The Times Report, 30 November 2016, medicalbrief.co.za
The SA Society of Obstetricians and Gynaecologists has warned that there won’t be any obstetricians left in the private sector by 2020, reports The Times.
Medical insurance premiums are rising steeply, making it impossible for many doctors to stay in business. This year, the report says, private-practice obstetricians had to pay R650,000 in medical insurance premiums and this is expected to hit R850,000 next year, forcing more of them to stop delivering babies and work only in gynaecology.
The SA Society of Obstetricians and Gynaecologists suggests that about 50 obstetricians quit helping women give birth this year, leaving about 450 obstetricians in the private sector. They need to charge a minimum of R13,000 a delivery to cover their costs, including rent and staff, but medical aids pay them less than this. About R5,000 of the fee is to cover medical insurance. And, the report says, the society is expecting between 50 and 100 of the 450 obstetricians to stop private practice next year because of the high insurance rates. “There are going to be probably 200 to 350 obstetricians left next year. If things continue as they are, by 2020 we will not have a private-practice obstetrician in this country,” society head Johan van Waart warned.
The report says there are no paediatric neurosurgeons left in private practice because they are too specialised and expensive to insure. They are now found only in state hospitals.
Claims are so high because negligence pay-outs are so much higher as living costs must be paid into adulthood for babies injured at birth, said Wits professor Ames Dhai, part of a team working on reducing medical negligence under instruction of the health minister. The children’s families claim millions – in one case asking for horse-riding lessons to be included in the pay-out, she said. Pay-outs can be between R10m and R21m. In some cases families who have sued the state for millions abused the money and the disabled child became dependent on the state, she said.
Also driving up claims is that injured children can claim for 18 extra years, not just the standard three. The report says this leaves 21 years in which to bring a lawsuit.
On 11 November the Society of Obstetricians and Gynaecologists asked Health Minister Aaron Motsoaledi to intervene in the crisis. It put four suggestions to the minister which it believes will save the profession: capping of pay-outs; structuring of pay-outs: monthly or annually; if doctors are found not to have been negligent, lawyers must pay the cost of the litigation; and there must be mediation before a claim goes to court.
Motsoaledi is quoted in the report as saying that he wanted pay-out claims capped. The millions paid are crippling the state sector, he said. The Health Department owes at least R35bn. But Dhai says this would be difficult legally and capped pay-outs have been successfully challenged in the US on constitutional grounds. She said she believed that judges who presided over medical negligence cases needed to be trained to understand hospital work so that claims were not unfairly awarded.
Van Waart said private patients would all be pushed into the state sector by 2020 if private sector doctors refused to deliver babies. Another follow-up meeting is planned with Motsoaledi. The report says Motsoaledi and his team have been meeting provincial heads of health departments, hospital chiefs and doctors regularly about the crisis.
Dhai said another answer would be to use mediation. “People say they will sue the pants off you but the lawyer gets the pants. This is why mediation works better – a negotiated settlement is reached without lawyers getting huge fees. Another problem is the contingency law by which lawyers take cases for free and then claim 25% of the payout.”
“This contingency law will kill your health system,” World Health Organisation head Margaret Chan warned Motsoaledi, because lawyers get a huge percentage of the payout. “It can destroy a medical system.” The law reform commission is looking into the contingency law, Motsoaledi is quoted in the report as saying.
Legal Risk Adviser at Aon South Africa, Sam Baleson said the risk and costs currently far outweighed the reward and benefit of practising in an “ever evolving industry”. “A combination of the high-risk nature of obstetric and gynaecological disciplines, an increased and heightened awareness of potential litigants of their rights, and lawyers offering services on a contingency or no-win, no-fee basis are all factors that contribute to a high pressure pot that is bubbling over at an alarming rate,” he is quoted in a Cape Argusreport as saying.
He said damages claimed for were either patrimonial loss, which is a reduction in a person’s financial position, and non-patrimonial damage, which is unrelated to finances but compensations for matters like pain and suffering.
“The mother can bring a claim of medical malpractice if the doctor’s carelessness caused her injury prior to or during birth. For example, if the doctor fails to note the mother’s high blood pressure prior to delivery, a sign of a condition known as pre-eclampsia, and the mother has a seizure during delivery, the mother may have a claim for medical malpractice to recover for injuries caused by the seizure.”
Baleson said medical malpractice of this nature, on average, can easily be in excess of R10m.
The Western Cape Health Department’s spokesperson Mark van der Heever said in the report that they were aware gynaecologists and obstetricians were finding it difficult to cover their medical insurance, and that public sector specialists had a heavily subsidised rate for insurance.
“There is concern many of those patients who previously made use of private delivery units may add extra pressure to existing government services, but there is no indication at the moment what the situation may be.” He said currently around 82% of the citizens in the Western Cape relied on government health services, including emergency care as well as pre- and post-natal care.
“No patient requiring assistance with their pregnancy and birth will be turned away.”
Mediclinic South Africa said it believed the decision to continue to practice in private hospitals should rest with the doctors themselves.
“At this point we have not identified any significant trends in this regard across our hospitals. However, we have requested our hospital general managers continue to monitor the matter and we will then assess the situation once additional information becomes available,” the private hospital group is quoted in the report as saying.
