How can a hospital recoup costs from treating a penniless patient?


Persida Acosta

Dear PAO,
Is there any law that we can refer to when it comes to collection of unpaid medical bills from a patient? Since Republic Act 9439 prohibits a medical institution from detaining its patients who are not capable of paying hospital bills, how can the hospital recover from its expenses in attending to the medical care of a patient who has no money at all?
Thank you, and God bless!

Dear Jadhe,
The hospital or medical clinic is not without recourse in cases where patients are financially incapable to pay their hospital bills or medical expenses. Under Section 2 of Republic Act (RA) 9439 (The Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of Non-payment of Hospital Bills or Medical Expenses), the patients who are financially incapable to settle their expenses in hospitals and medical clinics who have fully or partly recovered shall be allowed to leave upon the execution of promissory note covering the unpaid obligation secured either by a mortgage or by a guarantee of a co-maker, who will be jointly and severally liable with the patient for the obligation.

“A promissory note is a solemn acknowledgment of a debt and a formal commitment to repay it on the date and under the conditions agreed upon by the borrower and the lender. A person who signs such an instrument is bound to honor it as a legitimate obligation duly assumed by him through the signature he affixes thereto as a token of his good faith” (Sierra vs. Court of Appeals, G.R. No. 90270, July 24, 1992 (ponente, former Associate Justice Isagani Cruz). It should be noted, however, that those obliged to deliver or to do something incur delays from the time the obligee (medical institution) judicially or extrajudicially demands from them the fulfillment of their obligation (Article 1169, New Civil Code).

If the patient still fails to pay after demand to pay is made, the medical institution can enforce the payment through the filing of a small claims case in the lower court in accordance with A.M. No. 08-8-7-SC, The 2016 Revised Rules of Procedure for Small Claims Cases, if the amount of the unpaid obligation does not exceed two hundred thousand pesos. If the obligation exceeds this amount, the medical institution can file a collection of sum of money. If, however, such promissory note was secured by a mortgage, the medical institution can foreclose the mortgage on the property to satisfy the debt. In Marilag vs Martines (G.R. No. 201892, July 22, 2015; ponente, Associate Justice Estela Perlas-Bernabe) citing Bachrach Motor Co. Inc. v. Icarangal (68 Phil. 287, 293-294, 1939), it was held that “a mortgage creditor may institute against the mortgage debtor either a personal action for debt or real action to foreclose the mortgage. In other words, he may pursue either of the two remedies, but not both. By such election, his cause of action can by no means be impaired, for each of the two remedies is complete in itself. Thus, an election to bring personal action will leave open to him all the properties of the debtor for attachment and execution, even including the mortgaged property itself. And, if he waives such personal action and pursues his remedy against the mortgaged property, an unsatisfied judgment thereon would still give him the right to sue for a deficiency judgment, in which case, all the properties of the defendant, other than the mortgaged property, are again open to him for the satisfaction of the deficiency. In either case, his remedy is complete, his cause of action undiminished, and any advantages attendant to the pursuit of one or the other remedy are purely accidental and are all under his right of election.”

On the other hand, if a co-maker secured the note, a collection suit for the unpaid obligation may be instituted against either the patient or the co-maker or the both of them. Section 2 of RA 9439 specifically provides that the patient and the co-maker who guaranteed the note are jointly and severally liable for the obligation. Under Article 1216 of the Civil Code, the creditor may proceed against any one of the solidary debtors or some or all of them simultaneously for the whole unpaid obligation.

We find it necessary to mention that this opinion is solely based on the facts you have narrated and our appreciation of the same. The opinion may vary when the facts are changed or elaborated. We hope that we were able to enlighten you on the matter.

Editor’s note: Dear PAO is a daily column of the Public Attorney’s Office. Questions for Chief Acosta may be sent to


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