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Unscrupulous lawyers are milking the Eastern Cape’s health department dry, as its legal bill now stands at R17 billion.
But much of this is made up of bogus and fraudulent claims, say officials.
At least three lawyers in the province have claimed R900 million between them.
Health officials say that since the Road Accident Fund turned off its taps to dodgy lawyers and encouraged victims to claim directly from the fund, the department has become the new target.
Last week, Eastern Cape finance MEC Sakhumzi Somyo said in his budget speech that claims against the provincial health department amounted to R17 billion – 72% of its R23.6 billion budget.
Provincial health spokesperson Sizwe Kupelo said the R17 billion figure related to 1 800 claims dating back to 1999.
“There are genuine cases of negligence that call for compensation,” he said.
“But there are generally deliberate attempts to defraud the state. There are people who photocopy documents on behalf of these lawyers. There is a duplication of claims. In one instance you have five lawyers making claims using the same case.
“There are three top lawyers, who are the top claimants against the state, who each have made over R300 million through these claims. That is R900 million between these three lawyers. But these claims have not been paid
“I have personally been approached by claimants complaining that they have received R100 000 out of a R10 million claim that has been paid out by the department.”
Kupelo said the lawyers used “spotters”, including people who worked at hospitals, to steal patients’ confidential medical documents. They then used these to lodge claims.
In some cases, the claimants were unaware of the claims being lodged on their behalf.
In others, they were aware, but were paid small amounts while the lawyers took the bulk of their payout.
Kupelo said the department hired law firms – including Norton Rose Fulbright and local firm Smith Tabata – in October last year to investigate the authenticity of the claims.
They had already managed to save the department R75 million in claims because some of the questionable lawyers withdrew cases when they realised they were under scrutiny.
He said the R17 billion would decrease because forensic investigators had found some of the claims were too old and they would apply for the courts to dismiss them.
“Any claim that has not been paid in five years is likely to be set aside, but that is subject to legalities,” he said.
The hospitals in the former Transkei were the most targeted, including Nelson Mandela Academic Hospital in Mthatha and Butterworth Hospital, Kupelo said.
A total of 30 health facilities had been identified as being the targets of litigation.
“But once we started investigating all the claims, the lawyers literally moved from making claims in Mthatha and are now focusing on East London.
“It’s not that there are too many cases in East London. It’s because these lawyers fled Mthatha thinking that the investigation was only based there.”
Kupelo, however, acknowledged that there were cases of “pure negligence” in their facilities.
One such case was a patient who, it was discovered by a specialist in Pretoria, had a foreign object in her abdomen which was left there during an operation at Nelson Mandela Academic Hospital. This resulted in a successful claim against the department. In another case a man got stabbed in Lusikisiki and surgeons left a pair of scissors in his stomach.
“I think he sued us for R8 million,” Kupelo said.
He warned that those lawyers involved in making fraudulent claims would face the music. The culprits had been identified and cases had been opened with the Hawks. Kupelo would not disclose further details as the investigations were at a sensitive stage.
In one fraudulent claim, Kupelo said “spotters” working for a lawyer visited a family. They allegedly claimed to be working for the department of social development.
They allegedly told a member of the family, who had just returned from hospital, that they could arrange a social grant for them.
They took all the documents they needed and lodged a claim against the health department, without the claimant’s knowledge.
“The claim got paid and the claimant was not even aware, despite millions being paid to him,” Kupelo said.
He said the lawyers went as far as hiring cars for their “spotters” and stationed them at hospitals around the province.
“Their area of interest is accidents, orthopaedic operations as well as maternity cases. They steal patients’ information and even pretend to be health officials and promise them the world.
“They book these patients into fancy hotels and get specialists to assess them in order to build a case against the department,” he said.
Kupelo said from October, when the law firms began their work for the department, a total of 44 cases had been submitted. Five were immediately identified as duplicate cases and were rejected.
“This issue is really hurting service delivery. For instance, during the months of February and March, the [budget] was severely under pressure. What normally happens is that when we get to the next financial year, we are already limping with accruals from the previous financial year as a result of these medical legal claims. It’s a serious matter.
“The health sector is under siege,” Kupelo said.
DA provincial health spokesperson Celeste Barker said while the lawyers might be cashing in on the situation, they did not create the problem.
“Basically medical-legal claims are a human rights violation and a consequence of the department dragging its feet in acknowledging that this is really happening. Something needs to be done.”
She said medical staff made mistakes due to exhaustion from being overworked.
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