The South African government is under pressure to reform its medical negligence redress system, with claims against the state reaching crisis proportions. The issue has been on the agenda for over a decade, with the South African Law Reform Commission investigating the state's skyrocketing medico-legal bills and making recommendations on how to fix the problem. The commission's work was considered vital by parliament, but its report sat gathering dust for over 18 months before being released by the department of justice and constitutional development at the end of September.
The report proposed reforms to the compensation system, warning that changes must be accompanied by significant improvements in the quality of public health services. The institutional maternal mortality ratio in South Africa is shamefully high, standing at 111.7 per 100,000 live births in 2023, compared to 67 per 100,000 live births in Brazil and 15 per 100,000 live births in Turkey. This poor maternal care is linked to the majority of medical negligence claims relating to birth injuries.
Provincial health departments have made progress in reducing their contingent liabilities for medical negligence claims, from R111bn in 2019/20 to R50.2bn in 2024/25. However, the state continues to pay out about R1.5bn a year to victims, diverting funds from frontline care and compromising patient care. These awards are not budgeted for, and the lion's share often ends up in the pockets of lawyers, expert witnesses, and unscrupulous relatives.
The Law Reform Commission's proposed fix introduces two new pieces of legislation, enabling victims of medical negligence to seek redress through a new administrative system or the courts. The plan includes structured settlements with a lump sum for past expenses and periodic payments for loss of earnings and caregiving costs. If the state is unable to provide required services, it is expected to contract with private providers.
A crucial aspect of the plan is that it promises cash flow relief for strained provincial health budgets, but it will only work if accompanied by an effective drive to improve care. The government has been criticized for its lack of urgency in addressing the issue, with the problem persisting for over a decade. The proposed reforms aim to provide redress to victims while also improving the quality of public health services.
The issue is complex, with multiple stakeholders involved, including the health department, the department of justice, and the Treasury. The government faces challenges in balancing the need to provide redress to victims with the need to manage its finances and improve public health services. The proposed reforms will require careful implementation to ensure that they are effective and sustainable.
The government is expected to take action soon, with the proposed reforms offering a way forward. Key to the success of the reforms will be the government's ability to improve the quality of public health services, while also providing redress to victims of medical negligence. The issue remains a pressing concern, with the state's financial and health challenges highlighting the need for urgent action.
Key points
- The South African government faces calls to reform its medical negligence redress system, with claims against the state reaching crisis proportions.
- The proposed reforms aim to provide redress to victims while also improving the quality of public health services.
- The government has been criticized for its lack of urgency in addressing the issue, which has persisted for over a decade.
