investigating the impact of medical malpractice litigation on

Transcription

Journal of Research and Development (JRnD) Vol. 2, No. 11, 2016
www.arabianjbmr.com
INVESTIGATING THE IMPACT OF MEDICAL MALPRACTICE
LITIGATION ON HEALTHCARE DELIVERY IN GAUTENG
Johanna Salome Mosime
Graduate of the Regent Business School, Durban, Republic of South Africa
Nishika Reddy
External Dissertation Supervisor Attached to the Regent Business School, Durban, Republic of South
Africa
Anis Mahomed Karodia
akarodia@regent.ac.za
Professor, Senior Academic and Researcher, Regent Business School, Durban, Republic of South Africa
Abstract
The purpose of this study was to investigate the consequences of the increasing cases of
malpractice litigation for the South African health care delivery system. Malpractice litigation
has been on the rise in both state and private hospitals, throughout the country. The study was
conducted in the province of Gauteng where increasing malpractice litigation has cost the Health
Department millions of Rands. The study followed a quantitative research methodology
approach. The data collection was conducted through a questionnaire survey; a technique which
was selected because it enabled the collection of large amounts of data from many people
in a short space of time. The targeted population numbered 244 and the sampling was done using
a probability sampling technique (simple random sampling), which gave all the respondents an
equal chance of being selected for the sample. The data analysis was carried out using the
Statistical Program for Social Sciences computer program. The results were presented in
frequency tables and charts.
Kew Words: Impact, Medical, Litigation, Malpractice, Healthcare.
Introduction
The issue of medical malpractice is fast gaining momentum throughout the world and the South
African health sector has not been spared. Medical malpractice is defined as the failure of a
medical practitioner, hospital or hospital employee, in rendering services, to use the reasonable
care, skill or knowledge ordinarily used under similar circumstances (Reed, 2009:1). According
to Pepper and Slabbert (2011:29), litigation involving medical malpractice has been rising
in South Africa. Medical malpractice claims have escalated, in terms of both size and
frequency, and this is affecting both private and public sectors, equally.
The rise in cases of medical malpractice litigation has been further increased through people
being encouraged by the legal fraternity to become aware of their rights. According to Studdert,
Mello and Brennan (2004:283), there are three main social goals of malpractice litigation: to
deter unsafe practices, to compensate persons injured through negligence of medical
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practitioners, and to enable corrective justice. Choctaw (2008:13) argues that medical malpractice
litigation has a negative impact on the retention of doctors, as doctors are now leaving the field
of medicine, and those who remain are working in fear and silence.
Child (2015:1) further stated that Health Minister Dr Aaron Motsoaledi announced an
investigation into the reasons for the increase in medical litigation and negligence claims, as well
as recommendations for remedial action. The rise in medical negligence lawsuits led the Health
Minister to set up a team to investigate cases of medical malpractice. The minister suggested a
cap on payouts to help health departments avoid bankruptcy.
Subsequently, a litigation summit was held in Pretoria in March 2015 where the Minister
affirmed that the country is experiencing an explosion in malpractice litigation (The Citizen
2015:1).
The Aim of the Study
The study aims to investigate the consequences of increasing medical malpractice litigation for
health care delivery in South Africa, Gauteng.
Research Objectives
The objectives of the study are as follows:
To identify the causes of the increase in medical malpractice litigation in South Africa;
To ascertain the consequences of medical malpractice litigation for stake holders; and
To offer and provide recommendations to the state and professional bodies regarding
mitigating the causes of medical malpractice in South Africa’s health delivery system.
LITERATURE REVIEW
The issue of increasing medical malpractice is becoming grim in South Africa. Government
health institutions, as well as private institutions, are increasingly being confronted with litigation
related to medical malpractice. Pepper and Slabbert (2011:95) have reported that South Africa
has been gradually gaining prominence in matters relating to medical malpractice. The problem
of medical malpractice has resulted in medical insurance premiums rising rapidly and doctors
are now more wary of being sued by patients than in the years before.
There have been numerous incidences which have indicated the seriousness of medical
malpractice in South Africa. The Medical Law website (2015:1) reported that according to a
well-known medical journal in 2011, the percentage of reported negligence claims rose by
over 130 % in South Africa over a period of two years. This rise was attributed to the
increased awareness of patient rights across the world. The downside of the rise in medical
malpractice in South Africa has been the rise in medical costs.
Medical Malpractice Explained
Medical malpractice, also known as medical negligence, has been defined by the American
Medical Association as a doctor’s failure to exercise the degree of care and skill that a
physician or surgeon of the same medical specialty would use under similar circumstances
(Brenner, 2010:9). Oginski (2012:87) defined medical negligence as the departure from good or
accepted medical care. Medical negligence has also been defined as the lack of reasonable
degree of care and skill or willful negligence exhibited on the part of Medical Practitioner while
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treating a patient, resulting in bodily injury, ill health or death (Bardale, 2011:33). Medical
malpractice includes other forms of irregular medical practice that medical health professionals
might engage in, which is not fair or constitutes wrong practice.
Negligence is described as a state of mind, amounting to carelessness that leads to failure to meet
the set standards (Erasmus, 2008:5). Statsky (2012:124) defines negligence as the failure to use
reasonable care that an ordinary person would have used in a similar circumstance, and which
results in harm or some other kind of loss. The researcher defines negligence as the failure to take
the reasonable precautions that a reasonable person in the position of the health professional
would take when in conducting work as a health professional. The definition by Erasmus
(2008:5) brings in two key elements with regard to negligence: carelessness and failure to
achieve agreed standards.
According to Oginski (2012:87), medical negligence can cause significant and permanent injuries
to the victims. Society protects the rights of those who have been negligently injured in botched
operations, or simply through the negligence of health professionals in the hospitals and clinics.
Doctors are required to prepare for such eventualities by paying for medical insurance. In the
United States, doctors are required to take out annual malpractice insurance, which usually costs
over R1,54 million, while foreign doctors operating from the US are expected to pay insurance
equivalent to R46,000 (Connell, 2011:121).
Due to the rising levels of medical malpractice litigation, health professionals are urged to
understand the factors which lead to possible civil claims for negligence, and to considerably
more serious charges of criminal negligence. Both categories can arise from a failure to
uphold required and suitable standards of care (Bryden & Storey, 2011:124).
Medical Malpractice in South Africa
The global rise in medical malpractice litigation has reached South Africa, a developing African
country, which is now facing a serious rise in the numbers and frequency of legal battles related
to medical negligence.
According to Pepper and Slabbert (2011:29), until recent years, South Africa appeared to have
been spared the scourge of rapidly escalating global trend towards increasing medical malpractice
litigation. The country has since experienced a 132 % spike in clinical negligence claims,
with the five highest claims being reported between 2006 and 2010 (Bateman, 2011:216).
According to Bateman (2011:216), the most expensive medical negligence claim to be paid on
behalf of a South African doctor was R17 million, paid to a patient who suffered catastrophic
neurological damage in 2010. The largest claims have emanated from obstetrics, gynecology
and orthopedic surgery (Pepper & Slabbert, 2011:29).
The increases in malpractice settlements in South Africa have included compensation
being made to young children who have been harmed through negligent treatment, specifically
the substantial costs of funding lifetime care packages (Bateman, 2011:216). According to Dr
Graham Howarth, MPS Head of Medical Services for Africa, obstetricians, spinal surgeons and
pediatricians who perform neonatal work bear the greatest chance of facing the most expensive
negligence claims (Bateman, 2011:217).
According to Malherbe (2013:83), the cost of reported claims more than doubled between 2011
and 2012. The author states that claims exceeding R1 million have increased by nearly 550 %,
compared with those of 10 years ago, while claims which are valued over R5 million rose by
700 % in the past 5 years. This trend in medical malpractice litigation in South Africa is
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approaching that of the developed world, and this is an indication that the problem is expanding
with recent times. Other countries that have experienced notable malpractice suits include
Taiwan, where the largest settlement was between $100 000 (R1 151 million) and $200 000
(R2, 3 million), and Kenya where one case reached $500 000 (R5.75 million) (Uejima, 2011:24).
The results of the increase in medical malpractice litigation have seen a move away from
compassion-Centred health care towards ‘defensive medicine’, and have also revealed the
devastating emotional effects of lawsuits on health professionals (Moore & Slabbert,
2013:60). Medical practitioners are now being more careful as they attend to patients and they
are more fearful of facing exorbitant legal battles in the courts.
Causes of Medical Malpractice Litigation
Medical malpractice litigation has been driven by a number of factors which include a rise in
patients’ awareness of their rights, declines in professionalism by healthcare professionals and
changes in laws which have become more favourable and protective of patients (Bateman,
2011:629). Factors that are responsible for exacerbating medical negligence are discussed in the
following sections.
Decline in Professionalism among Healthcare Professionals
According to Malherbe (2013:84), in March of 2012, the acting CEO of the HPCSA reported
that a decline in the levels of professionalism among healthcare practitioners was one
of the reasons for the launch of the national radio awareness campaign which was targeted at
educating the public on the role of the HPCSA and to create awareness of patients’ rights
and responsibilities when accessing healthcare. The decline in the levels of professionalism
among healthcare givers has been counted as being one of the key factors which has caused the
rise in medical malpractice litigation in South Africa.
The issue of a decline in professionalism among healthcare professionals was refuted by
the South African Medical Association (SAMA). According to News24 (2012), Mark Sonderup,
who was then acting chairman of SAMA, criticized the HPCSA’s nationwide campaign,
which they said was aimed at touting for people to complaint against healthcare professionals.
It is, therefore, essential that medical professionalism be defined clearly, especially in light
of the rise in medical malpractice litigation.
Professionalism in the medical fraternity has been attracting increasing attention from
students, doctors, and the media. According to Engel, Dmetrichuk and Shanks (2009:1), medical
professionalism can basically be defined as a set of values and relationships which include
integrity, compassion, altruism, continuous improvement and excellence. Blackmer (2007)
described professionalism as the moral understanding among medical practitioners that gives
reality to what is commonly referred to as the social contract between medicine and society.
A Lancet review in 2001 emphasized the importance of a commitment to the teaching of
professionalism to medical students and suggested that rigorous research was required in
this area (Passi, Doug, Peile, Thistlethwaite & Johnson, 2010). According to the United
Kingdom’s Royal College of Physicians, medical professionalism has now become more
relevant than ever, and this has been partly attributed to high profile cases which have exposed
poor professionalism (Engel et al., 2009:1).
Changes in Regulation
Governments have introduced laws which have overhauled the field of medicine and healthcare,
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and these laws have been mostly aimed at protecting patients from being exploited by medical
practitioners. According to Malherbe (2013:83), the amendments which the South African
government made to the Road Accident Fund (RAF) legislation have resulted in damages claims
for injury suffered from motor vehicle accidents becoming less lucrative sources of work for
legal practitioners, and now the most lawyers have turned to other types of injury litigation, such
as medical malpractice, in search of better revenue streams. Seggie (2013:433) asserts that the
Contingency Fees Act of 1997 allows lawyers to offer free legal assistance in pursuing a suit
against a medical practitioner, if there is a good chance that the case will succeed. Other changes
to the law which have increased medical malpractice litigation include the Consumer
Protection Act (CPA) of 2008 which states that healthcare practitioners are liable for their
faulty equipment.
Slabbert and Pienaar (2013:116) indicate that under the Consumer Protection Act, a cardiologist
who correctly fits a pacemaker to a patient’s heart, and the pacemaker fails thereafter
prematurely, might be sued as the law now allows the patient to sue anyone who is on the supply
chain. The lucrativeness of medical malpractice litigation can also be attested to by the increase
on the number of RAF lawyers advertising their medical malpractice expertise (Malherbe,
2013:83).
The lawyers are well aware of the areas which have weaknesses and where they might pick up
many malpractice suits. According to Seggie (2013:433), medical malpractice lawyers have
been focusing on the Eastern Cape Health Department as a source of massive claims and this
focus has been prompted by incidents, such as the widely reported deaths of 29 neonates. The
neonates died because of the lack of basic infection control mechanisms at East London’s
Cecelia Makiwane Hospital. Neonates are newborn babies (Coon & Mitterer, 2010:85).
Technological Advances
Malherbe (2013:84) states that the costs of caring for an injured patient for the duration of his
or her life have quadrupled because of the introduction of new technologies which have
been designed to improve the quality of life. Advances in technology have been singled out as
one of the major drivers of healthcare costs in the 21st century. According to Wendel,
O’Donohue and Serratt (2014:65), the factors that have resulted in healthcare costs rising steeply
include advances in health care technology. Technology now permeates every aspect of critical
healthcare and it offers extraordinary benefits, as well as disadvantages, for patients (Funk,
2011:286). In the 1990s a procedure called Laparoscopic cholecystectomy was developed for the
treatment of gallstone disease (McMahon, McCarthy, Goodson, Stein & O’Donnell, 2005:1).
Prior to the development of this technology, the removal of a gallbladder was done using a
painful and disfiguring abdominal surgical procedure which required lengthy recovery periods.
Surgeons then lacked familiarity with the new technology and this led to new complications
which increased the chances of harming a patient’s common bile duct and perforation of the
bowel, and these increased risks led to an increase in malpractice claims (McMahon et al.
2005:2).
According to Malherbe (2013:84), the drivers of medical malpractice claims, which include
technological advances, continue to fuel increases in medical costs and if this trend continues,
the patient stands to lose. Howarth, Bown and Whitehouse (2013:1) agree with Malherbe
(2013:84) and state that the costs of patient care packages are increasing as a result of
technological enhancements, which have an impact on the size of clinical negligence awards.
Bogus Medical Practitioners
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Another factor that contributes to medical malpractice litigation is the existence of bogus medical
doctors. The problem of bogus medical doctors has been around for some time in South Africa.
In 2011, a number of bogus medical practitioners were arrested by the Hawks as they were
found to be involved in a scheme which fraudulently borrowed practice numbers in order to
defraud medical aid services (Seggie, 2011:207).
In one incident, a certain doctor who had qualified in the Democratic Republic of Congo misled
the Post-Graduate Education and Training Committee (PGETC) for Medicine into registering
him as a neurosurgeon (Bateman, 2012:626). The particular doctor, Nyunyi Katumba, practiced
for four years under probation in three of Gauteng’s hospitals from 2007, after the HPCSA’s
registration process had failed in its gatekeeper mission to protect the public. It was later
verified that Katumba was a General Practitioner from Kinshasa (DRC). Katumba had apparently
been dismissed in Zimbabwe and Botswana before he was cleared to work in South
African hospitals as a neurosurgeon, for which he had no qualification
(Moselakgomo, 2012:7).
The issue of bogus medical doctors is a problem in developing and developed countries,
including the USA, the UK, Australia, and New Zealand. However, people in developing
countries, such as South Africa and other African countries, are more vulnerable to these bogus
doctors, partly owing to the huge burden of disease on the continent (Seggie, 2013:207).
According to HR Future (2015:1), the incidence of fraudulent qualifications, across the board,
runs between 15 % and 18 %, and the medical profession is one of the most-targeted fields for
credentials fraud.
Academic investigations have not pinpointed any research material which has linked bogus
doctors and medical malpractice litigation, but it can be concluded that the likelihood of fake
doctors making life-threatening mistakes in their work is high, and that this can lead to deaths.
For example, the bogus neurosurgeon, Katumba, returned to practice after his victory at the
CCMA and worked with Dr Lekgwara who could not help but notice Katumba’s poor surgical
skills (Bateman, 2012:628).
The awareness of South Africans about their constitutional rights, especially with regard to
healthcare, has increased, especially following the HPCSA’s awareness campaign (Medical
Protection Society, 2013). It is also argued that in the past there existed an unwritten contract
between doctor and patient: the doctors were altruistic and they acted in the best interest of the
patient and they were not being challenged or sued (Howarth et al., 2013:1).
Patients in South Africa are now being encouraged to be more aware of their rights and to
exercise them well, and this has had an impact on clinical negligence awards. According to
Howarth et al. (2013:1), the rise in clinical negligence claims stems from heightened patient
awareness, which has been attributed to the HPCSA’s nationwide campaign and claimant
lawyer attention, rather than from the deterioration of the quality of care offered by
healthcare professionals.
Consequences of Medical Malpractice
Medical malpractice litigation has affected healthcare systems in most countries (Black,
2007:437). Laws have been tabled and some have already come into effect in other countries
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and these are meant to protect patients against doctors and nurses who do not perform their
duties with utmost care (Anderson, 2005:3).
According to Black (2007:437), the medical and legal professions have similar goals, which is to
do their best for the patient. However, when the patient of a doctor now becomes the client of a
lawyer, the medical goal of providing appropriate and safe care may somehow be distorted. The
occurrence of medical malpractice has furthermore led to rising medical insurance premiums, a
trend that has been taking place across the world (Sharkey, 2005:405). Major consequences of
medical malpractice are discussed in the following sub-sections.
High Medical Insurance Costs for Doctors
The increase in medical negligence litigation has had a negative impact on insurance costs for
medical practitioners in South Africa. According to Child (2015:1), there are only three pediatric
neurosurgeons in the country and all of them work in the public sector, because soaring medical
insurance costs have made it impossible for these specialists to survive in private practice. In
2012, medical doctors had to pay as much as R220 000 a year in medical insurance
premiums as more and more South Africans sued doctors for malpractice (City Press, 2012:3).
Child (2015:1) has indicated that since 2013, gynecologists’ insurance rates have increased by
60 %, and at the beginning of 2015, their insurance costs climbed to R450 000. In the United
States, there are ongoing public debates in which medical professional argue that the issue of
medical malpractice crises is resulting in rising liability costs, which consequently impact on
patients’ access to healthcare.
According to Mello, Studdert, DesRoches, Peugh Zapert, Brennan and Sage (2005:621),
healthcare providers have argued that the liability environment is not only a problem for
doctors and hospitals, but has also become a serious public health problem because liability
costs are either driving medical practitioners out of work, or medical practitioners cease to offer
high-risk services.
The quality of healthcare is threatened as many medical professionals now view their patients as
legal risks (City Press, 2012:3).
Defensive Medicine
The rise in medical malpractice lawsuits has given rise to defensive medicine. Manner
(2007:2) states that defensive medicine occurs when medical practitioners order tests, procedures
or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or only for that
reason) to minimize their exposure to malpractice liability.
Defensive medicine has been described by Ogunbanjo and Bogaert (2014:6) as the practice of
diagnostic or therapeutic measures conducted primarily as a safeguard against any possible
malpractice liability, rather than to ensure the health of the patient.
Doctors have argued that healthcare costs will continue to rise rapidly, as long as medical
malpractice payouts are not capped. However, Hermer and Brody (2009:471) have argued that
this is not the case, as they have concluded that a reform of laws concerning medical malpractice
suit payouts is an insufficient mechanism for containing costs.
Rising Medical Costs
The rise in medical malpractice lawsuits has already impacted on the cost and affordability of
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healthcare in many countries, including South Africa. The increase in medical malpractice
lawsuits has driven up the costs of insurance premiums for doctors and this has inevitably led
to an increase in the costs of healthcare throughout the world (Kessler, 2011:94). The
Congressional Budget Office (CBO) has estimated that the entire cost of the malpractice system
accounted for about only 2 % of the overall costs of healthcare (Mehlman, 2014:1).
According to Desmon (2013:3), high malpractice payouts do not add any significant weight to
the rising costs of health care. The author, therefore, argued that in order to reduce the rising
costs of healthcare, more had to be done to reduce defensive medicine, which was accused of
raising medical costs, rather than malpractice payouts.
Doctors Avoiding other Specialty Fields
According to Mannlein (2015:9), when choosing a medical specialty, students are influenced not
only by the salary but also by the malpractice premiums payable in that particular specialty,
and by malpractice premiums in other specialty fields. According to Mello et al. (2005:621),
some doctors leave practice altogether owing to the high liability costs caused by the increase
in malpractice lawsuits and tort law. The authors argue that there is a growing risk of
people not being able to find doctors when they need one, as doctors flee practices because of
unsustainable costs.
Research has also shown that doctors have resorted to avoiding patients whom they consider to
be high risk, in addition to avoiding specialties, such as neurosurgery, which they consider
to be a high-risk specialty (Nahed, Babu, Smith & Heary, 2012:1).
Healthcare Delivery in South Africa
The old healthcare system of this country has been described as one that was fragmented, racially
biased, and which largely benefited the minority population (Naidoo, 2012:149). After the first
democratic elections were held, the efforts to establish a single, non-discriminatory healthcare
system were frustrated by the development of what could be described as a two-tiered system of
healthcare, which divided healthcare into private and public spheres (Naidoo, 2012:149).
According to Van Holdt and Murphy (2006:1), on the basis of a study conducted on eight
hospitals in South Africa, it was revealed that many patients in public hospitals were not
receiving adequate healthcare.
The South African healthcare system has undergone some restructuring since 1994 and
substantial gains have been achieved, especially in terms of access, rationalization of health
management, and more equitable health expenditure. However, these early gains are said to have
been deeply impacted upon by the vast burden of diseases related to HIV and AIDS, weak health
systems management, and low staff morale, among other reasons (Harrison, 2009:2).
The two-tiered system developed after 1994 perpetuated inequalities in the healthcare system and
did not improve the quality of healthcare (Naidoo, 2012:149). Key personnel leave the country,
causing a hemorrhaging of skills. The public health system has lost skills to the private sector
owing to poor working conditions, poor remuneration and many other reasons (Naidoo,
2012:149). Factors which affected the South African healthcare system will be discussed in the
following sub- sections.
Human Resources constraints
The South African health system is faced with major human resources constraints, which
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constitute one of the factors that impact on healthcare service delivery. South Africa has fallen
below the minimum ratios of 20 medical practitioners and 120 nurses, respectively, per
100 000 people as recommended by the WHO’s guidelines (George, Quinlan, Reardon &
Aguilera, 2011:1). South Africa has resorted to sending doctors for training in Cuba in order to
increase the number of doctors (Bateman, 2013:603). George et al. (2011:2) argue that a middleincome country such as South Africa is expected to have a ratio of 180 doctors p e r
1 0 0 000 people. According to B a t e m a n ( 2013:603), S o u t h A f r i c a currently produces
1:300 doctors a year.
The country’s healthcare system is also experiencing a shortage of nurses, which is an
international phenomenon and is not restricted to South Africa (Wildschut &
Mqolozana, 2008:6). The high turnover of nurses contributes to the current shortages of these
scarce skills (Makoka, Oosthuizen & Ehlers, and 2010:1025). The shortage of nurses in South
Africa is attributed to a decline in the enrolment in nursing colleges across the country
(Makoka et al., 2010:1025). Figure 2.1 below sets out statistics which indicate the decline in
enrolment in nursing schools between 1996 and 2004.
Figure 0.1: Declining Enrolment in Nursing Schools
Source: Rispel (2008:10)
The human resource constraint in South Africa’s healthcare system which has led to a shortage
of specialists is attributed to a number of reasons, which include (Breier, 2008:38):
Poor working conditions;
Although better qualified, Senior Specialists are earning the same salaries as Chief
Specialists and this motivates specialist medical personnel to seek better opportunities and leave.
The problem of a shortage of healthcare workers is an African problem, according to Ryan
(2011:3); while African countries constitute 11 % of the world’s population, they only have +/3 % of the world’s population of healthcare professionals. The lower numbers of doctors and
nurses who remain in the system are not able to sustain high standards of healthcare.
Brain Drain in the Medical Field
South Africa’s healthcare system is negatively affected by the brain drain, with hundreds of
qualified medical personnel leaving the country. According to Shinn (2008:1), there is a well157
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known inclination for migration of highly educated Africans from developing countries to the
developed world. A newspaper report in 2004 estimated that by 2006, 40% of physicians
would have left South Africa to seek employment elsewhere in the world (Bezuidenhout,
Joubert & Struwig, and 2009:212). It was reported in 2008 that a third to a half of all graduating
doctors in South Africa migrated to the US, the UK and Canada (Shinn, 2008:1). Medical
practitioners who left the country had apparently left for various reasons, which are indicated in
the Table 2.1 below. The figures in the table were obtained during research conducted by
Bezuidenhout et al. (2009:213). Table 2.1 below indicates the top reasons why medical
practitioners had left South Africa for greener pastures.
Table 0.1: Top 10 Reasons for Medical Doctors left South Africa
Reasons selected (rated 4 or 5 on a scale of 1to 5)
Responses % (population of 29)
Financial reasons
86.2
Better job opportunities
79.3
High crime rate
75.9
Wanted to change immediate circumstances
58.6
Personally wanted experience something new
55.2
Feeling of restlessness regarding working conditions
55.2
Extended working hours
55.2
High prevalence of HIV/AIDS
51.7
South African Income tax system
51.7
Better schooling opportunities for children abroad
50.0
Source: Bezuidenhout et al. (2009:213)
Burden of Disease
The South African healthcare system is suffering from the burden of disease. HIV and AIDS
is wreaking havoc in the country’s health delivery system. According to Naidoo (Naidoo,
2012:1), the country faces a massive burden of diseases which are made up of HIV and
AIDS, TB, maternal and childhood diseases, and non-communicable diseases. The
country’s healthcare system is also burdened by injuries caused by interpersonal violence
and motor vehicle accidents, by mental health disorders related to alcohol and drugs such as tik,
and by chronic diseases (Househam, 2010:2). The burden of disease is further complicated by
the shortage of key human resources in the health sector. Bradshaw (2007:17) states that HIV is
a major cause of burden of disease in children and can be expected to continue into the coming
years.
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Figure 0.2: Projected Impact of HIV & AIDS Deaths and Orphans in South Africa
Source: Bradshaw (2007:18)
In 2007, South Africa had the second-highest numbers of people with AIDS in the world, as
indicated in Table 2.2 below. The figure indicates that the country’s health care system is
under immense pressure as it has a responsibility to provide healthcare to all the people infected
with AIDS, and at the same time it has to take care of other diseases that affect citizens (Brennan,
2007:11).
Table 0.2: Global AIDS figures in 2007
Rank
Country
Number of Persons
1
India
5 700 000
2
South Africa
5 500 000
3
Nigeria
2 900 000
4
Mozambique
1 800 000
5
Zimbabwe
1 700 000
6
Tanzania (United Republic)
1 400 000
7
Kenya
1 300 000
8
United States
1.200 000
9
Zambia
1.100.000
10
Congo (DRC)
1 000.00
Source: Brennan (2007:11)
Table 2.2 above indicates that South Africa had the second largest population of people with
AIDS in the world and this contributed to the country’s huge burden of disease. According to
a report in the Mail and Guardian, South Africa has the highest numbers of new infections and
HIV incidence in the world (Malan, 2014:1). In 2012, the country had 6.4 million people who
lived with HIV and this figure represented a quarter of the HIV infections in Sub-Saharan Africa
(Malan, 2014:1). The ravaging effects of HIV and AIDS in South Africa compound the
challenges that already face the country’s healthcare system.
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Poor Management Skills in Public Healthcare
Poor management skills found in those who are in management positions constitute a major
challenge. According Brennan (2007:20), planning and management skills are still weak at all
levels in the country’s health care system and the problem is especially worse in the public
hospitals. The development of leadership skills in the public healthcare system is a priority for
the government as a way of creating an efficient h e a l t h c a r e s y s t e m a n d i m p r o v i n g
s t a f f m o r a l e ( Engelbrecht & C r i s p , 2010:198). A report which appeared in one of the
online daily newspapers indicated that poor management was one of the contributing factors to
the poor health system, and not the lack of funds, as many people would think (Makhohlwa,
2013:1). The report used the example of the Chris Hani Baragwaneth Hospital (‘Bara’) in
Soweto, which is the country’s biggest hospital with 2 888 beds, and which had been suffering
from poor management for years, and had five CEOs in the past 10 years.
Some of the problems at Bara included theft of food, medicine and linen; broken equipment;
leaking water taps; and dirty, unusable toilets. Doherty (2014:3) has argued that public hospital
management reform in South Africa holds the keys to the country’s health system. Poor hospital
management includes poor human resources management, which slows down appointments
of clinical personnel and places undue pressure on staff (Doherty, 2014:11). Furthermore,
medical facilities in the rural areas are said to be run by incompetent management (Sean,
2012:1).
RESEARCH METHODOLOGY
Grove and Burns (2013:214) state that a research design gives you more control and helps in
enhancing the validity of the study. The choice of research design has far- reaching implications
for the research process and when an inappropriate research design is selected, it complicates the
research process. A research design, therefore, contains many elements which make the
research journey simpler to travel, and includes the research methodology, sampling strategy
and data collection method. Bechhofer and Paterson (2000:52) remind researchers that the choice
of a research design always takes place under constraints, such as financial and time limitations,
and these have an influence on the research.
Target Population
Johnson and Christensen (2012:291) defined a target population as being the larger population to
whom the study results are to be generalised. The term ‘target population’ has also been
described as being the group that is theoretically available to whom you expect to
generalised the research findings (Wood & Ross-Kerr, 2011:152). The target population in
the research was made up of registered nurses and doctors from two Gauteng Province public
hospitals, totaling 244 people. These represent the number of doctors and nurses who are actively
working in the two institutions and who were available for the survey. (Phakathi, 2014:85). Gill
and Johnson (2002:163) indicated that there are two main groups of validity and these are
internal and external validity. According to Beri (2008:120), internal validity is best improved
by using experts in the design of a research instrument. In this research, internal validity was
enhanced by asking former MBA research students to judge the validity of the research.
External validity is defined as the extent to which the results from a study can be generalised to
other populations and environments (Cozby & Bates, 2012:174).
Limitations of the Study
Virtually all research conducted has limitations (Crosby, DiClemente & Salazar, 2006:87) and
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this research study could not escape limitations. Not all hospitals in Gauteng could partake in the
study, and not all health professionals could be accommodated, owing to time and resource
constraints. The study utilised a few books that were more than five years old because of the
unavailability of newer books in the public libraries and University libraries which the
researcher visited. The researcher relied mostly on the internet to access new books and current
research journals.
RESULTS, DISCUSSIONS AND INTERPRETATION OF FINDINGS
Cronbach’s Reliability Test
A test for reliability was conducted on the data using the Cronbach’s Alpha. The
Cronbach’s Alpha is described as a popular measure for the internal consistency reliability of a
group of items (Andrew, Pedersen & McEvoy, 2011:202). The Cronbach’s Alpha
assumes that all items have equal reliabilities (Von Pock, 2007:90). According to Andrew
et al. (2011:202), it measures how well a set of variables o r i t e m s m e a s u r e s a
s i n g l e , o n e -dimensional l a t e n t construct. The Cronbach’s Alpha is a figure between 0
and 1, and when the figure is closer to one it points to high levels of reliability (Tabaco &
Dennick, 2011:53). The results obtained in the reliability test conducted using SPSS software are
presented in Table 4.1 below.
Table 0.1: Cronbach’s Alpha
Reliability Statistics
Cronbach’s
Alpha
N of Items
.802
27
The theory according to Tavakol and Dennick (2011:53) states that the closer the Cronbach’s
Alpha is to one, the higher the reliability is. The Cronbach’s Alpha for the reliability test was
0.802, which is nearer to 1, meaning that the data used in this study w a s h i g h l y r e l i a b l e .
Tavakol a n d D e n n i c k ( 2011:54) i n d i c a t e t h a t t h e acceptable values of alpha range
from 0.7 to 0.95, further indicating that the alpha in this study (0.802) shows that the reliability is
acceptable.
Demographic Results
The questionnaire was designed in such a way that it first posed demographic questions to the
respondents before it delved into the questions which addressed the research problem. The
demographic questions asked about gender, age, functional level, work position and work
experience. These questions were asked in order to gauge the demographics of the respondents.
Gender of Respondents
The respondents’ gender distribution is presented in the pie chart in Figure 4.1 below.
84.1%
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Male
Female
Figure 0.1: Gender of Respondent
The gender breakdown shows that 84.1 % (90) of the 107 respondents were female and 15.9
percent (17) were male. The results show that more women are working as doctors and nurses in
public hospitals than men are.
Age of Respondents
The respondents were asked to provide their ages on the questionnaires administered to them and
the responses are indicated in the frequency table presented in Table 4.2 below.
Table 0.2: Age of Respondents
18-25 years
26 – 35 years
36 – 45 years
Valid 46 -50 years
50 years + Untitled
Total
Frequen
cy
12
%
11.2
Valid %
11.2
Cumulative %
11.2
29
27.1
27.1
38.3
38
21
35.5
19.6
35.5
19.6
73.8
93.5
6
1
5.6
.9
5.6
.9
99.1
100.0
107
100.0
100.0
The results indicated that 11.2 % of the respondents were aged between 18 and 25 years,
27.1 % were aged between 26 and 35 years, and 35.5 % were aged between 36 and 45 years.
The results indicated that 19.6 % of the respondents were aged between 46 and 50 years, while
only 5.6 % were aged over 50 years. The results showed that the majority of the healthcare
professionals working in the two hospitals were aged between 36 and 45 years.
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Staff Level
The 107 respondents were asked to indicate their respective staff levels within their work places
and the results obtained are presented in the frequency table, 4.3 below.
Table 0.3: Staff Level
Frequency
%
Valid %
Cumulative %
Junior
48
44.9
44.9
44.9
Senior
44
41.1
41.1
86.0
Valid
Management
15
14.0
14.0
100.0
107
100.0
100.0
Total
The results presented in Table 4.3 above indicated that 44.9 % were junior staff, 41.1 %
were senior staff, and 14 % were part of management. The results pertaining to staff level
indicate that the majority of those that took part in the research were junior staff members
followed by senior staff members.
Position
The respondents were asked to indicate the respective positions that they held within the
organisations that they worked for. They were essentially choosing between doctors and nurses,
and the results are presented in the pie chart set out in Figure 4.2 below.
Nurses
Doctors
Figure 0.2: Position
The results presented in Figure 4.2 above indicated that 85 % (91) were nurses and 15 % (16)
were doctors. The research indicated that the majority of participants were nurses. This is a
consequence of the fact that, in the nature of things, hospitals require the services of more
nurses than doctors.
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Work Experience
The respondents were asked about their work experience in their organisations. The results are
Table 0.4: Work Experience
0 – 5 years
6 – 9 years
10 – 14
years
15 + years
Total
Frequency
32
%
29.9
Valid %
29.9
Cumulative %
30.8
31
29.0
29.0
59.8
42
39.3
39.3
99.1
1
107
.9
100.0
.9
100.0
100.0
The results indicated that 29.9 % of respondents had work experience ranging between 0
and 5 years, and 29.0 % had work experience of between 6 and 9 years. The results revealed that
39.3 % had work experience ranging between 10 and 14 years, and that only 0.9 % of the
respondents had experience of more than 15 years. The majority of the respondents had
experience of between 10 and 14 years. The lengthy work experiences of the majority of the
these respondents imply that the majority had gained much by virtue of their experience and
accordingly are more likely to give a better view of trends and the impact of skill and expertise.
Therefore, their views might help in reducing incidences of medical malpractice in their
institutions more than would those with the least experience.
State of Malpractice Litigation in South Africa
Section B of the questionnaire was aimed at finding out what the respondents felt about the state
of malpractice litigation in South Africa. Four questions were asked under this section.
Current State of Medical Profession in South Africa
The respondents were asked what they felt about the current state of the medical profession in
South Africa. The responses are presented in the frequency table, 4.5 below.
Table 0.5: Current State of Medical Profession in South Africa
Very Positive
Frequenc
y
23
21.5
21.5
21.5
50
46.7
46.7
68.2
26
24.3
24.3
92.5
7.5
100.0
Somewhat Positive
Valid
Somewhat Negative
%
8
Very Negative
107
Valid %
7.5
100.0
164
100.0
Cumulative %
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The results in Table 4.5 above indicate that 21.5 % of the respondents were very positive
about the state of the medical profession in South Africa, while 46.7 % were somewhat positive.
The results show that 24.3 % of the 107 respondents were somewhat negative and 7.5 % was
very negative. The results revealed that the majority of the respondents were somewhat
positive regarding the state of the medical profession in the country.
Morale of Healthcare Professionals
The respondents were asked what they thought about the morale levels in their respective
workplaces. The results are presented in Table 4.6 below.
Table 0.6: Morale of Healthcare Professionals
Very positive
Frequenc
y
28
%
Valid %
Cumulative %
26.2
26.2
26.2
42
39.3
39.3
65.4
28
26.2
26.2
91.6
8
7.5
7.5
99.1
107
100.0
100.0
Somewhat positive
Valid Somewhat negative
Very negative
The results in Table 4.6 above reveal that 26.2 % of respondents were very positive about
levels of morale, and 39.3 % were somewhat positive. The results show that 26.2 % were
somewhat negative with regard to the morale levels of healthcare professionals, and 7.5 %
were very negative. The results indicate that the majority of the respondents were somewhat
positive with regard to the morale levels of healthcare professionals. The majority of the South
African healthcare professionals were happy, indicating that despite the challenges they were
facing, they were still happy with their work environment. Harrison (2009:2) has stated that the
South African healthcare sector was suffering from low staff morale, among other things. This
was partly responsible for the deteriorating quality of healthcare services. This is in accord with
the outcome of the study which indicates that 50 % of respondents are in agreement that
employees experience low morale.
Seriousness of Medical Malpractice in South African Healthcare System
The respondents were asked about whether they thought medical malpractice was a serious issue
in the South African healthcare system. The results are presented in the frequency table 4.7
below:
Table 0.7: Seriousness of medical malpractice in South Africa
Mostly agree
Frequency
%
58 54.2
Valid %
39 36.4
Somewhat agree
Valid Somewhat disagree
Mostly disagree Total
6
4
107
5.6
3.7
100.0
165
100.0
Cumulative %
54.2
54.2
36.4
90.7
5.6
3.7
96.3
100.0
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The results presented in Table 4.7 above disclose that 54.2 % of the respondents mostly agree
that medical malpractice is becoming a serious issue in the South African healthcare
system, while 36.4 % somewhat agree. The results showed that 5.6 % somewhat disagreed,
while 3.7 % mostly disagreed. The extent of the medical litigation issue led to Health
Department holding a litigation summit on 9 March 2015 to discuss the causes, extent, impact
and recommendations (Citizen, 2015:1) The Gauteng Health Department is facing negligence
claims amounting to R1.28 billion for the 2012/2013 financial year (Health24.com, 2015:1).
These amounts of these claims clearly indicate the seriousness of the litigation facing the Health
Department.
Medical Negligence on the Increase
The respondents were asked whether they thought medical negligence was on the increase in
South Africa. The results are presented in the frequency table, 4.8 below.
Table 0.8: Medical Negligence on the Increase
Mostly agree
Somewhat agree
Valid Somewhat
disagree Mostly disagree
Total
Frequenc
y
50
%
46.7
Valid %
46.7
Cumulative %
46.7
35
14
32.7
13.1
32.7
13.1
79.4
92.5
8
107
7.5
100.0
7.5
100.0
100.0
The results in Table 4.8 above show that 46.7 % mostly agreed that medical negligence
was on the rise, while 32.7 % agreed. The results indicate that 13.1 % of the respondents
somewhat disagreed, and 7.5 % mostly disagreed. The results reveal that the majority of the
respondents mostly agreed that medical negligence was on the rise. According to Bateman
(2011:216), the highest medical negligence claims in South African history were experienced
between 2006 and 2010. A report in 2011 indicated that medical negligence payouts had soared
by 132% since 2006, amounting to R573 million.
Causes of Medical Malpractice
Section D of the questionnaire posed statements which were meant to ascertain what the
causes of medical malpractice were. A total of eleven statements were posed under this section.
Skills Shortages
The respondents were asked whether skills shortages in the healthcare system might be
one of the causes of medical malpractice. The results are presented in Table 4.9 below.
Table 0.9: Skills Shortage
Frequency
46
%
43.0
Valid %
43.0
Cumulative %
43.0
Agree
38
7
35.5
6.5
35.5
6.5
78.5
85.0
Neutral
Valid
Disagree
11
5
10.3
4.7
10.3
4.7
95.3
100.0
107
100.0
100.0
Strongly Agree
The results presented in Table 4.9 above disclose that 43.0 % of the respondents strongly
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agreed that skills shortage was a contributing factor to medical malpractice, and 35.5 % agreed.
The results indicated that 6.5 % neither agreed nor disagreed, while 10.3 % disagreed and
4.7 % strongly disagreed. The results indicate that the majority of the respondents (78.5 %)
believed that skills shortages caused medical malpractice. The skills shortage in the country has,
among other things, resulted in bogus medical doctors entering the healthcare sector.
Under-qualified Medical Professionals
The respondents were asked whether they believed that under-qualified medical professionals
contributed to the increase in medical malpractice. The results are presented in Table 4.10 below.
Table 0.10: Under-qualified medical professionals
Strongly Agree
Agree
Neutral
Valid
Disagree
Frequency
31
%
29.0
Valid %
29.0
Cumulative %
29.0
35
32.7
32.7
61.7
23
13
21.5
12.1
21.5
12.1
83.2
95.3
5
107
4.7
100.0
4.7
100.0
100.0
The responses indicated that 29.0 % strongly agreed, 32.7 % agreed, 21.5 % neither neither
agreed nor disagreed, while 12.1 % disagreed and 4.7 % strongly disagreed. The results
revealed that the majority of the respondents agreed that under-qualified medical
professionals contributed towards the rise in medical malpractice.
Inexperienced Healthcare Practitioners
The respondents were asked whether they thought that inexperienced healthcare practitioners
contributed to the rise in medical malpractice. The results are presented in the frequency table,
4.11 below.
Table 0.11: Inexperienced Healthcare Practitioners
Frequen
cy
32
%
29.9
Valid %
29.9
Cumulative %
29.9
Agree
44
14
41.1
13.1
41.1
13.1
71.0
84.1
Neutral
Valid
Disagree
14
3
13.1
2.8
13.1
2.8
97.2
100.0
107
100.0
100.0
Strongly agree
The results presented in Table 4.11 above disclose that 29.9 % strongly agreed, 41.1 %
agreed, 13.1 % neither agreed nor disagreed, 13.1 % disagreed, and 2.8 % strongly disagreed.
The results indicate that the majority of the respondents felt that inexperienced healthcare
practitioners caused medical malpractice. According De Beer, Brysiewicz and Bhengu (2011:1),
errors in the healthcare institutions are most likely to be made by inexperienced nurses.
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Practicing Above Professional Scope
The respondents were asked whether they attributed the rise in medical malpractice to poor
training of medical practitioners. The results are presented in the Table 4.12 below.
Table 0.12: Practicing Above Professional Scope
Strongly agree
Frequency
29
%
27.1
Valid P%
27.4
Cumulative %
27.4
34
31.8
32.1
59.4
16
20
15.0
18.7
15.1
18.9
74.5
93.4
6
106
107
5.6
99.1
100.0
5.7
100.0
99.1
Agree
Neutral
Valid
Disagree
Strongly disagree
The responses indicated that 27.1 % strongly agreed, 31.8 % agreed, 15.0 % neither agreed nor
disagreed, while 20 % disagreed and 5.6 % strongly disagreed. The results revealed that a
total of 58.9 % of the respondents agreed that practicing above their professional level or
scope by medical practitioners contributed to medical malpractice.
Poor Training of Medical Practitioners
The respondents were asked whether they thought that poor training of practitioners contributed
to medical malpractice. The results are presented in Table 4.13 below.
Table 0.13: Poor Training Medical Practitioners
Strongly Agree
Agree
Neutral
Valid Disagree
Strongly Disagreed
Total
Frequency
29
%
27.1
Valid %
27.1
Cumulative %
27.1
29
27.1
27.1
54.2
28
11
26.2
10.3
26.2
10.3
80.4
90.7
9
8.4
8.4
99.1
107
100.0
100.0
The responses indicated that 27.1 % strongly agreed, 32.7 % agreed, 21.5 % neither agreed nor
disagreed, while 12.1 % disagreed and 4.7 % strongly disagreed. The results revealed that the
majority of the respondents agreed that poor training contributed to the rising medical
malpractice. Bogus nurse training colleges are also responsible for generating a flow of poorly
trained nurses. According to Fanele (2015:2), a bogus nursing college in KwaZulu-Natal had
been closed after it had defrauded hundreds of aspiring nurses, who later realized that they had
been given fake certificates.
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Irrational or Unreasonable Patients
The respondents were asked whether t h e y
towards the rise in medical malpractice.
felt that unreasonable patients contributed
Table 0.14: Irrational or Unreasonable Patients
Strongly agree
Agree
Neutral
Valid
Disagree
Frequency
50
%
46.7
Valid 5
46.7
Cumulative %
46.7
33
30.8
30.8
77.6
13
7
12.1
6.5
12.1
6.5
89.7
96.3
4
107
3.7
100.0
3.7
100.0
100.0
The results presented in Table 4.14 above revealed that 46.7 % strongly agreed, 30.8 %
agreed, 12.1 % were neutral with regard to the statement, 6.5 % disagreed, while 3.7 % strongly
disagreed. The majority of respondents (77.5 %) agreed that unreasonable patients were a huge
contributing force in medical malpractice.
More Negligence in Public Hospitals than in Private Ones
The respondents were asked whether they thought that negligence was more concentrated in the
public sector than in the private sector. The results are presented in Table 4.15 below.
Table 0.15: More Negligence in Public Hospitals than in Private Ones
Strongly Agree
Agree
Neutral
Valid
Disagree
Strongly Disagree
Total
Frequency
27
%
25.2
Valid %
25.2
Cumulative%
25.2
29
27.1
27.1
52.3
21
17
19.6
15.9
19.6
15.9
72.0
87.9
13
107
12.1
100.0
12.1
100.0
100.0
The results in Table 4.15 above indicate that 25.2 % strongly agreed, 27.1 % agreed, 19.6 %
neither agreed nor disagreed, 15.9 % disagreed, while 12.1 % strongly disagreed. The
results revealed that the majority of respondents (52.3 % agreed that there was more negligence
in the public healthcare sector than in the private sector. Between January and September of
2014, a total of 532 cases were reported as emanating from Chris Hani Baragwaneth, Charlotte
Maxeke, Dr George Mukhari, and Steve Biko Pretoria hospitals (City Press, 2014:1). However,
the Health Minister, Dr Motsoaledi, reported at the Litigation Summit held in Pretoria that the
increase is experienced equally in the public and private sector. An example is a claim made
against Dr R Miya, at one of Netcare hospitals, who was sued for R9 m for pain and suffering
endured by a Maseko baby who waited skin cloning (City Press, 2015:1).
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Overcrowding in Public Hospitals and Malpractice Incidences
The respondents were asked whether they felt that overcrowding in the public hospitals was also
to blame for the increase in malpractice litigation. The results are presented in Table 4.16 below.
Table 0.16: Overcrowding in Public Hospitals and Malpractice Incidences
Strongly agree
Frequency
66
%
61.7
Valid %t
61.7
Cumulative %
61.7
29
6
4
2
107
27.1
5.6
3.7
1.9
100.0
27.1
5.6
3.7
1.9
100.0
88.8
94.4
98.1
100.0
Agree Neutral Disagree
Strongly disagree
Valid Total
The results in Table 4.16 above indicate that 61.7 % of respondents strongly agreed and 27.1 %
agreed, while 5.6 % neither agreed nor disagreed with the statement. The results further revealed
that only 3.7 % disagreed and 1.9 % strongly disagreed with this assertion. The results
convincingly indicated that the majority of the respondents attributed the rise in medical
malpractice in public hospitals to overcrowding. South African state-funded hospitals are
poorly resourced, overcrowded and underfunded, and this contributes to the poor healthcare
experienced in the public healthcare sector (Rosedale, K; Smith, ZA; Davies, H; Wood, D,
2011:1).
Negative or Bad Attitudes of Healthcare Professionals
The respondents were asked whether they felt that the negative or bad attitudes of some
healthcare professionals contributed towards the increase in malpractice litigation. The results are
Table 0.17: Negative or Bad Attitudes of Healthcare Professionals
Frequency
29
%
27.1
Valid %
27.1
Cumulative %
27.1
Agree
27
30
25.2
28.0
25.2
28.0
52.3
80.4
Neutral
Valid
Disagree
12
8
11.2
7.5
11.2
7.5
91.6
99.1
107
100.0
100.0
Strongly agree
The results in Table 4.17 above show that 27.1 % of the respondents strongly agreed that
the negative or bad attitudes of some healthcare professionals contributed to the increase in
medical malpractice. Another 25.2 % agreed, 28.0 % neither agreed nor disagreed, 11.9 %
disagreed, while 8 % strongly disagreed. The results revealed that the majority of the
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respondents (52.3 %) agreed that the negative attitudes of some healthcare professionals
contributed towards the rise in medical malpractice.
Shortage of Medical Equipment
Shortage of equipment is one claim that was made by the researcher as being a contributing
factor towards the increase in medical malpractice in the country. When the respondents were
asked about whether they thought a shortage of necessary equipment contributed towards
malpractice, the responses in Table 4.18 below were obtained.
Table 0.18: Shortage of necessary Medical Equipment
Strongly agree
Agree
Neutral
Valid
Disagree
Frequency
62
%
57.9
Valid %
57.9
Cumulative %
57.9
31
29.0
29.0
86.9
10
2
9.3
1.9
9.3
1.9
96.3
98.1
2
107
1.9
100.0
1.9
100.0
100.0
The responses indicated that 57.9 % strongly agreed that a shortage of medical equipment
contributed towards the rise in medical malpractice. The results revealed that 29.0 % of
respondents agreed, 9.3 % neither agreed nor disagreed, while 1.9 % disagreed and 1.9 %
strongly disagreed. The results revealed that the majority of the respondents agreed that a
shortage of medical equipment was another variable to blame for the rise in medical malpractice
in South Africa. The Chris Hani Baragwaneth Hospital, one of the biggest public hospitals in
South Africa, has experienced an array of problems, which include broken equipment
(Doherty, 2014:11).
Patient’s awareness of their rights
The respondents were asked whether they thought that the improved awareness by patients of
their rights contributed towards the increase in medical malpractice litigation. The results are
Table 0.19: Patients awareness of their rights
Frequency
35
%
32.7
Valid %
32.7
Cumulative %
32.7
Agree
24
28
22.4
26.2
22.4
26.2
55.1
81.3
Neutral
Valid
Disagree
13
7
12.1
6.5
12.1
6.5
93.5
100.0
107
100.0
100.0
Strongly agree
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The responses revealed that 32.7 % of the respondents strongly agreed that the increase in
patients’ awareness of their rights contributed towards the rise in medical malpractice claims.
The results revealed that 22.4 % of respondents agreed, a noteworthy 26.2 % neither agreed nor
disagreed, 12.1 % disagreed and 6.5 % strongly disagreed. The results indicated that a total of
55.1 % of the respondents, who formed the majority, agreed that the increase in patients’
awareness of their rights was linked to the increase in malpractice litigation in the country. The
awareness of the South African people about their constitutional rights, especially with regard
to healthcare, has particularly increased f o l l o w i n g t h e H P C S A ’ s awareness campaign
(Medical Protection Society, 2013).
Impact of Medical Malpractice on Healthcare System
Section E was designed to find out if medical malpractice had an impact on the healthcare
system. The section had ten questions.
Decrease in Trust in Public Healthcare
The first statement endeavoured to ascertain whether the respondents thought that medical
malpractice resulted in a decrease in trust in the public healthcare system. The results are
presented in the frequency table, 4.20, below.
Table 0.20: Decrease in trust in public healthcare
Strongly agree
Agree
Neutral
Valid
Disagree
Frequency
39
%
36.4
Valid %
36.4
Cumulative %
36.4
39
36.4
36.4
72.9
19
9
17.8
8.4
17.8
8.4
90.7
99.1
1
107
.9
100.0
.9
100.0
100.0
Table 4.20 above revealed that 36.4 % of the 107 respondents strongly agreed, and 36.4 % of
respondents agreed, that medical malpractice was resulting in a decrease in trust in the public
healthcare. The results showed that 17.8 % of the respondents neither agreed nor disagreed with
the claim, 8.4 % disagreed and 0.9 % strongly disagreed. The majority of the respondents
(72.8 %) agreed that medical malpractice was resulting in a decline in trust in the public
healthcare system.
Increase in the Cost of Healthcare
The respondents were asked whether they thought that medical malpractice litigation was
responsible for increasing costs in healthcare in South Africa. The results are presented in Table
4.21 below.
Table 0.21: Increase in cost of healthcare
Frequency
%
172
Valid %
Cumulative %
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Strongly agree
Agree
Neutral
Valid
Disagree
50
46.7
46.7
46.7
36
33.6
33.6
80.4
13
7
12.1
6.5
12.1
6.5
92.5
99.1
1
107
.9
100.0
.9
100.0
100.0
The responses indicated that 46.7 % of respondents strongly agreed that medical malpractice
litigation was resulting in an increase in the costs of healthcare. The results revealed that
33.6 % of respondents agreed, 12.1 % neither agreed nor disagreed, 6.5 % disagreed, and
only 0.9 % strongly disagreed. The results disclosed that an overwhelming 80.3 % of
respondents believed that medical malpractice was resulting in an increase in the costs of
healthcare. Defensive medicine is the practice of carrying out diagnostic or therapeutic
measures conducted primarily as a safeguard against any possible malpractice liability, rather
than to ensure the health of the patient (Ogunbanjo & Bogaert, 2014:6).
Healthcare Institutions Negatively Impacted by Malpractice Litigation
The respondents were asked whether they felt that malpractice litigation was having negative
effects in the healthcare system, which included employees leaving the sector and increases in
running costs. The results are presented in Table 4.22 below.
Table 0.22: Healthcare institutions are negatively impacted
Strongly agree
Agree
Neutral
Valid
Disagree
Strongly disagree
Frequency
46
%
43.0
Valid %
43.4
Cumulative %
43.4
37
34.6
34.9
78.3
16
6
15.0
5.6
15.1
5.7
93.4
99.1
1
106
107
.9
99.1
100.0
.9
100.0
100.0
Table 4.22 above revealed that 43.0 % of the 107 respondents strongly agreed, and 34.6 %
agreed, that healthcare institutions were negatively impacted on by malpractice litigation in a
number of ways, which included employees leaving the sector. The results showed that
15.0 % of the respondents neither agreed nor disagreed with the claim, 5.6 % disagreed,
and 0.9 % strongly disagreed. The majority of the respondents (77.6 %) agreed that medical
malpractice was negatively impacting on healthcare institutions and had resulted in
employees leaving the sector and caused high running costs. Medical practitioners are practicing
defensive medicine because of the rising levels of malpractice litigation.
Medical Malpractice Litigation Impact on Professionals’ Morale
The respondents were asked whether they felt that medical malpractice litigation impacted
on the morale of professional healthcare personnel.
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Table 0.23: Medical Malpractice Litigation Impact on Professionals’ Morale
Frequency
%
Valid %
Cumulative %
51
47.7
48.1
48.1
39
36.4
36.8
84.9
15
14.0
14.2
99.1
1
.9
.9
100.0
106
107
99.1
100.0
100.0
Strongly agree
Agree
Valid
Neutral Disagree
Total
Total
The results in the frequency table, 4.23 above, revealed that 47.7 % of the 107 respondents
strongly agreed, and 36.4 % agreed, that medical malpractice was affecting the morale of nurses
and doctors. The results showed that 14.0 % of the respondents neither agreed nor disagreed
with the claim, and 0.9 % disagreed. The majority of the respondents (84.9 %) agreed that
medical malpractice litigation was impacting negatively on the morale of healthcare
professionals. Medical malpractice has resulted in escalating insurance costs for doctors, a rise in
the practice of defensive medicine, and a decline in morale among healthcare professionals
(Staunch, 2007:497).
Healthcare Practitioners Suffer Stress and Burnout
The researcher postulated that healthcare practitioners were now suffering from stress and
burnout because of the increase in medical malpractice litigation. The results are presented in the
frequency table, 4.24 below.
Table 0.24: Healthcare Practitioners suffer stress and burnouts
Strongly agree
Agree
Valid
Neutral
Disagree Total
Total
Frequency
61
%
57.0
Valid %
57.5
Cumulative %
57.5
33
30.8
31.1
88.7
9
3
8.4
2.8
8.5
2.8
97.2
100.0
106
107
99.1
100.0
100.0
Table 4.24 above shows that 57.0 % of the 107 respondents strongly agreed, and 30.8 %
agreed, that healthcare practitioners suffered stress and burnout. The results showed that 8.4 %
neither agreed nor disagreed with the claim, and 2.8 % disagreed. The m a j o r i t y o f t h e
r e s p o nd e nt s ( 87.8 %) agre ed t ha t h e a l t h c a r e p r a c t i t i o ne r s suffered stress and
burnout.
Malpractice Litigation Increases Employee Turnover
The respondents were asked whether malpractice litigation causes an increase in the numbers
of healthcare practitioners leaving the medical profession. The results are presented in Table 4.25
below.
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Table 0.25: Malpractice Litigation Increase Employee Turnover
Strongly agree
Agree
Neutral
Valid
Disagree
Frequency
60
%
56.1
Valid %
56.6
Cumulative %
56.6
33
8
30.8
7.5
31.1
7.5
87.7
95.3
3
2
2.8
1.9
2.8
1.9
98.1
100.0
106
107
99.1
100.0
100.0
Strongly disagree
The results in the frequency table, 4.25 above, show that 56.6 % of the 107
respondents strongly agreed and, 30.8 % agreed, that medical malpractice was resulting in an
increase in employee turnover. The results show that 7.5 % neither agreed nor disagreed,
2.8 % disagreed, and 1.9 % strongly disagreed. The majority of the respondents (86.9 %)
agreed that medical malpractice litigation was causing an increase in employee turnover in
the healthcare system. According to Sage and Kersh (2006:23), the rise in medical
malpractice litigation led to an increase in doctors exiting the medical field, and was
discouraging new entrants as well.
Malpractice Litigation discourages new entrants in Healthcare field
The respondents were asked whether malpractice litigation indeed discouraged new entrants from
going into the healthcare field. The responses collected from the 107 respondents are presented in
the frequency table, 4.26 below.
Table 0.26: Malpractice Litigation Discourage New Entrants in Healthcare
Frequency
%
Valid %
Cumulative %
Strongly agree
46
43.0
43.4
43.4
Agree
Neutral
Valid
Disagree
33
30.8
31.1
74.5
16
9
15.0
8.4
15.1
8.5
89.6
98.1
2
106
107
1.9
99.1
100.0
1.9
100.0
100.0
Strongly disagree
The results presented in Table 4.26 above indicate that 43 % of the respondents strongly
agreed with the statement above, and 30.8 % agreed. The results obtained from the
respondents showed that 15 % of respondents were not decided on whether they agreed or
not, thus their response was neutral. The results showed that 8.4 % disagreed, and 8.4 % strongly
disagreed with the assertion. The results indicate that a total of 73.8 % of the respondents who
participated agreed that malpractice litigation was discouraging new entrants to the
medical field. Medical malpractice is discouraging new entrants from going into the medical
field, and induces existing physicians to retire early (Sage & Kersh, 2006:23).
Fears of Litigation Negatively Impact on Performance
The respondents were asked whether fears of litigation negatively impacted on their
performance. The responses are itemized in Table 4.27 below.
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Table 0.27: Fears of Litigation negatively impacts on performance
Strongly agree
Agree
Neutral
Valid
Disagree
Strongly disagree
Frequency
45
%
42.1
Valid %
42.9
Cumulative %
42.9
34
31.8
32.4
75.2
11
10
10.3
9.3
10.5
9.5
85.7
95.2
3.8
99.0
4
105
2
107
3.7
98.1 100.0
1.9
100.0
Total
Table 4.27 above reveals that 42.1 % of the respondents strongly agreed with the statement
above, and 31.8 % agreed. The results obtained from the respondents show that 10.3 % of
respondents neither agreed nor disagreed with the assertion. The results show that 9.3 %
disagreed and 3.7 % strongly disagreed with the assertion. The results show that the
majority of the respondents (73.9 %) agreed that fears of malpractice litigation were negatively
impacting on their performance. The rise in medical malpractice litigation has led to medical
practitioners treating patients as legal risks and to practice defensive medicine, meaning that their
focus is no longer on giving the best medical care, but on protecting themselves from the threat
of malpractice litigation (City Press, 2012:3).
Malpractice Litigation Discourages Specialization in Affected Areas
The respondents were asked whether medical malpractice litigation was discouraging
medical professionals from specializing. The results of responses to this statement are
Table 0.28: Malpractice Litigation Discourage Specialization in Affected Areas
Strongly agree
Agree
Neutral
Valid
Disagree
Frequency
54
%
50.5
Valid %
50.9
Cumulative %
50.9
32
29.9
30.2
81.1
9
9
8.4
8.4
8.5
8.5
89.6
98.1
2
106
1
107
1.9
99.1
.9
100.0
1.9
100.0
100.0
Strongly disagree
Total Missing System
Total
The results in the frequency table, 4.28 above, reveal that 50.5 % of the respondents strongly
agreed, and 29.9 % agreed, that malpractice litigation was discouraging specialization in the
affected areas. The results showed that 8.4 % neither agreed nor disagreed with the claim, 8.4 %
disagreed, and 1.9 % strongly disagreed. The majority of respondents (81.1 %) agreed that
malpractice litigation was discouraging medical professionals from specializing in affected
areas or fields. Mello et al. (2005:621) have stated that some doctors leave med ica l
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practice altogether owing to the high liability costs caused by the increase in malpractice
lawsuits and tort law.
Medical Malpractice Litigation Negatively Impacts on Motivation
The respondents, who all work in the medical field, were asked whether malpractice litigation
was impacting negatively on their motivation. The responses are presented in Table 4.29 below.
Table 0.29: Malpractice Litigation Negatively Impact on Motivation
Strongly agree
Agree
Neutral
Valid
Disagree
Strongly disagree
Frequency
47
%
43.9
Valid %
44.8
Cumulative %
44.8
35
12
7
4
105
2
107
32.7
11.2
6.5
3.7
98.1
1.9
100.0
33.3
11.4
6.7
3.8
100.0
78.1
89.5
96.2
100.0
The results in Table 4.29 above reveal that 43.9 % of the respondents strongly agreed, and
32.7 % agreed, that malpractice litigation was impacting negatively on the motivation of
medical professionals. The results showed that 11.2 % of the respondents neither agreed nor
disagreed with the claim, 6.5 % disagreed, and 3.7 % strongly disagreed. The majority of the
respondents (81.1 %) agreed that malpractice litigation was impacting negatively on the
motivation of medical professionals.
Correlations among Variables
The researcher also compiled cross tabulations in order to find out how some of the variables
linked to malpractice litigation in the healthcare sector were related, according to the
responses of the 107 respondents working in Gauteng’s public hospitals. The findings are
discussed under this section.
View About Current State of Medical Profession and Staff Level
Cross tabulations were conducted in order to find out if there was a relationship between an
employee’s staff level and how he or she felt about the current state of the medical profession in
South Africa. The Chi-Square results are presented in Table 4.30 below
Table 0.30: Current State of Medical Profession and Staff Level
Chi-Square Tests
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Value
9.257a
11.966
Df
Asymp. Sig. (2-sided)
.160
.063
Pearson Chi-Square
6
Likelihood Ratio
6
Linear-by-Linear
.001
1
.982
Association
N of Valid Cases
107
The a b o v e c r o s s t a b u l a t i o n t e s t s
whether a r e l a t i o n s h i p e x i s t s
b e t w e e n a respondent’s Staff Level and his or her views on the current state of the medical
profession in South Africa (Section B: Question 1). The Pearson Chi-Square statistic in the
Asymp.Sig (2-sided) column is 0.160 (greater than 0.05 alpha level of significance), which
means there is a statistically insignificant relationship between these two factors. This means that
those at senior levels in the organisations studied are more likely to have a different view from
those at junior levels with regard to the state of the medical profession in South Africa.
Work Position and View on Malpractice Causing Labour Turnover
A cross tabulation was conducted to find out if there was a relationship between a
respondent’s position and whether he or she thought that malpractice litigation led to high
employee turnover.
Table 0.31: Work Position and View on Malpractice Causing Employee
Turnover
Value
Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases
Df
16.463a
13.961
7.861
Asymp. Sig. (2-sided)
3
3
1
.001
.003
.005
106
The above cross tabulations were conducted to determine if a relationship existed between a
respondent’s position and his or her view on whether malpractice litigation was causing an
increase in the numbers of healthcare practitioners leaving the medical profession. The Pearson
Chi-Square statistic in the Asymp.Sig (2- sided) column is 0.001 (lower than 0.05 alpha level
of significance), which means that there is a statistically significant relationship between these
two factors. This means that there was an association between a respondent’s positions and
how he or she felt with regard to the issue of whether malpractice litigation caused an increase in
labour turnover.
Statistically insignificant relationships
The Chi-Squared tests revealed a number of insignificant relationships among variables which
were thought to be related. It was revealed that there was no relationship between a respondent’s
position and his or her view on whether litigation had an impact on employee performance. This
indicates that there were other variables that explained the negative impact on employee
performance, besides a respondent position. A Chi-Squared test was also conducted to find out
if there was a causal relationship between a respondent’s work experience and his or her view on
whether malpractice litigation impacted on the morale of employees. The Chi-Squared tests
revealed that there was no statistically significant relationship between these variables. This,
however, signifies that there were other factors besides work experience that affected how
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respondents viewed the effect of malpractice on the morale of medical professionals in the
healthcare sector.
CONCLUSIONS AND RECOMMENDATIONS
Findings from Study
The findings from the study are divided into findings drawn from the literature study and
findings from the empirical study. These findings are presented in Section 5.2.1 and 5.2.2 below.
Literature Review Findings
The following key findings were drawn from the literature study:
Medical malpractice is caused by a number of things. Lack of professionalism has been
mooted as being one of the drivers behind the rise in medical malpractice in the South African
public health sector. Malherbe (2013:84) has argued that the decline in professionalism among
healthcare professionals has contributed towards the increase in medical malpractice litigation.
Changes in the law that brought about more inflexible legislation, which is more protective
of patients, are also contributing to the rise in malpractice litigation. Such legislation includes the
Consumer Protection Act which can result, for example in doctors being sued for correctly
fitting a pacemaker which later prematurely fails;
Technological advances have been singled out as constituting a key driver of medical
malpractice litigation. The lack of familiarity among medical practitioners with new technology
has also been identified as increasing the risk of medical malpractice. The new gallbladder
removal technology that replaced the old technology (which had been responsible for painful
and disfiguring abdominal surgery) led to new complications which increased the chances of
harming a patient’s common bile duct and perforation of the bowel, and these increased
risks led to an increase in malpractice claims (McMahon et al., 2005:2);
Medical malpractice litigation has resulted in high medical insurance costs for doctors.
Child (2015:1) has stated that there are only three pediatric neurosurgeons in the country, and
all of them work in the public sector and this is attributable to the fact that soaring medical
insurance premiums have made it impossible for these specialists to survive in private
practice.
According to Child (2015:1), gynecologists’ insurance rates have increased since 2013 by
60 %, and at the beginning of 2015, their insurance bill climbed to R450 000;
Medical m a l p r a c t i c e h a s l e d t o t h e p r o l i f e r a t i o n o f d e f e n s i v e m e d i c i n e .
Defensive medicine is the practice of conducting diagnostic or therapeutic measures primarily as
a safeguard against any possible malpractice liability, rather than to ensure the health of the
patient (Ogunbanjo & Bogaert, 2014:6). Medical malpractice litigation has also resulted in the
rise in medical costs across the world (Kessler, 2011:94); and
Doctors, because of a fear of malpractice claims, now even avoid some high- risk
procedures which might help some patients. Nahed et al. (2012:1) report that, in order to
minimize malpractice risks, some neurosurgeons have eliminated high-risk procedures.
According to Mello et al. (2005:621), some doctors leave the medical field altogether
owing to the high liability costs caused by the increase in malpractice lawsuits and tort law.
Empirical Findings
The following findings were deduced from the primary study which used a survey method to
collect data:
Skills shortage was identified as one of the top causes of medical malpractice in the
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public healthcare sector;
The survey revealed that a total of 78.5 % of respondents identified skills shortage
as one of the major causes of medical malpractice. Of t h e 1 07 respondents, 71.0 %
revealed that they were of the opinion that inexperienced healthcare practitioners were
responsible for the spike in medical malpractice claims. The skills shortages can lead to
healthcare institutions falling prey to under-qualified and bogus medical professionals;
Demands by irrational or unreasonable patients also increase the incidences of medical
malpractice. The empirical results discovered that a total of 77.5 % of respondents identified
irrational or unreasonable patients as constituting one major cause of medical malpractice;
Another major factor, which has been highlighted as being one of the drivers of medical
malpractice, is the issue of medical professionals practicing above their professional scope. The
results indicated that 58.9 % of the respondents revealed that they were of the view that those
who practice above their professional scope were also to blame for the increase in medical
malpractice in South Africa;
The public health system in the country is currently not in a desirable state and this has
contributed to the rise in medical malpractice in South Africa. According to the empirical
findings, 88.8 % of the respondents agreed that overcrowding in public hospitals has led to the
rise in medical malpractice litigation. Another factor which is evident in the state of the public
healthcare system is the issue of shortages of necessary medical equipment. The empirical
findings revealed that a significant 86.9 % of respondents indicated that shortages of necessary
medical equipment were a leading cause of medical malpractice in the public healthcare sector.
The lack of adequate equipment entails that resources are not adequate and that other lifesaving
medical procedures will not be conducted on time, or will be carried out using rundown
equipment, which will increase the likelihood of mishaps occurring;
The South African public has been made aware of how important their rights are, specially
when they interact with medical professionals. The awareness of patients’ rights have
resulted in an increase in medical malpractice litigation. The empirical findings showed that
55.1 % of the respondents believed that the increase in awareness of patients’ rights
contributed to a spike in medical malpractice. Patients who now know what their rights are
will not hesitate to challenge physicians whom they believe were careless in conducting their
work;
These instances of medical malpractice litigation have had a negative impact on the
country’s public healthcare system. According to 72.8 % of the respondents, there has been a
decrease in trust placed in the public healthcare sector. The reduced trust in the public
healthcare system might lead to more people seeking healthcare in the private sector, or even
abroad, and this paints a bleak image of the country’s public healthcare system;
Other consequences of medical malpractice litigation include the rise in the cost of
healthcare in the country. A total of 80.3 % of the 107 respondents stated that they believed that
medical malpractice litigation has contributed immensely to increases in the costs of healthcare.
This increase in healthcare costs means that few people will be able to afford quality healthcare;
Medical malpractice litigation has also impacted negatively on the morale of
healthcare professionals. The empirical findings indicated that 84.1 % of the respondents
believed that medical malpractice litigation was having a negative impact on health
professionals’ morale. Besides suffering low levels of morale, healthcare professionals were also
suffering from stress and burnout attributable to the issues surrounding medical malpractice and
its legal consequences. The results indicated that 87.8 % of the respondents agreed that they
were now suffering from increased stress levels and burnout as a result of medical malpractice
litigation. It was discovered that 78.1 % of the respondents indicated that medical malpractice
litigation had a negative impact on the motivation of medical practitioners; and
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Employees do not stay where they are often stressed or unhappy. The empirical results
indicated that a total of 86.9 % of the respondents stated that medical malpractice litigation
had contributed to employee turnover in the public healthcare sector. Unhappy employees
in the public healthcare sector have either joined the private healthcare sector or have migrated to
other countries where they believe the situation is more favourable.
Conclusions
This research project has provided an in-depth view of the issue of medical malpractice and how
it has impacted on South Africa’s public healthcare system. The research revealed that medical
malpractice litigation has increased by remarkable margins over the past ten years and this is
attributable to the various factors which have been identified. Among the key factors that have
been linked to the increase in medical malpractice in the country are: lack of professionalism
among healthcare professionals, the changes in law that have brought about more inflexible
legislation which is protective of patients, and the country’s perennial skills shortage.
Technological advances which have taken place in the medical field have also been held
responsible for increases in medical malpractice. Medical professionals struggling to become
acquainted with new technology have been accused of making mistakes which have contributed
to medical malpractice. Medical malpractice has impacted negatively on the public healthcare
system, as the results have indicated. Healthcare costs have increased steeply as doctors’
medical insurance premiums have increased at unprecedented rates over recent years. The public
is losing trust in the healthcare system of this country and medical professionals are suffering
from low morale and motivation levels. The exorbitant amounts utilised to pay litigation
claims could be better used to improve hospitals, buy equipment and pay for up-skilling health
professionals.
Recommendations
This research study suggests the following recommendations for the South African public
healthcare sector. The recommendations are based on the key findings ascertained from the
empirical findings:
In order to counter the problem of skills shortages, the government needs to increase its
budget for funding doctors and nurses who are trained locally, and for those trained outside
the country in places such as Cuba. The increase in the funding for training medical
professionals will result in a steady increase in the numbers of medical professionals in the
country. A long-term measure will be to increase the numbers of medical schools in the country,
which will ensure that the capacity to train more doctors and nurses is increased;
The doctors and nurses who are trained by the government should be bound by contractual
agreements to serve the country for an amount of time which ensures that the country does not
suffer skills shortages, even though it is producing qualified medical professionals;
Some medical professionals have been accused of lacking professionalism and this can
result in irrational and unreasonable patient behaviour. The Department of Health needs to
ensure that the standards of conduct required from medical professionals are reinforced among
existing professionals through seminars for doctors and nurses. The universities and colleges
which are responsible for the training of doctors and nurses, respectively, need to include a
course on professionalism in the workplace as part of their curriculum. The curriculum for the
training doctors and nurses should include courses on ethics and malpractice;
In order to deal with the problem of healthcare professionals who operate above their
professional level, more visible hospital management in the hospital will help to alleviate
this problem. The hospital’s management also needs to work with the South African Police
Services to apprehend those who are practicing beyond their scope and this should act as a
deterrent to would- be culprits;
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The government needs to allocate adequate funding to the country’s healthcare
sector. This will ensure that necessary equipment becomes available and that more hospitals
are built in order to avoid issues of overcrowding. Importantly, the increased funding will
also result in more medical professionals being trained;
The government also needs to address the rights of medical professionals, because the
current laws seem one-sided and only protect patients and do not protect doctors and nurses.
The laws need to also protect doctors and nurses from unfair malpractice litigation.
The study recommends the capping of malpractice claims and the introduction of
alternatives to payment of claims, for example payment for required health services and support
services by monthly grants, rather than by lump sum payments.
It is also recommended that all malpractice incidences be reported, including those settled
out of court, with the intention of publicizing them.
The study lastly recommends the establishment of complaints offices to manage
complaints efficiently. The instituting of an ombudsman for malpractice litigation should
also be explored.
Conclusion
This research project has established the fact that medical malpractice litigation is on the rise and
that the amounts of money involved in the litigation now run into several millions of Rand. The
causes of medical malpractice have been identified and these include skills shortages, medical
professionals performing above their professional scope, and the poor state of the country’s
public healthcare system. The country’s public healthcare system is faced with serious
challenges which include lack of equipment and overcrowding. It is these challenges that have
also contributed to the increase in medical malpractice litigation. The rise in medical malpractice
litigation in South Africa has had a number of negative consequences, such as increases in
healthcare costs, a decline in the public’s trust in the public healthcare sector, healthcare
professionals leaving these noble professions totally, and some suffering from stress, burnout
and low morale. Funds utilised to settle malpractice claims could be better spent on buying
new, or replacing, required equipment. The findings of this investigation need to be considered
in order to reduce the impact of medical malpractice on public healthcare.
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