Health bills differ, and the patient dies?
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.