Why the Gauteng Health Department is coughing up in court

Gauteng MEC for Health, Qedani Mahlangu Picture: Dumisani Sibeko

Gauteng MEC for Health, Qedani Mahlangu Picture: Dumisani Sibeko

Published Oct 20, 2016

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Johannesburg - The DA chief whip in the Gauteng legislature, Mike Moriarty, revealed this week that the consolidation of all government departments’ annual reports had revealed that the province had spent R881m in legal fees, almost double that of the previous year, when R469m was spent.

“The biggest spender is the Department of Health, whose legal costs increased from R238m to R569m,” said Moriarty, who placed the blame on Gauteng Health MEC Qedani Mahlangu, labelling her “callous”.

DA Gauteng spokesperson for health Jack Bloom also attacked Mahlangu’s conduct, particularly in dealing with negligence claims.

“Her department is expected to pay out about R1 billion this year in settlement of medical negligence cases,” he said.

The Department of Education was high on the list in terms of legal fee spending, dishing out R42m on legal fees and services - up from R27m.

Also a big spender on legal fees was the Infrastructure Development Department, which incurred R46m.

“Excessive legal claims and legal fees are a natural consequence of an uncaring and inefficient government that forces citizens and suppliers to take legal action. As a result, Gauteng’s most vulnerable, the poor and unemployed, are being penalised by delayed service delivery due to budgetary constraints,” said Moriarty.

He blamed Premier David Makhura and the ANC government for spending millions on billboards claiming clean audits in Gauteng, which he described as a “smokescreen to cover up the reality that the provincial government is still not delivering”.

However, in a comprehensive response to questions by The Star, the Gauteng provincial government explained why, in particular, the Department of Health has incurred such costs.

“It is clear from our own analysis that the departments such as Education, Health, the police and others account for the bulk of legal claims against the government as they are at the coalface of government service delivery. It is important for us to pay particular attention to the Health Department as it accounts for over half the claims against the government,” the statement said.

According to the provincial government, this stems from the fact that Gauteng runs the biggest public health-care system in the SADC region. The province services patients from Gauteng as well as adjacent provinces (Free State, North West, Limpopo and Mpumalanga) at a primary, tertiary and central level. The province also hosts the highest number of central hospitals, including Chris Hani Baragwanath, Charlotte Maxeke, Steve Biko and George Mukhari hospitals.

These are then supported by three tertiary hospitals: Helen Joseph, Kalafong and Tembisa.

According to the provincial government, these hospitals service 7.1 million patients annually, as opposed to the 6 million in KwaZulu-Natal, 3 million in the Eastern Cape and 2 million in the Western Cape.

Because Gauteng remains the country’s economic hub, it attracts people searching for better lives - according to Stats SA, an average of 200 000 people migrate to Gauteng every year and 70 percent of these are serviced by the public healthcare system.

The government said the Department of Health has a total of 67 000 employees, with a current budget of R37bn.

Medico-legal cases

According to the provincial government's analysis, the reason for such major spending on legal fees within the Health Department is because of litigation against the department, the majority of which comes from tertiary and central hospitals.

“These hospitals deal mainly with complicated and severe ailments. For example, hospitals such as Chris Hani Baragwanath, which has to deal with complicated pregnancies referred to it by surrounding clinics. Tembisa and Charlotte Maxeke hospitals also deal with a lot of referrals,” the statement said.

Globally, the three main sources of litigation in the healthcare sector are negligence, malpractice and adverse events.

According to the provincial government, the main areas of litigation include obstetrics and gynaecology, neurosurgery, neonatology and orthopaedic surgery.

“The sheer size and shape of our public health system partly explains the high number of cases against Gauteng. In addition, and like any other public health system in the world, we also have incidents of malpractice, negligence and adverse events,” it added.

To combat this, the government vowed in its statement to strengthen its human resource capacity as it tries to fill all vacant posts and appoint competent and qualified health professionals.

One way to improve these appointments is expected to emerge from a local partnership with the University of Lancaster in England to train hospital chief executives in management and leadership.

Crime within the healthcare system

The department has claimed it is also dealing with incidents of crime, corruption and collusion within its ranks that have led to legal fee cost increases.

“We have evidence of instances where files are stolen in order to expose the department to litigation. Some of the incidents of the stealing of files are done in collusion with our officials.

“In cases where we find this we do not hesitate to act,” the government said.

Last month, two members of a syndicate involved in the theft of files at Chris Hani Baragwanath Hospital were arrested. The provincial government believes this syndicate has involved law firms and hospital staff to commit its crimes.

“The modus operandi of some of the syndicates is to target areas such as cerebral palsy, and head and spine injuries. In these cases the lawyers will calculate future medical care, housing, special education and contingency fees.

“There is also the distortion of the market by inflating fees when dealing with government,” the statement said.

“The government is taking practical steps to reduce legal spending through training and retaining skilled personnel, acting decisively where incidents of negligence are found, mediation of cases wherever possible, and an establishment of a legal audit project that will systematically co-ordinate work related to legal claims.”

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The Star

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