Beyond “malpractice” reconstructing medical negligence in Indonesia through the lens of patient safety, defensive medicine, and health system error

Abstract

Introduction: Medical negligence in Indonesia is often compressed into the single public label of “malpractice,” although contemporary legal and patient-safety scholarship distinguishes unavoidable medical risk, human error, professional negligence, reckless conduct, and organizational failure. This review aims to reconstruct medical negligence in Indonesia through the integrated lenses of patient safety, defensive medicine, and health system error.

Methods: This narrative legal-policy review synthesized peer-reviewed scientific journal articles published between 2022 and 2026, with legal analysis limited to Indonesian statutes and regulations. Sources were selected when they addressed medical negligence, hospital liability, professional accountability, patient safety culture, incident reporting, defensive medicine, or hospital risk management.

Results: Indonesian medical negligence should not be assessed only as individual fault, but as a layered phenomenon involving clinical judgment, team communication, institutional governance, safety culture, reporting systems, and regulatory design. Law No. 17 of 2023 on Health strengthens the legal basis for patient rights, professional accountability, hospital responsibility, and dispute processing, while Minister of Health Regulation No. 11 of 2017 provides a patient-safety framework for incident prevention and learning. However, fear of litigation and criminalization may encourage defensive medicine, while blame-oriented cultures suppress incident reporting and weaken organizational learning.

Conclusion: Reconstructing medical negligence beyond “malpractice” requires a shift from retrospective blame toward proportionate accountability, just culture, system learning, and legally coherent risk management. Indonesian health law should be implemented in a way that distinguishes medical risk from negligent conduct, protects patients’ rights, supports fair professional evaluation, and makes hospitals accountable for preventable system failures.