The disproportionately large contribution of a “small group of practitioners” towards South Africa’s medicolegal burden suggests a need for strengthened peer review and regulatory oversight, found a study in the SA Medical Journal.
Regarding birth-related injuries, the contribution of system failures needed quantification and further interrogation, found the study by Bettina Taylor and Associate Professor Susan Cleary of the Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences at the University of Cape Town.
The study also concluded that the higher number of gynaecological medical negligence demands and settlements in comparison with obstetric cases in South Africa is “contrary to international experience and public sector findings”, meaning that surgical training and accreditation standards in gynaecology may need review. The authors called for further research to identify reasons for this finding.
A retrospective, observational study of medicolegal cases against obstetricians and gynaecologists in South Africaʼs private sector –
B. Taylor, S. Cleary
Published in South African Medical Journal July 2021
The viability of obstetric practice in the private sector has been threatened as a result of steep increases in professional indemnity fees over the past 10 years. Despite this, empirical research investigating key aetiological factors to target risk management interventions has been lacking.
To explore private practice medico-legal data linked to obstetricians and gynaecologists (O&Gs) to identify factors in clinical practice associated with claims, for the purposes of guiding future research and risk management solutions.
This was a retrospective, observational study of private sector O&Gsʼ medico-legal case histories. All incidents declared to a prominent local professional indemnity insurer were categorised in terms of medico-legal case type, as well as clinical parameters. To allow for risk- adjusted calculations of case incidence, year of entry into private practice was estimated for all practitioners.
Steep increases in medico-legal investigations and demands were demonstrated for both obstetrics- and gynaecology-related cases from about 2003 to 2012. Whereas the total numbers of claims, regulatory complaints and requests for records were similar for obstetrics and gynaecology in recent years (accounting for 52% v. 48% of known cases, respectively), a significantly greater percentage of demands and paid settlements related to gynaecology rather than obstetrics (58% and 76% v. 42% and 24% of cases, respectively). In obstetrics, about half of all cases on record with a paid settlement were in the context of severe neonatal birth-related neurological injury (n=9).
For gynaecology, procedure-related complications accounted for 92% of settlements, of which at least 41% were for intraoperative injuries to internal organs and vessels.
Laparoscopic procedures were most frequently associated with such intraoperative injuries, followed by vaginal and abdominal hysterectomies/oophorectomies and caesarean sections. For O&Gs in private practice for >2 years, 50/458 (11%) accounted for 138/228 (61%) of demands over a 10-year period.
The higher number of gynaecological demands and settlements in comparison with obstetric cases was unexpected and is contrary to international experiences and public sector findings, calling for more research to identify reasons for this finding. Other than further exploring surgical outcomes in private sector gynaecological patients, aspects of surgical training and accreditation standards in gynaecology may need review. Regarding birth-related injuries, the contribution of system failures needs quantification and further interrogation. The high contribution towards the medicolegal burden by a small group of practitioners suggests a need for doctor-focused interventions, including strengthening of peer review and regulatory oversight.
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