Drowning in negligence claims, but health department has plan

Strategy to stem future medicolegal cases requires ambitious investment in ‘clinical, administrative and forensic’ interventions

The Eastern Cape health department says it is making extraordinary interventions to limit the R30bn contingent liability it faces as a result of a tidal wave of negligence claims.

The auditor-general’s office told parliament last week the Eastern Cape was one of eight provinces that had not yet fully implemented a mandatory case management system designed to help provincial health departments defend themselves against financially devastating negligence claims.

But provincial health spokesperson Mkhululi Ndamase said the department was taking several special measures to address the decades-old medical negligence payout crisis.

Provincial treasury head Daluhlanga Majeke predicted in 2021 that the debacle would cause the department’s collapse and heap more financial misery on the already overburdened treasury.

However, Ndamase believes the department’s multipronged approach will stop it being overwhelmed by multimillion-rand court-ordered negligence payouts.

Many of these cases involve babies born with lifelong disabilities, including cerebral palsy, due to medical negligence during childbirth.

The department’s strategy includes preventing future cases through better and safer healthcare, deploying a tactical and co-ordinated legal defence strategy with medicolegal cases — some of which are fraudulent

— and strengthening the chaotic administration of medicolegal matters.

It will require ambitious investment in “clinical, administrative and forensic” interventions, as well as a sustained and serious bid to generally improve healthcare in the province.

These include:

● Revising standard operating procedures and referral patterns, and improving EMS capability;

● Filling of critical vacancies; ● Training clinicians and nurses on medicolegal risk identification and management, with a focus on how to avoid medical negligence;

Addressing record management challenges through placement of additional human resources in “highly litigated facilities”; and

Mobilising the province’s medical specialists as an internal resource to provide expert advice and identify opportunities to promote safer and better care.

Ndamase said the provincial government had already established a specialised litigation unit under the office of the premier and procured an additional legal panel to “supplement” the state attorney’s office to address the deluge of negligence claims.

“This has strengthened our capability to mount a co-ordinated legal defence strategy.”

The department was also already rolling out its in-house health management system, known as HMS².

“This is an electronic medical record system aimed at recording the patient’s journey from point of registration to discharge. The system is already operational at 10 hospitals and will be implemented in our 28 most litigated facilities over the next three years.”

He said the HMS² would, in the long run, save time and money and improve the turnaround time for services.

Ndamase did not indicate if this was the same as the case management system mandated by the national department.

He said all these measures had already started to benefit the province, with the number of medical claims decreasing “year on year” after peaking a few years ago.

But, even so, Businesslive reported last week that a health specialist with the auditorgeneral’s office, Clothilde Oliphant, revealed to parliament’s portfolio committee on health that the Eastern Cape remained the worst provincial offender over the past financial year.

In 2021/2022 alone, the Eastern Cape health department had been hit with 4,443 new negligence claims, which accounted for almost 30% of the 15,148 claims lodged countrywide.

She reportedly told the committee the government had spent R1.2m to roll out the case management system in all provinces, but only the Free State was actually using it.

Ndamase conceded that the department’s contingent liability still stood at about R30bn as a result of the negligence cases it faced.