Guidelines for Anti-Torture Act Health Implementation

Legal basis and declared policy

The implementation guidelines are anchored on Section 19 of the Implementing Rules and Regulations of Republic Act No. 9745 (Anti-Torture Act of 2009).
The Order affirms that every human being must be treated with dignity and respect.
The Order affirms that every human being has the right to health, including suspects, detainees, and prisoners.
The DOH upholds the constitutional condemnation and prohibition of torture and reiterates commitments to the International Covenant on Civil and Political Rights, Convention on the Rights of the Child, Convention on the Elimination of All Forms of Discrimination Against Women, and Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
The DOH, together with the Philippine Medical Association, supports the Declaration of Tokyo (1975) (including its detailed rules for physicians).
The DOH upholds The Istanbul Protocol and similar international and national covenants applicable to medical and allied health practice.
The Order establishes that healthcare professionals and practitioners, together with partner agencies and organizations, are jointly responsible for disseminating and implementing the Anti-Torture Act of 2009 provisions in the health sector.

Purpose and healthcare-sector objectives

The Order establishes healthcare workers’ participation in implementing the Anti-Torture Act of 2009.
The Order provides mechanisms enabling healthcare workers—especially the responding medical doctor—to protect the right of torture victims or potential torture victims to demand a medical examination by a physician of their own choice.
The Order issues directives to build capability for competent implementation in assessment, diagnosis, and treatment of torture victims, their families, and perpetrators.
The Order directs capability building for documenting and reporting probable incidences of torture.

Core definitions and key terms

“Torture” is defined by Republic Act No. 9745 as an act intentionally inflicting severe pain or suffering, whether physical or mental, for purposes including: obtaining information or a confession; punishing; or intimidating/coercing for any reason based on discrimination, when inflicted by or at the instigation of, or with the consent or acquiescence of, a person in authority or agent of a person in authority; it does not include pain or suffering arising from, inherent in, or incidental to lawful sanctions.
“Act” means Republic Act No. 9745 or the Anti-Torture Act of 2009.
“Person in authority” refers to any person directly vested with jurisdiction, whether as an individual or as a member of a court or government corporation, board, or commission.
“Agent of a person in authority” refers to any person charged by direct provision of law or by election/appointment with maintenance of public order and protection/security of life and property, including anyone who comes to the aid of persons in authority.
“Custodial investigation” includes issuing an invitation to a person investigated for an offense suspected to have been committed, subject to liability of the inviting office for law violations, as defined in Republic Act No. 7438.
“Independent and competent doctor” is defined by DOJ and CHR Implementing Rules of RA 9745 as a physician freely chosen by the victim or authorized representative to conduct physical examination and treatment of tortured victims; physicians belonging to arrest/detention agencies are excluded unless the victim specifically allows examination and circumstances so require; a physician licensed by the Professional Regulatory Commission as a medical doctor is considered a competent doctor.
“Healthcare worker” is a person directly providing legitimate health services or someone who works in a healthcare institution or healthcare facility.
“Medical Examiner” is a physician who conducts the victim’s physical and/or psychological examination and evidences it with a medical report signed by him/her.
“Healthcare or health facility” includes buildings/edifices used for healthcare services, including hospitals and outpatient clinics such as rural health units, health centers, barangay health stations, birthing facilities, newborn screening centers, dental clinics and laboratories, drug testing laboratories, drug abuse treatment facilities, blood service facilities, and other facilities for specialized health services.
“Medical examination” means physical examination and other adjunct assessment methods used by the medical examiner to determine presence of injuries and illness.
“Forensic medicine” is the science applying medical knowledge to legal questions.

General healthcare obligations and torture categories

Healthcare workers—especially those mandated to directly attend to victims or probable victims—must raise awareness or suspicion to identify torture victims adequately.
The Order classifies torture-related conduct into physical torture and mental/psychological torture, and it also recognizes other cruel, inhuman and degrading treatment or punishment.
Physical torture includes severe pain/exhaustion/disability/dysfunction inflicted by a person in authority or agent, such as systematic beating, head banging, punching, kicking, striking with truncheon or rifle butt or similar objects; food deprivation or forcible feeding with spoiled food/excreta/other non-normally eaten substances; electric shock; cigarette burning or burning by heated rods/hot oil/pepper chemicals on mucous membranes/acids/spices directly on wounds; submersion of the head in water polluted with excrement/urine/vomit/blood until brink of suffocation; forced fixed and stressful bodily positions; rape and sexual abuse including insertion of foreign objects; mutilation/amputation of essential body parts; dental torture or forced extraction of teeth; pulling out fingernails; harmful exposure to elements; plastic bag over the head to asphyxiation; administration of psychoactive drugs to induce confession or reduce mental competency or induce extreme pain/disease symptoms; and other analogous acts of physical torture.
Mental/psychological torture includes acts calculated to affect/confuse the mind or undermine dignity/morale, such as blindfolding; threats of bodily harm/execution or other wrongful acts to the person or relatives; confinement in solitary cells/secret detention; prolonged interrogation; preparing for show trials/public display/public humiliation; unscheduled transfer to create belief of summary execution; maltreating family members; causing torture sessions to be witnessed by family/relatives/third parties; denial of sleep/rest; shame infliction such as stripping naked, parading in public, shaving head, or putting marks against will; deliberately prohibiting communication with family; and other analogous acts of mental/psychological torture.
Other cruel, inhuman and degrading treatment or punishment covers deliberate and aggravated treatment/punishment not enumerated as physical or mental/psychological torture that attains a level of severity sufficient to cause suffering, gross humiliation, or debasement inflicted by a person in authority or agent on a person in custody.

Rights of persons in custody; examination access

Health workers must respect absolute rights to freedom from torture and other cruel, inhuman and degrading treatment or punishment in all circumstances.
Every person in custody must receive a right to own choice, meaning the person must be informed in oral or written form in a language/dialect understood by the alleged torture victim or the person concerned of the right to demand a physical examination by a physician of his/her own choice.
Every person arrested, detained, or under custodial investigation must receive the right to physical examination, requiring prompt and thorough medical examination to determine whether torture has been inflicted.
The right to physical examination must be availed before and after interrogation and immediately before and after any transfer to places of detention.
Access to physical, medical, and psychological examination for treatment is an immediately executory right upon the demand of the victim, without need of any court order or legal process.
The Order provides the right to physical/medical/psychological access also to members of the victim’s immediate family.
Victims must receive institutional protection through prompt and impartial fact-finding investigation within sixty (60) days by the CHR, PNP, DOJ, and other concerned government agencies where the complaint is lodged.
When the victim is a child, the child must always be accompanied by a social worker from the local Social Welfare and Development Office.
Victims of torture and witnesses to torture must be able to avail of benefits under Republic Act No. 6981 (Witness Protection, Security and Benefit Act) and other applicable laws.

Medical examiner duties and organizational support

A medical examiner must never directly or indirectly participate in acts constituting torture or cruel, inhuman and degrading behavior.
A medical examiner must diligently and completely conduct the necessary medical examinations on victims or probable victims of torture.
A medical examiner must prepare a comprehensive medical report within the prescribed period and according to the standard DOH-recommended reporting form.
A medical examiner must institute immediate treatment and necessary referral to mitigate physical, health, and psychological effects of torture.
A medical examiner must make referrals for appropriate laboratory and ancillary procedures when necessary.
A medical examiner must make referrals to appropriate health facilities and experts for treatment and rehabilitation of victims of torture.
A medical examiner must make recommendations on psychological management or rehabilitation of family members and eyewitnesses to torture.
A medical examiner must assist the government in the administration of justice in relation to the Act as required by the Code of Ethics of the Medical Profession.
Any violation of the medical examiner obligations by act or omission must be referred to relevant authorities and medical associations for further investigation.
Employing organizations/health facilities must provide physical and administrative environment enabling medical examiners and responders to perform duties, including: a room or secured area for history taking and physical examination with audio and visual privacy; medical supplies, documentation, and video equipment, and facilities/report forms for diagnosis, treatment, referral, or rehabilitation; transportation and allowable incidental expenses; coordination for safety and protection of the medical examiner and the records/reports; work schedule policies ensuring Act implementation time is official business; mechanisms to identify and network alternative physician teams (example, PMA and NGOs); and access to information and training to improve knowledge, skills, and attitude for Act implementation.

DOH roles, reporting rules, and funding

The National Center for Health Facilities Development (NCHFD) must establish referral diagnostic facilities for forensic medicine within DOH health facilities with capabilities including DNA tests, radiology services, and chemical, toxicologic and serologic tests.
The Information Management Service (IMS) must establish continuous databases on injuries, partner agencies, health human resources, and other resources vital to implementing the Act.
The IMS must incorporate into the administrative order on the “National Implementation of the Unified Registry System of Chronic Non-Communicable Disease, Injury-Related Cases, Persons with Disabilities, and Violence Against Women and Children” the indicators and other information required to meet Act implementation data needs.
The National Epidemiology Center (NEC) must establish continuous databases on injuries, partner agencies, health human resources, and other resources vital to implementation of the Act.
The Health Human Resource and Development Bureau (HHRDB) must identify technical resources and experts in forensic medicine, medical jurisprudence, and related disciplines for formal training opportunities for physicians in government health service.
The HHRDB must provide opportunities for orientation of healthcare workers on Act-related provisions on health services.
The HHRDB must prescribe standards for health service provision related to the Anti-Torture Act to be incorporated into medical and paramedical educational and training programs.
Each Center for Health Development (CHD) must ensure victims are referred to appropriate health facilities in its jurisdiction per Section 19 of the IRR for RA 9745.
DOH must use its regulatory functions, as far as practicable, to strengthen Act implementation and similar laws.
DOH, in coordination with DSWD and other agencies, must formulate rehabilitation programs for torture victims and their families and parallel rehabilitation for persons who committed torture and related acts, per Section 37 of the IRR.
DOH must institute actions to address complaints from medical examiners/doctors and other health workers assisting torture victims or their families.
Medical and psychological reports must comply with Section 24 of the Implementing Rules and Regulations of the Anti-Torture Act.
The Guidelines for Medical Evaluation of Torture and III-Treatment (Istanbul Protocol) serves as the basis for the Medical Report Form for probable victims of torture in Annex A.
In principle and as stated in Section 23 of the IRR, the medical report on a torture victim must be treated as a public document for persons who seek to avail of it with legal interest, subject to confidentiality rules for medical reports involving children and victims of sexual violence under existing laws.
The Medical Report Form for Probable Victims of Torture must be released by the medical examiner or the health facility’s medical records custodian only to persons with legal interest, specifically: the victim (unconditional release); next of kin (adequately validated); lawyers of victims (authorized in writing); perpetrators and representatives of suspected perpetrators (after presentation of a court order); others authorized in writing by the victim; and others authorized by a court of law.
All accomplished Medical Report Forms must be assigned a permanent report number, and safekeeping within a health facility is the responsibility of the designated Records Custodian.
Completeness and report quality must take priority over haste when responding to requests.
The Medical Report Form for Probable Victims of Torture is recommended to be completed as early as possible to support inquest proceedings.
Supplementary reports such as diagnostic results, psychiatric evaluation, photographs, and other documents must be prepared as soon as possible and submitted to appropriate authorities as necessary.
DOH must set aside budget through its bureaus, offices, services, hospitals, and field units to implement this issuance.

Repeals, separability, and penalties

The Order does not establish penalties or fines for non-compliance.
The Order does not set administrative sanctions for violations.
The Order does not provide separability or sunset clauses.