6.malpractice - Human Error-Min-1 PDF

Do’a
belajar
Asyhadu
anlaa ilaaha illalloh
wa asyhadu anna Muhammadan rasuululloh
Rodliitu billaahi robbaa

wa bil-islaami diinaa
wa bi Muhammadin nabiyyaw wa rosuulaa
Robbii zidni ‘ilmaa

warzuqnii fahmaa
Aamiin....
@PRIME
Amanah-Profesional-Iman Ilmu Amal-Integritas-Moralitas-Excellent
Profesional-Qurani
Mal
Proof of Mal
Practice Legal Practice
Vs Mal
Human Practice Liability Settle-
ment
Error
@PRIME
Profesional-Qurani
INSPANNINGS
VERBINTENNIS
(EFFORT)
patient /
MIDWIFE
client
RESULTAATS
VERBINTENNIS
- Trust (RESULTS)
- Expertise & authority
- Professional Standards
@PRIME
Profesional-Qurani
• The failure of a planed action to be
completedas intended (i.e., error of
ERROR execution) or the use of a wrong plan
to achieve an aim (i.e., error of
planning) (Institute of Medicine)
• Errors in establishing a diagnosis of

MIDWIFE midwifery care or errors in following
ERROR up on a prescribed midwifery
diagnosis.
@PRIME
Profesional-Qurani
• Symptoms are sometimes difficult to distinguish from
1 the symptoms of the disease itself.
• Midwives do not recognize any problems (events) due

2 to midwife errors.
• Something went wrong, but it was not reported in the

3 midwifery care document as an error midwife.
• Some problems that occur are reversible or disappear

4 on their own after cessation of midwifery care.
@PRIME
Profesional-Qurani
MIDWIFE ADVERSE
ERROR EVENT
• Injury (events that are
ADVERSE contrary to expectations) that
are more caused by medical
EVENT intervention than by the
disease itself.
PREVENTABLE • Adverse events caused

ADVERSE by errors and can
actually be prevented
EVENT
NEGLIGENT • Preventable
adverse events that
ADVERSE can be associated
EVENT with negligence.
@PRIME
Profesional-Qurani
Number of
hospitalized patients
Adverse
2,9 – 3,7 % Events
Adverse Event
2,03 – 2,59 % because of
Error
Adverse events that
can be categorized
0,56 – 0,71 % as Error Negligence
(Culpa)
@PRIME
Profesional-Qurani
• komplikasi
19%
obat
• infeksi
14%
luka
ADVERSE
13,6% • Dead
EVENT
extension of hospitalization,
3,7% abnormalities when discharged
from the hospital or both.
2,6% permanently disabling injuries
@PRIME
Profesional-Qurani
• technical
44% error
• diagnostic
17% error
PREVENTABLE
ADVERSE
EVENT
BECAUSE OF
THE ERROR • failure to
12% prevent
(Leape et al, 2001) injury
10% error in the use of a

drug
@PRIME
Profesional-Qurani
TIPE ERROR
• Kesalahan atau keterlambatan membuat diagnosis.
DIAGNOSTIC •
•
Tidak menggunakan tes yang diindikasikan.
Menggunakan tes yang sudah ketinggalan zaman.
• Tidak bertindak terhadap hasil atau monitoring tes
• Errors in work processes, procedures or tests.

• Error giving action.
TREATMENT
• Error dosage or how to administer medication.
• Delay (which can be prevented) from giving
• Action or respond to abnormal results of a test.
• Perform actions that are not true or not indicated.
• Does not provide prophylactic treatment.

PREVENTIVE • It is not enough to carry out monitoring or follow-up on the
actions that have been given.
• Communication failure.
OTHERS • Equipment failure.
• Failures from other systems.
@PRIME
Profesional-Qurani
WHAT IS
MALPRACTICE?
@PRIME
Profesional-Qurani
MALPRACTICE MISCONDUCT
PROFESSIONAL
• Is a term that:
• General nature Literal meaning =
• It is not always legal connotation (it can implementation or wrong
also be ethical). action.
• Only used in the professional field. Terminological meaning =
• Derived from the word "mal" (which wrong action in order to
means wrong) and the word "practice" carry out a profession.
(which means implementation or action).
@PRIME
Profesional-Qurani
In Common Law, Recent international trends,
both in America and in the UK,
malpractice is included have begun to make efforts to
as a tort (negligence) so try to criminalize those who
that health profession commit malpractice (mainly
are not convicted, but those that cause death),
although there are still very few
only pay compensation. (around 15 cases).
MALPRACTICE
In Indonesia, there is
Clause 359 of the In New Zealand, the
Criminal Code which law allows for
allows health profession criminal prosecution
to be charged with this of health profession.
article in criminal cases
@PRIME
Profesional-Qurani
An attitude of wrong
Midwives' malpractice
conduct that violates
morals and law is related to the error
(Soeryono Sukanto) of midwives in
performing their
Cannot examine, do practices in accordance
not judge, do not act with the standards of
or ignore things that service for the patient's
Midwife who are condition, or lack of
generally good in the
ability or indifference
same situation, DEFINITION in providing services to
examined, assessed,
done or ignored OF clients that are the
(Berkhower and MALPRACTICS main causes of injury
Vorstman).
to clients
@PRIME
Profesional-Qurani
CAUSES OF MALPRACTICE
• open the secrets of medicine, without
Misconducts rights, illegal abortion, euthanasia,
sexual assault, false information, practice
without permission
• below the competency standard; outside

Lack of skill of competence (not the competency /
authority
• malfeasance (take inappropriate actions, fail

to make decisions);
Negligence • Misfeasance (make improper choices,
neglect execution);
• Nonfeasance (do not carry out obligations)
@PRIME
Profesional-Qurani
Contrary to
law
The result can

be imagined
Culpa lata
The result can
Culpa/ be avoided
Negligence Culpa levis
Level His actions
can be blamed
Culpa
levissima
@PRIME
Profesional-Qurani
Proof of negligence (malpractice)
according to the field of civil law
Duty (no obligation but not implemented): professional
obligation; obligations with patients
Dereliction of Duty: irregularities of obligations based

on professional standards: violation of these obligations
Damages: injury, death or loss
Direct Causalship: a causal relationship between

negligence and injuries
@PRIME
Profesional-Qurani
STANDARD
Size and benchmark that should be achieved;
It is a benchmark that; reflect the "legal" validity that
should be done everyday
Scales è Size~ Standard

BALANCE
right obligation
•Professional Standards
•Professional Ethics Standards
•Professional Education Standards
•Competency standards right right
•Standard Operating Procedure
•Minimum Service Standards
•Performance Standards
obligation obligation
Midwife Client
Right-obligation è Fair equality
@PRIME
Profesional-Qurani
Elements of Professional
Standards
Acting carefully (associated with culpa lata)
According to the size of midwifery
Avarage compared to the same midwifery category
the same condition situation
Means of effort (middelen) are proportional / proportional
@PRIME
Profesional-Qurani
Proof of Res Ispa
negligence Loquitur
The fact has spoken

- Gauze is left behind
- Scissors left behind
@PRIME
Profesional-Qurani
Proof of negligence (malpractice)
according to the field of criminal law
Culpa Lata
Deviations based on professional standards
Accident/risk in treatment/error in judgement: risk
Informed consent: related to medical records
Medical liability
@PRIME
Profesional-Qurani
ADVERSE EVENT
FULFILLED SERVICE STANDARD

SERVICENOT
STANDARDS FULFILLED
DIRECT DUE TO
MEDICAL
RISK
DAMAGES
UNEXPECTED EXPECTED
MALPRACTICES
RISK RISK
DAMAGES
NOT MAL - DO Without
PRACTICE DIRECT DUE TO
ANTICIPATION
@P RIME
ANTICIPATION
Profesional-Qurani
chance or possibility
exposure to injury or
of loss or bad
financial loss (Roach,
consequence (Oxford
Chernoff, Esley)
Dictionary)
RISK
probability of
a variation of results something different
that can occur over a outcome (outcome)
period of time than expected
(Williams & Richard) (Hermawan Darmawi)
@PRIME
Profesional-Qurani
• serious and immediate danger (Oxford
Dictionary)
• the cause of any loss (Webster Dictionary)
Peril • events that cause losses (Soeisno
Djojosoedarso)
• danger, or risk (Oxford Dictionary)

• conditions that increase the occurrence
Hazard of peril (Soeisno Djojosoedarso)
@PRIME
Profesional-Qurani
Sources of excessive heart
feelings (for example over
confident).
Morale Hazard
Physical Hazard RISK Moral Hazard
Based on the physical Based on behavior

characteristics of the related to morality.
object.
Legal Hazard
Based on actions that do not

heed the rules (including law)
@PRIME
Profesional-Qurani
PROCESS OF DISPUTE
PRE CONFLICT
There are conditions that underlie dissatisfaction
CONFLICT
Circumstances where parties are aware of feelings of dissatisfaction.
DISPUTE
Circumstances where conflicts are publicly stated or third parties are involved.
@PRIME
Profesional-Qurani
ALTERNATIVE DISPUTE SETTLEMENT
• let the dispute go and assume that it doesn't need
Lumping it to be extended anymore
• choose not to relate to those who have been

Avoidance detrimental
• one part imposes a solution on the other party (for

Coercion example using a debt collector).
• negotiate, where both sides are decision makers

Negotiation
• use third parties to help find compromises
Mediation
• both parties agreed to ask a third party to resolve
Arbitration the dispute and accept the decision
• there is a third party that has the authority to

Adjudication interfere with the problem (verdict and execution)
@PRIME
Profesional-Qurani
CONFLICT SETTLEMENT BY LAW PATH
CLIENT LEGAL MIDWIFE

LOGIC LOGIC LOGIC
LEGAL LOGICS can shift (take sides)

to logic patient or on the Midwife's
logic or not on both
@PRIME
Profesional-Qurani
LEGAL LOGIC
IN TERAPETIC RELATIONS
The therapeutic relationship is a contractual relationship so that the
principles in contract also apply
The form of engagement that occurs is inspirational, so that midwives are only
required by law to give the right effort according to their theory.
Adverse events that occur do not automatically prove the existence of

MALPRACTICS
Misdiagnosis does not always mean MALPRACTIC.

Midwives can be prosecuted only if their actions fulfill the criminal formula
(mens rea & actus reus).
Midwives may be sued if there is a loss due to broken promises (default) or

due to illegal acts
@PRIME
Profesional-Qurani
Responsibility in Health
Services
GOVERNMENT
PROFESSIONAL
ORGANIZATION HOSPITAL MASS MEDIA
COMMUNITY
@PRIME
Profesional-Qurani
LAIBILITY IN HEALTH SERVICES
Management sarana kes

(public liability) - Civil
LIABILITY - Administration
Professional Health Profession

(Medical liabillity) - Civil
- Criminal
- Administration
@PRIME
Profesional-Qurani
Vicarious liability: the
Strict liability: responsibility for the lower
the profession's own part of the doctor to the
midwife who executes the
responsibility order
Character of
Liability
Cardiac-arrest
Corporate liability:
liability: stand-alone corporate responsibility
responsibility from (employees-hospital /
the profession of health service facilities)
anesthesia
@PRIME
Profesional-Qurani
Please midwives are sued to pay
Please midwives are arrested if compensation if the patient
they have actually committed experiences a loss because the
midwifery actions that fulfill the midwife has broken promises or
criminal formula, namely: taken unlawful actions as
evidenced by the existence of Res
a. actus reus (the existence of a
Ipsa Loqoitur or the existence of
disgraceful act)
4D (Duty, Dereliction of duty,
b. mens rea (the existence of a Damage, Direct causation
wrong inner attitude). between damage and
dereliction).
@PRIME
Profesional-Qurani
BASIC CRIMINAL CASE CLAIMS
• Started to shift to criminal cases
• Families report to police, prosecutors,
courts
• Basis of the Criminal Code Article:
Ø 359, negligence causes death
Ø 360, negligence caused serious injuries
Ø 304, letting people need help
Ø 349, abortion
Ø 344, euthanasia
Ø 284, sexual assault
Ø 267-268, false statement
Ø 322 jo PP 10/66, divulging the secrets
of medicine
@PRIME
Profesional-Qurani
TAKE HOME
Seorang bayi berusia 41 hari dalam keadaan sehat dibawa ke

Posyandu dan disuntik imunisasi Difteri Pertusis Tetanus (DPT)
HB dengan 5 dosis @ 0.5 ml oleh seorang Bidan. Malamnya, bayi
panas 38 derajat, sehingga Bidan memberikan paracetamol
sirup.
Karena panas tidak turun, bayi dibawa ke Puskesmas rawat inap,
tetapi panas tidak kunjung turun, bahkan disertai kejang-kejang.
Akhirnya bayi dirujuk ke Rumah Sakit, tetapi bayi tidak dapat
diselamatkan dan meninggal dunia karena bayi mengalami
radang selaput otak (meningitis) dan terlambat dirujuk.
Orangtua bayi tidak menerima kematian anaknya, sehingga
menuntut Bidan telah melakukan malpraktik.
@PRIME
Profesional-Qurani
Apakah tindakan Bagaimana
Bidan tersebut pembuktian
legal? Apa dasar malpraktik oleh
hukumnya? Bidan?
Take home via

e-learning: 17-11-2018
Bagaimanakah Bagaimana perlindungan
pertanggung- hukum bagi Bidan?
jawaban Bidan Bagaimanakah cara
dalam kasus penyelesaian kasus
tersebut? tersebut?
@PRIME
Profesional-Qurani
Do’a penutup majelis
Subhaanakallohumma
wabihamdika
asyhadu anlaa illaaha illa anta
astaghfiruka wa atuubu ilaika
@PRIME
Profesional-Qurani

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Do’a

Rodliitu billaahi robbaa

Robbii zidni ‘ilmaa

• Errors in establishing a diagnosis of

• Midwives do not recognize any problems (events) due

• Something went wrong, but it was not reported in the

• Some problems that occur are reversible or disappear

PREVENTABLE • Adverse events caused

2,6% permanently disabling injuries

10% error in the use of a

• Errors in work processes, procedures or tests.

• Does not provide prophylactic treatment.

• below the competency standard; outside

• malfeasance (take inappropriate actions, fail

The result can

Dereliction of Duty: irregularities of obligations based

Damages: injury, death or loss

Direct Causalship: a causal relationship between

Scales è Size~ Standard

According to the size of midwifery

Avarage compared to the same midwifery category

the same condition situation

Means of effort (middelen) are proportional / proportional

The fact has spoken

Deviations based on professional standards

Accident/risk in treatment/error in judgement: risk

Informed consent: related to medical records

FULFILLED SERVICE STANDARD

• danger, or risk (Oxford Dictionary)

Physical Hazard RISK Moral Hazard

Based on the physical Based on behavior

Based on actions that do not

• choose not to relate to those who have been

• one part imposes a solution on the other party (for

• negotiate, where both sides are decision makers

• there is a third party that has the authority to

CLIENT LEGAL MIDWIFE

LEGAL LOGICS can shift (take sides)

Adverse events that occur do not automatically prove the existence of

Misdiagnosis does not always mean MALPRACTIC.

Midwives may be sued if there is a loss due to broken promises (default) or

Management sarana kes

Professional Health Profession

Seorang bayi berusia 41 hari dalam keadaan sehat dibawa ke

Take home via

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