Every problem is an opportunity for us to improve things for the medical risk industry.

At EthiQal, we are celebrating one year of living our vision of changing the risk landscape with you, our partner, to ensure trusted outcomes between doctors and patients – in sickness, adversity and health, now and in the future.

In a short time, we have made vast strides, together with doctors, their Associations and Societies, the legal profession and representatives from Government to secure the future of the medical profession and the delivery of quality patient care.

We are proud to share with you some of the highlights of our journey where every day we find silver linings and make change happen.

 

 

The industry is fragmented and poorly aligned.

 

 

01

We are making the change by creating bridges to work towards health for all.

We truly believe that open dialogue builds bridges. When we focus on the needs of patients in these discussions, we will find the best solutions. Whereas no-one alone will solve the threats to access to good quality care, together we can make the change

As a fledgling team, we feel privileged to have already been part of many of these conversations at diverse forums, of which many have been directly initiated by ourselves.

  • We have hosted an industry workshop with the Department of Health to explore ways of changing the current legal status quo and its detrimental impact on the access to healthcare

  • On invitation by Professional Societies like the Neurosurgery Society and the Paediatric Management Group to their annual conferences, we have deliberated medico-legal issues alongside our competitors

  • We have hosted prominent and influential speakers like Judge President Hlophe at our inaugural EthiQal For All conferences at the CSIR Convention Centre in Pretoria and the ICC in Cape Town

The costs associated with clinical negligence can be prohibitive both financially and emotionally.

02

We’ve innovated cost structures to reduce premiums, whilst bolstering benefits.

At EthiQal, we pride ourselves in having revolutionised medical indemnity cover. Not only are we the first insurer to provide a choice of both occurrence based and claims-made cover, but our approach to providing medical indemnity cover has meant that we've been able to reduce the cost of standard cover.

In addition to this, we've been listening to doctors to understand what they require for true peace of mind.

As a result we have added the following unique benefit extensions into our packages at no additional cost:

Product liability cover to protect against claims arising out of defective workmanship, packaging and labelling of products

Income protection against loss of income as a result of attending disciplinary and legal proceedings

 

 

In times of need, doctors should not stand alone.

 

 

03

We've strengthened our ability to protect our doctors in times of need.

Dealing with an aggrieved patient, knowing that a clinical mistake has been made, having a complaint lodged at the Health Professions Council of South Africa (HPCSA), being involved in an inquest, receiving a demand for notes or, worse, a court summons, are highly stressful circumstances for any practitioner.

For doctors not to stand alone during these times, they need easy access to the right expertise at the right time.

Our medico-legal team of inhouse clinical and legal experts who offer the first line of support can be contacted by policyholders at any time. Where specialist legal advice is required, we have contracts with five legal firms that have leading specialist medical law practices devoted to the defence of medical cases. Wherever possible, we encourage non-litigious ways of resolving disputes.

To provide the most appropriate clinical expertise for purposes of fair dispute resolution, we are actively engaging with Professional Societies and Associations to facilitate unbiased and trusted expert opinion. At any time, our in-house medico-legal advisory team has access to an extensive network of clinical experts across all disciplines.

 

 

The medico-legal landscape is threatening access to quality care.

 

 

04

We've been actively researching and campaigning for law reform.

Within three months of opening our doors, we hosted an industry conference in conjunction with the Department of Health to explore practical solutions to the medico-legal crisis and identify opportunities for legislative reform, with the intention of safeguarding the sustainability of the healthcare system in South Africa. Subsequent to this and our associated submission of recommendations on this matter to the ANC NEC Subcommittee for Health and Education, the South African Law Reform Commission was appointed by the Departments of Health and Justice and Correctional Services to initiate a formal investigation into the merits and substance of potential legislative changes.

Following the Commission’s first comprehensive report and invitation for stakeholder comment, our response included recommendations in relation to the following:

  • Introduction of mandatory mediation prior to litigation
  • Amendments to the Contingency Fee Act
  • Advertising by personal injury law firms
  • Capping of claims
  • Creation of structured settlement and annuity funding models aligned to rehabilitaion and health needs

There is a scarcity of factual information on local risk.

05

We are collating local practice, clinical and medico-legal data to understand the doctors' risks holistically.

Without a sound understanding of the types of exposure, doctors cannot effectively manage their practice management and clinical risks. Committed to assisting the profession in mitigating these, we have made our first strides in painting a picture of the local risk scenery by:

  • Investing in a database of more the 100 judgements handed down by the Higher Courts which deal exclusively with incidents of alleged medical negligence
  • Reviewing HPCSA complaints
  • Developing a database of our doctors' previous and new notifications, complaints and claims for purposes of analysis and reporting
  • Calling on our major competitors, as well as all other stakeholders to share established risk data for the benefit of doctors and patients

 

 

Funding for local risk management solutions has been lagging.

 

 

06

We invest in wide ranging risk management initiatives.

As an insurer who cares about the future of South African doctors and patients and who is dedicated to their long-term well-being, we are committed to facilitating the development and implementation of focused and effective risk management solutions, Our ethos is to support initiatives by professional bodies that improve doctor driven risk management strategies such as:

  • Improved patient consent
  • Definition of clinical protocols and practice guidelines
  • Peer review and support mechanisms
  • Development of clinical data collection platforms
  • Sharing of practice risk information

To this end, we're already the proud sponsor of Safe Surgery South Africa (SSSA), an initiative by perioperative clinicians. This collaborative project aims to establish a perioperative health record which will allow the better identification of opportunities for focused interventions After all, excellence in research and teaching is an important cornerstone of good clinical practice.

We are also co-sponsoring the SASA Practice Guidelines 2017 which define minimum requirements for the safe provision of anaesthesia. Other than being used as a standard reference for best practice by anaesthesia clinicians, they assist hospital managers in the effective planning of facilities, including their design, equipping and staffing.

"Undoubtedly the current healthcare crisis is a complex issue requiring a well-considered and responsible approach by all stakeholders in the healthcare environment."

"We are encouraged by the ongoing contributions and commentary made by our colleagues who offer their support and recommendations to resolve this current impasse. We have made it our priority to listen to South African doctors in order to understand what they require, thus ensuring their peace of mind. We have therefore realised the need to include additional benefits to our professional indemnity offering."

JP Ellis

Legal Risk Manager

JP is an admitted attorney, and prior to joining the team, was a senior attorney at Clyde & Co, a global law firm. Although JP’s extensive experience spans across the insurance industry, his focus area is professional indemnity, where he boasts a successful track record as a medical defence attorney. Amongst other things, he provides general policy advice and management, engaging with panel attorneys in the management of claims and coordinating EthiQal’s legal reform initiatives with various industry stakeholders.

"It is paradoxical that negligence litigation is eroding healthcare funding whilst government is looking to better support it."

Medical malpractice claims against public hospitals stand at more than R50 billion. Rapidly risking professional indemnity premiums are threatening the viability of some specialist practices. Lengthy court proceedings can distract the important attention of healthcare professionals unnecessarily. And litigation which is meant to help the patient is threatening to implode the public healthcare system.

This isn't a picture of a sustainable future. If South Africa's medical industry is going to survive with the best possible practitioners within it, things have to change.

I'm exceptionally privileged to be part of a team which is committed to this change. We believe the current status quo is undermining rather than promoting high quality healthcare. Which is why we're striving to find and deliver better ways to protect patients, practitioners and medical funding.

Together with doctors, lawyers, government and everyone who shares our vision, we aim to preserve and build superb medical care in South Africa for everyone's benefit.

Dr Bettina Taylor

Clinical Risk Specialist

After starting her career as a clinician, lecturer and researcher in academic practice, Bettina joined the funding industry to pursue her interest in health policy. Other than furthering her studies in health economics, bioethics and risk management during this time, she served on various government, industry and academic bodies aimed at promoting efficient quality healthcare. Bettina has more than 20 years’ experience in healthcare financing and delivery models, including the risks associated with these.