Fil-Am doctor-lawyer wins landmark case

Medical doctor, lawyer, chemist, molecular biologist, PhD and MBA degree holder. Professor of medicine, cancer director in several US hospitals, leading figure in stem cell research, cancer therapy and bioregenerative medicine. He is also a cancer survivor.

Filipino-American Dr. Samuel D. Bernal has a string of letters and dots after his name. He has authored numerous books and scientific articles and embarked on groundbreaking researches which have gained him fame and respect in the daunting field of molecular science and cancer therapy. But the latest feat that excites him has something to do with both medicine and law—in one blow, that is.

This doctor lawyered and won on behalf of a cancer-stricken Filipino-American based in San Francisco, California. Bernal filed a malpractice suit against a group of doctors, a hospital and an HMO last year. (He’s handling other cases of this nature.) He sued for extraordinary damages and after several months of litigation, the contending parties arrived at a settlement last December 2008. The settlement was in the vicinity of $.5 million which exceeded the usual.



“What we want to convey here is not the specifics of this case,” Bernal explains, “but that care of patients must be personalized and not based on menus or so-called standard-of-care and evidence-based medicine that often do not apply to specific individual patients. Doctors have an obligation to carefully consider the unique condition of each patient.”

Bernal is a staunch advocate of personalized, customized diagnosis and care of patients. “We sued based on the argument that you cannot put patients in boxes where they do not belong. Population-based statistics do not always reflect the situation of an individual patient.”
Patient X was diagnosed as suffering from late-stage liver cancer that was inoperable and, from the looks of it, no longer curable. It shouldn’t have come to that, Bernal rues, had the patient’s doctors not put him in a box.

“Had he been treated by a doctor who used clinical judgment, he could have been diagnosed early and cured of his disease. Instead, he ended up with no chance of cure.” The patient died last month.

Bernal says that Patient X’s family approached him. Looking at the records, he saw that the doctors, in dealing with the patient, simply adhered to standard-of-care and evidence-based medicine based on population statistics.

He rages: “When you are a doctor you cannot be a librarian. You must use your ability to evaluate a patient and look at what is unique about that patient. Now these doctors have to realize that when they just follow standard-of-care and evidence-based medicine they are going to be sued and they are going to lose!”

In the past, Bernal says, a lot of cases were won by hospitals and doctors whose defense was, well, standard of care. “This is one of the remarkable cases where the hospital and the doctors lost because they used that defense. They can no longer hide behind that defense.”

So, is it laziness or negligence? It is the menu and the protocolized approach, Bernal answers. Then he threatens: “When you stick to menus and protocols and guidelines that you memorized and then put patients into simplified categories out of convenience, be careful, because you are going to be sued and you are going to lose.”

Bernal offers some lessons. “You have to practice personalized medicine. Your clinical judgment trumps any population-based statistics. Treatments that are evidence-based or FDA-approved are just guides. Remember statistics are a bell curve. There are those who do not fit. Many are either on the right or the left of averages. If the patient does not fit protocol A, do you put him in protocol B? It does not make sense. An Asian patient is different from an American patient. A smoker who got lung cancer is different from a non-smoker.”

And then Bernal speaks about the field of molecular biology which now makes personalized medicine even more imperative. “At the molecular level, things are even more dramatic,” Bernal gushes. “In this era of molecular biology, we are now recognizing even more that personalized medicine involves analyzing the molecular characteristics of a patient.”

But not everything has to go under the microscope. “You must also listen to the patient, pay attention, use your clinical judgment, not the assembly-line approach. In the past, when doctors entered the room, they talked to the patients, listened carefully and observed. That is part of the art of healing. Look carefully at the urine sample, don’t just order a CAT scan. Spend time, observe the patient, how is he is emotionally, spiritually.”

Then he speaks of the physician-healer. “A physician-healer should not be trained to do rote memorization. This is one of the mistakes of medical schools. Filipinos imitate the American approach.”

There is more to Bernal, molecular biology, bioregenerative medicine and stem cell therapy in the Philippines which he has helped significantly to be in step or several steps ahead of other countries. Few people know that. And so I am writing a series on this exciting subject. By the way, stem cell therapy was Time magazine’s cover story recently.

“Molecular medicine,” Bernal proclaims, “is now, the present. Not the future.” He is here and in many parts of the world spreading the news about bioregenerative medicine. He had applied it on himself when he was thought to be dying. Many patients, Filipinos included, have thrived under his care. He is here often, cheering, rooting for the Philippines. He is teaching, researching, healing, giving. On a clear day, you will find him at The Medical City. Brilliant guy.

We called him Sammy when we were kids.

Gang rape-murder in Antique

The rape-murder case has been in cyberspace in the last week or so. It took some time for the national media to take notice and in fact there’s still very little about the case in the media in spite of the heinous nature of the crime that was committed.

I got my first facts about the gang rape-murder case from Restituto Tapacal a.k.a. Antiqueno Sumakwel who has taken up the burden of contacting media institutions and persons and giving them the basics of the case. His nom de plume reminds me of the land where the seafaring Malay datus first settled and how they became part of our multi-racial ancestry. The datus’ major historical intrusion into aboriginal territory was not defined by brutality and bloodshed as far as I know. But that is another story.

Antiqueno Sumakwel could very well be the EveryAntiqueno. Writing about the rape-murder, he says Antique has not seen this kind of brutality since the murder of Evelio Javier in 1986. As I recall, Javier’s murder was brutal, yes, but death came swiftly. Martyrdom became him. He soon entered the pantheon reserved for the great men and women who shed their blood for love of country.



But the gang-rape murder of an innocent young teenager in the blush of maidenhood is a different story. Reading the account made me think of Ingmar Bergman’s “The Virgin Spring” (1960), an Oscar award-winning black-and-white masterpiece about the rape and murder of a girl in medieval Sweden. The crime cried out for vengeance. And vengeance there was.

Here now, in 2009, is a real case of brutal savagery crying out for brutal punishment.

On Jan. 30, Saturday, an unspeakable crime took place in Antique and shocked the peace-loving people who have not known anything like it. A teenage high school student and cheerleader was raped and murdered in a manner so heinous it was unprecedented in Antique’s history.

According to a report, that evening, the victim, an only daughter from a prominent family, was riding on a motorcycle with her boyfriend along a road in Barangay Dalipe when a group of men hit them with a wooden club. The boy lost consciousness. The men then brought the girl to a place called “Kampo”, an area near police headquarters. The men took turns raping the girl. And while they were brutalizing her, her cell phone rang. The girl’s mother was on the line asking about her daughter’s whereabouts. The man who answered the phone told the mother that her daughter was fornicating. He said it in a most vulgar way in the local dialect and I don’t want to quote what he said.

The girl was found dead the following day. She looked like she had been clubbed on the head. She could hardly be recognized because of the lacerations on her face. A sharp weapon had been used on her face. Her body bore marks of beating. Her sexual organ was slashed and stuffed with sand, plastic and pieces of wood.

Unknown to the rapists, the girl’s boyfriend regained consciousness and found his way home. He recalled what happened, how they were accosted by a group of men, but he could not say where the men took the girl. The victim’s father, upon learning about what befell his daughter, suffered a stroke and died.

An 18-year-old suspect has surrendered. Initial reports said that nine men participated in the crime. But the number could well be 15.

I hope nobody brings up the issue of the victim being out late in the day with her boy friend and therefore had it coming. Blaming a rape victim, a dead one at that, is brutalizing the victim all over again.

Rape is no longer a “private crime”. The Anti-Rape Law of 1997 classifies rape as “a crime against persons”. For a long time rape was considered merely as “a crime against chastity” which seemed to suggest that persons who were unchaste were fair game.

The Antique case deserves as much attention as the case of Subic rape victim “Nicole” and convict Lance Corporal Daniel Smith which is again in the news because of the custody issue.
I remember the day the Inquirer had the banner headline that “Nicole” was not, repeat not, a sex worker. Women’s groups were aghast because the headline seemed to suggest that if “Nicole” were a sex worker she would have been fair game. (The headline was a response to questions on who she was.)

Defense lawyers who dredge up the sexual reputation of rape victims and cast aspersions on their morality to bolster their defense of the accused should know this strategy could boomerang on them.

Here’s a quote from Susan Brownmiller, author of “Against Our Will”: “Man's discovery that his genitalia could serve as a weapon to generate fear must rank as one of the most important discoveries of prehistoric times. From the prehistoric times to the present, rape has played a critical function. It is a conscious process of intimidation by which all men keep all women in a state of fear.”

As a feminist lawyer has emphasized, “Rape is not a crime against the hymen. It is a crime against the whole person.” It is a crime of the strong against the weak, it is a crime of conquest. The Subic rape case took on a political color because the accused were citizens of a former colonizing nation that still throws its weight around.

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Romualda Gan-de la Torre, 89, Mommy de la Torre to a generation of activists, political detainees and militant church workers, passed on into the light on Feb. 13. Her remains will be laid to rest today in Naujan, Or. Mindoro. There will be a Mass and memorial service for her at the Bantayog ng mga Bayani in Quezon City at 11 a.m. on Sunday, Feb. 22.

Remembering Fr. Abe and TLJ

Last Feb. 1, I was at a special gathering of friends, comrades, colleagues and fellow sojourners and seekers. The occasion was a celebration of the life of Fr. Carlos Abesamis SJ whose first death anniversary was on Jan. 31. The venue was the new chapel and the cool environs of the Religious of the Good Shepherd in Quezon City.

It was also the occasion to launch the book “Fr. Abe: A Scrapbook”, a compilation of personal recollections and reflections of those who knew Fr. Abe. The book was edited by Fr. Abe’s younger siblings Willie and Marilen who also wrote their own pieces on their kuya (elder brother) who was also kuya to a countless many who were seeking or already walking the road less traveled.

My first close look at Fr. Abe was as a participant in a seminar on—hold your breath—“Marx and the Bible” more than 20 years ago. I had just come from a long Asian “spiritual sojourn” at that time and I needed to get back on the ground. I still have the Bible that I used for that seminar. We had two days of Fr. Abe and no one ended up a Marxist.



Fr. Abe was known as a grassroots theologian. He came down from his perch and got involved with the poor and those who worked among the poor. Church worker Jess Agustin recalled: “Long before it became fashionable to talk about a theology of the grassroots, Fr. Abe’s theology dared proclaim that the real theologians are not perched on the hills of Loyola School of Theology or in the Gregorian University in Rome, but people who are in the thick of things struggling, promoting justice and human dignity, fighting and dying for basic human rights.”

Fr. Abe, a Jesuit, was one of the founders of the Ecumenical Association of Third World Theologians and as such, he popularized grassroots theology, backpacking so to speak, with farmers, the urban poor, workers, women and church workers. If he were a doctor (his father was), he would be called a barefoot doctor.

Church worker Bert Cacayan remembers: “…this was Martial Law time, many people were suffering from injustice and impoverishment, and my Christian faith, or my institutionalized religion, was orientated heavenward. Abe was instrumental in my embracing this new way of thinking: the understanding that faith and life in its totality are one; that the Christian faith seeks for a holistic total salvation for all creatures; and that the Reign of God begins in the here and now, and the building of the Reign invites the participation of all people, of all beings, of the whole cosmos.”

As “Fr. Abe: A Scrapbook” tells it, “He advocated…a kind of activism that came from the depths of a person’s core. Without doubt, many expected Fr. Abe to join the UG or the underground movement, as many priests did… The role he chose to play was to give guidance and direction to those who were waging the war out in the mountains, the farms and the factories. Many had lost their faith and found no meaning in the Church they felt had betrayed them in many ways. Fr. Abe provided them with the physical presence of the Church. He brought Jesus to them no matter where they were, in the sacraments, the Mass and confession…
“Constantly counseling and meeting with them, he showed them the real meaning of their struggle…He told them that to fight for justice and life was spiritual because the Spirit was there. Many were blessed with a renewed faith.”

Soft spoken and refined in his ways, Fr. Abe was not a rabble rouser. Maryknoll Sr. Helen Graham, a theologian, called Fr. Abe “Old Bedroom Eyes”. “We used to argue whether we could go from Bible directly to the Third World experience or whether we had to pass through European theology,” Graham recalled. “We never reached agreement on that subject!”

Fr. Abe wrote a lot. Among the fruits of his immersion in the grassroots are two books “A Third Look at Jesus”, now popularly known as TLJ and “Backpack of a Jesus-seeker” both of which I had taken up in this space.

In TLJ, Fr. Abe said there are at least three ways of looking at Jesus—the First Look which is as Jesus looked at himself, The Second Look which is as Western theology has looked at Jesus, and the Third Look which is how the poor look at Jesus.

Fr. Abe explained that the First Look was how Jesus looked at his own life and his work. Many first generation Christians had this outlook.

The Second Look was the Graeco-Roman and the Western way of seeing. Explained Fr. Abe: “…while Jesus' concern was the total well-being of the total human person, the Second Look tended to make redemption of souls Jesus' concern. While Jesus liked to talk in terms of food, the Second Look spoke in terms of sanctifying grace.

“This Second Look lasted from approximately 50 C.E (Common Era) to the 1960s! A very long segment of Church history. It is the view which early missionaries from Europe and North America…taught us.”

So what is this Third Look? It is the view of “the awakened, struggling and selfless poor who want to create a just, humane and sustainable world. It is also the view of people who themselves are not poor but are in genuine solidarity with the poor.”

To the question “Where are we finally going?” the Second Look would answer, “Heaven.” The First and Third Looks would cry out: “A new heaven and a new earth!”

Fr. Abe hailed the Second Plenary Council of the Philippines for presenting that Jesus of the Third Look, and not the “dessicated Jesus, abstracted from real life, preserved in immobile theological formulas, but rather a Jesus that has life and motion and story.”

A Jesus with a human face, I dare to add.

Microfinance in these hard times

To whom will the poor go as the world faces a global financial crisis, an economic slow-down and lately, here in the Philippines, with mismanaged small banks closing down? To whom will they turn for cash and small capital for their small livelihood enterprises so that these could be sustained? Should the small enterprising citizens switch off the lights and close shop too?

Last week the Philippine-Australian Community Assistance Program (Pacap) held a two-day microfinance development forum with the theme “Microfinance Amidst the Global Financial Crisis.” I should not miss this one, I said to myself. I had written articles on microfinance in the past but now, with the current context of a dark scenario, I thought I should listen again to what the “micro” people have to say.

Even as so-called finance wizards are shaking their heads and talking about trillions that vanished in the air because of unmonitored greed, there is a need to immediately address various needs especially in the grassroots where every small cent counts. “Micro” could spell the difference in the lives of the poor these days and those who have been involved in it and made it accessible to small and medium enterprises are indeed heroes in these trying times.



Do you know that in 2000 the Bangko Central ng Pilipinas declared microfinance as the flagship project for poverty alleviation?

There are three sectors engaged in microcredit. These are the rural banks, the cooperatives and the nongovernmental organizations (NGOs). According to a report, in 2004 there were 500 NGOs, 195 banks and 4,579 savings and credit cooperatives engaged in microfinance. There should be more now.

The National Credit Council (NCC) under the Department of Finance was the agency that approved the Regulatory Framework for Microfinance Institutions in 2002. The NCC, in coordination with stakeholders, is supposed to develop a uniform set of performance standards that will cut across all types of institutions involved in microfinance.

NCC defines microfinance as “the viable and sustainable provision of a broad range of financial services (savings and credit) by the private sector to poor and low-income households engaged in livelihood and microenterprise activities using non-traditional and innovative methodologies and approaches (e.g., non-collateralized cash-flow based lending).” The maximum individual loan amount is P150,000.

What are the general features of microfinance according to NCC? Clients come from the low-income sector, they lack assets for collateral, they are usually self-employed in the informal sector, and are engaged in some economic livelihood activities. The grant of loans is based on the borrower’s household net cash flow. Non-traditional forms of security are acceptable.

Documentation requirements are simple. Loan processing is fast and loan release is timely. Lending schemes may be on a group or individual basis. Loan sizes are typically small, not exceeding P150,000. Loans are short-term and amortizations are either on a daily, weekly, semi-monthly or monthly basis.

The interesting trend is that big banks that used to be engaged only in big transactions and did not have small borrowers on their list are now, in fact, offering their money to microfinance institutions (MFI). Why? Because there’s a lot to be earned from small borrowers who have a good record of payment. Women entrepreneurs especially. But that is now known all over the world.

Trust the women during hard times. Trust them to make things work, innovate and pay on time and in full.

So, during these times when food security should be everyone’s concern, small food producers in the countryside should have first crack at credit. With climate change and all, who will insure their crops? And now disaster in the rural banking community has struck. Who is to blame for the indiscretions?

One of the speakers at the forum was Dr. Jaime Aristotle B. Alip, managing director of the Center for Agriculture and Rural Development-Mutually Reinforcing Institutions (CARD-MRI), 2008 institutional RM Awardee for Public Service.

CARD-MRI which started with a few hundred pesos and a small typewriter 11 years ago in Sept. 1997 is now worth P5 billion. Thousands upon thousands of Filipinos have benefited from it.

CARD-MRI’s interest rate which used to be like 3 percent per annum is now down to 1.8 percent. Who needs the Bombay whose “five-six” scheme charges 182 percent (20 percent for 40 days)?

MFI practitioners like Alip cannot help but notice exciting trends. NGOs are transforming into banks and financial institutions (FI). Banks and FIs are putting up NGOs and MFIs. Banks and FIs are establishing MFI units. And there’s the mutually reinforcing approach where the NGOs, banks, business schools and training institutions.

The challenge for MFIs, Alip pointed out, are the three Cs: lack of capital, lack of capacity and the high cost of delivering microfinance. But the last one could be addressed with technology, that is, by computers, ATMs, even mobile phones.

Indeed, there is a world out there waiting to avail of MF. If only there were more daring individuals like Alip. During the forum I met individuals from grassroots NGOs, cooperatives and rural banks that are into in MF. I listened to their stories and indeed they are unsung heroes.

Those who want to learn more about microfinance could contact Pacap (www.pacap.org.ph) for the Microfinance Technokit.