Skyrocketing liability claims are among the factors behind an exodus of obstetrician-gynaecologists (ob-gyns) from SA, an organisation representing the specialists says.
The rise in legal claims means ob-gyns can now expect to pay more than R1m a year for malpractice insurance, about four times more than they did six years ago.
The estimated number of obstetricians in SA
— 800
Johannes van Waart, a council member of the South African Society of Obstreticians and Gynaecologists (Sasog) says: "The indemnity insurance premiums are high not because of the number of claims but because the actual claims in obstetrics are high and can come many years later."
"While in 2015 the highest quantum for a claim would have been in the region of R20m, it is not uncommon nowadays to see an obstetrics claim of R50m-R80m."
He says one of the reasons that patients are claiming dramatically bigger amounts could be that personal-injury lawyers are seeking a new income stream because of legislative changes affecting the Road Accident Fund (RAF).
"[These changes] have prevented lawyers from deriving their incomes from the RAF," he says. "We also believe that the focus for litigation is on obstetricians, as the quantum of the claims is high."
Adriaan Taljaard, acting chief marketing officer for the RAF, says the fund has no data that would either support or counter Van Waart's assertion about personal-liability lawyers.
"The RAF has, however, noted in the recent past similar sentiments expressed in the media, especially in relation to public- health establishments. Whether a correlation exists, and to what extent, if any, is not for the RAF to say."
Asked to comment on the allegation that personal-injury lawyers target ob-gyns, the Law Society of SA did not respond.
Van Waart says SA has almost 800 obstetricians, but the number is dropping due to emigration or doctors ceasing to practise.
He says Sasog does not have formal statistics on how many ob-gyns have left SA but, on anecdotal evidence, the number is rising.
An increasing number of doctors across all medical disciplines are quitting their practices, he says, citing the proposed National Health Insurance scheme as a contributing factor.
Many doctors are also concerned at the precedent set by the criminal charges brought against paediatrician Dr Peter Beale and anaesthetist Dr Abdulhay Munshi in December last year, Van Waart says.
He says ways to address the liability issue include legal reforms that would, among other things, encourage mediation between doctors and aggrieved patients and provide for negligence matters to be dealt with outside the criminal justice system.
Dr Chris Archer, CEO of the South African Private Practitioners Forum, said: "I think there are quite a few young doctors who have decided not to pursue obstetrics and gynaecology because of the perceived risks and the high costs of malpractice insurance."
Like Van Waart, he says malpractice insurance is a major cost impact for ob-gyns. Archer says some ob-gyns are mitigating the risk by dropping obstetrics to focus on gynaecology. "So it does mean that there is an impact on the availability of sufficient specialists to provide a service for the people of SA," he says.
The Health Systems Trust this week released its latest "South African Health Review", which reported that contingent liabilities for medical malpractice of all types in provincial health departments reached about R104bn last year, as estimated by the Treasury.
The biggest claims were in the Eastern Cape (R29bn), Gauteng (R28.9bn) and KwaZulu-Natal (R20.7bn).
The report attributes the size of the amounts in part to a lack of "proper patient-centred complaint systems", which means litigation is the only recourse for patients.
The private sector has also been affected, with liability insurance for private medical practitioners increasing. The report says 122 nursing malpractice and medico-legal cases were finalised in the private sector last year.
