Legal Processes and how to avoid litigation Prof. Abdul Wahab Barday HPCSA Ombudsman MB.ChB(UCT) MFGP D.ForensicMed DTM&H DPH(Wits) DHSM FCFP(SA)
Issues we will touch on: Communication from the HPCSA Certificates Disciplinary Process Local Anaesthetic Complication (Press Cutting) Stitching What are the lessons? Can you treat your family? Split Billing J88 s PRE-AUTHORIZATION from Medical Aids Parting Shots
Communication from HPCSA: Annual Registration Change of address Complaints Certificate of Status
Certificate of Illness/Report: Full Name Registered Qualifications Full Address (not PO Box) Telephone / Cell / Fax / Email / Number Date and Time of Original Consultation HPCSA Number / Practice Number Description of illness in layman s terms, with patient s informed consent
Certificate of Illness/Report: (cont.) Basis of issuing certificate: Personal observations during examination or patient information - proven medically Whether patient is totally indisposed for duty or could perform less strenuous tasks Exact period of recommended sick leave Signature / Locum Full Name and Degrees/MP Date of issue of certificate
Complaints: Must be WRITTEN and ADDRESSED to : The Registrar HPCSA Letter Box 205 Pretoria 0001 553 Madiba Street, Pretoria 0001 Email legalmed@hpcsa.co.za Fax 012 328 4895
Lets look at the Complaints Process
The COMPLAINT (LOC) FLAG (LOE) from Respondent Legal Department LOC + LOE Committee of Prelim Enquiry Ombuds Office DEFLAG C O S Mediation Full Public Enquiry Appeal
FINALISED MATTERS : BROKEN DOWN ACCORDING TO OFFENCES 01 April 2012 to 31 March 2013 TYPE OF OFFENCE TOTAL Unethical Advertising 05 Incompetence 10 Breech of confidentiality 06 Damaging Professional Reputation of Colleague Insufficient Care/Treatment & Mismanagement of Patients 41 Negligence 15 Unacceptable/Inappropriate Relationship with Patients 08 Refusing to treat patients 02 Misdiagnosis 11 Practicing Outside Scope of competence 04 Fraudulent Certificates/Incorrect Information on Death Certificates 12 Refusing to complete forms / producing inaccurate reports 07 Overcharging / charging for Services not Rendered 30 Issues relating to Consent 16 Fraud and theft 49 Bringing the Professions into disrepute 15 Employing unregistered practitioners 06 Unethical dispensing and prescribing of drugs 05 Contempt of Council 06 Supersession Contravening the Hazardous Substances Act, 1973 248 TOTAL
MATTERS FINALISED EITHER AT INQUIRY, ADMISSION OF GUILT FINE OR PRELIM RESOLUTIONS BROKEN DOWN PER BOARD : 01 APRIL 2012 TO 31 MARCH 2013 BOARD ABBREVIATIONS 1. Medical and Dental DB/MP/DP Med 1 Med 2 Med3 Med 4 Dent 2. Dental Therapy and Oral Hygiene DOH/TT/OH 04 3. Dietetics DTB/DT 01 4. Medical Technology MT/MTB 5. Occupational Therapy, Medical Orthotics & OCP/OT/OTA/OS 02 Prosthetics 6. Optometry & Dispensing Opticians ODO/OP/OD/SOD 22 7. Physiotherapy, Podiatry and Biokinetics PPB/PT/PD/BK/CH/SPT 07 8. Psychology PSB/PS 20 9. Speech, Language and Hearing SLH/GAK/STA/AM 1 10 Emergency Care Personnel EMB/ANT/BAA/ANA 1 11 Radiography and Clinical Technology RCT/DR/KT/SDR 6 12 Environmental Health EPH/HI TOTALS 248 39 43 74 03 25
COMMITTEE OF PRELIMINARY INQUIRY MED 4: ACROSS ALL BOARDS SPECIAL COMMITTEE All Complaints Concerning: Human Rights Violations Racial Discrimination Fraud, especially corporate Inappropriate Sexual Conduct Perverse Incentives
THE OMBUDSMAN S OFFICE Set Up 5 Years Ago Sort out referred complaints informally & quickly through a process of mediation, especially matters of miscommunication Mediation face-to-face meetings Tariff Matters Anaesthetic charges
The COMPLAINT FLAG X LOE from Respondent Legal Department Committee of Prelim Enquiry Ombuds Office DEFLAG C O S Mediation Full Public Enquiry Appeal
THE OMBUDSMAN S OFFICE Set Up 8 Years Ago Sort out referred complaints informally & quickly through a process of mediation, especially matters of miscommunication Mediation face-to-face meetings Tariff Matters / Overcharging Anaesthetic charges Complaints between colleagues! Parking Rage
Callous doctor barred
GUILTY VERDICT: The committee found Dr M A.. guilty of unprofessional conduct of a disgraceful nature and sentenced him to an effective 5(five) year suspension, active immediately. He was informed of his right to lodge an appeal in writing, if he desired so, within 21 days.
NB points: Full Public Inquiry New Committee Legal and long process Lawyers on 1.Committee 2.Team representing the accused 3.Lawyers representing HPCSA -ProfomaComplanant Public, Family and colleagues PRESS - a cutting..
36 No. 33385 GOVERNMENT GAZETTE, 23 JULY 2010 HEALTH PROFESSIONS ACT, 1974 (ACT NO.56 OF 1974) REGULATIONS RELATING TO FINES WHICH MAY BE IMPOSED BY A COMMITTEE OF ENQUIRY AGAINST PRACTITIONERS FOUND GUILTY OF IMPROPER OR DISGRACEFUL CONDUCT UNDER THE EHALTH PROFESSIONS ACT, 1974 Minimum fine Maximum fine 1 Improper or disgraceful conduct relating to: a advertising R2 500.00 R10 000.00 b communication R3 000.00 xr15 000.00 c supersession R1 000.00 R8 000.00 d itinerant practice R2 500.00 R10 000.00 e certificates and reports R2 000.00 R10 000.00 f reputation of colleagues R1 000.00 R8 000.00 g fees and commission R5 000.00 R8 000.00 2 Overcharging patients in fees R5 000.00 R15 000.00 3 Practicing beyond the scope of own profession and/or employing unregistered person R5 000.00 R15 000.00 4 Withholding emergency services R5 000.00 R15 000.00 5 Over-servicing R20 000.00 Amount claimed for over-servicing + 5% of such amount or R20 000 whichever is greater 6 Exposing patients to danger or harm R5 000.00 R20 000.00 7 Providing insufficient care to a patient R5 000.00 R15 000.00
36 No. 33385 GOVERNMENT GAZETTE, 23 JULY 2010 8 Providing treatment to patient without patient's or next-of-kin's consent 9 Sharing consulting rooms with a person or entity not registered in terms of the Act Minimum fine Maximum fine R2 000.00 R10 000.00 R5 000.00 R15 000.00 10 Allowance by a practitioner to be exploited R5 000.00 R10 000.00 11 Incompetence R10 000.00 R50 000.00 12 Negligence R20 000.00 R70 000.00 13 Fraud R20 000.00 R70 000.00 14 Giving or receiving perverse incentives or kickbacks R20 000.00 Amount of incentive + 5% of such amount or R20 000 which ever is greater 15 Unprofessional conduct emanating from criminal conviction R10 000.00 R50 000.00 16 Issuing of improper prescription R5 000.00 R20 000.00 17 Engaging in unacceptable relationship R20 000.00 R50 000.00 18 Contravention of rule 23 of the rules R5 000.00 R15 000.00 19 Engaging in undesirable business practices or models R10 000.00 R30 000.00 20 Divulging confidential information about a patient. R10 000.00 R30 000.00 21 Defeating or obstructing ends of justice R2 500.00 R10 000.00 22 Defeating or obstructing the Health Professions Council in the performance of their duties R2 500.00 R10 000.00 Signed: Minister of Health Date 24/4/2010
HPCSA Tariff Why an HPCSA Tariff? Complaints from public - Regulator Sec53 HPAct Competitions comm. Court finding >> vacuum 2008-09 2011 New Tariff Committee appointed Consultations.- stakeholders SP/Funders/Stat. bodies Aug 2012 Guideline Tariff Can charge more Opposition from the doctors and dentists Tariff withdrawn after a few days - see website Inviting all sakeholders to submit You are nb. S/holders We will be consulting afresh with SPs/Funders/Public orgs-unions/sec27/hjf Stat or Reg bodies:comp Comm, OHSC, DOH, CMS, Independent Health Economists, Actuaries cost study experts
WHAT ARE THE LESSONS?
CAN YOU TREAT YOUR FAMILY?
SPLIT BILLING J88 s PRE-AUTHORISATION from Medical Aids
IMPORTANT PARTING SHOTS AVOIDING LITIGATION: The majority of complaints to the HPCSA concerns : POOR COMMUNICATION
IMPORTANT PARTING SHOTS AVOIDING LITIGATION I AM SORRY - Does not mean I am guilty
IMPORTANT PARTING SHOTS AVOIDING LITIGATION: 99% of Healthcare Practitioners are good practitioners!
Thank you