The role and powers of the Council
The Health Professions Council of South Africa (the Council) is mandated, under the Health Professions Act 56 of 1974, to regulate registered healthcare practitioners.
The Medical and Dental Board regulates medical and dental practitioners. It does this by:
- Setting and maintaining standards of training and practice for healthcare professionals, and disciplining those who fall short of those standards, if necessary
- Setting and monitoring mandatory requirements for the continuing professional development of all registered practitioners and ensuring that training institutions adhere to the Council’s standards
- Setting professional and ethical standards and publishing guidelines for practitioners to follow.
The core document that all medical practitioners should be aware of is the Ethical Rules of Conduct for Practitioners Registered Under the Health Professions Act, 1974
The core document that all medical practitioners should be aware of is the Ethical Rules of Conduct for Practitioners Registered Under the Health Professions Act, 1974. It contains rules (not just guidelines) that medical practitioners are expected to adhere to (see Box 2). If they don’t, they may be subject to discipline by the Council.
Box 2: Main responsibilities of health practitioners
A practitioner shall at all times:
- Act in the best interests of his or her patients;
- Respect patient confidentiality, privacy, choices and dignity;
- Maintain the highest standards of personal conduct and integrity;
- Provide adequate information about the patient’s diagnosis, treatment options and alternatives, costs associated with each such alternative and any other pertinent information to enable the patient to exercise a choice in terms of treatment and informed decision-making pertaining to his or her health and that of others;
- Keep his or her professional knowledge and skills up to date;
- Maintain proper and effective communication with his or her patients and other professionals;
- Except in an emergency, obtain informed consent from a patient or, in the event that the patient is unable to provide consent for treatment himself or herself, from his or her next of kin; and
- Keep accurate patient records.
HPCSA, Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act, 1974 (as amended by Government Notice No. R 68 of 2 February 2009), para 27a
The Ethical Rules cover almost every aspect of practice, from advertising and financial probity to patient confidentiality and relationships with professional colleagues. These somewhat tersely stated principles have been further expanded into a series of 16 guidance booklets (see the list in Appendix 1), which practitioners can use to inform their practice and thus ensure that they are operating within the bounds of the Rules.
If nothing else, all medical practitioners should read Guidelines for Good Practice, which sets out the 13 core values that should govern all medical professionals’ practice, and against which their conduct will be measured in the event of a complaint to the Council.
The Medical and Dental Board of the Council may discipline a doctor for infringing any of the ethical rules, and lists the following examples on its web page:
- Unauthorised advertising
- Overservicing of patients
- Criminal convictions
- Improper relationships with patients
- Improper conduct of practitioners
- Operational procedure without patient’s permission or consent
- Disclosure of information in regard to patient without his/her permission
- Incompetence in regard to treatment of patients
- Excessive fees charged/overcharging
- Insufficient care towards patients
- Racial discrimination
- Rude behaviour towards patients
- Prescriptions to already addicted patients
- Perverse incentives and kickbacks.
The Board has the power to impose a wide array of penalties on doctors whose professional conduct is found wanting
The Board has the power to impose a wide array of penalties on doctors whose professional conduct is found wanting. The most severe penalty is to be completely struck off the register, but other sanctions include suspension from practice and fines (see Box 3 for examples of transgressions and the penalties they incurred).
A doctor was suspended from practice for 12 months for failing to provide follow-up care following an invasive procedure
Box 3: Examples of cases of unprofessional conduct decided in 2011
- A doctor was suspended from practice for 12 months for failing to provide follow-up care following an invasive procedure and for failing to arrange for a postmortem examination following an unnatural death.
- A doctor who provided substandard care to a critically ill patient was fined R10,000.
- A fine of R10,000 was imposed on a doctor for disclosing confidential information without the patient’s consent.
- Another doctor’s practice was suspended for 12 months (with a further four-year suspension suspended provided he is not found guilty of a similar offence during that period) for entering into a sexual relationship with one of his patients.
- A doctor who employed a locum who was not registered with the HPCSA and also fraudulently claimed for professional services not actually rendered had his practice suspended for three years.
- The practice of a doctor who worked as a locum in private practice while his registration limited him to work in the public sector under supervision was suspended for 12 months.
- A doctor found guilty of indecently assaulting and sexually harassing a patient was removed from the register.
HPCSA, Finalised Matters January to December 2011.