Board of Medicine vs. Ota

The reciprocity requirement for a foreign citizen seeking to take the Philippine medical board examinations or obtain a medical license is satisfied by competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that the foreign country's existing laws permit Filipino citizens to practice medicine under the same rules and regulations governing citizens thereof — it is not required that a Filipino has actually been granted a license or is actually practicing in that foreign country.

Respondent Yasuyuki Ota is a Japanese national married to a Filipina who has resided in the Philippines for more than ten years. He graduated from Bicol Christian College of Medicine in 1991 and completed a one-year postgraduate internship at Jose Reyes Memorial Medical Center. Petitioners are the Board of Medicine, its Chairman, and the Professional Regulation Commission (PRC), the statutory bodies tasked with regulating the practice of medicine in the Philippines. The dispute centers on the interpretation of the reciprocity requirement under Section 9 of R.A. No. 2382 (the Medical Act of 1959) and Section (j) of P.D. No. 223, which govern the admission of foreign citizens to the Philippine medical board examinations and the issuance of medical licenses.

Yasuyuki Ota, a Japanese national married to a Filipina, has continuously resided in the Philippines for more than ten years. He graduated from Bicol Christian College of Medicine on April 21, 1991 with a degree of Doctor of Medicine and thereafter completed a one-year postgraduate internship training at the Jose Reyes Memorial Medical Center. He then filed an application to take the medical board examinations to obtain a medical license. The Professional Regulation Commission required him to submit an affidavit of undertaking stating that, should he pass, he would not practice medicine until he submitted proof that reciprocity exists between Japan and the Philippines in admitting foreigners into the practice of medicine.

Respondent submitted a duly notarized English translation of the Medical Practitioners Law of Japan, authenticated by Consul General Jesus I. Yabes of the Philippine Embassy to Japan. He was allowed to take the Medical Board Examinations in August 1992, which he passed with a general average of 81.83, scoring higher than 80 in nine of the twelve subjects. Notwithstanding his successful examination, the Board of Medicine, by letter dated March 8, 1993, denied respondent's request for a license to practice medicine in the Philippines. The Board stated that it believed no genuine reciprocity could be found in the law of Japan, as there is no Filipino or foreigner who can possibly practice there.

Respondent filed a Petition for Certiorari and Mandamus against the Board before the RTC of Manila on June 24, 1993, which he amended on February 14, 1994 to implead the PRC through its Chairman. He alleged that the Board and the PRC had acted arbitrarily in refusing to issue a Certificate of Registration, in contravention of Section 20 of R.A. No. 2382, depriving him of his right to practice his profession. The RTC, on October 19, 2003, found that respondent had adequately proved that the medical laws of Japan allow foreigners like Filipinos to be granted a license and admitted into the practice of medicine under the principle of reciprocity, and that the Board had a ministerial duty to issue the Certificate of Registration and license. The RTC ordered the Board to issue the same.

Petitioners appealed to the Court of Appeals, arguing that while respondent submitted documents showing foreigners are allowed to practice medicine in Japan, it was not shown that the conditions for practice there are practical and attainable by a foreign applicant, and that the PRC and the Board's power to regulate the practice of medicine is discretionary and not compellable by mandamus. The CA denied the appeal and affirmed the RTC ruling. Petitioners then elevated the case to the Supreme Court via a Petition for Review on Certiorari.

• Insufficiency of Reciprocity Evidence: Petitioners argued that respondent failed to establish by competent and conclusive evidence that reciprocity in the practice of medicine exists between the Philippines and Japan. While documents show that foreigners are allowed to practice medicine in Japan, they do not show that the conditions for the practice of medicine in that country are practical and attainable by a foreign applicant. The requirements to practice medicine in Japan are practically impossible for a Filipino to comply with.
• Ambiguities in Japanese Law: Petitioners pointed to ambiguities in the Medical Practitioners Law of Japan that respondent failed to clarify, including the provisions of the School Education Laws, the criteria of the Minister of Health and Welfare in determining whether foreign medical graduates have the same or better academic and technical capability as Japanese graduates, and who can actually qualify to take the preparatory test for the National Medical Examination.
• No Filipino Actually Licensed in Japan: Petitioners noted that Consul General Yabes stated there had not been a single Filipino issued a license to practice medicine by the Japanese Government, and that the publication showing foreigners practicing medicine in Japan did not specifically show that Filipinos were among those listed.
• Discretionary Nature of Licensing Power: Petitioners maintained, relying on Professional Regulation Commission vs. De Guzman, that the power of the PRC and the Board to regulate and control the practice of medicine includes the power to regulate admission to the ranks of those authorized to practice, which power is discretionary and not ministerial, hence not compellable by a writ of mandamus.

• Existence of Reciprocity: Respondent argued that Articles 2 and 11 of the Medical Practitioners Law of Japan and Section 9 of the Philippine Medical Act of 1959 show that reciprocity exists between the Philippines and Japan concerning the practice of medicine. Both countries allow foreigners to practice medicine as long as the applicant meets the educational requirements, training or residency in hospitals, and passes the licensure examination. Consul General Yabes stated in his letter dated January 28, 1992 that the Japanese Government allows a foreigner to practice medicine in Japan after complying with local requirements.
• No Actual Licensing Required for Reciprocity: Respondent contended that the fact that no reported Filipino has successfully penetrated the medical practice in Japan does not mean there is no reciprocity, since it does not follow that no Filipino will ever be granted a medical license by the Japanese Government. It is not the essence of reciprocity that a citizen of one contracting country must first be granted the same privilege before a citizen of the other country can demand its application.
• Ministerial Duty to Issue License: Respondent argued that Section 20 of the Medical Act of 1959 indicates the mandatory character of the statute and an imperative obligation on the part of the Board inconsistent with the idea of discretion. A foreigner who successfully passes the examination and has all the qualifications and none of the disqualifications is entitled as a matter of right to the issuance of a certificate of registration or physician's license, enforceable by mandamus.

• Reciprocity Requirement: Whether the Court of Appeals committed reversible error in finding that respondent had established the existence of reciprocity in the practice of medicine between the Philippines and Japan.

• Reciprocity Requirement: No reversible error. The reciprocity requirement under R.A. No. 2382 and P.D. No. 223 is satisfied by competent and conclusive documentary evidence, confirmed by the DFA, showing that the foreign country's existing laws permit Filipino citizens to practice medicine under the same rules and regulations governing citizens thereof; it is not necessary to prove that a Filipino has actually been granted a license or is practicing in that country.

• Reciprocity Requirement: R.A. No. 2382, Section 9, merely requires a foreign citizen to submit competent and conclusive documentary evidence, confirmed by the DFA, showing that his country's existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof. Section (j) of P.D. No. 223 similarly requires that the laws of the foreign state allow citizens of the Philippines to practice the profession on the same basis and grant the same privileges as citizens of that foreign state. Nowhere in these statutes is it stated that the foreign applicant must show that the conditions for the practice of medicine in said country are practical and attainable by Filipinos, nor that it must first be proven that a Filipino has been granted a license and is actually practicing in that country. Requiring respondent to prove first that a Filipino has already been granted a license unduly expands the statutory requirements. Respondent submitted the Medical Practitioners Law of Japan, particularly Articles 2 and 11, which allow foreigners who graduated from foreign medical schools or acquired a medical practitioner license in a foreign country to take the National Medical Examination if recognized to have the same or more academic ability and techniques as Japanese graduates. He also presented a Japanese Government publication, the Physician-Dentist-Pharmaceutist Survey, showing foreign physicians practicing in Japan, and the letter from Consul General Yabes confirming that the Japanese Government allows a foreigner to practice medicine after complying with local requirements. The absence of a Filipino actually licensed in Japan is attributable to the difficulty of passing the board examination in the Japanese language, not to any legal prohibition or impossibility. As to the mandamus issue, the Court distinguished Professional Regulation Commission vs. De Guzman, where doubts about the integrity of test results called for serious inquiry into applicants' compliance with Board requirements. Here, there was no doubt as to respondent's competence and qualifications: he finished his medical degree, completed internship at a government hospital, and passed the Medical Board Examinations with a general average of 81.83. Section 20 of the Medical Act of 1959 uses the word "shall" — a word of command with imperative meaning — regarding the issuance of certificates of registration to those who have satisfactorily complied with the requirements. When an examinee satisfies all requirements, the Board is obliged to administer the oath and register him as a physician. Since respondent had fully complied with all qualifications and the reciprocity requirement, the Board's duty to issue the certificate was ministerial and compellable by mandamus.

• Reciprocity in Professional Licensing — The reciprocity requirement for foreign citizens seeking to practice a profession in the Philippines is satisfied when the foreign country's existing laws permit Filipino citizens to practice the profession under the same rules and regulations governing citizens of that country, as confirmed by competent and conclusive documentary evidence authenticated by the Department of Foreign Affairs. It is not necessary to prove that a Filipino has actually been granted a license or is currently practicing in the foreign country; the legal permission in the foreign country's laws is sufficient. Requiring actual licensing of a Filipino unduly expands the statutory requirements.
• Ministerial Duty to Issue Certificate of Registration — When the law uses the word "shall" with respect to the issuance of certificates of registration, it is a word of command given imperative meaning. Once an examinee satisfies all the requirements for the grant of a physician's license — possessing all qualifications and none of the disqualifications — the Board is obliged to administer the oath and register the applicant as a physician. In such circumstances, the duty is ministerial and compellable by writ of mandamus. The Board's discretionary power to regulate the profession cannot be exercised in an arbitrary, despotic, or oppressive manner, and license legislation that vests in public officials discretion to grant or refuse a license without prescribing definite rules and conditions will be struck down.
• Limitations on Regulatory Power — While the power to regulate the practice of medicine includes the power to regulate admission to the profession, such power cannot be exercised by the State or its agents in an arbitrary, despotic, or oppressive manner. The legislature cannot validly bestow an arbitrary power to grant or refuse a license on a public agency or officer without prescribing definite rules and conditions for the guidance of said officials.

• "It is enough that the laws in the foreign country permit a Filipino to get license and practice therein. Requiring respondent to prove first that a Filipino has already been granted license and is actually practicing therein unduly expands the requirements provided for under R.A. No. 2382 and P.D. No. 223." — This passage articulates the core ratio decidendi: the reciprocity requirement is satisfied by the existence of legal permission in the foreign country's laws, not by proof of actual Filipino licensure or practice therein.
• "A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses the word 'shall' with respect to the issuance of certificates of registration. Thus, the petitioners [PRC] 'shall sign and issue certificates of registration to those who have satisfactorily complied with the requirements of the Board.' In statutory construction the term 'shall' is a word of command. It is given imperative meaning." — This quotation, drawn from Professional Regulation Commission vs. De Guzman and applied in this case, establishes the ministerial character of the Board's duty to issue certificates of registration once all statutory requirements are met, supporting the availability of mandamus.
• "[T]he power to regulate the exercise of a profession or pursuit of an occupation cannot be exercised by the State or its agents in an arbitrary, despotic, or oppressive manner." — This defines the constitutional and administrative-law boundary on the State's regulatory power over professions, ensuring that discretion in licensing must be guided by definite rules and conditions.

• Professional Regulation Commission vs. De Guzman, G.R. No. 144681, June 21, 2004, 432 SCRA 505 — Distinguished. In De Guzman, doubts about the integrity and validity of test results from a particular school warranted serious inquiry into applicants' compliance with Board requirements, precluding mandamus. In the present case, no such doubts existed as to respondent's competence and qualifications, making the Board's duty ministerial. The Court also relied on De Guzman's interpretation of Section 20 of the Medical Act of 1959 — that "shall" is a word of command — to support the ministerial duty to issue certificates of registration.
• Tablarin vs. Gutierrez, G.R. No. L-78164, July 31, 1987, 152 SCRA 730 — Cited for the proposition that the regulation of the practice of medicine is a reasonable method of protecting public health and safety, and that the power to regulate includes the power to regulate admission to the profession, including requiring board examinations and minimum educational requirements.
• Reyes vs. Sisters of Mercy Hospital, 396 Phil. 87 (2000) — Cited for the principle that a license to practice medicine is a right earned through years of education and training, requiring one to first secure a license from the state through professional board examinations.

• Section 9, Republic Act No. 2382 (The Medical Act of 1959) — Provides the qualifications for candidates for board examinations, including that a foreign citizen must submit competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his country's existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof. Applied to hold that respondent satisfied the reciprocity requirement by submitting the Medical Practitioners Law of Japan authenticated by the DFA.
• Section 20, Republic Act No. 2382 (The Medical Act of 1959) — Provides that the Board "shall sign and issue certificates of registration to those who have satisfactorily complied with the requirements of the Board." Applied to establish the ministerial duty of the Board to issue a certificate once all requirements are met, the word "shall" being imperative.
• Section (j), Presidential Decree No. 223 — Defines the PRC's power to approve registration and authorize issuance of certificates of registration to foreigners, subject to three conditions: (1) requirements for registration or licensing in the foreign country are substantially the same as those in the Philippines; (2) the laws of the foreign country allow Filipino citizens to practice the profession on the same basis and with the same privileges as citizens of that country; and (3) the applicant submits competent and conclusive documentary evidence confirmed by the DFA. Applied to confirm that respondent met all three conditions.
• Articles 2 and 11, Medical Practitioners Law of Japan — Article 2 requires anyone who wants to be a medical practitioner to pass the national examination and obtain a license from the Minister of Health and Welfare. Article 11, item 3, allows persons who graduated from a foreign medical school or acquired a medical practitioner license in a foreign country to take the National Medical Examination if recognized to have the same or more academic ability and techniques as Japanese graduates. Applied as the documentary evidence establishing that Japanese law permits foreigners, including Filipinos, to practice medicine under the same rules governing Japanese citizens.

Leonardo A. Quisumbing, Consuelo Ynares-Santiago, Antonio Eduardo B. Nachura, and Ruben T. Reyes concurred in the decision. No separate concurring opinions were written.