patients and higher professional fees given to doctors.”
“At this current rate, PhilHealth only pays for less than 30% of usual professional fees of a private medical practitioner. This is low return for the highly specialized and trained physician who spent lots of time, effort, study and training hours to get to the high-level specialization he attained,” Santos said.
“You can’t blame highly specialized doctors to leave and work abroad where they get better pay.”
Meanwhile, PMA said it is open to releasing its investigation results on the issue, subject to patient-doctor confidentiality and data privacy laws.
DISCLAIMER
This article provides general information and does not constitute medical advice. Consult your healthcare provider for personalized recommendations. If symptoms persist, consult your doctor.
