SA’s health dept faces R125 billion in malpractice claims

The department of health’s medicolegal claims have increased significantly over the years and now sit at R125 billion, the Office of the Auditor-General said yesterday – with the department under pressure to settle some of the claims.

Medicolegal claims are based on medical negligence or malpractice.

Officials from the Office of the Auditor-General yesterday briefed members of the select committee on appropriations in the National Council of Provinces that despite all methods to reduce medical claims for negligence, the number had increased, with the Eastern Cape having the most cases.

According to the 2019-2024 Medium Term Strategic Framework which was the second five-year implementation plan for the National Development Plan (NDP), included an outcome relating to universal health coverage for all South Africans to be achieved by the year 2030.

Auditor-General Business Unit leader Thabelo Musisinyani said the NDP’s intervention for the rising amounts on claims was to develop a comprehensive policy and legislative framework to mitigate the risks related to medical litigation.

“The target set was that government wants to see contingent liability of medicolegal cases reduced by 80% (under R18 billion) in 2024 from the baseline of R70 billion in 2018,” she said.

“As of 31 March, the total amount of medicolegal claims is about R77 billion (10% more than the baseline in 2018). Unfortunately, over the years, the balance has increased significantly above the baseline, rather than the planned/ intended reduction.”

Musisinyani said the sector was “currently at 110% of the target, with one year remaining in the Medium Term Strategic Framework”.

The AG report indicated at the end of March last year, there were 15 148 total claims lodged against the government which were valued at R125 billion, while the department of health noted claims were made to the value of R 10.1 billion in the 22/23 financial year.

“Ninety-six of the claims are attributed to medicolegal claims,” the report stated.

“During the 2021-22 financial year, the department paid R855.6 million (R1 756 million) towards medico-legal claims.”

The AG said the focus was to:

• Evaluate the two indicators included in the health department relating to medicolegal claims.
• Confirm that there were no budget overruns for the medicolegal claims project.
• Confirm that there was adequate contract management on the medicolegal claims project.

But the department of health did not meet the targets relating to medicolegal claims set for the 2021-22 reporting period.

Musisinyani noted that this indicated efforts to curb the medicolegal claims were slow.

“(The deparment of health) procured four service providers to assist with the medicolegal claims. “The scope of the service provider included conducting forensic investigations on top law firms that are litigating against the provinces on the medicolegal matters and forensic investigations on the medicolegal matters as provided by the provincial department,” the report stated.

It said only two service providers performed work related to medicolegal claims during the year under review.

“The department budgeted R39 million for the medicolegal claims project for 2021-22 and received R64 million from provinces as advances towards medicolegal claim.

As at 31 March 2022, a total amount of R93.8 million had been paid towards the medicolegal project.”

The claims have had an impact on the provision of quality healthcare services, the report said.

It outlined that the challenges in public health facilities included unnecessary loss of life due to medical negligence, serious harm due to medical negligence, poor record management and lack of sufficient resources in the lack of sufficient resources.

Musisinyani said this resulted in hefty medicolegal claims.

Musisinyani recommended that the committee closely monitor the areas which led to the funds being depleted, and which could have “otherwise been used to procure much-needed equipment, expand and maintain infrastructure, and increase capacity and skills” in the sector.

“These include the areas of medicolegal claim, fruitless and wasteful expenditure and better management of goods and services processes so that accruals are reduced,” she added.