Patterns of unprofessional conduct by medical practitioners in South Africa (2007–2013)¹

Abstract

A role of ethics in the medical context is to protect the interests, freedoms and well-being of patients. A critical analysis of unprofessional conduct by medical practitioners registered with the Health Professions Council of South Africa (HPCSA) requires a better understanding of the specific ethics misconduct trends. To investigate the objectives the case content and sanctions of all guilty decisions related to unprofessional conduct against HPCSA-registered medical practitioners in the period 2007 to 2013 were analysed. A mixed methods approach was followed. The quantitative component focused on annual frequency data regarding the number of decisions taken against practitioners, number of practitioners, number of specific sanctions and categories. Relatively few medical practitioners (between 0.11% and 0.24%) are annually found guilty of unprofessional conduct. The annual average number of guilty decisions per guilty medical practitioner ranged between 1.29 and 2.58. The three most frequent sanctions imposed were fines between ZAR10 000 and ZAR15 000 (28.29%), fines between ZAR1 000 and ZAR8 000 (23.47%) and suspended suspensions between 1 month and 1 year (17.37%). The majority of the unprofessional conduct involved fraudulent behaviour (48.4%), followed by negligence or incompetence in evaluating, treating or caring for patients (29%). Unethical behaviour by medical practitioners in South Africa occurs relatively infrequently.

Ethical misconduct by registered physiotherapists in South Africa (2007–2013): A mixed methods approach

“…Such fraudulent conduct constitutes a contravention of the HPCSA's Ethical and Professional Rules, specifically section 7(5) that deals with fees and commission (HPCSA 2008 ). The relative frequency of fraudulent-related transgressions in relation to all ethical transgressions for physiotherapists in this study is higher than what was found for other health practitioners in South Africa during the same period (2007–2013): dentists (55%) (Nortjé & Hoffmann 2014 ), medical practitioners (48.4%) (Hoffmann & Nortjé in press ) and psychologists (21%) (Nortjé & Hoffmann 2015 ). These findings support the opinion of Ogubanjo and Knapp van Bogaert ( 2014 ) that health care fraud is a serious ethical issue for many health care practitioners in South Africa, especially as this type of fraudulent personal gain behaviour almost always results in direct or indirect prejudice to the patient and medical aid scheme.…”

“…In some of the cases involving issuing misleading, inaccurate and/or false statements, or failure to obtain patient consent to perform procedures or interventions, or making derogatory /abusive remarks towards a patient, the sanctioned physiotherapists were ordered to attend a practice management course (7.4%, n = 2) or to attend a medical ethics and law course (7.4%, n = 2) ( Table 3 ). This is substantially higher than the 1.10% ( n = 5) of sanctioned medical practitioners in South Africa who were required to attend a medical ethics course in the period 2007–2013 (Hoffmann & Nortjé in press ); however, the low numbers of actual cases for physiotherapists ( n = 2) and medical practitioners ( n = 5) respectively in this regard indicate that any statistical interpretation should be approached with caution to avoid undue bias. The various penalties imposed to physiotherapists by the HPCSA indicate that the following transgressions are viewed as serious ethical misconduct: issuing misleading, inaccurate and/or false medical statements; false and/or inaccurate medical aid claims involving non-rendered services; over-servicing patients by performing redundant procedures; and failure to obtain patient consent to perform procedures and interventions, especially when it involves risks and potential complications.…”

“…The total of 37 transgressions across the study period (7 years) for an annual average of 5709 registered physiotherapists in South Africa is slightly higher than the total of five serious ethical transgressions for the period 2006–2013 (8 years) for approximately 4200 registered practitioners during the same period in New Zealand (New Zealand Health Practitioner Disciplinary Tribunal [NZHPDT] 2014 ). However, the South African figures compare favourably with the annual frequency of 0.09% sanctioned annual disciplinary enquiries against HPCSA-registered psychologists during 2007–2013 (Nortjé & Hoffmann 2015 ) and the average annual frequency of 0.17% sanctioned medical practitioners in South Africa during the same period (Hoffmann & Nortjé in press ). The overall mean number of guilty verdicts per sanctioned physiotherapist was slightly above one verdict (1.33), suggesting that sanctioned practitioners generally only engage in once-off acts of misconduct.…”

Exploring medical ethics’ implementation challenges

“…Unethical behavior can be the result of a lack of ethics knowledge; however, in many cases, despite ethics knowledge, professionals engage in unethical behaviors or reasoning. [ 29 30 31 32 ]…”