There is an urgent need for midwifery training in South Africa, and for a retraining of midwifery educators, say experts after a study on medical malpractice uncovered shocking shortcomings in the nursing profession and the huge sums being forked out for this from government coffers.
Nurses’ neglect in delivering babies resulted in three provinces’ Health Departments being sued for R120bn over 11 years, reports BusinessLIVE.
The study focused on 400 malpractice cases in Gauteng, the Eastern Cape and Western Cape between 2006 and 2016, and was led by Professor Ethelwynn Stellenberg, a veteran Stellenbosch University nursing academic and researcher, and chair of the SA Medico-Legal Association.
Half of the malpractice cases were found in Gauteng and the Eastern Cape High Court records. The rest were from private hospital groups in Gauteng and the Western Cape that allowed the researchers to work in their lawyers’ offices to extract clinical, legal and circumstantial data – on condition of anonymity.
The study’s findings were presented at a critical-care conference in Gqeberha recently.
Stellenberg cited cases of community-service nurses being left to run large primary health-care wards with little or no supervision, then being lambasted by their seniors when patients died.
She also identified other “adverse events”, preventable or unpreventable, relating to medical treatment, which can include medication side effects, injury, psychological harm or trauma, or even death.
Adverse events can also include a patient slipping on a mopped floor, a porter tipping a patient out of a wheelchair or a patient getting the wrong food.
But of those leading to malpractice litigation, 90.1% are related to maternity. Most involved public sector midwives, with 193 cases of babies being born with cerebral palsy because of poor monitoring.
In the public sector, nurses and doctors were responsible for 71% of adverse events, while in the private sector it was 43%. And in the private sector, 53% of qualified nurses were involved, but only 12% in the public sector. Junior nurses were connected to 23% of adverse events in the private sector and just 2% in the public sector.
Altogether 89% of “extreme adverse events” occurred in the public sector, where 9% of linked deaths occurred. In the private sector it was 39% with 21% related to deaths.
Eighty percent of events that affected quality of life were found to be in the public sector, against 69% in the private sector. Permanent disability accounted for 71% of cases in the public sector against 25% in the private sector.
Failing to apply guidelines was a contributing factor in 91% of adverse events, with poor monitoring running at 75% and “clinical manifestations not picked up” at 73% of cases.
“Failure to give treatment as indicated” and “an accumulation of admissions” contributed to half of all cases: 42% were due to an accumulation of errors, with a lack of knowledge and system failures. A lack of training accounted for 19% of all adverse events, and behavioural errors for 27%.
Of all the long-term patient-care plans – those resulting from harm suffered – 63% were completed in the private sector and 22% in the public sector.
However, 64% of these plans had been implemented in the private sector, 15% below those being carried out in the public sector. Progress reports were at 41% in the private sector and at 14% in the public sector.
Stellenberg says: “Nurses have tick fever – they fill in the boxes but don’t know what they’re doing.”
Midwives were responsible for 84% of adverse events in the public sector and just 8% in the private sector.
Stellenberg and her team of PhD and master’s students recommend urgent midwifery training. “We need a retraining of our educators … involving integrity and ethical leadership, and regular workshops on all phases of the nursing process.
“Many patients admitted to health establishments are subject to malpractice negligence not related to their actual problem, resulting in extensive morbidity and mortality.”
BusinessLIVE article – Bad nursing: a R120bn problem (Restricted access)
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