Medical negligence claims in E Cape plummet by 65%

Eastern Cape health MEC points to huge reduction in new cases since integrated medicolegal strategy introduced

The Eastern Cape government’s integrated medicolegal strategy, introduced early in 2023, has resulted in a 65% reduction in new claims — saving the state millions of rands.

Despite the improvement, provincial health spokesperson Mkhululi Ndamase said the province still faced a mountain of claims and contingent liabilities amounting to more than R22bn relating to medical negligence.

These are claims that are yet to be tested and decided on in court.

Over the years, the provincial health department had to pay out billions in negligence claims — money which could not be budgeted for and which had to be taken away from core departmental functions, compromising the provision of quality health services.

MEC Ntandokazi Capa said the number of new claims had decreased from 553 in the 2017/2018 financial year to just more than 190 in the 2023/2024 year.

Capa, lamentiing that negligence claims were affecting the state’s ability to provide quality services, said more than R4.5bn had been paid out in the past decade.

Delivering her budget and policy speech at the Bhisho legislature recently, the MEC said she was glad the strategy employed to deal with the escalation of claims was bearing fruit.

“The settlement of medicolegal claims and contingent liabilities associated with medicolegal claims is impacting the state’s ability to provide quality services, and threatens the financial liquidity of the provincial health department and of the entire province,” she said.

“Many of these cases stem from as early as 2004 and have resulted in medicolegal settlements of over R4.5bn since the escalation of claims against the state as from 2011/2012 onwards.

“These lump sum payments are made from budgets originally allocated for other health services and have led to increasing accruals and payables year on year.”

The government, she said, had responded to this challenge by implementing the integrated medicolegal strategy.

Capa said the strategy aimed to halt the outflow of funds from the department through large upfront lumpsum settlements, strengthen administrative systems and the legal defence of current cases, and target clinical and forensic interventions that reduced the risk of future litigation.

Disbursements for historic claims against the state in the past year had been significantly reduced since the integrated medicolegal interventions and “new claims against the state have decreased significantly”.

“The number of new claims in the 2023/2024 financial year was 192, as opposed to the peak of 553 claims against the state in the 2017/2018 financial year, a 65% reduction,” she said.

Ndamase said in the 2023/ 2024 financial year, the provincial government had paid out more than R340m in negligence claims.

So far this financial year, an amount of R95m had been paid out since April 1. Finance MEC Mlungisi Mvoko agreed that the number of crippling claims against the embattled health department, and by extension the provincial government, was declining. “Despite facing hurdles, health has demonstrated commendable progress in addressing medicolegal claims and enhancing records management. “Notably, there is a decreasing trend in claims registered, displaying effective interventions in this realm,” Mvoko said during his department’s policy speech. Medicolegal claims, he said, continued to pose a significant liquidity risk to the provincial fiscus. “But concerted efforts led by the provincial treasury, the provincial health department and premier Oscar Mabuyane’s office are actively mitigating this fiscal challenge through the implementation of a proper, comprehensive, turnaround strategy for health.” Mvoko added: “The strategy has five focus areas, which are leadership, organisational development & human resources, financial sustainability, clinical & specialised services, facilities & equipment and, lastly, digitisation & litigation.”

DA MPL Jane Cowley said because of the crippling medicolegal claims and huge salary bill, “the department is factually bankrupt and has no cash flow to speak of”.

She said the DA was convinced that additional strategies could be explored that would contribute to improving the department’s finances.

She said it was struggling to provide basic services due to its cash flow challenges.

“From a budget of R30.1bn for the 2024/2025 financial year, a whopping R6.2bn was owed for payables and accruals to service providers and suppliers from the previous financial year,” she said.

“Of the remaining R23.9bn, about R1.6bn goes to payments of capital assets.

Another R400m goes to transfers and subsidies, and a massive R20.1bn goes to compensation of employees,” Cowley said.

“This leaves a paltry R1.8bn for the goods and services budget, which has to cover medicines, surgical supplies, implants, medical equipment, oxygen, food, linen, and all the other soft services at hospitals across the province — and that is a great concern.”

Nehawu provincial secretary Mlu Ncapayi said the union welcomed the huge reduction in medicolegal claims, saying the money saved could be deployed to where it was needed most when it came to providing decent healthcare services.

Nehawu had always believed many of the claims were not genuine, but “man-made” and that this was being exposed by the government interventions.

Ncapayi said the department should quantify the money saved from the reduction in claims and be forthright about where the savings would be used.