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Paediatrics and neonatology: risks increase in South Africa

04 March 2019

Growing risk and rising claims continue to affect paediatrics and neonatology, two areas of clinical practice already renowned for their inherent riskiness. Dr Graham Howarth, head of medical services (Africa) at Medical Protection, looks at the numerous factors driving these changes

For doctors in South Africa, it is not unusual to face clinical negligence claims in the millions of rand, defence and indemnity costs included. This is especially true for clinicians who manage infants within the early neonatal period, as they have a greater risk of being involved in complex, high-value litigation, involving catastrophic outcomes.

This article looks at our data to explore what is driving this risk growth – as the reasons can be complex, and many in number.

Claims – growing in value and frequency


Claims involving injuries resulting in cerebral palsy are some of the highest value claims we see and, in cases where the paediatrician is a named defendant, the paediatrician has borne most – if not all – of the apportionment.

To date, the highest value paediatric claim Medical Protection settled on behalf of a member was over R36 million, and we are currently assisting on individual cases each valued between R16m and R17m. 

Attorneys are litigating birth injury claims more aggressively. Our data shows that between 2008 and 2017, the number of claims reported against paediatric members in South Africa increased 350% over the ten-year period, compared to 57% for the medical members as a whole.

During that same period, the number of cases (involving incidents other than claims, such as complaints, HPCSA inquiries, inquests) opened on behalf of paediatric members increased 146%, relative to 2008’s figures.

Why is this happening?

A major cause in the increasing cost of such claims is the natural delay in when they are reported to us: only 12% of paediatric claims in South Africa are reported within the first two years of an incident occurring. In fact, the average delay between incident date and the date of a claim arising is 2.8 years, with a further delay of 2.8 years on average until it is resolved and an outcome achieved.

As a result of this delay, many factors can intervene to impact on the final cost of a claim, such as legislative or legal changes, increases in the cost of care and improved life expectancy.

For example, wages for care workers are rising, in line with the general wage inflation for domestic workers in South Africa, and a deteriorating exchange rate has driven up the cost of specialised, assistive devices imported from the US and UK.

Fighting your corner

Contrary to popular belief, we do not settle claims quickly in order to save time and money. We have published more on this, but ultimately, if this was our approach to handling claims, it would only encourage more claims in the long run.

Of course, where compensation should be paid to a patient, we do aim to resolve claims as quickly as we can – but where possible, we robustly defend claims: in 2017, we successfully defended over 71% of paediatric and neonatology claims in South Africa.

Clinical causes of claims

Five causes of high value paediatric and neonatology claims reported to Medical Protection are:

  • Missed/delayed diagnosis of diabetes mellitus and neonatal thyroid disease, leading to catastrophic outcomes such as brain injury and global developmental delay


  • Delay in diagnosis of and referral for retinopathy of prematurity (ROP); failure to maintain, monitor and screen O2 level, leading to blindness


  • Dehydration and poor line placement leading to brain injury, amputation or nerve/tissue injury


  • Rh incompatibility and jaundice – missed/delayed diagnosis, or failure to monitor, leading to deafness, blindness, kernicterus and autism


  • Missed/delayed diagnosis of sepsis, meningitis, pneumonia and fever, causing seizures or brain injury.

Your subscription

Unfortunately, continued escalation in the paediatric claims environment has an impact on members’ subscription rates. This is because we must anticipate and price for the full potential costs of these high-value paediatric claims falling in future, so that we are able to provide the right level of defence and support you may need should the worst happen.

We strongly believe that prevention is better than cure. As a member of Medical Protection, you have access to a wealth of online resources on our website and e-learning platform, PRISM – to help you act now to safeguard your future practice.