The current medico-legal landscape Key factors in complaints against medical practitioners Measures to combat current trend in medical malpractice

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2 The current medico-legal landscape Key factors in complaints against medical practitioners Measures to combat current trend in medical malpractice claims

3 SAJBL June 2011: Is South Africa on the verge of a medical malpractice litigation storm? Medical Chronicle June 2011: To avoid litigation, make sure you know your patient NEJM August 2011: Harvard study shows most doctors face malpractice suits MPS Casebook January 2012: Counting the cost of litigation MPS Casebook January 2013: The worst of times MPS Casebook January 2014: How reliable is healthcare?

4 Contrary to expectations, the public awareness programme did not lead to a dramatic increase in complaints or negligence. During the 2011/12 financial year, the Legal Department registered a drop of 7% from the previous year's high, and also lower than the complaints recorded in 2009/10. The complaints largely revolved around insufficient care/treatment and mismanagement of patients, followed by incompetence and overcharging/charging for services not rendered. The majority of new cases reported are due to alcohol abuse followed by scheduled medication, with other categories ranging from schizophrenia and bipolar disorder, cocaine and opiate use, Post Traumatic Stress Disorder (PTSD) and poor vision.

5 Greater patient awareness of constitutional rights Economic climate

6 More lawyers advertising extensively for malpractice claims, No win, no fee system

7 2 main factors that influence and impact medicolegal risk: THE PATIENT THE DOCTOR / PRACTICE NO PATIENT / NO DOCTOR = NO RISK

8 Diversity of patients Vulnerable patients Changing burden of disease, co-morbidities and multiple pathologies Unrealistic expectations Access to global web based information Know your patient!

9 Failure to appreciate legal and professional ethical responsibilities Problems in clinical management, including medication errors Breaching medical confidentiality Acting outside scope of practice Over-reliance on written materials and support staff

10 Insufficient recordkeeping (electronic records) Improper assessment before treatment, inadequate instructions after treatment Off-label use of medication Failure of proper communication Practicing Defensive medicine Absence of proper informed consent

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12 Failure to appreciate legal and professional (ethical) responsibilities Practitioners must ensure that they have a reasonable understanding of the legal and ethical framework within which they practice Practitioners must at all times know what the current ethical rules are Amendments to Ethical Rules?

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14 Health Professions Act - Ethical Rules - Scope of Practice National Health Act Mental Healthcare Act Children s Act Medicines Control and Related Substances Act Medical Schemes Act

15 HCP must at all times act in the best interest of their patients respect patient confidentiality, privacy, choices and dignity maintain the highest standards of personal conduct and integrity provide adequate information to patient to make informed decision keep professional knowledge and skills up to date maintain proper and effective communication with patients and other professionals obtain informed consent for treatment keep accurate patient records

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17 Ensure that you have necessary skills and competence, and act within scope of practice Be caring, honest and explain what can or cannot be done; manage patient s expectations realistically Ensure adequate professional indemnity cover and strict product liability insurance - understand types of malpractice cover

18 Comply with legislation, ethical rules and guidelines Implement a risk-assessment checklist and strategies to address areas of risk Communicate properly and know when to say NO

19 What is secret to successful practice? Drive thy business or it will drive thee (Benjamin Franklin) Competence Compassion Care

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