The Free State Department of Health is grappling with a staggering R5.7 billion in outstanding medical-legal claims, placing enormous pressure on an already strained provincial budget, according to the latest Auditor-General’s report.

These claims, linked to medical negligence and malpractice in Free State hospitals and clinics, are having devastating consequences for healthcare service delivery across the province.

The massive liability means funds that should be directed towards critical service delivery—including addressing the shortage of ambulances, filling vacant medical posts, and improving patient care—are instead being diverted to settle claims that could have been avoided through proper medical practices.

The Auditor-General’s report for the 2024/25 financial year highlighted the severity of the situation, flagging significant leadership challenges alongside financial and performance issues within the department.

Rising claims indicate systemic problems

The increase in outstanding claims between the 2023/24 and 2024/25 periods indicates the department’s failure to meaningfully address underlying issues. The escalating liability suggests that problems with medical care standards and professional oversight remain unresolved.

Medical-legal claims typically arise from allegations of substandard care, surgical errors, misdiagnosis, or other forms of professional negligence. When these claims are successful, they not only result in significant financial payouts but also indicate serious shortcomings in patient safety and care quality.

The financial burden of these claims creates a vicious cycle: as more money is allocated to settling legal disputes, fewer resources are available for improving healthcare infrastructure and services. This can lead to further deterioration in care standards, potentially generating more negligence claims in the future.

The situation is particularly concerning given the Free State’s existing healthcare challenges, including staff shortages, ageing infrastructure, and resource constraints that already limit the department’s ability to provide optimal patient care.

Questions have been raised about the department’s transparency and willingness to confront the underlying issues that contribute to these claims. Without addressing root causes—such as inadequate training, poor supervision, or systemic failures—the province risks continuing to face mounting legal costs.

Transparency and accountability concerns

The scale of the problem suggests the need for comprehensive reform, including improved clinical governance, better risk management systems, and enhanced professional development programmes to ensure healthcare workers can deliver safe, effective care.

David Masoeu, DA Spokesperson for Health in the Free State Legislature, attributed the crisis to leadership failures. “These failures are a direct result of the ANC’s poor leadership style and another example of their inability to bring cadres to order,” Masoeu said.

“The only sustainable way to address these challenges, especially in specialised sectors such as healthcare, is to ensure that appointments are merit-based, with the most qualified and capable individuals entrusted with positions of authority.”

Masoeu indicated that the DA would continue pressuring the department for accountability. “We will continue to pressure the department to ensure that a tangible plan is put in place to address outstanding medical claims, reduce future frivolous healthcare costs, and prioritise and improve service delivery. We have submitted questions to the MEC for Health, Mr Mahlatsi, seeking clarity and accountability on the medical-legal claims against the Department.”