Health bills differ, and the patient dies?

Leony Aurora, The Jakarta Post, Jakarta

Agus Subiantoro was happy that the operation to empty his bladder went smoothly and painlessly. A few days later, he was surprised to find out there was a tiny tube in his kidney.

His surgeon told him the tube was needed to dissipate kidney stones and that it would later need to be removed. Agus insisted that he had never been informed about a second operation, and that he could not afford it.

The case, which took place in 2001, ended with a settlement and a free operation for Agus.

It is usually quite difficult to bring an alleged malpractice case to court and win. Plaintiffs say that doctors as witnesses tend to protect colleagues while doctors can often overwhelm judges, who have little or no medical background, with the complexity of medicine.

A malpractice trial can drag on for several years before a verdict.

In a bid to protect and ensure legal certainty for both the provider and recipient of health services, the House of Representatives has proposed a bill on medical services.

The bill calls for the establishment of a Medical Practitioner Discipline Court, which would have health and law experts as members/judges, to hear malpractice cases.

However, other policymakers have a different view regarding legal settlements of malpractice cases.

"Such a court would take a long time to establish," Azrul Azwar, Director General of Public Health at the Ministry of Health, told The Jakarta Post recently.

Therefore the Cabinet has proposed its own draft that promotes a Discipline Committee, which comprises doctors and health law experts.

"This committee will promote mediation, but if the plaintiffs are not satisfied with the ruling, they can proceed to the court," said Azwar.

Medical practitioners and observers, however, are pushing for a standard for medical services, which specifies required tests or actions for specific diseases. Neither of the drafts stipulate such a standard.

Marius Widjajarta of the Indonesian Health Consumer Empowerment Foundation (YPKKI) said medical service standards should be made legally binding through a government regulation in the implementation of Law No. 23/1992 on health.

He said such standards could also protect doctors facing lawsuits, because it would be easier to prove they had done their job properly.

Azwar denied there was a lack of standards in the profession.

"Just use the curriculum under which a doctor is trained," he said. "One school may differ slightly from another, but there is no contradiction.

"We may have no national standard yet, but I don't see the rush for one," he said.

Taufik Basari, a lawyer from the Jakarta Legal Aid Institute, who is currently handling a malpractice suit filed by a man who lost his wife to an apparently treatable condition, said the standards should be formalized by a law.

"The society has to have access to it," he said.

He said a disciplinary committee, which would have closed trials, would keep people from direct involvement.

Taufik also slammed the lenient punishment and the short period available, 30 days, for people to file a lawsuit over malpractice.

Sanctions through the disciplinary committee are limited to reprimands and suspension of licenses for a year, while according to the government draft, malpractice would also carry a Rp 25 million (US$2,906) fine for damages to be paid to a winning plaintiff.

"Such sanctions do not protect the integrity of the medical profession itself," Taufik said.

In his client's case, more than Rp 47 million was spent on his wife's medical bills, but she still died.

Info-box

Comparison between drafts of medical law

House of Representatives draft

Article 52: The Medical Practitioner Discipline Court falls under the district court for people seeking justice for malpractice.

Article 62: Judges include law experts and medical experts.

Article 136: Sanctions include one-year suspension of practice license/letter of assignment. Material damages can be paid up to Rp 25 million.

Article 93: Complaints are only admissible within two years after medical treatment has taken place.

Government draft

Article 31: A disciplinary commission is an independent institution to uphold justice in a case of malpractice.

Article 39: All trials heard in the disciplinary commission are held behind closed doors, unless specified otherwise.

Article 43: Sanctions can be a written reprimand, revocation of licenses or an obligation to take a special training course.

Article 32: Lawsuit can only be submitted within 30 days after an alleged malpractice occurs.