Indonesian physicians converged on Central Jakarta on Wednesday in a hundreds-strong protest against what they called the "criminalization" of medical professionals following the imprisonment of two gynecologists over the death of a patient.
Some 600 members of the Indonesian Doctors Association (IDI) and the Indonesia Obstetrics and Gynecology Association (POGI) staged a one-day strike in the Indonesian capital, marching from the Hotel Indonesia roundabout to the State Palace and the Supreme Court. The doctors, many carrying signs reading "Stop Criminalizing Doctors," demanded the Supreme Court release two jailed doctors until a judicial review concludes.
"This didn't happen suddenly, we have tried everything," POGI chair Nurdadi Saleh said. "We sent a letter to the Supreme Court asking please do not put the doctors in jail while waiting for the judicial review, but our numerous requests have been ignored.
"The doctors have been thrown in jail like criminals despite the fact our investigation found they didn't do anything wrong."
Nationwide, thousands of doctors took to the streets in simultaneous protests held in Makassar, South Sulawesi; Madiun, East Java; Lombok, West Nusa Tenggara; Kupang, East Nusa Tenggara; Balikpapan, East Kalimantan; and Pekanbaru, Riau, according to reports in local media.
The strike centered on a Sept. 18, 2012 Supreme Court ruling declaring three OB/GYNs — Dewa Ayu Sasiary Prawani, Hendy Siagian and Hendry Simanjuntak — guilty of negligence over the 2010 death of a woman following a Cesarean section at a Manado hospital. The gynecologists were sentenced to 10 months in prison for their role in Julia Fransiska Makatey's death from heart complications stemming from a gas embolism. While the court called the sentence just, the nation's doctors likened it to a witch hunt and warned of lasting repercussions.
POGI claimed that its own investigation into the woman's death failed to uncover signs of negligence. But a panel of judges at the Supreme Court ruled otherwise, overturning a prior verdict by a local court and finding the three guilty. According to the court, the doctors failed to receive the consent of Julia or her family before the surgery and did not check the patient’s vital signs.
Julia died a short time after the procedure when a substantial amount of gas trapped in her vascular system reached her heart. While it is normal for air to enter the circulatory system during surgery, it takes a sizable amount of gas — in excess of 100 ml — to stop the heart. Gas embolisms are a common risk for surgeries like Cesarean sections, but deaths resulting from embolisms following C-sections are rare when proper preventative measures have been taken.
Although Indonesia has made strides in recent years to reduce maternal mortality rates, the nation still has one of the highest rates of death for pregnant mothers in Southeast Asia. According to data compiled by the World Bank, 220 mothers die for every 100,000 live births. Vietnam, the Philippines, Malaysia, Singapore and Myanmar all reported lower death rates.
Allegations of malpractice are common in Indonesia, but doctors’ so-called “conspiracy of silence,” has hindered efforts to prosecute negligent health care professionals. When Ayu, Hendry and Hendy were first brought up on malpractice charges, the three were declared innocent by a local court. By the time the verdict was overturned, the doctors had vanished, ignoring summons from the Attorney General's Office to serve their sentences.
The doctors were declared fugitives from the law. Ayu was found working in Balikpapan on Nov 8 and detained. Her former colleague Hendry was detained a short time later. Hendy, the third OB/GYN, is still at large.
Patients 'thoroughly disappointed'
The strike divided Indonesian observers on Tuesday as allegations of long waits and cancelled medical procedures began to hit social media. The physicians claimed the protests wouldn't put patients at risk, explaining that doctors would still be on-call for emergency situations. But patients voiced their doubts over Twitter, relaying reports of poorly staffed medical facilities and postponed appointments.
“There are doctors who stayed at the emergency departments and other doctors conducted their visits to patients before joining the action,” said IDI chairman Zaenal Abidin.
The Indonesian Consumer Protection Foundation (YLKI) urged patients to file reports of poor care by medical staff during the protests, explaining that patients had the right to demand care under the nation's Consumer Protection Law.
"As citizens, doctors have the right to demand justice," Tulus Abadi, a commissioner with YLKI, said. "But we urge them to not abandon the patients. We ask the people, especially the patients, to monitor whether the protests had a negative impact on health facility services or not."
Reports of poor service came pouring in through the day. In Balikpapan, East Kalimantan, a pregnant woman was unable to receive care at a local community health clinic (Puskesmas) during the protest.
"I am thoroughly disappointed because I have been waiting since the morning to have my pregnancy checked," Siti Nurhuda said. "The doctors is not here because of the demonstration. I decided to go home and ask a midwife to check on me instead."
In Malang, East Java, dozens of scheduled procedures were postponed as 500 doctors rallied in front of the Saiful Anwar Hospital. The hospital routinely treats 1,200 patients and conducts more than 50 surgeries — 20 of them urgent — in a single 24-hour period, director Budi Rahaju said.
Budi was unapologetic about the delays, saying that the hospital will catch up on Thursday.
"The service will return to normal tomorrow and we will reschedule some appointments to catch up with the delay," he said.
The national gynecological association asked patients to stick by doctors as they held the protest. Service would return to normal on Thursday, Nurdadi said.
"We have ordered our doctors to treat emergency patients as usual, we just did not do consolation for one day, please bear with us," he said.
A case for reform
Indonesian lawmakers slammed the protests on Wednesday, accusing doctors of attempting to circumvent the judicial system and ignoring a ruling by one of the nation's highest courts.
"If the Indonesian Doctors Association has an objection to the decision made by the Supreme Court they should have talked to the Commission III and not demonstrated on the street," Al Muzzamil Yusuf, vice head of the Commission III of the House of Representatives overseeing legal affairs said Wednesday.
The doctors should have filed an appeal and waited for the court's decision, he said. No professional is immune from the law, Yusuf added, explaining that malpractice charges were common in Indonesia.
Fellow commission III member Pieter Zulkifli Simabuea called the protests "irresponsible" and questioned doctors' ethics.
"Doctors are allowed to protest, but if they staged a demonstration and ignored their social responsibility then what they did was wrong," Pieter said. "A doctor should have had a great logic."
The Indonesian Consumer Protection Foundation (YPKKI) urged the Ministry of Health to establish clearer guidelines regarding doctor's conduct and malpractice suits.
"There are no such guidelines in Indonesia," YPKKI chairman Marius Widjajarta said. "This causes a lot of confusion when a problem appears and this confusion often ends up in a criminal and civil lawsuit against the doctors.
"So instead protesting and putting lives at risk let's sit together to create this national guideline to create a legal protection for the doctors and their patients as the consumers."
Marius, who is a doctor himself, called the protests "regrettable," and accused the doctors of further neglecting patients.
"I strongly oppose the demonstration," he said. "We can't let let one case cause many patients to be neglected. In the end it will create many more cases like this one."
The case against the three doctors was strong, Marius said. They deserved the Supreme Court's sentence.
"There are many irregularities and mistakes have been done by those doctors," he said. "There was no anesthesiologist [present] during the surgery. It's a fatal mistake and I really regret there's a movement to defend these doctors."
But the associations stood by their actions, stating that the doctors had exhausted all other measures.
"It's funny that some people called us irresponsible and said we demanded impunity," Nurdadi said. "We're not, we don't have any other way and nobody will fight for us. How can we not do anything when it has come to this?"