EC negligence strategy raises more questions than answers
Health department lists ‘interventions’ but curious discrepancies in cost of equipment
The Eastern Cape health department has released a detailed list of “interventions” to deal with its burgeoning R29bn slate of medico-legal claims for negligence by hospital and clinic staff, but the strategy raises many questions.
It is clear from the document that the provincial government warned President Cyril Ramaphosa a year ago already that “the medico-legal challenge ... could collapse the provincial administration”.
The provincial government’s executive committee passed a resolution then which also paved the way for the provincial treasury and the office of the premier (OTP) to take steps, including withholding funds, to address problems in the health department.
Treasury was mandated to conduct a forensic audit while the OTP was supposed to take over health’s legal functions.
All the proposals are contained in a document tabled during a lengthy presentation to the provincial legislature’s standing committee on public accounts (Scopa) on July 30.
There was little updated information on the current status of plans first discussed almost a year ago.
The raft of interventions to stop the financial and administrative haemorrhaging within the department included “a safe caesarean section plan”, appointing clinical staff to health facilities, training community health workers, a review of cases by retired specialist doctors, and supply of medical equipment to 28 targeted facilities.
The document, titled “ECDOH Medico-legal strategy update — July 2020”, contains scant detail.
The department simply notes that it has “strengthened its systems to respond to the medico-legal challenge”.
The document contains a glaring error in a calculation of the amount spent on medical equipment for 26 targeted healthcare facilities, which calls into question the full schedule of items procured.
A query submitted to department spokesperson Siyanda Manana and copied to superintendent-general Thobile Mbengashe went unanswered.
The strategy distinguishes between clinical, legal and administrative interventions.
Under clinical strategies, it notes that 26 “highly litigated hospitals” have been gathered together to ensure safe caesarean sections are performed.
“The department is conducting monthly audits of caesarean sections and using the results of these audits to refine the strategy.
“Continuous training on surgical skills and competency assessment of doctors is ongoing.
“The department is also strictly monitoring patient safety incident (PSI) reports as a proactive way to manage medico-legal claims.”
By December 2019, the department had 2,752 PSIs, of which 426 were cases that could lead to death and/or litigation.
In the 2018/19 financial year, more than 1,300 negligence cases were received, mostly as a result of poor management of women in labour.
The document notes that about four full-time doctors are required to assess the files and build a defence in these cases, most of which demand damages far in excess of what it suggests might be reasonable.
The department appointed 735 clinical staff by March 2020 and procured medical equipment for targeted facilities, including those in Aliwal North, All Saints, Bhisho, Butterworth, Cradock, Tsolo, Sterkspruit, Lusikisiki, Humansdorp, Madwaleni, Libode, Mount Fletcher and Uitenhage.
A Dispatch tally of the items which are listed comes to R11,842,646.58.
However, the total which is indicated on the department’s list is R16 514 84.58 [sic] or more correctly R1,651,484.58.
There are other curious anomalies.
Dr Malizo Mpehle Hospital in
Tsolo was allocated two continuous pressure air pump (CPAP) machines at a total cost of R343,594.
No equipment specifications are indicated in the document and no reason is given for allocating two machines to the same hospital, although the equipment is indicated as “mostly used in neonatal care”.
The Dispatch ’ s research indicates a top-of-the-range individual CPAP for home use retails for about R15,000.
Bhisho Hospital was allocated five ultrasound transducers at a total of R91,752 (R18,350 per unit).
Butterworth Hospital was allocated two “ultrasound” at a total cost of R932,897 or R466,448 each — the same unit cost as St Elizabeth and Lusikisiki hospitals.
Humansdorp was allocated one “ultrasound” at a cost of R375,843, while the cost for the Victoria Hospital “ultrasound” was R427,231.
In all instances, the note explaining the need for the equipment refers to “various diagnostic procedures including foetal condition”.
There is no explanation for the difference in pricing.
It might be assumed that the cost of a transducer — the handheld device which is passed over a patient’s body — is significantly lower than the cost of the full suite of ultrasound equipment including transducer, processor, monitor, keyboard, and data storage.
But it does not explain the almost R100,000 difference in unit costs between Humansdorp, on the one hand, and Butterworth, St Elizabet and Lusikisiki.
Humansdorp was also allocated two foetal Doppler machines to monitor the heart rate of a foetus at a total cost of R5,394 (R2,697 each). Five foetal Doppler machines for two other hospitals show a total cost of R26,974 (R5,394.80 each).
At Bhisho hospital, 10 emergency suction units — used in emergency and surgical units, and general wards — were bought at R18,600 apiece. In three other hospitals, the equipment cost R28,111 each.
About four full-time doctors are required to assess the files and build a defence in these cases, most of which demand damages far in excess of what it suggests might be reasonable