D

octors across the country took to streets on Wednesday in protest of what they say is the criminalization of their profession. The move followed the detention of their colleagues, obstetrician-gynecologist Dewa Ayu Asiary Prawani and Hendry Simanjuntak, in North Sulawesi after the Supreme Court convicted them of malpractice.

The case centered on a caesarean performed by Ayu, Hendry and another doctor, Hendy Siagian, on 25-year-old Julia Fransiska Makatey at Kandou Hospital in the North Sulawesi capital of Manado in 2010. Julia was referred to the hospital from a primary healthcare center due to delay in delivery that could have endangered her baby'€™s life.

Twenty minutes after delivery, the baby was alive but the mother died. From the autopsy report, the forensic expert concluded that Julia died due to air embolism, rather than a failure in the delivery process. This condition is unpredictable, which was why the Manado District Court acquitted the three doctors. Before the trial, the Medical Ethics Council stated the three doctors were not guilty.

More malpractice cases have been heard in court and doctors deem this as criminalization of the profession. Doctors do not want their medical practices to harm their patients, so it is hard for them to accept prosecution, citing their compliance with standard medical procedures.

The medical profession is deeply related with the Good Samaritan laws, which offer legal protection to people who provide reasonable assistance to those injured, ill, in peril, or incapacitated. In some cases, the Good Samaritan laws encourage people to offer assistance (duty to rescue). The protection is intended to reduce bystanders'€™ hesitation to assist, for fear of being sued or prosecuted for unintentional injury or wrongful death.

People should know that medical malpractice itself is defined by a professional negligence by act or omission by a healthcare provider in which the treatment provided falls below the accepted standard of practice in the medical community, which varies by country.

The issue of malpractice is regulated under the 2004 Medical Practice Law. It says every doctor is committed to practice based on the standard professional procedures set up by the college of medical profession. Every malpractice case should be first heard by the Medical Discipline Council, not the general court.

Many still do not know that doctors are in a profession that emphasizes the process rather than the result. Doctors believe that the result is in God'€™s hands and they can only do the best according to procedure.

In the case of patients who die during hospital treatment, people tend to blame the doctors and accuse them of malpractice, even if the death is due to natural causes. This can lead to the practice of ordering excessive and unnecessary medical tests and procedures to avoid potential malpractice lawsuits. This situation has become more common in a litigious society, giving rise to healthcare costs without improving the state of health.

Eventually, fear about malpractice lawsuits may drive defensive medicine more than the actual risk.

There is a widespread consensus that physicians alter their behavior to reduce their malpractice liability, but there is considerable disagreement about the magnitude of cost, harm and potential benefits associated with the practice of such defensive medicine.

The Indonesian Medical Association (IDI) should protect physicians from malpractice charges if they have document adherence to evidence-based clinical-practice guidelines, use qualified health information-technology systems and use clinical decision-support systems that incorporate guidelines to assist them with patient diagnoses and treatment options.

Furthermore, patients who file malpractice lawsuits have to prove their physicians fail to meet the standard of care when treating their specific conditions.

Under this practice, guidelines would define the legal standard of care. Patients could still present evidence that the guidelines were
not applicable to their situation or that their physicians did not follow the guidelines.

Reforming medical malpractice law is one piece of unfinished business for healthcare reform.

There are some solutions to the malpractice issue. First, law enforcers should really learn about medical issues because doctors do not intentionally hurt someone.

They should hear advice on malpractice cases from the Indonesian Medical Council. The Medical Discipline Council will hear the testimony from all parties that have legal dispute when there is a malpractice case. Only if the committee finds evidence of guilt can the doctor then be accused in a general court due to negligence in health services.

The media should be more balanced in viewing malpractice cases. If more negative images of Indonesian doctors appear in the media, this will lead more patients to go abroad for medical help and our money will eventually go to other countries.

The Indonesian Medical Association should be more active in raising awareness of the malpractice issue. It should educate doctors to work according to standard procedures and give suitable punishment to doctors who work below required standards and bring negative impacts on the patient.

The health minister should also protect doctors from criminalization. An inappropriate statement from the minister last week hurt many doctors. Whatever the reason behind the statement, it was a wrong statement for the minister to make.

In the end, the patient'€™s safety is key in medical service. Doctors can promote safe practices if they work according to standard medical procedures. Safe practices are key to preventing malpractice lawsuits and the criminalization of doctors.

The writer is a general physician who resides in Jakarta.