JP/4/yearend

JP/4/yearend

The Jakarta Post
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.