Question NW95 to the Minister of Health

Reply:

The National Department is supporting and overseeing the Provinces in the handling of medico-legal cases. In this regard, the common approach is the public health defence with regard to future medical treatment. This is to ensure that future medical expenses must not be paid in monetary value but in kind by providing future medical treatment in public health facilities. This approach has been dealt with in the case of Zulu. The Zulu Case was confirmed by Judge Keightley in the Gauteng Local Division of the High Court in which the Court developed the common law by allowing that MEC for Health in Gauteng to provide services (future medical treatment) at Charlotte Maxeke Academic Hospital instead of paying a lump sum of money.

Furthermore, the State Liability Amendment Bill, 2018 is being revived to expressly provide for the provision of services (future medical treatment) at public facilities. In this regard, there are Gazetted health facilities in the implementation of the Bill.

The South Africa Law Reform Commission (SALRC) is also conducting an investigation into law reform in the field of medico-legal litigation in terms of Project 141. The Issue Paper was issued in May 2017 with due date of comments to 30 September 2017 which recommended the amendment to the State Liability Act. The SALRC is currently busy with the Discussion Paper.

Mediation is also being encouraged to Provinces as one of the intervention measures and aimed at the reduction of the legal costs and lengthy and costly court processes.

Further intervention relates to forensic investigations of suspicions cases. The investigations project commenced in December 2019 with a focus on identified cases in KZN and recently in EC; as well as investigations of the top law firms participating in the medico-legal cases at provincial leave. In addition, the services of the newly established Health Anti-Corruption Forum will be utilized. Partnership with the Special Investigating Unit (SIU) is also being forged as it is already a case in the Eastern Cape Province.

Provinces: As per the table below:

((a) number of claims of negligence have been submitted against the National Department and in each province in the past two financial years,

(b) details of each claim have been summarised in the third column in the table below per province;

(c) number of the claims paid out per province;

(d) total monetary value of claims per province.

2017-18 FINANCIAL YEAR
NAME OF THE PROVINCE	NUMBER OF MEDICO- LEGAL CLAIMS SUBMITTED (including letters of demand)	SUMMARY DETAILS OF EACH CLAIM	MEDICO- LEGAL CLAIMS ACTUAL PAYMENTS	TOTAL AMOUNT OF CONTINGENT LIABILITY MEDICO- LEGAL CLAIMS (not paid)
			No of claims	Total Amount paid
Eastern Cape	524	Cerebral Palsy; Surgical	59	R427 706 138.84	R7 741 496 122.24
Free State	52	Cerebral Palsy, Wrong diagnosis / medication, Surgical complications	5	R 14 150 000.00	R 584 222 853.00
Gauteng	386	Cerebral Palsy; surgical	74	R 243 250 339.32	R 3 660 646 406.20
Kwazulu- Natal	402	Obstetrics & Gynaecology; Surgical Oncology; Urology; Ophthalmology	151	R 134 436 666.80	R 2 978 441 462.30
Limpopo	275	Cerebral Palsy; Obstetrics & Gynaecology Orthopaedic Other Surgical	9	R 17 550.000.00	R 2 880 271 000.00
Mpumalanga	80	Maternity cases Orthopaedic cases Mental Health care user case	25	R 25 947 455.00	R 1 025 412 726.00
Northern Cape	23	Cerebral Palsy; Surgical	0	0	R 315 855 194.00
North West	77	Maternity cases; Orthopaedic cases	10	R 34 633 128.60	R 601 176 148.00
Western Cape[1]	92	Obstetrics, surgical, neurosurgery	50	R86 873 630.75	R614 857 118.09
TOTALS	1911		384	R 984 547 359.31	R 20 402 379 029.83

2018-19 FINANCIAL YEAR
NAME OF THE PROVINCE	NUMBER OF MEDICO- LEGAL CLAIMS SUBMITTED (including letters of demand)	SUMMARY DETAILS OF EACH CLAIM	MEDICO- LEGAL CLAIMS ACTUAL PAYMENTS	TOTAL AMOUNT OF CONTINGENT LIABILITY MEDICO- LEGAL CLAIMS (not paid)
			No of claims	Total Amount paid
Eastern Cape	459	Cerebral Palsy; Surgical	87	R 797 120 477. 00	R 6 673 891 443.79
Free State	67	Cerebral Palsy, Wrong diagnosis / medication, Surgical complications	7	R 10 400 258.25	R 873 494 171.00
Gauteng	120	Cerebral Palsy; surgical	70	R 378 983 765.88	R 1 357 938 619,11
Kwazulu- Natal	446	Obstetrics & Gynaecology; Surgical Oncology; Urology; Ophthalmology	86	R 444 129 604.90	R 2 636 105 361. 09
Limpopo	254	Cerebral Palsy; Obstetrics & Gynaecology Orthopaedic Other Surgical	6	R 9 800 000.00	R 2 329 815 300.00
Mpumalanga	132	Maternity cases Orthopaedic cases	18	R 25 597 039.12	R 2 170 079 941.43
Northern Cape	19	Cerebral Palsy; Surgical	2	R 3 600 000.00	R 176 438 110.00
North West	92	Maternity cases; Orthopaedic cases	7	R 34 027 549.00	R 513 958 416.73
Western Cape	46	Obstetrics, ophthalmology, neurosurgery	32	R 60 971 721.70	R 2 536 987 682.49
TOTALS	1 635		315	R 1 764 630 415.85	R19 268 709 045.64

As at March 2019, the Contingent liability submitted by provinces was at R100 billion over a period of ten years. There is currently a cleaning up process of the data and the amount to ensure that the contingent liability is only for medico-legal cases and does not include all litigation matters such as RAF; Procurement matters; non-payment of invoices due to disputes or budget issues etc. As at June 2019, the reduced amount was R68b and this is an ongoing process.END ↑