Medico-legal claims against the national Department of Health have soared to an 'unsustainable R125bn', the Auditor-General has warned, saying despite all measures taken to reduce medical claims for negligence, the number of claims has increased.
Officials from the Office of the Auditor-General yesterday told members of the Select Committee on Appropriations in the National Council of Provinces that in 2018, the department had said it would reduce claims by 2024, but in fact the cases of negligence have risen sharply, IOL reports.
Acting Business Leader in the AG’s office Thabelo Musisinyani said they started monitoring the issue of the claims a few years ago when they noticed large payouts made by the department.
“As at the end of March 2022, there were 15 000 claims that had been lodged against the department and were valued at R125bn. Ninety-six percent of the claims are attributed to medical legal claims. We also indicating that during the 2021/22 financial year the department paid just paid over R800m towards medical claims.
“What is important here is that the majority of the provinces did not budget for claims. In some cases, additional funds were requested from relevant Treasury to cover these claims.”
Additionally, the report also found in some cases the provincial departments were in a shambles, as they did not have medical records to defend medical claims in court. They instead choose to settle these cases out of court.
He said there would be 10 consulting rooms, four gyms and 10 offices with a boardroom and a ‘relaxation area,” at NMAH.
The plan is to complete one CP Centre of Excellence for each of the eight provincial Health districts within three years, with hospitals supported by the NMAC unit from next year.
Dr Ben Gaunt, the newly appointed clinical medico-legal manager for the province, said he was currently working with 140 claims, as well as reviewing 372 others, some dating back to the early 1990s.
Of these 80% were maternity related and about three quarters of those were CP cases.
“In addition to the numbers of claims, we’re seeing big increases in the amounts claimed. As recently as 2015/16 claims were on average about R12m to R15m each. More recently, I’ve been doing some that are R30m to R40m. Usually, the issue is about how did we record the monitoring during labour. So, it’s a combination of (the procedure), not being done properly and not being documented properly – or sometimes simply that it has faded. We just didn’t see this coming. We’re dealing with cases from 10 to 15 years ago, and often the cardiotocograph, (aka an electronic fetal monitor) heat-sensitive paper has faded.”
“Often though, it’s just a function of claims being grossly inflated. We refer the dodgier ones to the Special Investigation Unit, things like MRIs submitted for the wrong child. We only want legitimate, and defensible, cases to get to court. There’s also a lot of work happening with provincial Treasury and the Department of Health to use mechanisms in the Public Finances Management Act to recoup some of the money back into the Department of Health.”
Gaunt said the legal costs, when added to the court settlements, were crippling. “All of these accumulate over time. With accruals at over R5bn, it means that at the beginning of the year, as the HOD said, some institutions have already got up to 73% of their budget spoken for. That percentage is getting worse over time, so I understand the metaphor of bailing a sinking ship,” he added.
Asked what the other major drivers of CP were, Gaunt, a veteran rural doctor who helped transform Zithulele Hospital near Mthatha into an award-winning, globally admired district facility, said there were ‘times where we’ve been understaffed or had junior staff trying to manage cases. It’s difficult to tease out how much that was the case, because you don’t know who was on duty that long ago.”
Pressed on the main drivers of the CP burden, he answered, “definitely midwives not always recording what they do during labour, but sometimes it’s clinicians or midwives misinterpreting CTGs, or at other times just doing their best to be as efficient as possible in terms of how they act during emergencies.”
“I mean in SA we’ve always been under resourced, and we’ve done a remarkable job of sticking it out. What changes it is this kind of medico-legal pressure – and that makes people fearful and practise defensive medicine. Junior people are then scared to do something and would rather do nothing – ironically with the same result.”
Gaunt added, ‘the more we think of healthcare as a commodity with a 100% outcome, the worse we make it. It’s impossible for it to be like that. There must be a measure of saying we’ll hold you accountable, but people also must realize that we can’t expect a 100% product. And that’s not an excuse, it’s just a reality. So, it’s that kind of balance.”
The most telling intervention for CP and other infant maladies would come from a high-risk pregnancy and infant early identification and monitoring programme using parent facilitators paid with a stipend by NGOs.
“They’re in the community, attend community meetings and do random home visits. If you make it a doctor’s problem, you lose your kids. Or you end up 18 years later with people who fell out of the system. That, and transport are two key mitigators,” he said.
IOL – Auditor-General worried medical claims skyrocketed to R125 billion