The Urgency of Hospital Internal Regulations in Governance Indonesian National Army Hospital

This research analyzed the component of hospital bylaws in the corporate governance of the Indonesian National Army Hospital and the urgent of hospital bylaws in association with the protection and legal certainty of the Indonesian National Army Hospital. As a legal subject, the Indonesian National Army Hospital has certain legal obligations and they are not free from lawsuits, therefore the Indonesian National Army Hospital must equip themselves with adaptive and up-to-date hospital by-laws that provide protection and legal certainty to the medical officers in peace and armed-conflict time. The hospital bylaws must contain the characteristics of the Indonesian National Army Hospital including the code of ethics for military medicine, Indonesian National Army law, military discipline law, military court law, humanitarian law, and human rights law, and also describe the relationship between the owner of the hospital, in this case the chief of the staff of the army, with the head of the hospital and medical staff. Therefore, this research is juridical-normative research using statute, conceptual, and comparative approaches.


INTRODUCTION
Invite The 1945 Constitution mandates that "everyone has the right obtain service health" and "the state is responsible answer on provision facility service proper health".The government responsible in matter planning, organizing, organizing, coaching and supervising maintenance effort health in accordance mandate Article 6 paragraph (1) of the Law Number 17 of 2023 concerning Health.Every House Sick must carry out governance House illness and management good clinical _ in accordance Article 36 of the Hospital Law.And, every House Sick must organize and implement internal house rules sick (Article 189 letter (r) Health Law of 2023).
Shift paradigm House Sick from institution social become corporation and subject law make it prone to lawsuit, even the TNI Hospital.In 2006 , RSPAD Gatot Subroto was sued wife patients who consider RSPAD neglectful husband plaintiff with method No give blanket so that patient die cold.(Rosneini Birman v Main Director of the Central Army Hospital (RSPAD) Gatot Soebroto , Cs, Decision Central Jakarta District Court Number 569/ Pdt.G /2013/ PN.Jkt.Pst .) Presidential Decree Mandatory National Health Insurance all House Sick government carry it out make House sick of the TNI, which is its core business is serve soldier become serve public general too, of course bring consequence law and potential vulnerability lawsuit .
The TNI Hospital has distinctiveness , unique and different than House Sick others , General Hospital belongs Government nor Private .TNI Hospital apart from works as facility health , also works as Chivalry or base military .In it applies Constitution Discipline Military , Law Justice Military and regulations military like Regulation Internal Service Affairs (PUDD ), Regulation Discipline Military (PDM) for personnel military , and there are warehouse weapons , munitions as well as room prisoner like worthy chivalry others .
What is meant Chivalry is something place or base military in it there is facilities , means and infrastructure office as well as housing area unity For support activity member unit and led by the Commander Chivalry .What is meant Regulation Internal Service Affairs (PUDD) are governing regulations _ life soldier good during office hours or outside office hours inside _ _ knighthood / headquarters For security , discipline , order , neatness , cleanliness and health unity to get it walk with orderly and orderly To use support implementation task principal .( Article 1 number (1) Regulations TNI Commander Number 73 of 2018 concerning Regulation TNI Internal Service Affairs ).
What is meant Regulation Discipline Military (PDM is all form rules and regulations about obedience and obedience to all order officialdom from each superior with careful and responsible answer , as applicable for military , okay in carry out duties and obligations officialdom nor in life everyday .( Article 1 number (2) Regulations TNI Commander Number 44 of 2015 concerning Regulation Discipline military ).
TNI Hospital internal regulations apart from is obligation For created , contents must be reflect characteristics of TNI Hospitals such as the Code of Ethics Medical Military , TNI Law, Disciplinary Law Law Military , Justice Law Military , Humanitarian Law , Human Rights Law which illustrate connection owner with head House sick and staff the medical .

RESEARCH METHODS
Study This arranged with use type study juridical normative , that is study Which focused For study application rule -rule or internal norms law positive .Study juridical normative is study Which done based on material law main with method examine theories , concepts , principles law as well as regulation related legislation _ with study this .Study This known also with study literature, ie with learn books, rules legislation and other related documents with research.Study This use approach legislation (statute approach) and approach conceptual (conceptual approach).Approach legislation (statute approach) is usually used For research regulation deep legislation the norm Still there is lack or rather fertilize practice deviation Good in level technical or in its implementation in field .Approach This done with examine all regulation legislation Which is concerned disconnected with problems (issue law) which is moderate faced.Approach legislation This for example done with learning consistency / conformity between Constitution Base with Invite -Invite, or between Constitution Which One with Law.Connection staff medical with Karumkit adjust employment status staff medical the following : a.For doctors military , Karumkit is superior , superior direct and ankum .b.For Ministry of Defense civil servant doctors and doctors remains non-PNS Ministry of Defense , Karumkit is superior , superior straight away .c.For doctors partner or doctor guest , Karumkit is superior .

RESULT AND DISCUSSION
What is meant Superior is military that because rank and/ or his position domiciled more tall than military others .( Article 1 number (9) of the Disciplinary Law Law military ).What is meant by partner doctors ?or doctor visitor or doctor beak time is contracted doctor _ House Sick For present at certain times or days certain although not full time.Hospital _ own control to method Work doctor the in give service medical .(Zamroni,.

What is meant
According to Hermien Hadiati Koeswadji , relationships law doctor with House Sick is : (Zamroni, 2022:47) a. Connection occupation ( dienstverband ), doctor work at home Sick For carry out task his profession .b. Connection contract For nurse patient ( toelating contract ).
The doctors who did it service medical at home Sick can differentiated into two , namely status doctor _ as employees and doctors _ _ guest ( independent contractor ).
Internal Staff Regulations Medical also contains about authority clinical .Authority clinical ( clinical privilege ) is right special a staff medical For do group service medical certain in environment House Sick For something period certain in environment House Sick For period certain things are implemented based on assignment clinical ( clinical appointment ).( Article 1 paragraph (7) Minister of Health Regulation Committee Medical ).
Internal Staff Regulations Medical arrange Committee Medic .Committee medical is device House Sick For implement governance _ clinical ( clinical governance ) so that staff medical at home Sick awake his professionalism through mechanism credentials , safeguards quality profession medical and maintenance ethics and discipline profession medical .( Permenkes 755 of 2011 concerning Maintenance Committee Medical in Hospital).

Internal TNI Hospital Management Compartment Defense
The TNI Hospital has task For support task principal of the TNI, both OMP and OMSP.The TNI Hospital is a strategic unit located in One unity chain command in compartment defense .
Indonesia is a very large archipelagic country between two continents and two oceans requires a service unit health always strategic _ ready and able moved anytime if needed if There is threats ( eg disaster disaster nature , epidemic ) or war ( conflict armed ) or task statehood ( medical security and food security President /Vice President Republic of Indonesia, assignment world peace ); The TNI Hospital was present at the situation like that .Definition of TNI Hospital here in a deeper sense wider , more than just building House sick , yes in form House Sick field ( rumkitlap ) Yuana, L. (2020) or House Sick ship ( Dispen Lantamal VI (2021).

Management of TNI Hospitals in Times of War
The administration and position of the TNI Hospital in circumstances peace nor war or conflict _ armed , is nature command .Organization and governance follow TNI organization , which is different with organization House Sick government in the environment Ministry of Health .
At the moment war or conflict _ armed , TNI Hospital submits to Humanitarian Law and Human Rights Law.When a Military Doctor face situation dilemma , loyalty double (Pariani et al., 2022:14) (US Defense Health Board, 2015:2), namely loyalty to patients and loyalty to superior , then there is a Code of Ethics Medical Military as guide will be very helpful .Especially in situation instrumental assignments _ infrastructure and supplies health all round limited whereas demands task high .When a Military Doctor Still junior , young in age and experience , take decision important in situation dilemma no easy , if without guide .

Certainty and Legal Protection of TNI Hospitals in
Following This Principles of the Code of Ethics Medical Military from British Medical Association ( British Medical Association, 2012) : 1) Patient health is the main thing 2) Management loyalty double 3) Agreement action 4) Guard confidential medical 5) Guard competence 6) Guard treatment to prisoner 7) Didn't do it violation ethics (Zamroni, 2022:61-81) Not quite enough sue doctor in practice service medical can based on actions violate law , can also be based on violations contract (Ewoud Hondius , 2010).

Liability of Doctors and Hospitals Loss Patient
Not quite enough sue doctor born Because exists losses suffered _ patient in implementation service medical .Loss the can happen consequence from negligence doctor , or consequence from negligence power lower health _ _ _ supervision doctor , or Because patient join in contribute to emergence loss .
Not quite enough sue House Sick on losses suffered _ patient can differentiated into two types , namely consequence negligence House Sick as corporation ( corporate negligence ) and the consequences negligence power health at home _ _ illness ( vicarious liability of respondeat superior ). 1) Not quite enough sue doctor consequence negligence doctor 2) Not quite enough sue doctor consequence negligence power existing health _ in supervision Not quite enough sue doctor consequence negligence doctors and negligence contribution patient 1) Not quite enough sue House Sick consequence negligence corporation 2) Not quite enough sue House Sick consequence negligence power health

Liability of Doctors and Hospitals Default
According to Zamroni, default is No fulfil achievement , late fulfil performance , no fulfil performance as it should be .
Performance parameters or default doctor and home Sick in implementation contract service medical must based on implementation law fulfilling agreement _ condition reasonableness ( redelijk ) and propriety ( bilijk ).Reasonableness and propriety here _ is fairness and propriety in practice service medical .That is , situations and conditions must seen in a way factual case by case when doctor and home Sick give service medical to patient ; the doctor who gave it service medical at a comprehensive health center limited No can equalized with service medical doctor at home sick which means more complete .
Contract service medical is engagement effort ( inspanningsverbintenis ) is not based on the results achieved ( resultaatsverbintenis ) so that the achievement parameters or default doctor or House Sick be measured based on the efforts made doctor or House Sick in give service medical to patient .(Zamroni, 2022:99) Doctor and home sick who is not do effort best considered violate obligations trust ( the fiduciary duties ), according to Sutan Remy Sjahdeini .
According to Sutan Remy Sjahdeni , who included in the fiduciary duties including the duty of competence, the duty of good faith and fair dealing, the duty of confidentiality, the duty of loyalty, the duty of obedience, the duty of prudence, the duty to avoid conflicts of interest .(Zamroni, 2022:101-102).
If doctor and home Sick has do effort best in give service medical to patient , though the result bad ( eg patient disabled or died ), then doctor and home Sick No responsible sue based on default .(Zamroni, 2022:100)

Liability of Doctors and Hospitals Actions Breaking the Law
According to Hoge Raad, action violate law ( onreghtmatige daad , unlawful act, tort ) is deed violate statutory norms , violate other people's rights , violate obligation law si transgressor , contradictory with good morals , contrary with appropriate caution _ in association life social .(Zamroni, 2022:110-111).

Legal Aid
Hospital In accordance with TNI Commander Decree Number 1089 of 2017 concerning Instruction Maintenance Legal Assistance within the TNI, who are entitled accept help TNI law is units within the TNI, TNI soldiers and civil servants, families TNI soldiers and civil servants, organizations wife TNI soldiers , retired TNI officers, retired TNI civil servants, warakawuri , widows / widowers retired TNI civil servants, veterans in the TNI environment , people who are equal with TNI soldier , soldier students , cooperatives and foundations within the TNI, business entities established by cooperatives and foundations within the TNI , partners cooperatives and Foundation partners within the TNI, those who have connection Work in frame support task principal of the TNI.

Humanitarian Law and Human Rights
In accordance Article 4 Minister of Defense Regulation Number 9 of 2013 concerning Application of Humanitarian Law and Human Rights Law in Maintenance National Defense , every TNI soldiers are required obey provisions of Humanitarian Law and Human Rights.Principles of Humanitarian Law (Putri, 2011:11) is principle interest military ( military necessity ), ie parties to the dispute justified use violence For subdue fight to achieve it objective war , principle humanity , namely _ _ parties to the dispute required For notice humanity Where they forbidden For use possible violence _ give rise to excessive injury _ or suffering that is not necessary , basic chivalry ( chivalry ) , i.e. inside war , honesty must takes priority .Use tools that don't Dear , various type hoax tricks and methods _ _ treacherous prohibited .
Humanitarian Law applies for all countries, whether they recognize it Convention Geneva or not _ admit .And, the validity period since broken dispute armed .(Putri, 2011:13) Convention Geneva 1949 also regulated those who had to protected in conflict armed (Putri, 2011:15) : i.People who have become victims of conflict ii.Fallen civilians _ _ to hand enemy iii.People who because his job must respected or not can attacked , like officer medical , clergy .Apart from civilians , prisoners , officers medical and clergy ; Humanitarian law also regulates protection to combatant .
What is meant Combatant is member troops combat from warring parties _ including levée en masse , except officer medical and clergy .(Melzer, 2019:87).Form protection to combatant are (Putri, 2011:25-26 ): a. Wounded and sick combatants _ must respected and protected in all circumstances .b. Combatant must treated humane by the parties in dispute and treated without based detrimental differences ._ c.Forbidden hard do test murder or action violence to they like murder and extermination , made object persecution or test biological , abandoned without help maintenance or other actions that result they get disease contagious .

Hospital Coverage at the time Disputes Armed
In order protect mission medical For interests of the injured , sick and the ship Karam , Humanitarian Law not only protect officer medical and clergy , but also facilities , transportation , equipment and supplies medical , home sick , center transfusion blood , institute treatment preventive , medical depot , shop medical , pharmaceutical and similar .

CONCLUSION
Hospital Internal Regulations are very necessary in the governance of TNI Hospitals in order to achieve this task main TNI Hospital as facility service health, as component strategic good national defense in peacetime nor war.Adopted Hospital Internal Regulations from the Government Hospital in the area Ministry of Health Not yet accommodate characteristics of TNI Hospitals such as connection Karumkit with staff medical doctor Ankum military nature.
Existence Hospital Internal Regulations become urgent in the era of litigiousness and demands high society, for protection and certainty law for House sick and staff medical in it .There are regulations form Hospital Internal Regulations will form awareness law for TNI Hospitals and staff medical so that can made as prevention emergence problem law, fine That law health, law military, law humanitarian and human rights law; besides help laws (from the existing TNI Legal Development Agency (Babinkum).

REFERENCES
( Article 1 number (18) Minister of Defense Regulation Number 3 of 2011 concerning Construction of Flat Type Country Houses in the Environment Ministry of Defense and TNI).
Superior Direct is superiors who have authority command direct to The subordinate concerned .( Article 1 number (11) of the Disciplinary Law Law military ).What is meant Entitled Boss _ Punishing (Ankum) is given superior _ authority drop Punishment Discipline Military to Subordinates who are below _ authority his command .( Article 1 number (12) of the Disciplinary Law Law military ).What is meant by a permanent doctor is employee still House illness based on an agreement Work time No certain .Permanent doctor get wages monthly and bound fully with House sick .(Zamroni, 2022Z:47).
TNI soldiers violated the Disciplinary Law Military nor criminal offenses that have been sentenced punishment and have powerful law fixed , given penalty administrative in accordance Regulation TNI Commander Number 11 of 2018 concerning Penalty Administrative for TNI Soldiers .Penalty administrative influential to development career TNI soldier in education and rank ( Article 4 paragraph (3) Perpang TNI 11/2018).Punishment Punishment Discipline Military depends classification penalty administrative ( Articles 8-12 of the Disciplinary Law Law Military , Articles 10-17 Regulations TNI Commander Number 11 of 2018 concerning Penalty Administrative for TNI Soldiers and Articles 16-19 of Regulations TNI Commander Number 44 of 2015 concerning Regulation Discipline Military), from the lightest form reprimand until criminal prison .

Regulations in TNI Hospital Governance 1. Duties , Functions and Characteristics of TNI Hospitals
In accordance Article 20 paragraph (3) of the Hospital Law, TNI Hospital is part from House Sick managed public _ Government .The TNI Hospital has task For support task principal TNI with method give support health ( dukkes ), service health ( yankes ) as well intelligence medical ( Article 3 paragraph (1) Minister of Defense Regulation Number 39 of 2020 concerning Medical military ).What is meant The Indonesian National Army (TNI) is component The main thing is ready used For carry out task national defense .( Article 1 number (3) Minister of Defense Regulation Number 18 of 2020 concerning Medical Military .2020 State Gazette Number 1571) .What is meant Task The principal of the TNI is straighten up state sovereignty , defending the territory of the Unitary State The Republic of Indonesia which is based on Pancasila and the 1945 Constitution as well protect all nation and whole spilled Indonesian virgin from threats and harassment to wholeness nation and state.Corporate Internal Regulations contain: name , purpose and philosophy House Sick established , authorized , responsible answer and who That owner or representation owner ( governing body ), organization House pain , mechanism supervision , position , duties , responsibilities responsibility and authority director ( karumkit ). 3. Clinical Governance of TNI Hospitals Hospital Internal Regulations govern staff medical called Internal Staff Regulations Medical ( medical staff bylaws ) is something regulation organization staff medical and committee medical at home illness determined by the owner House sick ( Minister of Health Decree 631 of 2005 concerning Medical Staff By Laws ).

Times of Peace 1. Indonesian Hospital Code of Ethics and Doctor's Code of Ethics Article
8 of the Indonesian Hospital Code of Ethics ( Kodersi ) mandates House Sick must implement governance _ House good illness ( good corporate governance ) , governance good clinical governance and governance _ _ good ethics ( good ethical governance ) that guarantees care patient given in accordance with applicable moral, business , social and legal norms .What is meant with Codersi is the Indonesian Hospital Code of Ethics , compiled by the Indonesian Hospital Association (PERSI) which includes load summary hospital values and norms To use made guidelines in administration and management hospitals in Indonesia.(IndonesianHospitalAssociation .(2022).Indonesian Hospital Code of Ethics ( Kodersi ).Application of ethical norms doctor and home Sick No regardless from principles / rules base bioethics , that is do good ( beneficence ), no detrimental ( non -maleficence ) , including weigh with Good effect side possible treatment _ harm patient , appreciate autonomy patient ( autonomy ), included in it No intervene decision other doctors against patient and applicable fair ( justice ) , including _ determine cost in a way fair .(Parianietal. , 2022 :29)2.

Code of Ethics Medical Indonesian Military
Every Military Doctor must uphold high Code of Ethics Soldiers , Officer's Code of Ethics and Doctor's Code of Ethics ( Indonesian Doctors Association Executive Board , 2012).Code of ethics profession This is guidelines binding moral behavior and guidelines its members .A TNI soldiers ( incl doctor military ), which violates code ethics soldier This will charged punishment ( article 1 number (5) of the Discipline Law Law military ).What is meant by the Code of Ethics Soldier is Sapta Marga and Eight Mandatory TNI, while the Code of Ethics for Officers is Budhi Bhakti Wira Utama.( Explanation Article 38 paragraph (1) TNI Law).What is meant Violation of Disciplinary Laws Military is all actions and/ or actions carried out by the Military that violate law and/ or regulation Discipline Military and/ or do contradictory actions _ with joints life military based _ Sapta Marga and Oath Soldier .( Article 1 number (5) of the Disciplinary Law Law military ).Apart from the Code of Ethics Soldier and Officer Code of Ethics, a Military Doctor bound by an Oath Soldier ( Article 35 of the TNI Law).As officer and doctor , a Military Doctor bound by the Eleven Principles of Leadership and the Oath Hippocrates ( Reg Government Number 26 of 1960 concerning Pronunciation Doctor's Oath .State Gazette of 1960 Number 69).
_ get protection law through the 2023 Health Law in carry out service health ( Article 191 letter (f)), home Sick No responsible in a way law if patient refuse / stop possible treatment _ caused death patient ( article 192 paragraph (1)), home Sick No can sued in carry out duties ( article 192 paragraph (2)).Article 273 paragraph (1) letter (a) of the 2023 Health Law states that power medical and energy health entitled get protection law .Every problematic TNI soldier law entitled get help law or must accompanied advisor law in all level examination ( Articles 105, 215 of the Judicial Law military ).
Article 42 of the Human Rights Court Law Commander military can accountable to follow crimes committed by subordinate troops his command or consequence from No done control troops in a way proper.Indonesia has ratify Convention Geneva 1949 with he took it out Constitution Number 59 of 1958 concerning The Republic of Indonesia participates in The entire Geneva Convention 12 August 1949.Humanitarian Law and Human Rights have been implemented socialized and implemented in accordance Regulation TNI Commander Number 73 of 2010 concerning Opposition to Torture and Other Cruel Treatment in Law Enforcement within the TNI.With Thus , Military Doctors and TNI Hospitals are required implement this Law, Humanitarian and Human Rights .
Regulation of the Minister of Defense Number 3 of 2011 concerning Construction of Flat Type State Houses within the Ministry of Defense and the Indonesian National Army .2011 State Gazette Number 152.Regulation of the Minister of Defense Number 9 of 2013 concerning Application of Humanitarian Law and Human Rights Law Man in Maintenance National Defense .2013 State Gazette Number 324 .Regulation of the Minister of Defense Number 11 of 2014 concerning Standardization Level III Hospital Health Equipment within the Ministry of Defense and the Indonesian National Army .2014 State Gazette Number 383 .Regulation of the Minister of Defense Number 51 of 2014 concerning Management Finance Reception Non-Tax within the Ministry of Defense and the Indonesian National Army .2014 State Gazette Number 1520.Regulation of the Minister of Defense Number 18 of 2020 concerning Medical Military .2020 State Gazette Number 1571 .Minister of Health Decree Number 772 of 2002 concerning Guidelines Hospital Internal Regulations ( Hospital Bylaws ).Minister of Health Decree Number 631 of 2005 concerning Guidelines Internal Staff Regulations Medical ( Medical Staff ByLaws ) at the Hospital.Minister of Health Regulation Number 755 of 2011 concerning Committee Medic .Regulation of the Minister of Finance Number 143 of 2018 concerning Mechanism Implementation Budget State Expenditures within the Ministry of Defense and the Indonesian National Army .2018 State Gazette Number 1512 .Regulation TNI Commander Number 44 of 2015 concerning Regulation Discipline Military .Regulation TNI Commander Number 24 of 2018 concerning Organization and Tasks Puskesad , Kesdam , Denkesyah and Dron 31/Serbu.Regulation TNI Commander Number 73 of 2018 concerning General Internal Service Regulations .Regulation Head Army Staff Number 26 of 2019 concerning Organization and Duties of the TNI Army Headquarters (Orgas Mabesad ) Regulation Head Army Staff Number 27 of 2018 concerning Organization and Health Tasks of Regional Military Commands (Orgas Kesdam ) Regulation Head Army Staff Number 28 of 2018 concerning Organization and Tasks Regional Health Detachment (Orgas Denkesyah ).Main Director of the Central Army Hospital (RSPAD) Gatot Soebroto , Cs, Decision Central Jakarta District Court Number 569/ Pdt.G /2013/ PN.Jkt.Pst .Book Ruhardi , Pidada , Bagenda .(2022).Humanitarian Law .Bandung: Widina Bhakti Persada.Defense Health Board.(2015).Ethical Guidelines and Practices for US Military Medical Professionals .Office of the Assistant Secretary of Defense Health Affairs.Sihotang , E. (2021).Legal Principles in Hospital Governance .Surabaya: Medina Tower.Atmadja , IDG., Budhiartha , INP. (2018) Legal Theories .Malang: Setara Press.Isharyanto .(2016).Legal Theory: An Introduction with Approach Thematic .Yogyakarta: WR Publishers .Yunarto , I. (2014).Management Central Government ( Budgeting and Realization Budget ) .Education and Training Center Supervision of the Supervisory Board Finance and Development.Mohamad, K. (1995).Hospitals: Between Commercialization and Ethics .Jakarta: Gramedia Widiasarana Indonesia.Zamroni, M. (2022).Health Law: Liability of Doctors and Hospitals in Practice Service Medical .Surabaya: Scopindo Media Pustaka.