Only one province using system to rein in medical negligence claims

Only one province is using a case management system designed to help provincial health departments defend themselves against potentially crippling medical negligence claims, a situation verging on fruitless and wasteful expenditure, the auditor-general told parliament on Tuesday.

While only a fraction of the legal claims levelled against provincial health departments are paid out, the sums the government hands over to victims of medical negligence are nevertheless significant and are crowding out expenditure on personnel and vital goods and services.

The case management system is one of several government efforts seeking to rein in spending on medico-legal claims, and should theoretically have delivered quick improvements while other processes unfold.

The government has spent R1.2m to roll out the case management system in all provinces, but only four have imported data into the system and the Free State is the sole province that is actually using it, Clothilde Oliphant, a health specialist with the auditor-general’s office, told parliament’s portfolio committee on health.

The department’s 2021/2022 performance plan says the scheme should have been implemented in at least seven provinces by the end of March.

Dodgy claims

In a separate process, the SA Law Reform Commission is considering public comments made in response to a discussion paper it released last November, which proposes replacing lump-sum settlements with a structured schedule of annual payments.

Once that process is completed, the government is expected to draft legislation updating the 2018 State Liability Amendment Bill, which was rejected by parliament’s justice committee earlier this year.

At the same time the Special Investigating Unit is investigating dodgy claims in a sweeping probe authorised by President Cyril Ramaphosa in July.

Contingent liabilities for medico-legal claims stood at R120.3bn in the 2021/2022 fiscal year, constituting 96% of the total R125.3bn in legal claims levelled against provincial health departments, Oliphant told parliament the figure for contingent liabilities for medico-legal claims remains unchanged from the prior year.

A total of 15,148 claims were lodged against provincial health departments in 2021/2022, said Oliphant.

Eastern Cape was hit hardest, with 4,443 claims against its health department, followed by Gauteng (3,783) and KwaZulu-Natal (2,915).

The majority of the medical negligence claims levelled against the state are for severe birth injuries, such as cerebral palsy. Provincial health departments paid out R855.6m to successful legal claimants in 2021/2022, compared with R1.76bn the year before. The reduced figure did not indicate a sustained improvement, as it was largely due to delays between when a claim was received and actually paid out, said Oliphant.

Gauteng and KwaZulu-Natal were the hardest hit and paid out R349.5m and R265.8m, respectively. There was a marked reduction in the claims paid out by the Eastern Cape, which stood at just R38.7m compared with R866m the year before.

Oliphant said staff from the auditor-general’s office had assessed three public health facilities in each province and found the majority did not have adequate systems in place to manage adverse events, medical records and legal claims.

These failings were compounded by weak IT systems and poor record keeping, and increase the likelihood of litigants succeeding in their claims against the state, she said.

The department of health had not responded to Business Day’s request for comment at the time of publication.

kahnt@businesslive.co.za