Medical Malpractice and Proof in the Indonesian Health Law System - Arina Shiva Official Website

Achmad Shiva’ul Haq Asjach

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The development of modern healthcare services has brought increasingly complex legal consequences to the relationship between medical personnel and patients. In healthcare practice, not all medical interventions result in the cure expected by patients. Treatment failures, medical complications, and patient deaths often give rise to allegations of medical malpractice against healthcare providers or hospitals. However, not every loss suffered by a patient can automatically be classified as medical malpractice.

The main issue in medical malpractice cases lies in the aspect of proof, as the medical field is highly technical and scientific in nature, making it difficult to be understood by the general public, including law enforcement authorities. Therefore, proof in malpractice cases requires an in-depth analysis of professional standards, medical service standards, causation, and the degree of negligence committed by medical personnel.

From a terminological perspective, medical malpractice (or medical negligence) refers to negligent actions by medical personnel in the course of performing their professional duties that result in harm to patients. Within the Indonesian health law context, the term “medical malpractice” is not explicitly defined in statutory regulations; however, its concept can be found in various provisions governing professional responsibility and legal negligence of healthcare providers. According to Guwandi (2004), medical malpractice is the failure of a physician or medical professional to apply the level of skill and knowledge that is ordinarily used in treating patients within the standards of the same medical professional community. Thus, the primary benchmark in determining malpractice does not lie in the outcome of treatment, but rather in the process and the conformity of medical actions with applicable professional standards.

In practice, medical malpractice may take the form of ethical violations, civil violations, criminal violations, or administrative violations. Ethical malpractice relates to breaches of the medical professional code of ethics, while civil malpractice concerns patient losses arising from breach of contract or unlawful acts. Criminal malpractice arises when medical negligence results in serious injury or death of a patient, thereby fulfilling the elements of a criminal offense as stipulated in the Indonesian Criminal Code (Kitab Undang-Undang Hukum Pidana/KUHP). In addition, there is also administrative malpractice, which relates to violations of medical practice licensing requirements or other administrative provisions governing healthcare services.

A medical act can be classified as malpractice only if several essential elements are fulfilled. First, there must be a duty of care owed by the medical personnel to the patient. This duty arises from the establishment of a therapeutic relationship between physician and patient, which creates reciprocal rights and obligations for both parties. The physician is obliged to provide the best possible medical effort in accordance with professional standards, while the patient is obliged to provide accurate information regarding their health condition (Nasution, 2013).

Second, there must be a breach of that duty, for example in the form of misdiagnosis, delayed treatment, medication errors, surgical procedures that deviate from established protocols, or failure to obtain informed consent. In this regard, the physician’s fault is assessed based on the conformity of medical actions with applicable professional standards and competencies within the medical profession (Komalawati, 2002).

Third, there must be damages suffered by the patient, whether in the form of physical injury, disability, psychological suffering, economic loss, or death. Damage is a crucial element because without it, a malpractice claim cannot be brought. Fourth, there must be a causal relationship between the medical personnel’s actions and the patient’s loss. This element of causation is often the most difficult aspect to prove, as a patient’s health condition may be influenced by multiple factors, such as pre-existing illnesses, medical complications, or the patient’s physiological response to treatment.

In Indonesian civil procedural law, the general principle of evidentiary burden is regulated under Article 1865 of the Indonesian Civil Code (Kitab Undang-Undang Hukum Perdata), which stipulates that anyone who asserts a right or claims a specific legal fact is obliged to prove such claim. Accordingly, in medical malpractice cases, the patient as the plaintiff generally bears the burden of proof to demonstrate the existence of medical negligence by healthcare personnel.

However, proof in medical cases is not straightforward, as patients are often in a weaker position due to limited medical knowledge and restricted access to medical service records. In contrast, medical personnel possess greater access to information and higher technical competence. Therefore, in practice, a limited shifting of the burden of proof has developed, particularly when there are strong indications that medical personnel have deviated from professional standards.

Evidence in medical malpractice cases is typically established through medical records, informed consent documents, medical audits, hospital documentation, witness testimony, and, in particular, expert medical testimony. Expert testimony holds a crucial role because judges generally do not possess the medical expertise required to assess whether a particular medical act complies with professional standards. Therefore, the opinion of medical experts often serves as the primary basis for determining whether medical negligence has occurred (Guwandi, 2004).

Professional standards and medical service standards play a central role in the evidentiary process of medical malpractice cases. Professional standards refer to guidelines that determine how a medical professional should act based on applicable medical science and practice. Meanwhile, medical service standards and standard operating procedures (SOPs) serve as objective benchmarks to assess whether medical actions have been performed correctly and professionally.

If medical personnel have acted in accordance with professional standards and SOPs, a failure in treatment outcomes cannot automatically be classified as malpractice. Conversely, if it is proven that there has been a deviation from professional standards or SOPs resulting in harm to the patient, the element of negligence may be deemed to have been fulfilled.

Law of the Republic of Indonesia Number 17 of 2023 concerning Health affirms that medical personnel are obliged to provide healthcare services in accordance with professional standards, service standards, and standard operating procedures. This provision demonstrates that Indonesian health law positions professional standards as the primary basis for legal protection for both patients and medical personnel. Accordingly, professional standards function not only as technical guidelines for healthcare delivery but also as a legal instrument in determining whether medical liability exists.

From a critical perspective, the process of proving medical malpractice cases in Indonesia still faces several challenges. First, there is no specific regulation that comprehensively governs evidentiary mechanisms in medical disputes. Second, patients are often in a weaker position in obtaining access to medical records and healthcare information. Third, the independence of medical experts is sometimes questioned due to collegial relationships within the medical profession. In addition, the public still frequently equates medical failure with medical malpractice, even though the medical field inherently involves risks in the form of complications and adverse events that may occur despite compliance with professional standards.

On the other hand, an overly repressive legal approach toward medical personnel may lead to the practice of defensive medicine, namely the tendency of physicians to perform excessive medical procedures in order to avoid legal claims. Such a condition may ultimately harm the healthcare system as a whole, as medical personnel become more focused on self-protection rather than optimizing patient care.

Based on the foregoing discussion, it can be understood that medical malpractice constitutes a form of medical negligence that must be proven through the fulfillment of several elements, namely professional duty, breach of duty, damages, and causation. In the evidentiary process, professional standards and medical service standards play a crucial role as benchmarks in determining whether medical personnel have committed an error. Therefore, strengthening regulatory frameworks, ensuring transparency in healthcare services, protecting patient rights, and upholding medical professionalism are necessary to create a healthcare legal system that is fair, balanced, and oriented toward patient safety.

References

Guwandi. (2004). Hukum medik (Medical law). Balai Penerbit FKUI.

Indonesian Civil Code (Kitab Undang-Undang Hukum Perdata).

Indonesian Criminal Code (Kitab Undang-Undang Hukum Pidana).

Komalawati, V. (2002). Peranan informed consent dalam transaksi terapeutik. Citra Aditya Bakti.

Nasution, B. J. (2013). Hukum kesehatan: Pertanggungjawaban dokter. Rineka Cipta.

Law of the Republic of Indonesia Number 17 of 2023 concerning Health.