Nadya Natahadibrata and Arya Dipa, Jakarta/Bandung – Wednesday's national strike by doctors protesting a Supreme Court ruling that sentenced three doctors to 10 months in jail for the death of a patient has highlighted a serious flaw in the national health system.
Marius Widjajarta, the chairman of Indonesian Health Consumers Empowerment (YPKKI), said that the controversy over the court's ruling was rooted in the fact that Indonesia had no set of national medical service standards, a diagnostic and treatment process doctors should follow for certain types of patients, illnesses and circumstances.
"Such standards are very important to protect good doctors from malpractice allegations, and also to protect patients, to ensure that they receive proper treatment," Marius told The Jakarta Post on Thursday.
He argued that the lack of set standards had complicated malpractice allegations because no benchmarks for proper medical treatment were available to guide courts. He added that the only guidance available were the standard operating procedures (SOPs) applied by each hospital and health facility.
On Wednesday, doctors held nationwide rallies to reject the court's ruling that found three obstetricians, Dewa Ayu Sasiary Prawani, Hendry Simanjuntak and Hendy Siagian, guilty in the death of Julia Fransiska Makatey in 2012 due to a heart embolism during a Caesarean procedure at Kandou Hospital in Manado, North Sulawesi.
Based on the Supreme Court's ruling, the three doctors did not properly inform Julia and her family of the risks of the Caesarean procedure. Relatives were told it was an emergency situation to save both the mother and the infant although Julia was left neglected at the hospital from 9 a.m. to 6 p.m., after being referred from a community health center.
The ruling also stated that the doctors were not licensed to perform the procedure, nor had they permission from an obstetrician, as they were still obstetrics and gynecology students when they operated on the patient.
Marius said that the absence of medical service standards had forced the court to use the Criminal Code in the case, in which the Supreme Court found the three doctors guilty of violating Article 359 of the Criminal Code on manslaughter.
The Indonesian Doctors Association (IDI) said that malpractice was regulated under the 2004 Medical Practice Law and that every malpractice case should be first heard by the Medical Discipline Council, not a district court. According to Marius, medical service standards would be the basis for the public to file a lawsuit alleging malpractice, as is common in developed countries.
Meanwhile, Akmal Taher, the Health Ministry's director general for health development said it was impossible for the ministry to regulate standard procedures for every type of treatment.
"There are probably around 500,000 type of disease in the world so it is impossible to regulate all of them. Therefore, we have a national guideline used as a basis for determining the standard operating procedures in every hospital in the country, based on the hospital's human resource capacity and facilities," he said.
"Every hospital has their specific SOPs and I'm sure that Kandou Hospital has strict SOPs that were used as guidance in determining this case," he continued.
IDI chairman Zainal Abidin said that national medical service standards were essential, adding that the current guidance was not enough. "The absence of medical service standards is the ministry's responsibility, not the three doctors who have been criminalized."
Meanwhile, the Association of Indonesian Consumers Institution (HLKI) filed a report with the West Java Ombudsman on Thursday, claiming that the West Java Health Agency chief Alma Lucyati and several hospital directors in West Java had neglected their public services during the strike on Wednesday.
"They neglected both medical and non medical services during the strike, which meant that many health facilities were unavailable," HLKI chairman Firman Turmantara Endipraja said.