South Africa's severe shortage of ambulances and urgent care beds at hospitals, resulting in emergency medical services buckling under the pressure, are putting lives at risk and leading to an escalation in medico-legal cases.
Law firm DSC Attorneys says it has seen an uptick in cases it deals with related to ambulance delays, where a suitably-equipped EMS could have prevented severe injury or death, Business Tech reports.
It noted that national EMS standards recommend one ambulance per 10 000 people, yet in many provinces, including the Eastern Cape, North West, and parts of KwaZulu-Natal, this target is nowhere near being met.
Health Minister Aaron Motsoaledi recently confirmed a shortage of about 2 000 ambulances, while Professor Fathima Paruk, head of the Department of Critical Care Services and Emergency Medicine at the University of Pretoria, noted that the country is short of about 10 000 hospital intensive care unit beds.
Reports point to patients waiting hours for help or receiving none at all, and those in need of aid suffer the consequences.
However, even if patients can get to hospitals, they may find themselves without the proper care facilities, especially in government institutions.
Paruk said that while private hospitals can build and create space for critical care as needed, the public sector is restricted to existing infrastructure.
“In the private sector, you can literally create an ICU bed. In the public sector, you have x number of beds and that’s it.”
Skills crisis exacerbates problems
Apart from the shortage of beds and services, there was also a severe lack of skills needed to run these units, Paruk added.
“You can’t run an ICU bed without nurses and doctors who are trained in critical care, and we are extremely short on them in both the public and private sectors,” she said.
Countrywide, only 25% of ICU nurses are trained in critical care, and the situation worsens when further specialisation is required.
The professor noted that a critically ill patient in South Africa requires a specialist who has had additional training in critical care, known as an intensivist or critical-care subspecialist.
There are fewer than 100 of these specialists in the country, she said.
Consequently, many ICU patients, especially in the private sector, are managed by general specialists. She attributes these shortages mainly to a lack of training posts.
According to DSC, these shortages risk putting the state in a precarious position, as, legally, there must be liability for the consequences of failing to provide these critical services.
The law firm said that liability could lie anywhere along the chain. In cases of EMS failure, liability may fall on:
• The provincial Department of Health, if the failure stems from systemic under-resourcing or poor management;
• EMS providers, if they act negligently or breach their contractual duties; or
• Hospitals, if delays in co-ordinating ambulance responses lead to injury or death.
“Legal claims could fall under medical malpractice, personal injury, or even constitutional claims for the violation of the right to healthcare,” the firm said.
Medico-legal claims are already a massive burden on the National Department of Health’s budget.
In 2024, the department said an “an explosion of litigation” in medical claims since 2015 amounted to more than R100bn.
However, around R33bn of these are under SIU investigation for possible fraud.
The Auditor-General has reported that the government failed to meet its target of reducing medico-legal contingent liabilities to under R18bn by 2024. Instead, claims stood at R77bn in March 2024, with most cases involving birth injuries such as cerebral palsy and brain damage, reports Business Day.
And they show no signs of abating, with the Eastern Cape and Gauteng reporting thousands of active cases and financial liabilities continuing to climb.
Since 2019, the cumulative cost of claims across provinces has exceeded R6.1bn, with R1.1bn paid out in 2024 alone. Up to June, Gauteng Health had 707 active medical negligence cases and the Eastern Cape 2 332.
The figures were according to a written reply by Health Minister Aaron Morsoaledi to a parliamentary question submitted by EFF MP Mbali Dlamini.
The Minister referred to two key engagements where the issue was addressed in detail: a joint press conference hosted by the National Department of Health and the Special Investigating Unit (SIU) in August 2024; and a follow-up briefing to a joint meeting of the Committees of Health, the Standing Committee on Public Accounts (Scopa) and the Standing Committee on Appropriations in September 2024.
During these sessions, the department outlined a multi-pronged strategy to address the surge in claims, many of which were found to be inflated or fraudulent.
Patient safety protocols will be strengthened to reduce adverse events in facilities; record-keeping and communication between healthcare providers and patients will be improved; and legal reforms such as mediation, a review of contingency fees and staggered payments to claimants, will be introduced.
Costly litigation has diverted billions of rands from essential health services, said the Minister. Between April 2024 and early 2025, Gauteng spent R421m and the Eastern Cape R306m on medico-legal payouts.
While national payouts declined 8% from R1.2bn in 2022/23 to R1.1bn in 2023/24, Gauteng’s payouts rose 19% from R354m in 2022/23 to R421m between April 2024 and early 2025, and the Eastern Cape’s payouts rose 14% from R269m by January 2024 to R306m by January this year.
The SIU’s investigations have already saved the state more than R3.1bn by identifying and preventing fraudulent claims. In the Western Cape, the unit found 33 fraudulent birth injury claims worth R409m. National Treasury has also reported a decline in contingent liabilities in some provinces, with Gauteng’s liabilities dropping from R18.4bn in 2022/23 to R12.3bn in 2023/24.
BusinessTech article – South Africa’s emergency services are on the brink (Open access)
BusinessLIVE – Provinces pay out R6bn in medical negligence claims since 2019
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