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Kapil S Satyapal Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Safety & Sanctions A Medico - Legal Perspective

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Page 1: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Kapil S Satyapal

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Safety & Sanctions

A Medico-Legal Perspective

Page 2: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Cost of Litigation

2015:

R61 Billion

R85-90 Billion

2016:

2017:

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

2019: R93 Billion?

Plus REF DEBT 2017 / 2018 R206.3 Billion

Page 3: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Cost of Indemnity

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 4: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

“Public health system close to collapsing”June 2018 (Medical Ombudsman)

• Doctor burnout (Shanafeldt, US & Pinto, UK 2016)

• “Junior Doctors at breaking point”(Daily News, 19 June 2018)

Major Challenges

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 5: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

1. Obstetrics

2. Neonatology

3. Spine surgery

Highest Risk Specialties

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 6: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 7: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Patient Expectations

Always enquire about patient expectations

ComplaintsThe number of complaints received against a doctor is an

accurate predictor of litigation.

Communication Failure

At least 70% of all patient action against doctors can be

traced directly to communication failure.

Page 8: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

EmpathyDoctors that use empathy routinely,

“litigation-proof themselves”… Mark O’Brien

When something goes wrong: Apologise

Apology

Healthcare is TeamCareWhen more than one doctor is involved in the care of

a patient, risk rises exponentially.

Good clinical notes are important

Page 9: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Era of shared decision-making

Training doctors to be reliability

practitioners of the 21st century

Into the future

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 10: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Hungry

Angry

Late

Tired

Are you a HALT Doctor?

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 11: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Sanctions

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 12: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Legal Paradigm Shift

The Bolam Test

Oxford Reference

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 13: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

“A Reasonable Doctor”

“ A REASONABLE PATIENT”

1. Risks that apply to ANY patient

2. Risks that apply particularly to THIS patient

Bolam Test Shift

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 14: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Legal Precedent

I. Rogers vs. Whitaker (1992) 67 ALJR. 47 (High court of Australia)

I. Castell vs. De Greef(1994) (4) SA 408)

III. Montgomery vs. Lanarkshire Health Board [2015] UKSC 11 On appeal from (2013) CHIH 3

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 15: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

SPECIFIC STRATEGIES

Legal Profession

• Capping of settlement claims

• Contingency Fee Review

• Improve quality of legal representation

• Fast-track timelines in settlements

• Medical assessors to sit with judiciary.

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 16: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

SPECIFIC STRATEGIES

Academic Institutions

• Introduce risk management content into both under- &

post-graduate curricula

• Address perceived drop in professionalism & standards

• Targeted research into high risk medical conditions eg.

CP.

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 17: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Regulatory Bodies

• Introduction of Compulsory Malpractice

Insurance

• Assess Impact of NHI on Medical Litigation

• Role of HPCSA.

SPECIFIC STRATEGIES

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 18: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

ADR

• Medical Mediation.

SPECIFIC STRATEGIES

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 19: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

MEDICO-LEGAL REGULATORY BODY

SPECIFIC STRATEGIES

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Ministry of Health

HPCSA

Ministry of Justice

Page 20: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Acknowledgements

• HPCSA

Preliminary Committee of Inquiry

Professional Conduct Inquiry

• MPS

Risk Management Series

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN

Page 21: Safety & Sanctions · 2019. 10. 3. · Kapil S Satyapal: Professor Emeritus & Fellow: UKZN Patient Expectations Always enquire about patient expectations Complaints The number of

Kapil S Satyapal: Professor Emeritus & Fellow: UKZN


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