South Africa at risk of having no private practice obstetricians in four years

25 November 2016 - 02:21 By PENWELL DLAMINI and KATHARINE CHILD

Sky-high medical negligence claims are forcing obstetricians out of private practice - so much so that the gynaecological society has warned that there won't be any left in the private sector by 2020.Medical insurance premiums are rising steeply, making it impossible for many doctors to stay in business.This year private-practice obstetricians had to pay R650,000 in medical insurance premiums and this is expected to hit R850,000 next year, forcing more of them to stop delivering babies and work only in gynaecology.The SA Society of Obstetricians and Gynaecologists suggests that about 50 obstetricians quit helping women give birth this year, leaving about 450 obstetricians in the private sector. They need to charge a minimum of R13,000 a delivery to cover their costs, including rent and staff, but medical aids pay them less than this.About R5000 of the fee is to cover medical insurance.The society is expecting between 50 and 100 of the 450 obstetricians to stop private practice next year because of the high insurance rates."There are going to be probably 200 to 350 obstetricians left next year. If things continue as they are, by 2020 we will not have a private-practice obstetrician in this country," society head Johan van Waart warned.There are no paediatric neurosurgeons left in private practice because they are too specialised and expensive to insure. They are now found only in state hospitals.Claims are so high because negligence payouts are so much higher as living costs must be paid into adulthood for babies injured at birth, said Wits professor Ames Dhai, part of a team working on reducing medical negligence under instruction of the health minister.The children's families claim millions - in one case asking for horse-riding lessons to be included in the payout, she said.Payouts can be between R10-million and R21-million.In some cases families who have sued the state for millions abused the money and the disabled child became dependent on the state, she said.Also driving up claims is that injured children can claim for 18 extra years, not just the standard three. This leaves 21 years in which to bring a lawsuit.On November 11 the Society of Obstetricians and Gynaecologists asked Health Minister Aaron Motsoaledi to intervene in the crisis.It put four suggestions to the minister which it believes will save the profession:Capping of payouts;Structuring of payouts: monthly or annually;If doctors are found not to have been negligent, lawyers must pay the cost of the litigation;There must be mediation before a claim goes to court.Motsoaledi said yesterday that he wanted payout claims capped. The millions paid are crippling the state sector, he said. The Health Department owes at least R35-billion.But Wits professor Dhai says this would be difficult legally and capped payouts have been successfully challenged in the US on constitutional grounds.She said she believed that judges who presided over medical negligence cases needed to be trained to understand hospital work so that claims were not unfairly awarded.Van Waart said private patients would all be pushed into the state sector by 2020 if private sector doctors refused to deliver babies."If private patients have to go to the state, their claims will go up. At the moment there are claims of R49-billion against the state, and about 80% of that is on obstetrics. This means that only two-thirds of the health budget will be mobilised for healthcare."Another follow-up meeting is planned with Motsoaledi.Motsoaledi and his team have been meeting provincial heads of health departments, hospital chiefs and doctors regularly about the crisis.Dhai said another answer would be to use mediation."People say they will sue the pants off you but the lawyer gets the pants."This is why mediation works better - a negotiated settlement is reached without lawyers getting huge fees."Another problem is the contingency law by which lawyers take cases for free and then claim 25% of the payout.""This contingency law will kill your health system," World Health Organisation head Margaret Chan warned Motsoaledi, because lawyers get a huge percentage of the payout."It can destroy a medical system."The law reform commission is looking into the contingency law, Motsoaledi said.In the state sector touts in hospitals purloin the medical files of injured children to find cases so that they can promise mothers millions in compensation...

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