TEMPO.CO, Jakarta - On the third floor of the Indonesian Medical Council building, Ali, chairman of the Indonesian Medical Ethics and Disciplinary Council (MKDKI), sat on a chair, reading documents
For the past eight years, MKDKI has received 193 complaints on suspicions of malpractice. From those cases, 34 doctors were given written reprimands, six doctors were required to take re-training programs. Worst of all, 27 doctors had their registrations withdrawn, effectively invalidating their license to practice.
Despite the numerous complaints, Ali lamented the people's lack of awareness on how to deliver their grievances and complaints on medical malpractice. Article 66, Chapter 1 of Law No. 29/2004 on the Practice of Medicine clearly states that those who feel disadvantaged by a doctor's or a dentist's, may submit their grievances to the MKDKI. Ali added that the term 'malpractice' is inappropriate. He prefers the phrase, 'violation of medical discipline'.
Discussions on doctors' malpractice resurfaced when the case of Dewa Ayu Sasiary Prawani came under the public spotlight. Dr. Ayu, who is still a student in the Medical Specialization Program, was criminally charged with causing the death of a patient, Julia Fransiska Maketey. In response, Ayu's colleagues called a strike to protest on what they saw as a 'medical criminalization'. Ali regretted that the case was not reported to the Council.
"She should have been questioned by her seniors too, by the hospital and others," he said.
Two weeks ago, Ali met with Tempo reporters Heru Triyono, Nugroho Dewanto and Purwani Diyah Prabandari, at his office in Menteng, Central Jakarta. Ali, who is still a practicing doctor and gynecologist, explained the Council's procedures in handling cases of medical ethics and disciplinary violations.
Should Dr. Ayu get 10 years in prison for a malpractice case?
That's a difficult question to answer. I am aware that she does not have a license to practice (SIP) yet.
By operating on a patient without a license, wouldn't that be violating the law?
That's correct.
Who had the responsibility of checking whether she had her license?
The place where she works. If she had no license, the hospital should have reminded her to get one from the KKI (Indonesian Medical Council), through the local health office and should not have allowed her to practice before she got that license.
If it's true that Dr. Ayu is guilty of an error, why are the doctors protesting on her behalf?
According to the physician's oath, we must treat our professional colleagues, also the family of doctors, like they are members of one family. We do not charge families of doctors when we treat them. That's the Hippocratic Oath.
The central Medical Ethics Council (MKEK) said that there was no ethical or disciplinary violation in what Dr. Ayu did.
The party authorized to evaluate whether the doctor is right or wrong is the MDKI. The MKEK only covers ethical issues, not disciplinary ones. They are under the Indonesian Doctors Association (IDI). IDI is a professional organization, while we are a state organ established by Law No. 29/2004 on the Practice of Medicine. We are accountable directly to the President.
Ideally, malpractice cases should be tried by the MKDKI, but people suspect that doctors will always favor and protect their own kind.
The public need not doubt the neutrality of the MKDKI. Of the 11 Council members, two among them are law practitioners: Sabil Alwi, a doctor specializing in the legalities of health and Akhiar Salmi, a criminal lawyer.
Are judges, the police and the public aware and understand the discipline applied by the MKDKI, as regulated by law?
Not yet. We at MKDKI are in the process of doing a lot of public dissemination and socialization. It's not just the public alone, even some doctors don't understand the system yet. In fact, some journalists get it fatally wrong.
Doctors seem paranoid about being charged with malpractice, because they always insist that patients sign informed consent forms, even for minor operations.
All actions carry risks. A doctor is required to explain any risks involved when a patient is being treated for an operation, to the patient and members of the family. And it should be the attending doctor himself who must do it.
The complete interview can be seen in Tempo English Magazine published on December 16, 2013.
