Prof Alec van den Heever

Pre-existing
contingent liability resulting from medico-legal claims in the public health
service that cannot be avoided and which is now impacting on the Government’s
fiscal liability is a direct manifestation of multi-faceted governance failures
in the system.

“A future
contingent of medical liability will continue at the same scale unless
something changes,” Prof Alec van den Heever, Chair of Social Security Systems,
 Administration
and Management Studies at the University of the 
Witwatersrand,
warned in his SA Medico-Legal Association (SAMLA) Presidential Presentation at
the weekend.

Van den
Heever’s presentation was one of several on pressing medico-legal issues
video-recorded by SAMLA for submission to President Cyril Ramaphosa’s office.

Key among
these governance failures, he pointed out, was the absence of strategic
accountability frameworks comprising independent supervision, performance requirements,
transparency and consequences at both a meta- and micro-governance level.

“Each case
of medical negligence must result in an independent investigation of the
relevant service,” he stressed, “an investigation which must result in a public
report, remedial action, and consequences for all parties implicated in the
failure – including consequences for all failures to properly manage medical
records.”

Localised accountability
frameworks for all services, he added, should therefore be implemented immediately
and these should include the establishment of both interim and final supervisory
boards to remove, for example, hospital CEOs.

An equivalent
framework for the country’s emergency medical services, said Van den Heever,
should also be implemented to address medical negligence issues when they
arise.