The failure of nurses at private hospitals to follow guidelines, as well as poor monitoring of patients, lies behind rocketing liability claims, according to a Stellenbosch University study. The study also found that the costs of these claims are passed onto consumers.
Professor Ethelwynn Stellenberg from the department of nursing and midwifery, who conducted the study, says legal claims against private hospitals are skyrocketing – just as they are in the public-sector hospitals. She said the settlements due to nursing malpractice in private hospitals were a growing problem in South Africa. “The quality of care is declining, in both the state and private sectors,” she warned. “The cost of clinical mistakes is just too high.”
It is not only the increase in the number of claims that is troubling, but also the scale, with many amounting to pay outs of millions of rand. In the end these costs are passed on to the consumer, says Stellenberg. She finds it concerning that the majority of these cases are settled quietly, which means that important information does not reach the people who use private hospitals.
A grant from the National Research Foundation (NRF) has enabled Stellenberg to study the factors in nursing that lead to civil claims in South Africa. The first phase of the study, which focused on the private sector, has been completed. Under the guidance of Stellenberg, this phase also resulted in two students obtaining Masters degrees in March this year. The second phase concentrates on state hospitals and is currently underway.
Stellenberg paints a bleak picture of nursing care in private hospitals, where she found that staff take less and less initiative, and substandard appointments are made in critical care areas, like theatres. She is especially worried about the fact that care workers are performing the functions of nursing staff in many cases, hence her recommendation that care workers or sub-optimal staff not be employed in acute care hospitals as a basic premise.
The study mainly focused on Gauteng and the Western Cape, where the biggest hospitals are situated. Stellenberg reached out to large health care organisations early in the process to try and acquire court documents for the study, but her requests were denied after they sought legal advice.
Her Plan B was to approach attorneys involved in malpractice claims. “Fortunately, many of them saw the need for this research,” says Stellenberg, who has presented the findings of this study nationally and at the International Society for Quality Health Care. A total of 122 completed cases were studied, of which a fifth resulted in the death of patients. In all, 74% of the cases were settled out of court.
Nursing malpractice affected the quality of life of a considerable number of the victims (69%), with 43% requiring additional surgery and 25% left with disabilities. In total, 79% of the patients were forced to stay in hospital for a longer period of time.
At the top of the list of factors that contributed to civil claims is the failure to follow guidelines (91%), followed by, among others, a lack of knowledge (75%), poor monitoring of patients (69%), failure to administer prescribed medication (66%), failure to respond to clinical signs (63%) and insufficient training (52%).
Stellenberg noticed an alarming lack of interpretation among nursing staff. According to her, staff will write down the readings of machines monitoring patients, but they won’t necessarily pay attention to basic nursing care, like doing a physical examination after back surgery to make sure that patients have sensation in their feet or legs. In some cases, specific complaints about this issue were ignored, with serious consequences.
As far as nursing categories are concerned, registered nurses were involved in 87% of the cases. “This should raise a red flag for our country,” says Stellenberg. “Not only is the state sector under pressure, but the private sector as well. We are burying our heads in the sand if we think that nursing in private hospitals is better than in state hospitals. This issue can’t just be swept under the rug. We will have to find a way to apply pressure to ensure safe and quality care for patients. Profits can’t be pursued at the expense of the patient. And integrity and ethical leadership are of critical importance.”