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Blantika: Multidisciplinary Jornal Volume 2 Number 7, Mei, 2024 p- ISSN 2987- 758X e-ISSN 2985-4199 |
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HOSPITAL
EFFORTS IN FULFILLING PATIENTS' RIGHTS TO EMERGENCY UNIT HEALTH SERVICES Bandung Islamic University, Doctor of Law, Bandung, Indonesia Email: cicirfl@gmail.com |
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ABSTRACT A hospital is a health service
facility that provides complete individual health services through promotive,
preventive, curative, rehabilitative and/or palliative health services by
providing inpatient, outpatient and emergency services. The Emergency
Department (IGD) is a hospital unit that provides first care to patients.
Emergency Services are medical actions required by Emergency Victims/Patients
immediately to save lives and prevent disability. The current difficulty of
society is expensive health financing. Not only because of the doctor, but to
reach health facilities and infrastructure you also have to make a lot of
effort. We can see in several cases of patient refusal in the ER at hospitals
in several regions of Indonesia how difficult it is for people to get optimal
health services. The method used is the Normative Juridical Method which aims
to find legal regulations regarding hospitals in their efforts to treat
emergency patients. The problem formulation that the author can put into this
paper is how to implement and optimize hospital efforts to fulfill patients'
rights to health services in the emergency unit. The results of the author's
research are that in order to optimize the fulfillment of patient rights,
hospitals are required to form internal hospital regulations and require
hospitals to implement good corporate governance and good clinical
governance. Keyword: hospital; service; emergency; life; disability. |
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This work is licensed under a Creative
Commons Attribution-ShareAlike 4.0 International |
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INTRODUCTION
One of the goals of the Republic of Indonesia is to
protect the entire Indonesian nation and all of Indonesia's blood and promote
general welfare. Efforts to advance people's welfare means an effort to realize
an optimal level of social life in the form of physical well-being and inner
happiness with a quality of life that can fulfill the elements of basic human
needs, namely health. The health services sector is one of the elements of
health supplies as the most dominant factor in meeting the needs to achieve
this level of health (Basuki, 2020).
Achieving health efforts as mentioned above is
essentially one manifestation of general welfare as intended in the Preamble to
the 1945 Constitution. Health as an element of general welfare must be realized
in accordance with the ideals of the Indonesian nation as intended in the
Preamble to the Law The 1945 Constitution through sustainable national
development based on Pancasila and the 1945 Constitution. Health is a crucial
issue that must be faced by every country because it is directly correlated with
the development of the personal integrity of each individual so that they can
live with dignity (health, together with the level of education and purchasing
power society, is a component of assessing the achievements of the Human
Development Index of countries in the world). Countries whose people's health
is not well managed, resulting in low human resources, will find it difficult
to compete with other countries in the midst of fierce global competition. (Grenaldo, 2017).
Meanwhile, we look at the Emergency Unit cases in
the mass media, some of which are cases of poor Jambi patients who died after
allegedly being rejected by the hospital. A patient from a poor family died
after allegedly being refused further treatment at the Raden Mattaher Jambi
Regional Hospital due to lack of funds. The patient underwent surgery on July
16 2023 and was discharged from the hospital on July 26 2023. Four days after
returning from the hospital, the patient experienced pain again and was taken
to the hospital. At that time the patient was treated in the emergency room.
However, because they did not bring a certificate of incapacity (SKTM), the
patient was asked to go home to take care of the SKTM. Meanwhile, to make an
SKTM, the patient must first return to their village in Sarolangun and the SKTM
will be taken care of by the family in Sarolangun. Meanwhile the patient is in
Jambi. Because he was told to go home, the patient's life could no longer be
saved. One of the reasons the ER staff refuses patients is that it is full and
patients are told to go home and come back if they have taken care of BPJS and
SKTM.
We can see another case of Emergency Unit services
in the case of the A. Yani Metro Lampung Regional Hospital which allegedly
refused patients. With the chronology of the incident, the victim of rejection,
namely Mrs. XX, a resident of East Hadimulyo Village, initially she took her
child who was experiencing shortness of breath to the A. Yani Regional
Hospital, however, when he went to the emergency room, he received poor
treatment. The patient's family was asked to register first and then told that
the bed was full and the condition of the patient, namely Mrs. XX's child, who
was experiencing shortness of breath, was not given help or checked first and
was told by the staff that the room was full. The patient was not examined
first, the patient was carried by his mother with shortness of breath and he
was not even given a place to sit and the patient's family decided to look for
another hospital for help for their child. After being investigated by the
General Ahmad Yani Regional Hospital, Metro City, they admitted that one of the
patients had been rejected in the emergency room due to negligence by an
employee in the registration section. (Supriyadi, 2024).
One of the cases on social media that caught my
attention was about "There are lots of people talking about cases in
Subang, can hospitals refuse patients" with a chronology of events. A pregnant
woman breathed her last after being refused to give birth at Subang District
Hospital, West Java. The reason was that the hospital was full at that time.
Buniara Village Midwife, the patient was treated briefly in the emergency room,
before finally being taken to the PONEK room (special room for giving birth).
Upon arrival at the PONEK room, the nurse informed him that the PONEK room and
ICU were full, so he asked the patient to be taken to another hospital. Even
Euis' request to examine the patient first was ignored by the Subang Regional
Hospital nurses. Unfortunately, on the way to the Bandung hospital, the patient
died in the ambulance (Dzulfaroh & Herdiyanto, 2023).
In providing health services, several components are
related, such as medical personnel, health facilities and patients. Medical
personnel are parties who provide health services to cure certain diseases,
while patients are parties who need health services (Rondonuwu, 2018).
The current difficulty of society is expensive
health financing. Not only because of the doctor, but to reach health
facilities and infrastructure you also have to make a lot of effort. We can see
in several cases above how difficult it is for people to get optimal health
services.
The success of health efforts can depend on the
availability of health resources in the form of adequate quality personnel,
facilities and infrastructure. Hospitals are one of the health facilities
organized by both the government and the community. Health services as the main
activity of hospitals place doctors as health workers who are most closely
related to patients in treating disease. There are several relationships in
these health service efforts, namely the relationship between hospitals and doctors,
nurses and patients, relationships between doctors and nurses and patients; and
the relationship between nurses and patients (Praptianingsih, 2006).
RESEARCH METHODS
The method used is the Normative Juridical Method which aims to find
legal regulations regarding hospitals in their efforts to treat emergency
patients. It is hoped that the research objectives can be used to analyze the
problems identified. Next, the regulations will be reviewed regarding the
extent to which hospitals carry out their responsibilities so that they can
improve the quality of hospitals in fulfilling patient rights.
In this research, a qualitative research methodology was used with a
descriptive research type, namely describing things related to hospital law
through a conceptual approach. In this research, the Normative Juridical
concept is used, namely in this research, what is studied is library materials
or secondary legal materials, including primary, secondary and tertiary legal
materials.
Data collection instruments refer to the material tools used to obtain
data and record it. This research focuses on literature study or document study
and this research is carried out more on secondary data while primary data is
only complementary.
RESULTS
AND DISCUSSION
Implementation of Fulfillment of Patients' Rights to Health Services in
Emergency Units in Hospitals.
Hospitals are complex,
professional and capital intensive health care institutions. This complexity
arises from the fact that hospital services span different levels and types of
disciplines, including different service, educational, and research functions,
and enable hospitals to perform professional functions in both medical
technology and health care. To maintain and improve hospital quality,
facilities are needed to ensure quality improvement at all levels (Rustiyanto, 2009). America Hospital Association (1974) defines a
hospital as an organization that, through organized professional medical
personnel and permanent medical infrastructure, provides medical services,
continuous nursing care, diagnosis and treatment of diseases suffered by
patients. (De Carvalho, 2019).
In relationships that occur in
the community, hospitals can act as legal subjects if they enter into legal
relationships either with patients or with other parties who have an interest
in health services.
According to Kadir Sanusi, the
definition of a hospital is a building where accommodation is provided and
provides care for the healing and restoration of the health of patients for the
short and long term, where observation, diagnosis, therapy and rehabilitation
are carried out for patients suffering from an illness or injury and people
giving birth. (Sanusi, 1995).
Health Law Number 17 of 2023
concerning Health in Chapter I General Provisions Article 1 paragraph 10 states
that the definition of a hospital is a Health Service Facility that provides
complete individual Health Services through promotive, preventive, curative,
rehabilitative and/or Health Services. palliative by providing inpatient,
outpatient and emergency services.
Then in Article 1 paragraph 24
of the Health Law it is stated that an Emergency is a clinical condition of a
patient who requires immediate medical and/or psychological action to save life
and prevent disability. In paragraph 23 it is explained that a patient is
anyone who receives health services from medical personnel and/or health
workers.
The Emergency Department (IGD)
is a hospital unit that provides first care to patients. This unit is led by a
duty doctor with expert and experienced doctors in handling PGD (Emergency
Services), who then, if necessary, will refer patients to certain specialist
doctors. (Hidayati, 2014).
RI Minister of Health
Regulation No. 19 of 2016 concerning integrated emergency services system
Chapter 1 Article 1 paragraphs 1 and 2 explains that:
Emergency is a patient's
clinical condition that requires immediate medical action to save life and
prevent disability.
Emergency Services are medical
actions required by Emergency Victims/Patients immediately to save lives and
prevent disability.
Then, paragraph 7 of the
article above explains that Emergency Victims/Patients are people who are in
danger of death or disability who require immediate medical action.
Therefore, hospitals are seen
as liable for the errors and/or negligence of the health workers who work
there. Law Number 17 of 2023 concerning Health explains the Obligations of
Hospitals, including:
Providing correct information
about Hospital services to the community; Providing safe, quality,
anti-discriminatory and effective health services by prioritizing the interests
of patients in accordance with hospital service standards; Providing emergency
services to patients according to their service capabilities; play an active role in
providing Health Services during disasters in accordance with their service
capabilities; Providing facilities and services for disadvantaged or poor communities; Carrying out social functions,
among others, by providing service facilities for indigent or poor patients,
emergency services without down payment, free ambulances, services for disaster
and outbreak victims, or social services for humanitarian missions; create,
implement and maintain quality standards for Health Services in Hospitals as a
reference in serving Patients; Organizing medical records;
Providing adequate public
facilities and infrastructure, including prayer facilities, parking lots,
waiting rooms, facilities for people with disabilities, breastfeeding women,
children and the elderly; Implement a referral system; Rejecting patient wishes
that conflict with professional and ethical standards as well as statutory
provisions; Provide correct, clear and honest information regarding the
patient's rights and obligations; Respect and protect the rights of Patients;
Implementing Hospital ethics; Having an accident prevention and disaster
management system; Implementing government programs in the Health sector, both
regionally and nationally; Make a list of Medical Personnel who practice
medicine or dentistry and other Health Personnel; Prepare and implement
internal hospital regulations; Protect and provide legal assistance to all
Hospital officers in carrying out their duties; Implement the entire hospital
environment as a smoke-free area
In reality, the implementation
of fulfilling the patient's right to health services in the Emergency Unit at
the Hospital in the case that the author studied was that the Emergency Unit
should be obliged to carry out public services as well as possible, but this
could not be realized properly. Therefore, the Emergency Unit of Indonesian
Hospitals must pay attention to improving the quality of public services by
developing Standard Operational Procedures. These Standard Operational
Procedures must be owned by every service unit as a guideline in the
implementation of services which functions as a control in every service,
especially for hospitals in the Emergency Unit section which provides public
services in the health sector. Based on the research results, it can be
concluded that currently the service procedures provided by the Hospital
Emergency Unit do not comply with established standard procedures, the current
procedures that the public perceives are still complicated and so the service
is not running optimally.
The community as service
recipients certainly hopes that the service they receive will not be
complicated and will not make things difficult for them so that the service
time provided to the community can be made more effective and this is also the
hope of the community throughout Indonesia. Success in providing services to
the community can also be seen from the officers who provide services, where in
providing services to patients the Emergency Unit officers strive to always
provide fast service to the community and every community served is satisfied
with the services provided.
Efforts to Optimize the
Fulfillment of Patients' Rights to Health Services in Emergency Units in
Hospitals.
Law No.17 of 2023 concerning
health in Chapter I General provisions Article 2 point h explains that health
administration aims to provide legal protection and certainty for patients,
health human resources and the community. Therefore, every activity and effort
to improve the highest level of public health is carried out with
non-discriminatory, participatory, protective and sustainable principles which
are very important for the formation of Indonesia's human resources, increasing
the nation's resilience and competitiveness, as well as national development.
Efforts to improve the highest level of health initially took the form of
efforts to cure disease, then gradually developed towards integrated health
efforts for the entire community by involving the community at large which
includes promotive, preventive, curative and rehabilitative efforts that are
comprehensively integrated and sustainable (Notoatmodjo, 2003).
In general, in health law there
are two types of human rights or basic human rights, namely basic social rights
and basic individual rights. These two principles underlie health law. Social
rights in the health sector are the right to health care, a consequence of this
right arises the right to medical services. The right to health care/services
will be realized well or not, depending on four factors, namely:
1. Means
2. Geographical
3. Finance
4. Quality
Benyamin Lumenta said that
medical services are efforts and activities to prevent and treat disease, all
efforts and activities to improve and restore health which are carried out on
the basis of individual relationships between medical service experts and
individuals who need them. (Lumenta, 1989). then Dhany Wiradharma said that health services
need to be differentiated from medical services (Astuti, 2009). The latter are all efforts to prevent and treat
disease, as well as improve and restore health which are carried out on the
basis of an individual relationship between a doctor and the individual who
needs it. The function of health services and medical services is the same,
namely meeting the needs of society or individuals to normalize problems
related to health conditions.
Hospitals as a health service
facility are part of the health resources that are very necessary to support
the implementation of health efforts. The implementation of health services in
hospitals has very complex characteristics and organization (Indar, 2022).
Hospitals have a very strategic
role in efforts to accelerate the improvement of the health status of the
Indonesian people. This strategic role is achieved because hospitals are
technology-intensive and expert-intensive health facilities. This role is increasingly
prominent nowadays considering the emergence of changes in disease
epidemiology, changes in demographic structure, developments in science and
technology, changes in the socio-economic structure of society and services
that are better quality, friendlier and able to meet the needs of those who
demand changes in health service patterns in Indonesia. (Sabarguna, 2009).
From time to time, hospital
institutions are increasingly required to provide excellent service in the
health sector to the community. This need is in line with two important things,
namely the increasingly stringent competition in the hospital sector along with
increasing awareness and demands from clients/customers regarding the quality
of hospital services.
In today's developments,
hospitals have become one of the frontline health facilities which are expected
to provide health facilities and qualified medical personnel to accelerate the
prevention and treatment of emergencies and emergency patients in hospitals. So
in its development, the Hospital Law, which is currently being merged into one,
namely the Health Law, provides a number of legal bases for hospitals to know
their duties, functions, rights and obligations in health services. Apart from
that, more broadly, the Health Law can provide a perspective in health services
to prioritize service quality standards, especially for handling emergency,
emergent and emergency patients.
In an effort to optimize the
fulfillment of patient rights, the hospital has a mission to provide quality
and affordable health services to the community in order to improve the level
of public health. Its task is to carry out health efforts in an efficient and
effective manner, by prioritizing healing and recovery efforts which are
carried out in a harmonious and integrated manner. To meet these needs,
hospitals need to have the functions of medical services, medical support,
nursing services and care, referrals, education and training. , research and
development as well as carrying out general administration and finance (Grenaldo, 2017).
This requires skilled
personnel, good facilities and infrastructure as well as an adequate scale
monitoring system. In the field of management, managers of related units in
hospitals need to pay attention to demand management efforts, which are
characterized by a priority scale and providing services at the right time. In
general, these arrangements can be divided into patient services in emergency
situations (emergency), immediate services (urgent) and services that can be
scheduled/planned (scheduled). (Grenaldo, 2017). In order for efforts to optimize the fulfillment
of patient rights to run well, hospitals are required to form internal hospital
regulations and require hospitals to implement good corporate governance and
good clinical governance.
Guidelines for Internal
Hospital Regulations (Hospital by Laws) based on Minister of Health Decree
Number 772 of 2002 state that Hospital by Laws comes from two words, namely
hospital (Hospital) and by Laws (local or internal regulations). Hospital by Laws
aims to determine regulations, legal certainty and the continuity of hospitals.
Hospital by Laws are the "rules of the game" for Hospital management
to carry out its functions and duties. Hospital by Laws is a tool for carrying
out risk management and good governance programs well and successfully if
management rules and discipline have been created and implemented well.
If we trace the incidents or
cases described in the background of this research, such as the case "Poor
Jambi Patient Died Allegedly Rejected from Hospital" from this case the
principle of non-discrimination really does not work well in accordance with
the mandate of the law. Likewise, in the case of "RSUD A Yani Metro
Lampung suspected of rejecting patients," in this case it was a child who
was the victim who did not prioritize emergency care due to the negligence of
hospital staff. This is the hospital's duty to supervise and evaluate the
performance of each person. and/or officers, both medical and non-medical, who
work in hospitals together to be able to realize what has been legislated,
namely efforts to realize the highest possible level of health. "There is
a lot of buzz about the Subang case, can hospitals refuse patients?" This
case really attracted public attention and the result was that a pregnant woman
died on the way to the Subang Regional Hospital after being rejected from
another hospital. Health Law Number 17 of 2023 Chapter V Paragraph 1 concerning
Maternal Health in article 40 paragraph 1 Maternal health efforts are aimed at
giving birth to healthy, intelligent and quality children and reducing maternal
mortality rates. The hospital and everything in it helps the government in
reducing the maternal mortality rate so that of course this doesn't happen
again.
It can be concluded based on
the cases that the author has researched that the hospital still appears to be
unable to carry out its obligations in accordance with legislation and the
hospital's internal regulations are not running well. This unfortunately
happens in several hospitals and several regions in Indonesia. It is necessary
for the participation of Hospital Management to fully understand the
obligations of the Hospital, not just business, but also include social
functions that must be carried out to realize the state's goals as stated in
the preamble to the 1945 Constitution.
In essence, hospitals are
responsible for fulfilling patients' rights to create complete quality services
and will provide satisfaction because satisfaction is closely related to
improving service. The better the service provided to patients, the higher the
level of patient satisfaction and the fulfillment of patient rights goes hand
in hand. Efforts to fulfill patients' rights to health services are a guarantee
for the community to obtain optimal levels of health. Optimal health services
are the ultimate goal of providing services in hospitals. Health services in
hospitals will always be related to the process structure and outcomes of the
service system in the hospital. Health services in hospitals can also be seen
from the level of utilization of service facilities by the community, the
quality of service and the level of hospital efficiency.
Law Number 17 of 2023
concerning health has provided legal certainty, justice and benefits for the
community and health workers, regarding rights and obligations, so its
implementation needs to be implemented and obeyed so that implementation can
run in accordance with the objectives of the Health Law.
CONCLUSION
The implementation of
fulfilling patients' rights to health services in the Emergency Unit at the
Hospital cannot be realized properly. In Health Law Number 17 of 2023
concerning Health, Health Service Facilities, in this case the Hospital, are
obliged to provide complete individual Health Services through promotive,
preventive, curative, rehabilitative and/or palliative Health Services by
providing inpatient and outpatient services. roads, and Emergency. Indonesian
Hospital Emergency Units must pay attention to improving the quality of public
services by developing Standard Operational Procedures. These Standard
Operational Procedures must be owned by every service unit as a guideline in
the implementation of services which functions as a control in every service,
especially for hospitals in the Emergency Unit section which provides public
services in the health sector.
Hospital efforts to fulfill
patients' rights to health services in the emergency unit require the
establishment of internal regulations or Hospital by Laws and socialization to
all elements in the hospital so that they can be implemented well with the aim
of health services, especially in the emergency unit, being optimal. Hospitals
are obliged to carry out their responsibilities in accordance with what has
been legislated so that the country's goals in accordance with the preamble to
the Republic of Indonesia Constitution can be realized properly.
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