The R15m-plus damages award arising from the devastating injuries suffered by a child during birth at the Mthatha General Hospital presents the Eastern Cape health department with a dilemma for which there are no easy answers.
There should be no question that patients harmed through medical negligence are entitled to fair compensation.
In this case, the consequences will last a lifetime. The child was left severely disabled and will require extensive care and support.
An award intended to meet those needs should not be portrayed simply as money being taken from the health system.
But neither can the department's concern about the effect of multimillion-rand payouts on its ability to provide health care to millions of other people simply be dismissed.
Every rand paid from an already strained operational budget is a rand unavailable for medicines, equipment, ambulances, staff and facilities.
That creates an uncomfortable cycle.
Failures in the health system cause catastrophic harm. The resulting claims drain resources from that same system, potentially making it more difficult to provide adequate care and increasing the risk of further failures.
The answer cannot be to break that cycle at the expense of its victims.
The department has previously sought alternatives to large lump-sum awards, including providing future care through the public health system.
But there is an obvious difficulty in asking a family whose child has already been failed by that system to entrust his or her lifelong care to it.
The Supreme Court of Appeal earlier this year reaffirmed the principle of lump-sum compensation in such cases, while the SA Law Reform Commission has subsequently proposed legislation providing for structured settlements.
Those debates are important and deserve serious consideration. A compensation system should protect victims while ensuring that money awarded for lifelong care actually serves their needs.
But changing how damages are paid addresses the financial consequence of medical negligence, not its cause.
The most effective medico-legal strategy must therefore begin long before lawyers become involved.
It means identifying hospitals and clinical disciplines generating disproportionate numbers of claims, understanding why adverse outcomes occur, ensuring adequate staffing and supervision, maintaining proper patient records, improving maternity and neonatal care and holding people accountable where standards are repeatedly not met.
Fraudulent or inflated claims must also be vigorously challenged.
Legitimate ones should be resolved efficiently rather than dragged through years of expensive litigation.
There will always be adverse medical outcomes, and negligence can never be eliminated entirely.
But every preventable injury avoided represents something far more important than a saving to the provincial purse.
It means a child and family spared a lifetime of consequences.
That is where the department's efforts — and its resources — should be concentrated.
