Sari P. Setiogi, Jakarta – The joy of having a second child proved to be short-lived for Hasan Kesuma, 33, a self-employed resident of Bogor, West Java.
Just days after giving birth to their second child, his wife Agian Isna Naili, 33, slipped into a persistent vegetative state in July and has been on life support equipment for the past five months at the Cipto Mangunkusumo Hospital in Central Jakarta.
Agian delivered her second baby at the Islamic Hospital in Bogor without incident and later moved to the Yuliana Maternity Hospital for the convenience. Soon after she was admitted, she developed symptoms of hypertension, prompting family members to take her back to the Islamic Hospital.
The next thing family members knew, was that Dr. Gunawan Muhammad, a doctor who assisted during Agian's delivery, had to perform an operation on her.
What happened during that operation, only Gunawan and his assistants know. On the operating table, Agian fell into a deep comma and has not regained consciousness since.
Hoping against all odds, Hasan brought Agian to the Cipto Mangunkusumo Hospital, but doctors there told him his wife stood little chance of surviving the coma.
Claiming that he could no longer bear the suffering his wife was going through, Hasan filed a motion with the Central Jakarta District Court in October seeking to euthanize Agian. The court rejected the petition for administrative reasons. Meanwhile, Gunawan has consistently maintained a silence over what happened in the theater.
Agian's case has renewed the debate about how claims of malpractice by doctors should be dealt with in the country, an issue that has grown in prominence during recent years as patients and their families demand higher standards from medical professionals.
Indonesian Health Consumers Empowerment Foundation chairman Marius Widjajarta says the foundation has received about 30 reports of alleged malpractice from January to August this year.
"In 2003, there were only some 20 reports for the whole year. Most of the reports pointed their fingers at doctors," he told The Jakarta Post.
The Legal Aid for Health institute, meanwhile, says it has received 182 reports of malpractice allegations since 2002, or an average of about 60 cases a year.
Chairman Iskandar Sitorus says the actual extent of malpractice by doctors in this the country is likely to be much higher than reported as most Indonesians either have little knowledge about malpractice, choose not to contest cases or decide to settle them out of court.
Malpractice, according to Marius, mostly takes place because of negligence, carelessness and the incompetence of doctors. In some cases, though, doctors deliberately violate standard operating procedures.
Malpractice was also caused by a lack of laws regulating the performance of doctors in hospitals, he said.
"Doctors can do almost anything they like, as there are no standards about what is wrong and what is right," Marius told the Post.
He stressed Indonesia still had no clear legal definitions of malpractice. "Patients may claim that they have experienced malpractice, while doctors can easily claim what they did was not malpractice at all." The long-awaited law on the medical sector that was endorsed by the House of Representatives in September, has no specific provisions about the punishments for perpetrators of malpractice.
However, patients disappointed with or disadvantaged by the service provided by doctors or other medical professionals can now file lawsuits against them through the courts.
Doctors and dentists can lose their jobs or face stiff fines and even prison terms if they are found to have violated their profession's code of ethics.
The law also says doctors or dentists who provide medical services without valid licenses, or fake licenses, face prison term of up to five years and fines of up to Rp 100 million (US$10,869). The same penalties could be handed down to foreign doctors or dentists who provide medical services without registering themselves with Indonesian authorities.
Anyone who poses as a doctor or dentist and provides medical services faces a maximum prison term of up to five years and a fine of up to Rp 150 million.
However, Marius said the penalties did not protect patients from malpractice as the law only spells out administrative sanctions.
"The law is useless as it does not mention anything about malpractice and its legal consequences. It will protect doctors more than the public," he said.
"Patients here should be more pro-active. They have to learn to educate themselves and be more critical," Marius said.
Pulmonologist Tjandra Yoga Aditama told the Post the education of doctors here would impact on how they treated their patients later.
"Hospitals and nurses here are used to serving doctors, not patients. Doctors become gods who control other people's lives," said the practitioner who is also a member to the Indonesian Hospitals Union (Persi).
"The curriculum must be changed soon – the students should become interns in hospitals much earlier to make them more familiar with the real world. They should do this in their third year," said Tjandra. In the current system, students do not enter hospital as interns until their fourth year.
He said, a module teaching doctors about how to empathise with their patients had also been introduced in several important medical faculties recently, including at the University of Indonesia (UI).
"Doctors here need to listen more to their patients. They are not robots and patients are human beings as well," said Tjandra, who is a lecturer at UI.