Law Enforcement to Transcendental Based of Paramedic Doctoroid Practices in Health Service

Purpose of the study: This article aims to discuss the paramedic doctoroid practices in primary health care in Community Health Center conducted by paramedic doctors.Methodology: This research is socio-legal research; research on law application, viewing law acting as law in action, which involves the interrelation between law and social institutions.Main Findings: Delegation of duty policies under the roof of paramedic doctoroid practices in health services in Community Health Center. This research is a socio-legal aimed at uncovering the phenomenon of paramedic doctoroid practices.Applications of the study: The current study provides criticism for the government in creating inconsistent policies, poor supervision, and law enforcement behind doctoroid practice persistence.Novelty/Originality of the study: the concept of law enforcement is based on the philosophy of the first principle of Pancasila as the Indonesian ideology, transcendental-based law enforcement.


A. INTRODUCTION
The professionalism of health services in developed countries has become mandatory. Furthermore, the demands for unprofessional health services are increasingly widespread among the community in developed countries. 1 In Indonesia, violations of professionalism have become commonplace, either health services in Community Health Center or private primary health care in the community. Midwife or nurse can practice at the health center with a legal basis of delegation of duty policies. Ironically, due to the higher competence of doctors, they are expected to take a primary service education program after gaining a general practitioner certificate. 2 Any disruption, intervention, injustice, attention-deficit, ignorance or any form that results in illness to the human body/physical, mental, natural environment and social environment, regulation and law, as well as injustice in existence social management is a violation of human rights. 3 Article 28 H of 1945 Constitution of the Republic of Indonesia states that everyone has the right ... to access health services. The neglect of the right to health service in any form of protection and service of public health denial is a manifestation of human rights violation. From all constitutions, it is obvious that the Indonesian constitution has the lightest and simplest emphasis on the right to health. This triggers the poor implementation on the field. Violation of rights to public health is a violation of the state constitution. 4 The paramedics in Community Health Center should not practice delegation of duty but work collaboratively in primary health care resulting in good cooperation according to respective competencies. 5 Moreover, it is the human body being targeted. The cause of delegation of duty phenomenon is low gap ratio doctors to patients, 6 causing most patients in Community Health Center have to be treated by paramedics, midwives or nurses. 7 The presence of substandard services occurred. The negative effect of the sub-standard is then brought to the practice of private paramedics.
Thus, this situation leads to an increase in the number of patient referrals to the hospital. The later impact is the vast number of catastrophic diseases due to substandard and unprofessional health services. In practice, many of the doctor practices in private primary services are not conducted by doctors but nurses and midwives, and this especially occurs in the regions.

B. RESEARCH METHODS
This research is socio-legal research; research on law application, viewing the law as law in action, which involves the interrelation between law and social institutions. 8 The current research focuses on the process of law application and based on available data then it will be further analyzed and compiled into the concept of law enforcement against violations. 9 The focus is on violations of the practice of medical law by paramedics, poor law enforcement and the discovery of law enforcement concept.
This research is a qualitative descriptive analysis. According to its type, this research reveals the phenomenon of paramedic doctoroid practice in private primary health care services.

C. DISCUSSION
The practice of paramedic doctors in a study on the professionalism of health services is included in the category of practice under/out of competence -it is called as malpractice. According to The Oxford Illustrated Dictionary, 2nd ed, 1975 malpractice is the wrong (legally) attitude in providing health services to patients, illegal actions for profit while in a position of trust. (there are indications of abusing the mandate) . 10 Syahrul Mahmud limits malpractice if a person intentionally or as a result of negligence to meet the specified requirements whether in professional ethics, professional standards or health service standards, which results in losses from patients party. 11 Paramedics are individuals working in the health environment as doctors assistants, such as nurses and midwives. 12 Private primary care is a health service for minor illness cases as well as acts as the first layer health service for health problems in the community. For instance: Private Primary Clinic, private practice doctor. The types of services include preventive, curative, promotional and rehabilitative services. 13 The nature of law enforcement according to SatjiptoRahardjo is the process of turning legal desires or ideas into reality. Legal desires are thoughts of lawmakers in the form of ideas or concepts regarding justice, legal security, and social benefits as written in law. 14 According to Ann Helm, opportunities for nurses (paramedics) to do malpractice are contained in performing nursing tasks in a hospital. 15 Research on law enforcement efforts against malpractice on paramedic doctoroid practices in private primary service practices has never been reported. Even so, data on malpractice handled by PPNI from 2010 to 2015 reported 485 cases of malpractice committed by nurses. From those cases, it was found 46 cases of criminal malpractice due to negligence, medical action (accompanied by doctors) executed by nurses without the consent of the doctors resulting in injuries and disabilities in patients. 16 This is the effect of providing medical diagnoses and medical treatment by nurses (out of competence) when performing health services accompanied by doctors. Health services by incompetence personnel are highly risky to patients' safety. 17 According to the Law on Health Workers, Article 1 paragraph (5) states that competency is the ability possessed by a Health Worker upon knowledge, skills and professional attitude to practice. For life-related health professional workers, standard competency must be a primary concern in health services. Various effects of paramedic treatment that had been examined by doctor BrH including post-injection inflammation patients. Drug-induced tremor patients. Also, the TBC patient was misdiagnosed for cold and cough.
Misdiagnosis causes long-term illness as well as the possibility of a wide spreading of contagious disease to family. Some patients with complaints of breath-related heart disorders were diagnosed with a productive cough. As an effect, most patients could not be helped due to misdiagnosis. Some heart attack patients were diagnosed for gastritis . 23 The invalid perception towards patients regarding medication, such as immediate recovery post-injection. This inclines the desire of patients to ask medication to paramedics or midwives than doctors due to rejection in giving an injection. In examining injection cases patients, doctor BrH once found a patient with fever took medicine from private paramedic and was guaranteed with injection. In this case, the patient had a drug allergy, upon arrival, the patient had SJS (Steven Johnsons Syndrome), 24   Later it was found that the alleged person was not a midwife or a nurse but a mere unqualified person who had studied health science. This case according to dr. NT needed to be investigated by Health Office and staffs to avoid reoccurrence of the same case, which experienced loss and profession enactment through inappropriate practices. 32 The state of legal in these cases indicates that legal pathology in its health system. This occurred in all components of the legal system, such as legal substances (laws and regulations), legal structure (institutions, apparatuses, management, etc.) and the legal culture (values and attitudes towards the law) . 33 Paramedical doctoroid practices are categorized as malpractice according to the Repressive law enforcement in criminal cases should be changed, with a new paradigm with legal subjects that must be able to interact with other social elements involved in social life. The paradigm of legal thinking is at a substantial level which then increases public trust. 35 Law enforcement should be pursued in such a way to avoid forces and violence. This may occur that one has high understanding and ethical awareness in carrying out life activities, a high level of legal awareness. The highest attainment of a post-conventional level 2 ethical awareness is conscience, humanism, universalism, daring to oppose the flow, brave in solitude, never deceive oneself and consernt to human dignity. 36 The concept of law enforcement is based on Islamic transcendental. Departing from the thought of God-spot theory 37 , the writer assumes that one's God-spot will be activated when it is touched on the level of one's understanding or thinking. 38 One's motivation in behavior can be changed by activating one's God-spot to be a better person. Also, this is affected by the perception formed from information in (sensory nerves).
The second act in this concept is the theory of brain plasticity, according to this theory when information is given to the human brain repeatedly it will stimulate the nerves to create adaptations according to sensory acceptance, referred to as "cross-modal plasticity" 39 which is expected to be an awareness of someone towards God will appear more frequently and can motivate to act according to the conscience of truth. The concept is strived to underlie every law enforcement factors in the health legal system. Several factors affect law enforcement, according to SoerjonoSoekanto: 1) The legal factor, law / legal rules that include central and local regulations.
In delegation of duty contains legal antinomy, legal inconsistency, that is the law of medical practice. There are also errors found in the application of the unending legal discretion term.