Patients are at physicians' mercy
Ignorance often leads us to overlook certain issues, until we become a victim. Medical malpractice is one. Many of us do not even know what it is, and when we fall victim to it, do not know how to deal with it, or what our rights as patients are. In the following story, and two other stories on page two, The Jakarta Post looks into the matter.
JAKARTA (JP): People who don't feel well see doctors for advice or medical treatment believing they will get better. In some cases, they get the opposite.
In one case, a girl suffered brain damage and lost her eye during an eye operation. Others have also been handicapped or have even died.
On May 26, 1994, Jeanette Russel went to the Metropolitan Medical Center (MMC) for dental surgery. A dentist gave the her an anesthetic shot and told her the effect would wear-off in a week. However, some parts of her lip are still numb.
"I can't eat well," she told The Jakarta Post last week.
Is she a victim of medical malpractice?
"No, it's not a malpractice case," insisted Dr. Hadisudjono, the hospital's support director. What happened to Jeanette was "medical risk", which can happen to any patient, he said.
He compared the risk of having an operation with the risk of flying. "This is just like flying. A crash can happen at anytime," he said.
In response to Jeanette's complaints, MMC provided her with free physiotherapy and presented her case before the hospital's medical board.
The board decided that there was no medical malpractice, saying that the dentist was innocent. The patient volunteered for the surgery, while the dentist performed the operation in accordance with procedures and based on her proficiency.
The board didn't deny that the anesthesia lasted for more than a week; these things happen and the dentist isn't to blame, the board ruled.
Dr. Azrul Azwar, chairman of the Indonesian Medical Association (IDI), explained that a physician is said to have conducted medical malpractice if he or she fails to carry out their duty to help the patient, if they violate the standards of treatment, or if they make the patient suffer physically, mentally, economically or socially.
The central board of IDI hears two or three cases of alleged malpractice every month, but "only one" is categorized as malpractice, according to Azwar, who is also a member of IDI's medical ethics council. Malpractice cases sent to the central board are those that can't be handled by IDI's 250 branches. Data on malpractice cases at these branches isn't available, but most take place in big cities where patients' insistence on medical professionalism is higher.
When IDI determines the case is malpractice, it gives the physician a warning, a strong warning or recommends the health ministry revoke the delinquent doctor's license.
In the last four years the organization has only recommended one license be revoked. The government followed the recommendation.
The case happened earlier this year and involved a gynecologist who was found responsible for the death of a woman whop was three months pregnant. The case was not taken to court.
Very few malpractice cases go to court because most Indonesians who seek legal settlement are disappointed.
Proving malpractice allegations is not easy and there is a lack of legal protection for victims in Indonesia.
The national health law No.23/1992, which covers some aspects of medical ethics, malpractice and patient rights, is waiting for the issuance of enforcement regulations by the government before it is fully implemented, Dr. Sjamsi Jacobalis, the deputy chairman of the Indonesian Association of Medical Law, said.
"Law is a tool to prevent malpractice, but what's more important is to increase physicians' awareness of ethics and morality," he said.
Before treating patients, physicians should provide patients with information on the treatment and its risks. But not all doctors provide the information. Dr. Sjamsi said that in villages and small towns doctors don't tell the patients about the risk because the people might be discouraged and change their mind, even if the treatment is essential to save a patient's life.
Even in Jakarta, however, doctors don't always inform patients of the risks. People are required to sign an "informed consent paper" prior to any medical operation. It says the patient understands the risks and that he or she will not take the case to court if anything goes wrong. The form doesn't state the risk and is usually handed to a patient by a nurse, not the doctor, just before the operation.
Clearly, the informed consent paper is meant to protect the physician not the patient, stated Zumrotin K. Soesilo, the chairwoman of the Indonesian Consumers' Foundation, during an interview with the Post.
Conflicts emerge when treatment is far below the patients' expectations. Although doctors aren't wizards and therefore can't cure all ailments, acceptable medical risk and medical malpractice are very different things. In either case, however, it is the patients who will suffer in Indonesia. Minimizing such cases will take proper laws, the enforcement of those laws, and , most importantly, a better awareness from both patients and physicians about their rights and obligations. (als/aks/swa/sim/08)