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DOI 10.18551/rjoas.2019-10.18
LEGAL PROTECTION FOR PATIENTS AND TRADITIONAL HEALTH MEDICATION BASED ON GOVERNMENT REGULATION #103 OF YEAR 2014 ON TRADITIONAL HEALTH SERVICES IN PEKANBARU CITY
Iriansyah*, Associate Professor Afrita Indra, Lecturer Faculty of Law, Lancang Kuning University, Indonesia *E-mail: iriansyahhukum@gmail.com
ABSTRACT
Implementation of health efforts implemented through activities such as traditional health services. is an alternative therapy as a substitute in health problems for the community, even the possibility of recovering from diseases that have not been found in medicine. One of the requirements contained in Government Regulation No. 103 of 2014 is Traditional Health Workers Practices License (SIPTKT) issued by the regional government has full authority in regulating and enforcing regulations in overseeing the circulation of unregistered traditional medicines even containing chemicals that can be harmful to the government needs to assert itself in order to provide protection for health workers and users of traditional health services. The practice of traditional medicine in Pekanbaru City is still many that do not have SIPTKT, which can result if there is a claim of dissatisfaction or loss borne by the patient can not protect the rights of patients of traditional services. The research method is with sociological law, the location of research is Pekanbaru City. The results of the study found that the legal protection of patients and health workers based on government regulation number 103 of 2014 on traditional health services in the city of Pekanbaru, is one of the alternative treatment that until this is relatively more favored by the community, which in traditional medicine is a barrier in the problem it is less likely that the patient holds the responsibility of traditional treatment practices as well as the traditional or alternative treatment practices already have to be registered for the legality of the stronger and can also increase the credibility of his business. The settlement of losses among patients and health workers under government regulation number 103 of 2014 on traditional health services in the city of Pekanbaru, if there is a problem between the parties both patients and traditional medicine tends to solve the problem through peace and agreement between the parties.
KEY WORDS
Protection, patient, traditional services, public service.
Health is one of the individuals' needs such as clothing, food, and shelter. Life would be meaningless without health because they cannot do their daily activities well. A healthy life includes physical, mental, spiritual and social aspects. Healthy people are both socially and economically productive. Mental health covers mind, emotional, and spiritual components which are reflected from good religious, faith and action as the norms in the societies (Soekidjo Notoatmodjo; 2003). In order to increase the society's health level, health service is required as managed in Act Number 36 Year 2006 on Health which is furthermore called Health Act on Article 1 Paragraph (11) with the general principle: "Health effort is an activity and/or a set of activities which is done in integrated and continuous manner to maintain and improve the societies' health level in form of disease prevention and medication and health improvement and healing by the government and/or societies.
Article 48 Act of Health organizes the implementation of health effort which is performed through some activities such as traditional health service which is alternative therapy as the replacement of health problems for the societies and has been known earlier than conventional health service in the 19th Century. However, the method was more scientific and tested. So conventional service is more trusted by the societies. In its development, traditional service which is generally found in the village societies become
attractive for urban societies, moreover, malpractice of conventional health service open their mind towards traditional health service which offers back to the natural concept, even enable the healing of disease which has no medicine (Bunga Agustina; 2015). Based on the decision of Indonesia Republic Minister regulation Number 1076/MENKES/SK/VII/2003 mentioned that traditional medication classification has various medication techniques such as skill, mixed-traditional drink, and religious or supernatural approach medication technique. While based on the Government Regulation Number 103 the Year 2014 on Traditional Health Service in Article 1 Number 1-3, traditional health types cover: empirical, complimentary and integration traditional. The empirical health service staff is called a traditional health person who must-have skill and obtain a Registered Letter of Traditional Health Person (STPT) issued by the local Health Agency. While complementary health service is called as traditional health office must have certification from certain academy minimum Diploma (D3) and Practice License for Traditional Health Worker (SIPTKT) issued by the local government has full authority in managing and establishing regulation in monitoring traditional medicine distribution which is not registered or even contains of chemical substance cause fatal effect. So, the government should firmly manage to protect health workers or traditional health service users.
In Pekanbaru city, many traditional health service practices appear. We can find service practices on every road in Pekanbaru. They promise to treat chronical diseases without the expensive cost and provide a guarantee. Even they also post patients' testimonial on printed media or local television every Sunday or Friday evening that broadcasts live broadcast and free consultation by carrying the tagline "Trusted and Proven to Heal Various Acute and Chronical Diseases", there are also herbal and acupuncture clinics are demanded by the societies. There are also Acupuncture Health Clinic and Medication Practices which are assumed to heal medical and nonmedical diseases. In practice, traditional health service practice sometimes makes both intentional and unintentional medication procedure errors and cause patients' complaints. Even it may cause patients' physical defects to death. In this case, it can be said that patients are harmed parties.
Patients' rights are particularly managed in Act Number 29 the Year 2004 on Medical Practices. However, it only includes protection towards patients who use medical health services as performed by a doctor. However, health service in Indonesia does not only involve medical treatment performed by doctor and health workers, but also traditional treatment.
In traditional service practice, the dissatisfactory claim is borne by the patients. Whether it is imbalance information or a result of certain actions caused by the practice, how far the country protects traditional service patients' rights. If patients complain to a doctor, they can propose it to Medical Ethics Assembly (MKEK) and so on to process internally or if it cannot be settled, it becomes the legal conflict that needs the court to interfere. While for traditional medication, the people's protection mechanism, and how and is there legal protection insurance for traditional medication patients. Based on the explanation, the author is interested to carry out research which is entitled: Legal Protection of Patients in Traditional Medication Based on Government Regulation Number 103 the Year 2014 on Traditional Health Services in Pekanbaru City.
LITERATURE REVIEW
Legal protection is a protection provided by legal subjects in the form of preventive or repressive and oral or written medium. In other words, legal protection is an image of legal function which has the concept that law provides justice, law and order, certainty, benefit, and peace. According to Satjipto Raharjo, Legal Protection provides protection towards humans' rights which are harmed by other people and is given to societies so they can enjoy rights provided by the law (Satjipto Raharjo; 2000).
Traditional health service as one of nonmedical treatment or nursery science is utilized by the societies in solving their health problems. Non-medical medication is performed by the government because every people deserve to live in a wealthy life. The wealthy life rights are
managed in the formulation of the Constitution 1945 Article 28 Paragraph (1), which states each individual deserves to live physically and mentally wealthy, has residence, and get a good and healthy living environment and health service. In the article 5 Paragraph (2) and (3) Act Number 36 the Year 2009 on Health which states that every individual deserves to get secure, qualified, and affordable health service. Paragraph (3) states that every individual deserves independently and responsibly determines his/her health service. Traditional health service as one of the non-medical medications is formulated in Article 12 Paragraph (1) and (2) Health Minister regulation Number 1076//MENKES/SK/VII/2003 on traditional health service implementation that it is one of the medical efforts and /or other treatments outside medical and/or nursery science. Traditional health service as intended in Paragraph (1) is performed as the health improvement effort, disease prevention and medication, and/or health recovery.
Research on traditional health service had been done by previous researchers towards various different problems:
• Acupuncture traditional medical permit in Special Region of Yogyakarta which was written by Rahmat Dwi Suryanto in 2014 discussed a problem: acupuncture has to have a license in carrying out their practice which refers to Health Minister regulation Number 1076 the Year 2003. The result indicated that the licensing implementation has not obtained a license because of the implementation obstacle;
• Criminal responsibility for traditional medication on ignorance which causes individuals injured or die in Indonesian positive law which was written by Daniel Roring 2014: criminal responsibility on ignorance which can be used is the Code of Civil Law, health Act, and costumers' protection Act. The result concludes that criminal responsibility in Indonesian positive law is organized in the lex general Code of Civil Law Article 359 to 261;
• The legal protection of traditional health service customers which was written by Wade Eka Munawarty in 2013 discussed a problem concerning: responsibility towards traditional health service based on the Act of customers' protection and Health. Based on the result, the responsibility can be done in both criminal and civil way.
METHODS OF RESEARCH
In order to obtain accurate data which is relevant to the problem and expected result, the research method was:
The research was sociologist legal research that focused on problems that emerge. Therefore, the researcher emphasized on the discussion and regulations and saw how the law was practiced in societies. It was Field Research which was direct research on the field.
The research location was in Pekanbaru city, especially at the Health Office of Pekanbaru City, Indonesia National Agency of Drug and Food Control Pekanbaru and traditional medication clinics in the city.
The research populations were:
• Chief of Health Office of Pekanbaru City;
• Chief of Indonesia National Agency of Drug and Food Control Pekanbaru;
• Traditional Health Workers;
• Harmed traditional medication patients;
• Pasien Pengobatan Tradisional yang dirugikan.
Of the identified population, the researcher determined the samples by using random methods for traditional health workers and patients in Pekanbaru city and census method for Chief of Health Office and Chief of Indonesia National Agency of Drug and Food Control Pekanbaru.
The research data source was:
• Primary data is the main data which is obtained by the researcher through respondents or samples. This data comes from Chief of Health Office Pekanbaru City
or BPOM Pekanbaru, traditional health workers and patients who have a relationship with the discussed problem;
• The secondary data is data which is obtained from literature books that support the main problem. Secondary data can be in the form of a thesis, dissertation, journal, newspaper, paper, seminar, brochure, etc;
• Tertiary data is data that is obtained from a dictionary, encyclopedia, paper, etc which support the main problem.
Table 1 - Populations and Samples
No Population Type Population Sample Percentage (%)
1. Chief of Health Office Pekanbaru 1 1 100
2. Chief of Indonesia National Agency of Drug and Food Control Pekanbaru (BPOM Pekanbaru). 1 1 100
3. Traditional health workers 22 4 18,2
4. Harmed Traditional Medication Patients 8 4 50
Number 32 10 -
Source: Primary Data, 2017.
In order to get relevant data to answer the existing problems, the data collection techniques were as follow:
• Observation. It is a data collection method which was obtained by doing field observation towards relevant research object;
• Interview. The researcher did a direct interview with the respondents to get information from the respondents which have been determined in the population and sample table;
• Literature Stud. It is a data collection method through literature which has a correlation with the problem observed.
The researcher categorized the data based on existing problems. Then he analyzed the data qualitatively and presented it in descriptive qualitative language and sentence which provides an explanation to the problems and problem solving which were proposed systematically and fully.
RESULTS AND DISCUSSION
The implementation of traditional medication is based on the Republic Indonesia Health Minister regulation Number: 1076/Menkes/SK/VII/2003 on the Implementation of Traditional Medication. The regulations are aimed at:
• Train traditional medication effort;
• Provide protection towards societies;
• Inventorying the numbers, types and medication methods of a traditional healer.
The implementation forms of traditional medication are divided into two, such as:
• Traditional Healer Registered Letter (STPT). It is required to all traditional healers who run their traditional medication business as managed in Article 4 of Republic Indonesia Health Minister Regulation Number: 1076/Menkes/SK/VII/2003 on Traditional Medication Implementation;
• Traditional Healer Permit (SIPT). It is given to traditional healers whose methods have fulfilled the requirements of filtering, reviewing, research and testing and been proven to be secured and beneficial for health. One of acknowledged traditional healers are acupuncturists as managed in Article 9 Paragraph (2) Republic Indonesia Health Minister Regulation Number: 1076/Menkes/SK/VII/2003 on Traditional Medication Implementation which states: "Acupuncturists who have passed competency test from professional association/ organization in traditional medication field can be provided with Traditional Healer Permit (SIPT) based on this regulation".
Based on the interview result with Health Office Secretary of Pekanbaru City,dr Zaini Rizaldi Saragih (located at workspace at Melur Street No 103 Pekanbaru, on 14th February 2018), both independent or integrated traditional medication on pure health service system to achieve optimal societies' level. Therefore, traditional medication is one of the preferable alternatives by societies. So, health associations try to know and participate in traditional medication. The specific objectives are:
• Improving traditional medication service quality so societies can avoid the negative impact of traditional medication;
• Improving societies' independence to solve the health problem with traditional medication effort;
• Fostered traditional medication workers in the health service;
• Integrated traditional medication effort in pure health service program starting from the household, Puskesmas to referral.
As the regulation of Article 53 Paragraph (2) Health Act, every health worker is required to fulfill professional standards and respect patients' rights both professional standards in general or specific. Also, every health worker is bound and obey legal and ethical norms. The violence towards law and ethic has consequences in sanction provision that should be performed. In the article 58 Act Number 36 the Year 2009 on Health, it is mentioned: "Every individual deserves to demand compensation towards an individual, health workers and/or caretakers who cause loss or ignorance in accepted health service"
If the patients perceive that the health service which is provided by traditional medication harms them, they can propose a lawsuit to the court both it is in a civil or criminal manner. Besides, they should report. The violation of article 8 Act Number 8 the Year 1999 on Customers' Protection who produces/ trade service which is not relevant to the advertisement/ promotion.
Article 23 Act of Customers' Protection states that if the business actors and/or distributors refuse and/or do not report and/or fulfill the indemnity on the customers' lawsuit. So, the customers are given rights to sue the business actors and complete the settlement which emerges through institutions that are assigned to solve customers' disputes or by proposing a lawsuit to the justice body in which the customer is located.
DISCUSSION OF RESULTS
Legal protection towards patients in traditional medication based on the Government Regulation number 103 year 2014 on Traditional Health Service and health service in traditional medication center which become the obstacle is the lack of patients' understanding on prohibition, benefit, medicine types, dosage, medication period range, price and other requirements provided by the medication center. The instructions are written in the brochure and medical packaging by using small letters so they are difficult to read and understand. Based on the interview performed with traditional medication patients (P.Lubis, traditional medication patients, on 8th March 2016 at Health Clinic Akupresur The Nita on Srikandi Street, Public Residence Widya Graha 2 Pekanbaru) The anxiety feeling to spend additional cost to follow the medication, they had acknowledge to experience loss caused by the traditional medication center carelessness or ignorance. They are nor recovered although they have spent money or are usually called dowry which amount is IDR 200,000 to IDR 300,000. Then they ask for the responsibility of traditional medication practice but do not get a positive response. They insist that what is experienced by the patients/customers is caused by their mistake because they break the prohibition suggested by the traditional medication center. Certainly, the answer disappoints patients who previously expect recovery when getting treatment from traditional medication practice. Therefore, traditional medication centers are free to bind patients in partial agreement and harm them.
Based on the interview result with patients (Jasmawati as traditional medication patient, 14th March 2018 at Herbal Clinic Jeng Ana which is located at Sudirman Square City shop house Pekanbaru), she feels satisfied with traditional medication practice's responsibility. She recognizes to have good service and be guaranteed with recovery although she does
not spend much money, the recovery will be longer. They do medication until recovered by once payment, besides traditional medication is accompanied by a religious approach so that the patients perceive that recovery does not only come from medicine but their faith to be recovered. They have more faith to recover than medical treatment which more focusses on knowledge analysis and examination by using sophisticated equipment so the cost is higher than traditional medication. Based on the interview with the patient (Azid Tio, traditional medication patient, 20th March 2018 located at Al Highmah Medication which is located at Melur Ujung Street, Pekanbaru), it is one of the patient's reasons for doing medication through a traditional method which medication is given by therapy experts in Pekanbaru.
The obstacle which is found is the lack of government monitoring. It is relevant to the interview result with Health Office Secretary of Pekanbaru City dr Zaini Rizaldi Saragih (located in the workspace at Melur Street No 103 Pekanbaru, on 14th February 2018), they continuously visit traditional medication practice to provide understanding and training so that they are registered in Health Office. So far, the control towards traditional medication or alternative practice is persuasive. If the traditional practice is registered, the legality will be stronger and they can improve their business credibility. In the permitting aspect, there are some traditional medication practices which have not obtained traditional medication permit issued by Integrated Services and Investment Board (BPTPM) of Pekanbaru City.
Based on the interview with some therapists, traditional medication practice (located at Health Clinic Akupresur The Nita on 8th March 2018 at Srikandi Street Wadya Graha 2 Residence Pekanbaru) is not able to be fully responsive on all harms experienced by the patients because they consider that their procedures are correct. It is justified by one of the therapists in traditional medication who provides a guarantee until the patient is recovered. If not, all the money which is spent by the patients will be refunded. Until present, it does not occur. The medication practice party tends to be suspicious when patients ask for compensation because other patients who follow the medication do not experience the same thing. They will pay more attention to their complaints. Even by doing therapy, it is found that the patients do not follow their suggestion during the medication process and they do not routinely intake the medicine given by the medication center. The same thing was uttered by a therapist (at Herbal Clinic Jeng Ana on 14th March 2019 which is located at Shop office Sudirman Square City Pekanbaru) who acknowledges that he never gets complaints from the patient. Moreover, the mistake comes from the patients. Every job has its own risk, they will be ready to take responsibility if the problem is caused by them, but if it is caused by the patients, they will find a way together.
The Settlement towards Patients' Loss is based on the Government Regulation Number 103 the Year 2014 on Traditional Health Service in Pekanbaru. The legal effort can be performed to solve any legal problems which emerge. Based on the interview result with patients and therapists at traditional medication clinics, they tend to solve the problem through reconciliation and agreement among the parties. However, not all agreements provide positive results by providing remediation for free. Most of the traditional medication practices assume that the mistake is on patients. In general, the patients do not know which legal efforts that can be taken. In fact, not all traditional medication as medication service providers have a medication practice license. Many traditional medication service providers do not have standard operating procedures both in administration or provided medication aspect. Based on the interview result with some patients of traditional medication who became the research samples, most of them are afraid to sue because of some reasons. For example, they afraid if the service provider uses them back even some of them are afraid that their identity will be revealed.
Based on the interview with Deputy II of Traditional Cosmetic Supervisory Department, Cosmetic and Complementary Products of BPOM Pekanbaru Dra.Nurma Hidayati., APT., M.Epid (located in the workspace at Diponegoro Street Number 10, 20th February 2018), the result states that the majority of traditional medication practices in Pekanbaru do not fulfill the standard operating procedure as managed in Health Act, Health Minister Regulation or others which manage traditional medication. It should be known by the patients that besides traditional medication itself, they should understand the medication standard operational
procedures such as information of medicines used by them, or whether the medication has fulfilled the qualification and has been registered in BPOM as medicines that can be used by patients. Whereas, if the patients who bear the loss will process in legal and demand their rights through:
Legal Effort is reviewed from Act Number 36 the Year 2009 on Health, Act Number 36 the Year 2009 on Health which provides legal protection both it is for patients or customers. If the lawsuit between patients as customers and doctors as the health service providers occur using the law base. Article 27 formulates that health workers deserve to get compensation and legal protection in performing their tasks as the profession. While Article 29 formulates health workers matters who are assumed to neglect in performing. It should be settled through mediation.
The legal effort is reviewed from Act Number 8 the Year 1999 on Customers' Protection. Customers' dispute is a dispute which is related to customers' rights violation. The scope covers all law aspects, whether it is civil, criminal or state administration. According to Customers' Protection Act, customers' party can solve the dispute by following some judicature regulations or solve it outside the judicature. Not all traditional medication practices in Pekanbaru which become the research populations administer (make patients' status) who follow medication at the clinic. If the problem concerning the traditional medication service occurs, it will be difficult to prove because they do not have clear administration. Other than the Health Act and Customer Protection Act, the societies who experience and recognize the dispute between customers and business actors must report it to the Consumer Dispute Settlement Agency (BPSK). Even this problem can also be settled through the civil method. Traditional medication clinic party can be said as default, in which they have failed to fulfill their duties and harm the patients.
CONCLUSION
Legal protection towards patients and health workers based on the Government Regulation Number 103 the Year 2014 on traditional health services in Pekanbaru city is one of the medication alternatives which until presents are preferable by the societies. The traditional medication becomes the problem obstacle is the lack of patients' understanding, whether it is prohibition, benefit, medicine types, dosage, duration of treatment, the price which is issued and other requirements given by medication clinic. The regulations are written on the brochure and medicine package which is written small so that it's difficult to read or understand. Even some patients acknowledge that they are reluctant to ask for medication clinic's responsibility because they are afraid to bear higher medication costs. So far, Health Agency control towards traditional or alternative medicine practice is persuasive. If the traditional practice has been registered, the legality will be stronger and can improve their business credibility. Meanwhile, there are still many unregistered medication practices that are implemented.
The settlement towards the loss between patients and health workers is based on the government regulation number 103 the Year 2014 on traditional health service in Pekanbaru. Generally, they tend to settle the problem with reconciliation and agreement among the parties. However, providing free medication or compensation does not always provide positive result. The patients who follow the traditional medication must understand the standard operating procedure such as the information of medicine which is utilized by them, whether the medicines have fulfilled and registered in BPOM as medicines that can be used by the patients.
RECOMMENDATIONS
The patients should be more critical and consciously uses their rights without any fear if they are harmed by traditional practice parties and can understand the regulations so they can sue the traditional medication provider. Traditional medication practice should
understand Act, Government Regulation and other regulations concerning traditional medication. Therefore, patients' and medication providers' rights are guaranteed.
Health Agency, BPOM and relevant institutions in Pekanbaru can be synergized to each other for doing control and traditional practice permit in Pekanbaru. It is expected that they more emphasize the traditional medication practice which is established without having an official permit to prevent unwanted possibilities as organized by the Health Act, Health Minister Regulation, and other relevant regulations.
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