Rural hospitals flagged for sky-high negligence claims

Lack of critical skills and specialised equipment cited for high number of cases

If you need emergency medical care or have a high-risk pregnancy, you may be better off going to one of the province’s two metros.

Hospitals outside of the metros account for 83% of more than R255m in medicolegal claims, most of them for medical negligence, against the health department in the current financial year.

Hospitals in these centres account for over R214m of the payouts.

A report, compiled for the provincial legislature’s standing committee on public accounts, shows how serious the situation has become.

At the top of the list of shame is Butterworth Hospital, where R48m has been paid out.

Mthatha General Hospital is next with R39.5m, while Canzibe Hospital in Canzibe and Holy Cross Hospital in Flagstaff have each paid out more than R20m each.

Taylor Bequest Hospital, in Mount Fletcher, has paid out R16m.

Health MEC Nomakhosazana Meth’s spokesperson, Mkhululi Ndamase, admits that skills shortages at many hospitals mean the department can’t roll out the high-end equipment required to minimise the cases that lead to it being sued.

Information from the department shows that in this financial year, which began in March, it has already paid out a total of R255m for 82 cases, 45 of which are from rural hospitals.

The department says the majority of claims are for children with cerebral palsy.

Cerebral palsy, according to the Cerebral Palsy Research Foundation, a non-profit foundation based in the US, is caused by a number of factors, including birth-related complications, such as the baby suffering from a lack of oxygen.

The department says it is difficult to attract and retain medical specialists because of the province’s rural nature.

The equipment needed in some of the hospitals includes X-ray machines, C-arm imaging devices, anaesthetic machines, ophthalmic microscopes and optical coherence tomography equipment; CT scanners, high-end ultrasound equipment and endoscopic equipment.

In the report, the department says it needs to shift funds from key service delivery budget items to make the payments because they are unbudgeted for.

“The settlement of claims is in fact upfront payment of the estimated future medical and other expenses.

“This causes an enormous strain on the department’s ability to fulfil its service delivery imperatives,” the report states.

Ndamase said although the province faced a high number of claims, the number of medicolegal cases globally had been increasing.

“The department acknowledges that some of the most litigated facilities are in rural areas or rural towns.

“And the majority of litigation stems from claims for children with cerebral palsy.

“Ensuring a healthy outcome for mothers and children requires a number of factors to come into play.

“There are, therefore, a number of risk factors that increase the risk of poor maternal and child outcomes,” Ndamase explained.

He said the department was implementing an integrated strategy that sought to prevent future litigation, through addressing the risk factors associated with poor maternal and child health outcomes.

It was striving to ensure it was able to mount a tactical legal defence strategy and improve the administration of patient records and liability.

“Of course, we continue to train our professionals to ensure they maintain their knowledge and clinical skills.

“The budgetary constraints make it difficult to fill all the vacancies required at all

There are a number of risk factors that increase the risk of poor maternal and child outcomes

the rural facilities.

“But the teams do their best with the available resources to provide the best possible care.

“Rural communities typically have a number of socioeconomic factors that affect their health outcomes and far-flung communities do experience challenges like access to healthcare.

“There is a shortage of health professionals in rural areas, due to high levels of migration and demand globally.

“This then affects the ability of the rural facilities to attract and retain adequate skills needed,” Ndamase said.

He said the department was working at addressing staff shortages and had set aside R710m to employ 2,941 people, mostly clinical staff, for this financial year.

“It should also be noted that some of the high-end equipment that might be needed at the facilities cannot be availed due to the level of skill that is available, hence one would observe that the referral facilities bear a heavy burden of disease,” Ndamase said.

National Education, Health and Allied Workers Union (Nehawu) provincial secretary Mlu Ncapayi said the huge amount the department paid out in legal claims was hampering its efforts to fill vacancies.

“The issue of workers not wanting to go to rural areas, that’s a secondary issue.

“The primary issue is that the department does not have the resources to fill the vacant posts because of not being able to manage state resources through these medicolegal claims.”

He said rural hospitals were often understaffed, and in some cases there was a lack of supervisors.

“If those people are not there and you only have nursing assistants and there is a baby that has to be delivered, then it becomes an issue because workers [should] be supervised by specialists who are able to guide the process so that there are no fatalities.

“If then the department does not have those people in place, it therefore suggests that there is going to be a crisis,” he said.

He said nonpayment of a rural allowance for the union’s members was still an issue and this meant that there was little motivation for health workers to choose to work in rural areas.