Doctors shy away from risk that’s wrapped up in bundle of joy

FEAR of ending up in the courtroom is driving obstetricians out of the labour ward.

“Have your babies soon, because in future, there may not be doctors to deliver them,” warned Cape Town gynaecologist Dr Peter de Jong.

Health Minister Dr Aaron Motsoaledi shares De Jong’s concerns — and he blames lawyers for the situation.

Motsoaledi said an alarming rise in medical litigation cases was behind the high cost of indemnity insurance for specialists.

‘‘Obstetricians are scared to deliver babies . . . Doctors have sleepless nights fearing they might be targeted and end up in court,” said Motsoaledi.

Dr Chris Archer, who has more than 25 years in the field as a gynaecologist and obste- trician, said he had decided in April last year to stop delivering babies.

‘‘I did it for several reasons, but the high insurance premiums and the litigation [in general] was a major part of the decision,” he said.

Archer, the founder and CEO of the South African Private Practitioners Forum, said he was deeply concerned about the fact that the average age of specialists in South Africa was 55.

South Africa has just under 1 000 gynaecologists and obstetricians working in private practice.

‘‘There’s a big gap in the 35- to 45-year-old age group. Soon we’ll retire and there will be a critical shortage because the younger doctors don’t want to do obstetrics because it’s not worth it,” he said.

The spike in medical claims was tackled during a two-day medico-legal summit in Pretoria this week. Motsoaledi said lawyers were “pocket-lining”, raking in millions for medical negligence claims.

The summit set up a commission to improve medical outcomes and a second one to review law reforms and to streamline the litigation process.

Motsoaledi said: “The Road Accident Fund tap has run dry, now they [lawyers] are targeting medicine. If we had to pay out every claim we currently have, it amounts to 20% of the total health budget of the country. That’s about R25-billion.”

In the private sector, frustrated obstetricians, neurosur- geons, neonatologists and orthopaedic surgeons are equally tortured by the sky-high insurance premiums.

Dr Peter Koll, a Sandtonbased obstetrician and gynaecologist, said his field was flagged as the highest risk. He pays R37 000 a month for insurance.

‘‘A lot of guys have stopped practising obstetrics and continued with gynaecology because it is too expensive. You’re paying R300 000 just to insure yourself for obstetrics,” said Koll.

He said 100 births a year cost R3 000 per delivery in insurance. ‘‘Medical aid only pays R3 000 per delivery, so you’re doing the deliveries just to pay the insurance costs.”

Obstetricians who paid annual indemnity liability premiums of R76 000 eight years ago have to fork out R450 000 today.

Koll said the biggest lawsuits against obstetricians were for birth trauma and birth asphyxia. Birth asphyxia occurs when the baby becomes distressed. The child can end up with brain damage.

Koll said the most common claims these days were for having missed foetal abnormalities such as Down syndrome on an ultrasound scan.

He said obstetricians faced the biggest liability because the three-year statute of limitation to file a lawsuit was calculated from when the child turned 21.

‘‘If you retire at 60, you could be sued until you’re 80. And if you find yourself without insurance, you could lose everything,” he said.

In 2004, the parents of Nico Singh, who was severely disabled by cerebral palsy as a result of a hypoxic brain injury (lack of oxygen) sustained at birth, sued their gynaecologist.

The specialist gynaecologist, Dr Ashraaf Ebrahim of St Augustine’s hospital in Durban, admitted liability.

In 2007, after a marathon trial, the High Court in Durban awarded the Singhs R9-million. The matter went on appeal and they received R23-million.

Professional bodies have urged Motsoaledi to introduce a cap on claims.

Motsoaledi said the government was working towards so- lutions to reduce the burden of litigation. He said one of the options would be to consider mediation between patients and doctors to avert court action.

‘‘This is what happened in Australia and it brought the claims right down,” he said.

Andre Calitz, chief operating officer for Joseph’s Inc, the largest medical malpractice law firm in South Africa, said the minister’s comments about abuse involving lawyers were ‘‘outrageous”.

‘‘If you look at our healthcare spend as compared to our healthcare outcomes, there is a problem.

“And the reason is bad management and skills shortages. We can’t blame lawyers for that. There is an alarming increase of incidents of negligence,” said Calitz.

‘‘We are not the enemy of doctors.”

If we had to pay out every claim we currently have, it amounts to 20% of the total health budget