Who’s Liable When Resource Shortages Harm Patients in South African Hospitals?

Every day, resource shortages harm patients in South African hospitals – sometimes causing unnecessary death.

Patients suffer the consequences of resource deficits, such as extremely long ambulance delays and critical shortages of beds, medicines, equipment and staff. There are also serious training shortfalls.

Who is liable when an under-resourced hospital harms a patient?

Consider a real case

A 23-year-old woman is at full-term pregnancy and about to give birth. Due to a hospital transport shortage, her transfer from a district hospital to a provincial hospital is delayed by three hours.

At the hospital, no foetal monitor is available because most are broken. The baby’s severe distress goes unnoticed until the patient has been on the labour ward for 45 minutes.

An emergency C-section is delayed because the operating theatres are occupied and the lift in the building doesn’t work. The patient’s uterus ruptures and the baby dies.

Multiple hold-ups, a lack of resources and a delayed C-section compounded to cause the baby’s death.

This example is based on a case of medical malpractice published in the South African Medical Journal.

What constitutes medical malpractice?

Resource shortages are an inescapable reality in South African state hospitals and clinics. A lack of funding is not an adequate excuse for gross malpractice.

Medical malpractice is defined as a negligent act or omission by a medical professional that results in injury to the patient. In other words, when a medical professional’s actions don’t meet the accepted standards of care.

A mistake during diagnosis or treatment, a failure to provide adequate treatment within a reasonable timeframe or a surgery taking place without informed consent from the patient all constitute negligence.

Liability for negligence in hospitals

Shortages alone are unlikely to be sufficient grounds for a medical negligence case.

However, if mismanagement or negligence by the state, hospital management or health practitioners can be proven, they may be held liable for resulting harm to patients.

Even in a resource-starved hospital environment, the ethical rules for healthcare professionals apply. Barring an emergency, it would be negligent for hospital administrators to knowingly accept patients for procedures that can’t be performed adequately due to shortages.

In the case of the pregnant patient, healthcare managers could be held liable if resources (the ambulance) were negligently diverted, if they failed to carry out repairs to equipment (the lift) or if they failed to obtain medical items (foetal monitors) that are readily available.

South Africa’s ambulance shortage is a potential source of negligence claims.

A 2018 survey by Bhekisisa found that there are only enough state-run ambulances for a third of the population. This has resulted in injured people waiting unreasonably long times for ambulances to arrive.