Workers Compensation Research Articles

Mental Health Support for First Responders Provided Outside of California's Workers' Compensation System.

Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers' compensation (WC). We conducted 15 interviews across 5 California departments contracted with non-WC mental health (MH) providers. We performed content analysis. MH support outside of WC most often was a dedicated contract with outside MH providers for assessment, diagnosis, and treatment. Departments had formal financing mechanisms with union and city support designating funding for MH care. Frustration and past WC experiences drove the desire for WC alternatives. First responders reported high levels of stigma associated with MH care. Compared to WC, these alternatives allowed more comprehensive services to injured workers along with ease of accessing care, expediting the healing process. Contracting culturally competent MH providers outside of WC for first responders has potential and needs formal evaluation.

Diagnostic ecologies: Medical standards, tinkering, and worker health in Turkey

AbstractIn Turkey's occupational health system, doctors must use the International Labor Organization's (ILO) standards to classify the chest radiographs of workers at risk of lung diseases caused by dust exposure. Yet these standards do not provide a uniformity of care within the tripartite structure of the occupational health system, which divides disease surveillance, disease diagnosis, and worker compensation into distinct silos. This division often produces ambiguity and unpredictable outcomes for occupational disease claims. The traffic of diagnostic decisions among workplaces and medico‐legal institutions—what I refer to as diagnostic ecologies—shapes medical knowledge. The tripartite organization of the occupational health system in Turkey makes the evaluation of chest radiographs a space where professional expertise and professional ethics are constantly negotiated. A focus on diagnostic ecologies illustrates how disease ontology is distributed across the occupational health system's components.

Financial Toxicity Among Patients With Traumatic Finger Amputation: A Retrospective Study.

Patients face increasing financial toxicity (FT), defined as emotional distress due to the cost of medical treatment. However, little is known regarding FT in the context of upper extremity trauma. We surveyed patients who sustained traumatic finger amputation (October 21, 2011-January 1, 2021). We collected patient-reported financial distress using the Comprehensive Score for Financial Toxicity (COST-11), where a lower score indicates worse FT. We also collected data of patients' perceptions regarding the costs of their treatment. We used linear regression to assess patient-level characteristics associated with FT as measured by the COST-11 score. Of the 191 eligible patients, 46 patients completed the survey (response rate of 24%). A total of 41 respondents (89%) received an initial treatment of revision amputation, with the remaining patients receiving a semi-occlusive dressing. Patients with commercial insurance had significantly lower COST-11 scores (ie, worse FT) than patients with Medicare (β = 7.5, 95% CI: 0.5 to 14.5) and Worker's Compensation (β = 8.7, 95% CI: 1.8 to 15.6). Patients who were single/never married had significantly worse FT (β = -11.3, 95% CI: -18.7 to -3.9). Approximately 35% (n = 16) reported that the costs were higher than expected. More than a third of patients (39%) reported decreasing spending on basic items, such as food, at least once since surgery. Patients face FT when obtaining surgery following traumatic finger amputation. Variation in the FT is associated with type of insurance and marriage status, highlighting how underinsurance and social support likely affect the overall economic well-being of patients.

Regional Differences in Job Satisfaction among Chinese Social Workers: The Mediating Effect of Attitudinal Professionalism.

Job satisfaction is a vital factor associated with better physical health and subjective well-being among social workers. This study aims to explore the job satisfaction of social workers from China's Mainland and Macao and the role of attitudinal professionalism on regional differences. A cross-sectional survey collected data from 292 social workers in Mainland and 108 from Macao one year after the outbreak of COVID-19; 72 percent were female, less than half were married (44.8 percent), the average age was 32.64 years old, and the average working time was 6.07 years. Data were analyzed using descriptive statistics, independent t tests, and mediation analysis. Results indicated that Mainland social workers reported a significantly higher level of job satisfaction and attitudinal professionalism than Macao social workers. Moreover, attitudinal professionalism helped explain the regional difference in job satisfaction. The evidence from this study highlights the need to nurture professional beliefs and values among social workers, especially for Macao social workers, and also underscores the importance of developing continuing education programs to enhance social workers' identification with and commitment to the profession. We also need to improve financial compensation and social status for Mainland social workers to sustain their professionalism.

Impact of extreme bushfire seasons on rates of occupational injury and disease compensation claims in first responders.

This study aimed to use workers' compensation (WC) data to explore the impact of the extreme bushfires on injury/disease claim rates amongst first responders (FR) compared with other occupations and off-seasons. Data on WC claims for FR (ambulance officers, paramedics, firefighters, police) and other occupations were obtained from WorkSafe Victoria 2005-2022. Negative binomial regression models adjusting for age, gender and number of employed people were used to estimate incident rate ratios of all injury/disease, mental, musculoskeletal and respiratory claims among FR in summer and extreme bushfires compared to off-season/summer and other occupations. There were 120,022 claims in 2005-2022; 54% were musculoskeletal injuries. Claims rates were significantly higher for all injuries/diseases, mental, musculoskeletal and respiratory conditions in FR than other occupations across off-season, summers and extreme bushfires. FR were 1.5-3.9 times more likely to claim for mental health conditions during extreme bushfires than off-season compared with other occupations. Firefighters were at increased risk of all injury/disease and mental and musculoskeletal injury claims during summer and extreme bushfires than off-seasons. Ambulance officers and paramedics had the highest claim rates, particularly in off-seasons, with a higher risk of all injury/disease and mental claims in extreme bushfires than in summers. Respiratory and mental claims were increased amongst police and other occupations during extreme bushfires. Extreme bushfire events were associated with increased mental claims rates in all FR, with the highest in firefighters. Strategies to better prevent and manage injury/disease risk in FR are urgently required, particularly for mental health conditions.

Analysing the Impact of Minimum Wage Laws on Low-Income Workers in Selected Government Ministries, Agencies, Departments and Parastatals in Benue State

This study analyzed the Impact of Minimum Wage Laws on Low-Income Workers in Selected Government Ministries, Agencies, Departments, and Parastatals in Benue State. It specifically examined the impact of the National Minimum Wage Act on Minority Workers as well as the impact of the Labour Act on Rural Workers in selected government MDAs in Benue State. The target population is 2,803 and a sample size of 338 was derived from Krejcie and Morgan method. The hypotheses were tested with simple linear regression analysis on Statistical Packages for Social Science (SPSS) at a 5 percent significant level. Hypothesis one revealed a statistically significant negative impact of the National Minimum Wage Act on minority workers in selected government MDAs in Benue State. Hypothesis two showed that there is a strong negative impact of the Labour Act on Rural Workers in selected government MDAs in Benue State. The study concluded that there is a statistically significant negative impact of impact of minimum wage laws on low-income workers in selected government ministries, agencies, departments and parastatals in Benue State. It was recommended that policymakers need to review and adjust the National Minimum Wage Act to ensure fair compensation for minority workers in government MDAs by conducting wage audits and aligning wages with the local cost of living. Also, the government needs to revise the labour to address the unique challenges of rural workers in government MDAs by implementing region-specific policies and stronger enforcement mechanisms.

General unemployment and serious workplace injury rates: Workers compensation claims analysis from the Canadian province of Saskatchewan, 2007-2018.

There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007-2018, in order to provide new insight into injury prevention. Saskatchewan's retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker's compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons. The WRNFI rate has declined since 2007. On average, workers aged 20-29years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12-3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63-1.73) and construction (RR = 1.67, 95% CI 1.63-1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern. This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.

Opioid Prescribing Trends Among Workers' Compensation Patients Undergoing Foot and Ankle Surgery.

The purpose of this study was to evaluate opioid usage and prescribing trends among workers' compensation (WC) patients who underwent foot or ankle operative procedures compared with a control group. A retrospective review was conducted for WC and non-WC patients who underwent foot or ankle procedures in a single academic orthopaedic surgery practice. Outcome measures were total morphine milligram equivalents (MME) and number of opioid prescriptions. A total of 118 patients were identified, including 51 patients in the WC group and 67 in the non-WC group. After index surgery, 67% (34 of 51) of WC patients had 2 or more additional opioid prescriptions compared to 39% (26 of 67) of non-WC patients (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.4-6.7; P = .003). Collectively, there were greater prescriptions of oxycodone MME (P = .002) and hydrocodone MME (P = .07) in the WC cohort. Workers' compensation patients seem to be prescribed and consume opioids at a higher rate postoperatively. It is important for treating physicians to be aware of these trends, and discussions with patients regarding expected opioid use when planning surgical intervention may be beneficial. Physicians may need to set expectations preoperatively and suggest there are limits on the amount of opioids that can safely be prescribed. Level III, Retrospective cohort study, Prognostic.

What is the Role of Minimum Wages in Addressing Precarious Employment in the Informal and Formal Sectors? Findings from a Systematic Review.

This article presents synthesized evidence from 16 studies examining initiatives with potential to mitigate workers' exposure to precarious employment through the adoption of minimum wage policies. All studies were set in low-income countries and focused on both formal and informal workers. A systematic review of evaluated initiatives addressing precarious employment identified the evidence. We consider minimum wage policies as initiatives that could address precarious employment because of the central role of minimum wages in establishing employment terms for workers in precarious situations. We include initiatives aimed at formal and informal workers, given that precarious employment can exist in both sectors, that these workers share concerns regarding income and would benefit from minimum wage policies. The findings imply that minimum wage policies could increase precariously employed workers' financial compensation, although with some differences and with little or no effect on employment security. It is not feasible to extend these conclusions beyond low-income economies due to differences with high-income economies in how the mechanisms through which minimum wage policies could impact worker compensation and employment security. However, they should serve as a reminder for high-income economies, many of which experience expanding informal sectors, about the need for related research and policy.

Breast Cancer-Related Chemical Exposures in Firefighters.

To fill a research gap on firefighter exposures and breast cancer risk, and guide exposure reduction, we aimed to identify firefighter occupational exposures linked to breast cancer. We conducted a systematic search and review to identify firefighter chemical exposures and then identified the subset that was associated with breast cancer. To do this, we compared the firefighter exposures with chemicals that have been shown to increase breast cancer risk in epidemiological studies or increase mammary gland tumors in experimental toxicology studies. For each exposure, we assigned a strength of evidence for the association with firefighter occupation and for the association with breast cancer risk. We identified twelve chemicals or chemical groups that were both linked to breast cancer and were firefighter occupational exposures, including polycyclic aromatic hydrocarbons, volatile aromatics, per- and polyfluoroalkyl substances, persistent organohalogens, and halogenated organophosphate flame retardants. Many of these were found at elevated levels in firefighting environments and were statistically significantly higher in firefighters after firefighting or when compared to the general population. Common exposure sources included combustion byproducts, diesel fuel and exhaust, firefighting foams, and flame retardants. Our findings highlight breast-cancer-related chemical exposures in the firefighting profession to guide equitable worker's compensation policies and exposure reduction.

Financial Sustainability of Social Insurance: The Case of Korean Workers’ Compensation Insurance and Possibility of Triple Moral Hazard

Abstract This study examines the economic stability of Korean Workers’ Compensation Insurance (WCI), highlighting the system’s vulnerability to triple moral hazard. Korean WCI features more generous worker compensation, lower employer premiums, and more active government involvement in accident prevention in addition to a higher industrial accident rate, compared to the system in Germany and Japan. The negotiation process of the WCI among workers, employers, and insurance managers often prioritizes short-term benefits, undermining long-term financial health. Workers seek greater compensation, employers push for lower premiums, and insurance managers may prioritize collective interests, exacerbating the system’s economic instability. Over recent years, applications for occupational disease recognition have surged, and premium rates have decreased, indicating increasing strain. To mitigate these issues, the study proposes enhancing transparency and rationality, involving non-political experts in decision-making, and clearly defining the government’s role in managing WCI. These measures aim to balance stakeholder interests and ensure the WCI system’s sustainability for future generations.

B - 134 Validation of the Pcl-5 Rare Items Scale Embedded Symptom Validity Index in a Cross-Cultural Forensic Sample

Abstract Objective Recently, three embedded symptom validity indices were developed for the PTSD Checklist for the DSM-5 (PCL-5). The PCL-5 Rare Item (PRI) scale is one of those indices, which is calculated by summing examinee responses to infrequently endorsed item ratings. Preliminary findings indicate the PRI is effective in a research sample but potentially less effective in a clinical sample. The aim of the current study was to cross-validate the PRI in a cross-cultural forensic sample. Method Examinees were Macedonian and Kosovar contractors (N = 79). Contractors were previously employed at military bases in Afghanistan and Iraq. The examinees underwent defense psychological examinations related to pursuing federal workers compensation claims for PTSD. Examinations were conducted between 2018 and 2023 with appropriately translated instruments and assistance from certified interpreters. Two sets of analyses were performed for this study. First, examinees were categorized as responding validly or invalidly based on their Trauma Symptom Inventory-II Atypical Response Scale (ATR) scores. In a second set of analyses, validity status was based on a more conservative criterion of failing 2+ validity tests. Results Receiver operating characteristic analyses were employed. Area under the curve findings were acceptable (0.74) in both sets of analyses. When invalidity was based on the ATR, a PRI cutoff of 3 resulted in 95% specificity and 35% sensitivity. Similarly, when invalidity was determined by failure of 2+ validity tests, a PRI cutoff of 3 resulted in 95% specificity and 36% sensitivity. Conclusion Results of the current study support the utility of the PRI in a cross-cultural forensic sample.

B - 132 Validation of the PCL-5 Symptom Severity Scale Embedded Symptom Validity Index in a Cross-Cultural Forensic Sample

Abstract Objective Three embedded symptom validity indices were recently created for the PTSD Checklist for DSM-5 (PCL-5). The first, the PCL-5 Symptom Severity Scale (PSS), is derived from the PCL-5 total score, and preliminary findings have indicated its effectiveness in research and clinical samples. Our aim was to cross-validate this validity index in a cross-cultural forensic sample. Method Examinees were Macedonian and Kosovar contractors (N = 79) previously employed at military bases in Afghanistan and Iraq. Examinees underwent defense psychological examinations between 2018 and 2023 related to pursuit of federal workers compensation claims for PTSD. Testing was performed with translated instruments and administered with assistance from certified interpreters. Two sets of analyses were conducted in this study. In the first, examinees were categorized as valid or invalid responders based on their Trauma Symptom Inventory-II Atypical Response Scale (ATR) scores. In the second, validity status was categorized based on a more conservative criterion of failing 2+ validity tests. Results Receiver operating characteristic analyses were used to determine optimal cutoff scores and classification accuracy statistics for the PSS. The area under the curve was acceptable (0.77) in both analyses. When categorizing invalidity with the ATR, a PSS cutoff of 64 resulted in 95% specificity and 33% sensitivity. When categorizing invalidity by failure of 2+ validity tests, the PSS cutoff could be adjusted to 62 resulting in 90% specificity and 46% sensitivity. Conclusion Results of the current study are in line with those from previous research. These findings extend the utility of the PSS to a cross-cultural forensic sample.

Employee Compensation of Nonprofit Child Welfare Agencies in New York: Crises and Strategies

ABSTRACTWhile existing literature documents the low compensation of nonprofit human services workers, it is not well understood how managers of these organizations perceive and respond to the problem. Adopting resource dependency and competing institutional logics perspectives, we chose the New York nonprofit child welfare sector—a heavily government‐funded field—as a collective case to study these issues. Based on interviews with 17 leaders of the primary NY nonprofit child welfare agencies, we found that these agencies' employee compensation was primarily constrained by government contracts, and they were torn by conflicting institutional logics from the state, the labor market, private funders, and unions. Overall, government contracts and market competition determined worker pay, and nonprofit child welfare agencies faced labor competition not only from peer organizations, but also from the government and for‐profit sectors. With the “great resignation” atmosphere and increased cost of living intensified by the COVID‐19 pandemic, agencies were under tremendous pressure to raise worker pay. However, programs chronically underfunded by the government were incapable of providing competitive wages and were experiencing high staff turnover and vacancies. Agency leaders agreed on the need to push the government to pay programs adequately but disagreed about advocacy goals and messaging. Most leaders had reservations about aggressive collective bargaining measures such as “going on strike.” These common but attenuated labor dynamics, related managerial responses, and implications for the future of the sector are discussed, particularly in response to competing institutional pressures.

Incidence, trends and factors associated with psychological injury among health and social care workers in New South Wales, Australia: a retrospective cohort study of workers' compensation claims.

To describe and compare the incidence and trends of workers' compensation (WC) claims for psychological injury: (1) between health and social care (HSC) industry and other industries; (2) among specific occupations in the HSC industry; and (3) to determine if psychological injury claim rates differ by age and gender in the HSC industry and among specific occupations. A retrospective cohort study was conducted using data from the New South Wales WC system. Workers with accepted psychological injury claims between July 2012 and June 2021 were included. Negative binomial regression models were employed to estimate incidence rate ratios and 95% CIs. The HSC industry had a higher incidence (2.4 per 1000 workers) than all other industries combined (1.1 per 1000 workers). In the HSC industry, the incidence increased from 1.8 in 2013-2015 to 3.4 in 2019-2021. Ambulance officers had the highest incidence (24.9 per 1000 workers) and the highest growth rate. Nurses and midwives, and aged and disability care workers also had fast-growing incidence over the 9 years. Risk of psychological injury claims was highest among female workers and older adults. The increasing incidence and trend of psychological injury claims among HSC workers in New South Wales signify a growing public health issue. Greater efforts are needed to prevent work-related psychological injury in the HSC industry and support affected workers. The different patterns of psychological injury claims across occupations suggest that interventions should be tailored to each occupational group.

Estimating occupation-related crashes in light and medium size vehicles in Kentucky: A text mining and data linkage approach

Occupational motor vehicle (OMV) crashes are a leading cause of occupation-related injury and fatality in the United States. Statewide crash databases provide a good source for identifying crashes involving large commercial vehicles but are less optimal for identifying OMV crashes involving light or medium vehicles. This has led to an underestimation of OMV crash counts across states and an incomplete picture of the magnitude of the problem. The goal of this study was to develop and pilot a systematic process for identifying OMV crashes in light and medium vehicles using both state crash and health-related surveillance databases. A two-fold process was developed that included: 1) a machine learning approach for mining crash narratives and 2) a deterministic data linkage effort with crash state data and workers compensation (WC) claims records and emergency medical service (EMS) data, independently. Overall, the combined process identified 5,302 OMV crashes in light and medium vehicles within one year’s worth of crash data. Findings suggest the inclusion of multi-method approaches and multiple data sources can be implemented and used to improve OMV crash surveillance in the United States.

Rotator Cuff Tears, Repairs, and Shoulder Arthroplasties Among Workers' Compensation Claimants: A 16-year study of workers' compensation claims from a large nationwide workers' compensation insurance carrier.

Rotator cuff repair (RCR) is increasingly being performed for both acute traumatic and degenerative tears of the rotator cuff, while total shoulder arthroplasty (TSA) is reserved for osteonecrosis of the humeral head, arthritis of the glenohumeral joint and failed RCR. To assess the incidence and patient characteristics of rotator cuff tears (RCTs), RCRs, and TSAs among workers' compensation (WC) claimants. 8,347 RCT indemnity claims filed to Accident Fund Group from 2007 to 2022 were studied. Over the study period, the percentages of RCTs increased from 41% to 65% among shoulder injury indemnity claimants, RCRs increased from 88% to 92% of RCTs and TSAs increased from 1% to 5%. RCT, RCR, and TSA have increased dramatically among WC claimants, age of the injured worker being the primary determinant of the increase.

Improved patient reported outcomes with knotless double-row rotator cuff repair with and without lateral row biceps tenodesis at 2- and 5-years

BackgroundThe purpose of this study is to report outcomes of an arthroscopic knotless double-row (DR) rotator cuff repair (RCR) technique at 2- and 5- years postoperatively, and to compare clinical outcomes in patients undergoing knotless DR RCR with incorporated lateral row biceps tenodesis vs. those without lateral row biceps tenodesis. MethodsAll primary RCR surgeries were performed by a single surgeon at a single institution using a knotless transosseous equivalent (TOE) technique. The postoperative rehabilitation protocol was standardized for all patients. The primary outcomes collected included ASES Function, ASES Index, SANE, SST, VR-12 physical and mental, and VAS scores. ResultsThree hundred forty-two patients met inclusion criteria, of which 262 patients underwent isolated RCR and 61 underwent RCR with a concomitant lateral row biceps tenodesis, 15 underwent RCR with concomitant tenotomy and 4 had RCR with débridement of the biceps. Significant improvements in VAS, ASES, SANE, SST, and VR-12 scores were observed at all time points in all patient groups. No statistically significant differences in outcomes were noted in patients undergoing RCR with a lateral row tenodesis vs. those undergoing RCR alone. Similarly, no differences were seen when stratified by age, sex, BMI, Worker’s Compensation (WC) status, smoking, and diabetes mellitus (DM). Based on ASES, 81% of patients met minimum clinically important difference (MCID), and 64% met maximum outcome improvement (MOI) at 1-year postoperatively. ConclusionKnotless DR TOE arthroscopic RCR significantly improves patient-reported clinical outcomes at 1-, 2- and 5-year follow-ups. These results are reflected in clinical practice because 80% achieve MCID postoperatively. Patient-related factors, including BMI, age, sex, WC, and DM do not significantly affect patient-reported outcomes in the first 5 years after surgery. Smokers have worse baseline scores which persist at 2-year follow-up. Lastly, adding an arthroscopic lateral row biceps tenodesis in knotless DR TOE arthroscopic RCR provides similar clinical outcomes to knotless DR TOE arthroscopic RCR without biceps tenodesis.

Pre-injury methamphetamine use is associated with increased length of hospital stay in rural orthopaedic trauma patients

ObjectivesThe primary focus of this study is to determine if rural methamphetamine positive patients experience longer hospital length of stays compared to urban methamphetamine positive patients following an orthopaedic trauma. MethodsPatients presenting with traumatic orthopaedic injuries and urine drug screen were categorized into urban, suburban, and rural cohorts found in the Rural Urban Commuting Area codes based on home residence zip codes. Demographic, injury, hospital stay, and follow-up data were collected from the medical records. Comparisons between cohorts were determined by Chi square, Fisher exact, unpaired t-Tests, or ranked sum tests. DesignA retrospective cohort analysis. SettingAcademic Level I Trauma Center. Patient selection criteriaPatient records were examined between January 2013 to January 2023 for a traumatic orthopaedic injury and a urine drug screen result at the time of presentation to an academic Level I trauma center. Outcome measures and comparisonsMethamphetamine use status, patient age at time of admission, sex, marital status, insurance status, home zip code, orthopaedic injury location, complications, if the patient underwent surgery for orthopaedic injuries, admission date, discharge date, and discharge location were measured. Results249 patients met inclusion criteria for this analysis. Methamphetamine positive patients are significantly more likely to be younger, more likely to have surgery for orthopaedic injuries, experience a medical complication, or be discharged to home or a rehabilitation facility compared to methamphetamine negative patients. Urban patients experienced a shorter length of stay compared to suburban and rural patients, regardless of methamphetamine use status. Patients with Medicare, military, workers compensation, or commercial insurance are significantly more likely to attend follow-up appointments than patients with Medicaid or self-pay. ConclusionsMethamphetamine positive patients overall do not experience a longer length of hospital stay compared to methamphetamine negative patients. Rural methamphetamine positive patients experience a longer length of hospital stay compared to urban methamphetamine positive patients.

Responsibility Of Doctors In Medical Services To Patients According To Laws And Regulations

A doctor's legal responsibility is a doctor's "relationship" to legal provisions in carrying out his profession. The responsibility of a doctor in the field of law is divided into three parts, namely the responsibility of a doctor in the field of civil law (Articles 1365, 1366, 1426) criminal, (Article 322, Article 351, Article 356 of the Criminal Code regarding abuse, Article 359, Article 360, and Article 378 of the Criminal Code regarding acts of fraud and ethical responsibility. Legal protection for patients in health services claiming their rights as regulated in Article 276 of the Health Law, can claim compensation for health workers and/or health providers who cause losses due to errors or negligence of doctors.