Makna Kehadiran Dokter dalam Perspektif Hukum Kesehatan: Analisis On-Site, On-Call, dan Home-Call dalam Pelayanan Gawat Darurat
DOI:
https://doi.org/10.55606/jurrish.v5i3.8307Keywords:
Physician Presence, Emergency Medical Services, Health Law, Professional Responsibility, Protection of Medical PersonnelAbstract
Emergency medical care constitutes a fundamental patient right and an institutional obligation of hospitals that must be provided without temporal discrimination. However, in practice and public discourse, the meaning of “physician presence” is often narrowly reduced to physical presence alone, giving rise to allegations of medical negligence, particularly during weekends or outside regular working hours. This distorted understanding risks generating legal injustice, undermining the dignity of the medical profession, and encouraging defensive medical practice. This article aims to analyze the meaning of physician presence from a health law perspective through theoretical, normative, and systemic approaches, by distinguishing models of physician presence as on-site, on-call, and home-call/teleconsultation in emergency care services. This study employs a normative legal research method using statutory, conceptual, and limited comparative approaches. The analysis examines Law Number 17 of 2023 on Health, Government Regulation Number 28 of 2024, as well as health law literature and emergency care practices. The analysis demonstrates that, in legal terms, physician presence is not synonymous with physical presence, but rather should be understood as process-based professional responsibility, provided that care is delivered in accordance with professional standards, service standards, and an adequate triage system. Physician presence must be reconstructed as the presence of professional responsibility within an integrated emergency care system. Legal assessment in health law should be grounded in process and system integrity, rather than solely on clinical outcomes or public perception.
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Akhyar, A. (2024). Alternative Settlement of Medical Malpractice Cases in The Perspective of Legal Sociology. JURNAL AKTA, 11(1), 214. https://doi.org/10.30659/akta.v11i1.37358
Aldalati, A., Bellamkonda, V., Moore, G., & Finch, A. (2021). Three Cases of Emergency Department Medical Malpractice Involving “Consultations”: How Is Liability Legally Determined? Clinical Practice and Cases in Emergency Medicine, 5(3), 283–288. https://doi.org/10.5811/cpcem.2021.7.52680
Ali, N. Y., Lo, T. Y. S., Auvache, V. L., & White, P. D. (2001). Bad press for doctors: 21 year survey of three national newspapers. BMJ, 323(7316), 782–783. https://doi.org/10.1136/bmj.323.7316.782
Amalia, C. R. (2023). Legal Responsibility for Patient Rights for Negligence in Health Services According to Law Number 44 of 2009. Proceedings Series on Social Sciences & Humanities, 14, 39–43. https://doi.org/10.30595/pssh.v14i.914
Amina, S., Barrati, A., Sadeghifar, J., Sharifi, M., Toulideh, Z., Gorji, H. A., & Feazbakhsh, N. (2015). Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study. Global Journal of Health Science, 8(1), 143. https://doi.org/10.5539/gjhs.v8n1p143
Amirthalingam, K. (2021). Medical negligence and diagnosis: further inroads into Bolam? Northern Ireland Legal Quarterly, 71(4), 683–693. https://doi.org/10.53386/nilq.v71i4.555
Amirthalingam, K. (2022). Upending the medical duty to advise: Legislating the standard of care in Singapore. Medical Law International, 22(3), 189–216. https://doi.org/10.1177/09685332221103553
Barker, R. O., Stocker, R., Russell, S., & Hanratty, B. (2021). Future-proofing the primary care workforce: A qualitative study of home visits by emergency care practitioners in the UK. European Journal of General Practice, 27(1), 68–76. https://doi.org/10.1080/13814788.2021.1909565
Becker, C. D., Dandy, K., Gaujean, M., Fusaro, M., & Scurlock, C. (2019). Legal Perspectives on Telemedicine Part 1: Legal and Regulatory Issues. The Permanente Journal, 23(3). https://doi.org/10.7812/TPP/18-293
Bourne, T., De Cock, B., Wynants, L., Peters, M., Van Audenhove, C., Timmerman, D., Van Calster, B., & Jalmbrant, M. (2017). Doctors’ perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional survey of the UK physicians. BMJ Open, 7(11), e017856. https://doi.org/10.1136/bmjopen-2017-017856
Brown, H. L. (2021). Emergency Care EMTALA Alterations During the COVID-19 Pandemic in the United States. Journal of Emergency Nursing, 47(2), 321–325. https://doi.org/10.1016/j.jen.2020.11.009
Burström, L., Engström, M.-L., Castrén, M., Wiklund, T., & Enlund, M. (2016). Improved quality and efficiency after the introduction of physician-led team triage in an emergency department. Upsala Journal of Medical Sciences, 121(1), 38–44. https://doi.org/10.3109/03009734.2015.1100223
Cassels, A. K. (2007). The media-medicine mix: quality concerns in medical reporting. Open Medicine : A Peer-Reviewed, Independent, Open-Access Journal, 1(1), e52-4. http://www.ncbi.nlm.nih.gov/pubmed/20101292
Chang, H., Yu, J. Y., Park, H., Song, Y. J., Heo, S., Park, J. E., Lee, G. T., Lee, S. U., Kim, T., Yoon, H., Hwang, S. Y., & Cha, W. C. (2025). From prediction to action: a retrospective observational study on the real-world implementation of Critical Interventions (CrIs), an AI-based clinical decision support system changing clinical behavior in the emergency department. BMC Medical Informatics and Decision Making, 25(1), 405. https://doi.org/10.1186/s12911-025-03234-x
Cheng, I., Lee, J., Mittmann, N., Tyberg, J., Ramagnano, S., Kiss, A., Schull, M., Kerr, F., & Zwarenstein, M. (2013). Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times. BMC Emergency Medicine, 13(1), 17. https://doi.org/10.1186/1471-227X-13-17
Choi, A., Lee, K., Hyun, H., Kim, K. J., Ahn, B., Lee, K. H., Hahn, S., Choi, S. Y., & Kim, J. H. (2024). A novel deep learning algorithm for real-time prediction of clinical deterioration in the emergency department for a multimodal clinical decision support system. Scientific Reports, 14(1), 30116. https://doi.org/10.1038/s41598-024-80268-7
Cuthrell, K. M. (2025). Leveraging AI-Driven Simulation Training to Mitigate Defensive Medicine in Clinical Practice. Journal of Complementary and Alternative Medical Research, 26(9), 76–87. https://doi.org/10.9734/jocamr/2025/v26i9709
Damdin, S., Trakulsrichai, S., Yuksen, C., Sricharoen, P., Suttapanit, K., Tienpratarn, W., Liengswangwong, W., & Seesuklom, S. (2025). Effects of Emergency Medical Service Response Time on Survival Rate of Out-of-Hospital Cardiac Arrest Patients: a 5-Year Retrospective Study. Archives of Academic Emergency Medicine, 13(1), e36. https://doi.org/10.22037/aaemj.v13i1.2596
Daniels, L., & Marneffe, W. (2023). Does patient behaviour drive physicians to practice defensive medicine? Evidence from a video experiment. Health Economics Review, 13(1), 45. https://doi.org/10.1186/s13561-023-00458-3
Eachempati, P., Büchter, R. B., KS, K. K., Hanks, S., Martin, J., & Nasser, M. (2022). Developing an integrated multilevel model of uncertainty in health care: a qualitative systematic review and thematic synthesis. BMJ Global Health, 7(5), e008113. https://doi.org/10.1136/bmjgh-2021-008113
Farrohknia, N., Castrén, M., Ehrenberg, A., Lind, L., Oredsson, S., Jonsson, H., Asplund, K., & Göransson, K. E. (2011). Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19(1), 42. https://doi.org/10.1186/1757-7241-19-42
Ferorelli, D., Nardelli, L., Spagnolo, L., Corradi, S., Silvestre, M., Misceo, F., Marrone, M., Zotti, F., Mandarelli, G., Solarino, B., & Dell’Erba, A. (2020). Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency. Journal of Primary Care & Community Health, 11. https://doi.org/10.1177/2150132720985055
Fields, B. G. (2020). Regulatory, Legal, and Ethical Considerations of Telemedicine. Sleep Medicine Clinics, 15(3), 409–416. https://doi.org/10.1016/j.jsmc.2020.06.004
Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences, 117(35), 21194–21200. https://doi.org/10.1073/pnas.1913405117
Griffiths, F., Green, E., & Tsouroufli, M. (2005). The nature of medical evidence and its inherent uncertainty for the clinical consultation: qualitative study. BMJ, 330(7490), 511. https://doi.org/10.1136/bmj.38336.482720.8F
Helou, M. A., DiazGranados, D., Ryan, M. S., & Cyrus, J. W. (2020). Uncertainty in Decision Making in Medicine: A Scoping Review and Thematic Analysis of Conceptual Models. Academic Medicine, 95(1), 157–165. https://doi.org/10.1097/ACM.0000000000002902
Huang, L. H., Ho, Y.-N., Tsai, M.-T., Wu, W.-T., & Cheng, F.-J. (2021). Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest. Emergency Medicine International, 2021, 1–6. https://doi.org/10.1155/2021/5564885
ISIK, O., BAYIN, G., & UGURLUOGLU, O. (2016). Reflection of medical error highlighted on media in Turkey: A retrospective study. Pakistan Journal of Medical Sciences, 32(5). https://doi.org/10.12669/pjms.325.10042
Jeyaraman, M. M., Alder, R. N., Copstein, L., Al-Yousif, N., Suss, R., Zarychanski, R., Doupe, M. B., Berthelot, S., Mireault, J., Tardif, P., Askin, N., Buchel, T., Rabbani, R., Beaudry, T., Hartwell, M., Shimmin, C., Edwards, J., Halas, G., Sevcik, W., … Abou-Setta, A. M. (2022). Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis. BMJ Open, 12(4), e052850. https://doi.org/10.1136/bmjopen-2021-052850
Johansson, A., Ekwall, A., Forberg, J. L., & Ekelund, U. (2023). Development of outcomes for evaluating emergency care triage: a Delphi approach. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1), 10. https://doi.org/10.1186/s13049-023-01073-1
Kakemam, E., Arab-Zozani, M., Raeissi, P., & Albelbeisi, A. H. (2022). The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review. BMC Health Services Research, 22(1), 800. https://doi.org/10.1186/s12913-022-08194-w
Khan, N. (2024). The media, healthcare messaging, and the doctor–patient relationship. British Journal of General Practice, 74(743), 264–265. https://doi.org/10.3399/bjgp24X738345
Kitta, P., Indar, I., & Alwi, S. (2022). The Medical Committee’s Implementation of Hospital Internal Regulations to Improve Hospital’s Clinical Governance. Journal of Social Science, 3(3), 547–566. https://doi.org/10.46799/jss.v3i3.346
Knight, L., Neiva Ganga, R., & Tucker, M. (2024). Integrated care system leadership: a rapid realist review. Leadership in Health Services, 37(3), 327–341. https://doi.org/10.1108/LHS-12-2023-0092
Liddell, K., Skopek, J. M., Le Gallez, I., & Fritz, Z. (2022). Differentiating Negligent Standards of Care in Diagnosis. Medical Law Review, 30(1), 33–59. https://doi.org/10.1093/medlaw/fwab046
Madan, R., Das, N., Patley, R., Nagpal, N., Malik, Y., & Math, S. B. (2024). Consequences of medical negligence and litigations on health care providers – A narrative review. Indian Journal of Psychiatry, 66(4), 317–325. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_799_23
Manurung, M. E. M., Sitorus, J., & Hutahaean, A. (2022). The Relationship Between The Level of Knowledge of Nurses and Response Time in The Emergency Installation at Porsea Regional General Hospital Toba Regency. Journal of Midwifery and Nursing, 4(2), 55–62. https://doi.org/10.35335/jmn.v4i2.2197
Mashayekh, M., & Abbasi Sarmadi, M. (2025). From ancient healing to modern litigation: a historical journey through medical negligence and tort law. Journal of Medical Ethics and History of Medicine. https://doi.org/10.18502/jmehm.v18i19.20604
Maulana, A. (2021). Implementasi Hospital Bylaws dalam peningkatan mutu pelayanan rumah sakit. Jurnal Juristic, 2(03), 236–243. https://oaj.jurnalhst.com/index.php/jkug/article/view/660
McBride, S. M., & Richman, B. D. (2025). Medical Staff Bylaws and Shared Governance. JAMA, 334(7), 569. https://doi.org/10.1001/jama.2025.10908
McGarry, J., Krall, S. P., & McLaughlin, T. (2010). Impact of resident physicians on emergency department throughput. The Western Journal of Emergency Medicine, 11(4), 333–335. http://www.ncbi.nlm.nih.gov/pubmed/21079704
Mell, H. K., Mumma, S. N., Hiestand, B., Carr, B. G., Holland, T., & Stopyra, J. (2017). Emergency Medical Services Response Times in Rural, Suburban, and Urban Areas. JAMA Surgery, 152(10), 983. https://doi.org/10.1001/jamasurg.2017.2230
Minkman, M. M. N., Zonneveld, N., Hulsebos, K., van der Spoel, M., & Ettema, R. (2025). The renewed Development Model for Integrated Care: a systematic review and model update. BMC Health Services Research, 25(1), 434. https://doi.org/10.1186/s12913-025-12610-2
Miyawaki, A., Jena, A. B., Burke, L. G., Figueroa, J. F., & Tsugawa, Y. (2023). Association Between Emergency Physician’s Age and Mortality of Medicare Patients Aged 65 to 89 Years After Emergency Department Visit. Annals of Emergency Medicine, 82(3), 301–312. https://doi.org/10.1016/j.annemergmed.2023.02.010
Mutai, V. K. (2019). Legal risks in medical practice. Community Eye Health, 32(106), 31. http://www.ncbi.nlm.nih.gov/pubmed/31649428
Nandra, R., Brockie, A. F., & Hussain, F. (2020). A review of informed consent and how it has evolved to protect vulnerable participants in emergency care research. EFORT Open Reviews, 5(2), 73–79. https://doi.org/10.1302/2058-5241.5.180051
Pandit, M., & Pandit, S. (2009). Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective. Indian Journal of Urology, 25(3), 372. https://doi.org/10.4103/0970-1591.56206
Patel, P., Anderson, H. E., Keenly, L., & Vinson, D. (2014). Informed Consent Documentation for Lumbar Puncture in the Emergency Department. Western Journal of Emergency Medicine, 15(3), 318–324. https://doi.org/10.5811/westjem.2014.1.19352
Pell, J. P., Sirel, J. M., Marsden, A. K., Ford, I., & Cobbe, S. M. (2001). Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study. BMJ, 322(7299), 1385–1388. https://doi.org/10.1136/bmj.322.7299.1385
Pemerintah Pusat. (2024). Peraturan Pemerintah (PP) Nomor 28 Tahun 2024 tentang Peraturan Pelaksanaan Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan. Kemenkes RI.
Pemerintah Republik Indonesia. (2023). Undang Undang Republik Indonesia Nomor 17 Tahun 2023 tentang Kesehatan. In Pemerintah Republik Indonesia.
Ratna Devi, Parmin, N. (2019). ETHICO-MEDIKOLEGAL EMERGENCY SERVICE. Αγαη, 8(5), 55. https://jurnal.untagsmg.ac.id/index.php/ulrev/article/view/1073/988
Raya, M. B., Ginting, M., & Tresnajaya, R. (2024). The Relationship of Nurse Response Time with Patient Satisfaction BPJS at the Emergency Installation of the Bayukarta Hospital Karawang. Indonesian Journal of Health Research and Development, 2(1), 44–52. https://doi.org/10.58723/ijhrd.v2i1.172
Reisch, L. M., Flores, M. J., Radick, A. C., Shucard, H. L., Kerr, K. F., Piepkorn, M. W., Barnhill, R. L., Elder, D. E., Knezevich, S. R., & Elmore, J. G. (2020). Malpractice and Patient Safety Concerns. American Journal of Clinical Pathology, 154(5), 700–707. https://doi.org/10.1093/ajcp/aqaa088
Renkema, E., Ahaus, K., Broekhuis, M., & Tims, M. (2019). Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands. BMJ Open, 9(6), e025108. https://doi.org/10.1136/bmjopen-2018-025108
Rice, B., Pickering, A., Laurence, C., Kizito, P. M., Leff, R., Kisingiri, S. J., Ndyamwijuka, C., Nakato, S., Adriko, L. F., & Bisanzo, M. (2022). Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme. BMJ Open, 12(6), e059859. https://doi.org/10.1136/bmjopen-2021-059859
Ries, N. M., Johnston, B., & Jansen, J. (2022). A qualitative interview study of Australian physicians on defensive practice and low value care: “it’s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other”. BMC Medical Ethics, 23(1), 16. https://doi.org/10.1186/s12910-022-00755-2
Rudianto, R. R. (2018). Pelaksanaan Perlindungan Hukum Terhadap Tanggung Jawab Dokter Jaga Di Instalasi Gawat Darurat Berdasarkan Hukum Positif Indonesia. Jurnal Idea Hukum, 4(2).
Schuetz, P., Hausfater, P., Amin, D., Amin, A., Haubitz, S., Faessler, L., Kutz, A., Conca, A., Reutlinger, B., Canavaggio, P., Sauvin, G., Bernard, M., Huber, A., & Mueller, B. (2015). Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Critical Care, 19(1), 377. https://doi.org/10.1186/s13054-015-1098-z
Schwitzer, G. (2013). Addressing tensions when popular media and evidence-based care collide. BMC Medical Informatics and Decision Making, 13(S3), S3. https://doi.org/10.1186/1472-6947-13-S3-S3
Shenoy, A., Shenoy, G. N., & Shenoy, G. G. (2022). Patient safety assurance in the age of defensive medicine: a review. Patient Safety in Surgery, 16(1), 10. https://doi.org/10.1186/s13037-022-00319-8
Simianu, V. V., Grounds, M. A., Joslyn, S. L., LeClerc, J. E., Ehlers, A. P., Agrawal, N., Alfonso-Cristancho, R., Flaxman, A. D., & Flum, D. R. (2016). Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey. BMC Medical Informatics and Decision Making, 16(1), 153. https://doi.org/10.1186/s12911-016-0391-3
Sorić, M. (2022). Effect of the Introduction of Emergency Medicine Specialists on the Emergency Department Performance Indicators: a retrospective data analysis. Acta Clinica Croatica. https://doi.org/10.20471/acc.2022.61.s1.01
Stein, K. V. (2010). The cause for action? Decision-making and priority setting in integrated care. A multidisciplinary approach. In International Journal of Integrated Care (Vol. 10).
Stein, V., Barbazza, E. S., Tello, J., & Kluge, H. (2013). Towards people-centred health services delivery: a Framework for Action for the World Health Organisation (WHO) European Region. International Journal of Integrated Care, 13(4). https://doi.org/10.5334/ijic.1514
Sun, Y., Iwagami, M., Komiyama, J., Sugiyama, T., Inokuchi, R., Sakata, N., Ito, T., Yoshie, S., Matsui, H., Kume, K., Sanuki, M., Kato, G., Mori, Y., Ueshima, H., & Tamiya, N. (2023). Association between types of home healthcare and emergency house calls, hospitalization, and end‐of‐life care in Japan. Journal of the American Geriatrics Society, 71(6), 1795–1805. https://doi.org/10.1111/jgs.18268
Syauf, A., Haiti, D., & Mursidah. (2021). Application of Restorative Justice Values in Settling Medical Malpractice Cases. International Journal of Criminology and Sociology, 10, 103–110. https://doi.org/10.6000/1929-4409.2021.10.14
TAYLOR, W. I. (1965). HOSPITAL MEDICAL STAFF BY-LAWS: AN INSTRUMENT FOR SELF-GOVERNMENT. Canadian Medical Association Journal, 93(12), 653–658. http://www.ncbi.nlm.nih.gov/pubmed/14346464
Terp, S., Wang, B., Raffetto, B., Seabury, S. A., & Menchine, M. (2017). Individual Physician Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act: A Review of Office of the Inspector General Patient Dumping Settlements, 2002–2015. Academic Emergency Medicine, 24(4), 442–446. https://doi.org/10.1111/acem.13159
Thornton, R. G. (2000). The Edges of Physician Liability. Baylor University Medical Center Proceedings, 13(3), 300–302. https://doi.org/10.1080/08998280.2000.11927694
Tisherman, S. A. (2018). Defining “Community” and “Consultation” for Emergency Research that Requires an Exception from Informed Consent. AMA Journal of Ethics, 20(5), 467–474. https://doi.org/10.1001/journalofethics.2018.20.5.stas1-1805
Tsaneva-Atanasova, K., Pederzanil, G., & Laviola, M. (2025). Decoding uncertainty for clinical decision-making. Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences, 383(2292). https://doi.org/10.1098/rsta.2024.0207
Watson, G., Moore, C., Aspinal, F., Hutchings, A., Raine, R., & Sheringham, J. (2023). A mixed-methods process evaluation of an integrated care system’s population health management system to reduce health inequalities in COVID-19 vaccination uptake. Journal of Integrated Care, 31(4), 256–273. https://doi.org/10.1108/JICA-07-2023-0050
WILLIAMS, K. J., & OSBALDESTON, J. B. (1965). THE HOSPITAL MEDICAL ADVISORY COMMITTEE--THE CABINET OF THE MEDICAL STAFF. Canadian Medical Association Journal, 92(21), 1117–1124. http://www.ncbi.nlm.nih.gov/pubmed/14285296
Wilson, A., Bonevski, B., Jones, A., & Henry, D. (2009). Media Reporting of Health Interventions: Signs of Improvement, but Major Problems Persist. PLoS ONE, 4(3), e4831. https://doi.org/10.1371/journal.pone.0004831
Yap, J. (2021). Understanding Integrated Care with the Business Model Canvas. International Journal of Integrated Care, 20(3), 122. https://doi.org/10.5334/ijic.s4122
Yohanes Firmansyah, & St. Laksanto Utomo. (2021). A Hospital’s Legal Responsibility For Patient Rights During The Covid-19 Pandemic - A Review From The Health Sector’s Law Regulations. Jurnal Indonesia Sosial Sains, 2(08), 1392–1406. https://doi.org/10.59141/jiss.v2i08.392
Zibulewsky, J. (2001). The Emergency Medical Treatment and Active Labor Act (Emtala): What It Is and What It Means for Physicians. Baylor University Medical Center Proceedings, 14(4), 339–346. https://doi.org/10.1080/08998280.2001.11927785
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