Concerned experts have flagged the rising numbers of patients coming to harm in Gauteng’s public hospitals – injuries, permanent disability and deaths – because of preventable medical errors and substandard care, calling for enforced regulations, stronger disciplinary actions, and more accountability.
It comes as the Eastern Cape, a province struggling with a staggering load of medico-legal cases, was in recent months hit with two more multi-million rand payment orders, notes MedicalBrief.
Central News reports that from 1 April 2024 to 31 March 2025, the province recorded a staggering 7 386 serious adverse events (SAEs), up from the previous year’s already worrying 7 117, and highlighting a deepening healthcare emergency.
These incidents, they said, are often linked to overwhelming caseloads, staff shortages and weak oversight, and reveal a system struggling to protect those it serves.
Medical law attorney Johann Roux from JR Attorneys described the situation as a crisis affecting both public and private sectors, where overwhelmed professionals face impossible demands.
“We’ve got quite a problem with patient caseload. Along with India, we’ve got the highest number of trauma cases in the world. And if you compare India’s population, it’s 1.5bn compared with our 60m. The more patients you see per doctor, the higher the chances of negligence,” he said.
Trend escalates
SAEs are unintended harms to patients that can lead to injury, disability or death, often preventable with better care. The figures show a concerning upward trend: 6 910 in 2021, 4 701 in 2020 and 4 170 in 2019. This spike points to systemic failures, including poor hospital conditions, medication errors, infections and patient accidents.
In the Tshwane district alone, 12 provincial hospitals reported 2 281 SAEs, with Dr George Mukhari Academic Hospital in Ga-Rankuwa topping the list at 600, followed by Steve Biko Academic Hospital at 592 and Weskoppies Hospital at 426.
Province-wide, Chris Hani Baragwanath Academic Hospital recorded the highest at 1 257, while smaller facilities like Bheki Mlangeni in Soweto had 109.
Despite these numbers, only 55 disciplinary actions were taken across the province, raising alarms about accountability.
Roux notes that South Africa’s weak regulations and inefficient complaints system allow harmful healthcare workers to evade responsibility.
“The HPCSA, unfortunately, seems to be inefficient in dealing with patient case loads, and the complaints that get lodged, and that’s definitely a big vacuum in South Africa.”
Human tragedy
Behind the data are tragic human stories. In one instance, a patient lost an arm after a doctor waited seven hours to responding to a nurse’s urgent alert about a misplaced drip. No action was taken against the doctor, who continues to practice two years later.
Another case saw a child die after a routine tonsillectomy when a post-operative bleed was not addressed promptly. Such errors, often due to delayed responses or inadequate monitoring, underscore the risks patients face.
Other common SAEs include bedsores from neglect, falls due to poor supervision, self-harm in understaffed wards and healthcare-associated infections from unsanitary conditions.
Systemic failures fuel crisis
Experts attribute the rise to extreme caseloads, with South Africa handling trauma volumes comparable to much larger nations. Overburdened doctors and nurses increase error risks, compounded by shortages of staff and equipment.
Gauteng Health MEC Nomantu Nkomo-Ralehoko has outlined measures to curb SAEs, like risk assessments, consequence management, updated procedures, staff training, better handovers, regular audits and supervisory visits. However, critics argue these are insufficient, as numbers continue to climb.
The DA in Gauteng has called for urgent interventions, including management changes at high-incident hospitals, filling vacancies and strict disciplinary measures. DA health spokesperson Jack Bloom said: “Patients should be healed in hospitals, not suffer injury and even death because of poor care.”
Financially, the crisis is costly. Gauteng’s medical negligence payouts jumped 36% to R696m last year, while liability for civil lawsuits dropped from R18bn in 2023 to under R7bn by October 2025, partly due to settlements.
Roux said there was a “big vacuum” in the system, where the HPCSA struggles with complaint backlogs, leaving patients without justice. Stronger regulations, efficient disciplinary processes and better support for healthcare workers are essential to reverse the trend.
In the Eastern Cape, a month after being ordered to fork out R12m to the mother of a cerebral palsied child, the Eastern Cape High Court (Bhisho) has told the Eastern Cape Health Department to pay another patient R5m in damages for future hospital and medical care for a 19-year-old who was also left with cerebral palsy.
Daily Dispatch reports that Judge Justin Laing instructed the department to pay R5.2m for future hospital and medical-related expenses, and more than R390 000 for the costs of a trustee to manage the teenager’s funds.
This is to be kept in the attorneys’ trust account pending the establishment of a trust.
Health MEC Ntandokazi Capa was also ordered to pay the claimant’s legal costs.
In October, Judge Belinda Hartle had given Capa until 10 November to pay more than R12.1m in the earlier case: failure to pay within 30 calendar days of the order would make the defendant liable to pay interest.
In the teenager’s case, the plaintiff, now 19, born at Dora Nginza Hospital in Gqeberha, was assisted by Advocate Sandla Mlalandle as the curator in the proceedings.
The mother originally sued in her personal capacity as the mother and guardian of the child, who attained majority in 2024.
Given the youngster’s serious physical and cognitive disabilities, a curator was appointed to represent her in the pursuit of the recovery of her own damages.
The mother had claimed damages resulting from the alleged negligence of doctors and nurses at All Saints Hospital in Ngcobo during the birth of the child in September 2006, resulting in cerebral palsy.
She had also claimed for loss of personal income, but the court had ruled that the claim be dealt with in a separate hearing.
Laing said both parties agreed at trial that R5.2m was a reasonable amount for future medical expenses.
The teen lives in the Western Cape.
During the case, the provincial Health Department called the Chief Director of clinical support services, Kidwell Matshotyana, who said he was part of a team set up by the department to manage the implementation of public healthcare and undertaking-to-pay remedies.
Matshotyana acknowledged there was no co-operation agreement between the different provinces for the implementation of the remedies pleaded, and therefore the department was unable to offer the medical services required by the teenager at a facility in the Western Cape.
However, the department undertook to pay for the teenager’s needs.
Under cross-examination, Matshotyana said it was likely the teen would depend on private healthcare services and he also accepted that an order could not be enforced against the Western Cape public health authorities.
Sean Frachet, chief director for management accounting and integrated budget planning, testified that the provision of medical supplies and services to the teen would be between a private case manager, appointed by the mother, and a public case manager, appointed by the department but based in the Western Cape.
He said no budgetary provision had been made for lump-sum payments: an order to that effect meant funds had to be redirected, depleting available resources intended for other healthcare priorities.
Laing said Frachet presented compelling evidence for why the implementation of the undertaking-to-pay remedy was warranted from a financial management perspective.
He said funds allocated to the medico-legal compensatory service sub-programme would prevent problems relating to lump sum payment orders, which inevitably entailed shifting funds allocated to other needs.
He said what was missing from the provincial Health department’s evidence were “practical details of precisely how the remedy [to prevent problems with lump sum payments] would be implemented …”
The judge pointed out the order was enforceable only against Eastern Cape Health, and not the Western Cape Health Department, as there was no co-operation agreement between the two provinces.
The evidence presented by the [department] in relation to the feasibility of the undertaking-to-pay remedy was beset by too many unknowns to be sufficient for purposes of the present matter, he added.
The judge said the only remaining issue was the mother’s claim for loss of her earnings, adding that it “would be in the interests of justice for the issue merely to be separated from the rest of the matter, for determination in due course”.
Central News article – Gauteng Hospitals in Crisis: Over 7,300 Patients Harmed by Preventable Errors as SAEs Rise to 7,386 (Open access)
Daily Dispatch – Health Department forced to fork out R5m
See more from MedicalBrief archives:
3 832 die in Gauteng’s public hospitals from ‘negligent’ SAEs
Serious adverse events top 7 000 in hospitals as vacancy rates rise
2 000 patients died from severe adverse events at Gauteng Hospitals last year