Category: Ethics and Law

Admin and Ethics should be the Basis of Your Healthcare AI Stratetgy

Technology continues to play a strong role in shaping healthcare. In 2023, the focus was on how Artificial Intelligence (AI),  became significantly entrenched in patient records, diagnosis and care. Now in 2024 the focus is on the ethical aspects of AI.  Many organisations including practitioner groups, hospitals and medical associations are putting together AI Codes of Conduct, with new legislation planning to be passed in countries such as the USA.

The entire patient journey has benefited from the use of AI, in tangible ways that we can understand. From online bookings, the sharing of information with electronic health records, keyword diagnosis, sharing of visual scans, e-scripts, easy claims, SMS’s and billing, are all examples of how software systems are incorporated into practices to facilitate a streamlined experience for both the patient and doctor. *But although 75% of medical professionals agree on the transformation abilities of AI, only 6% have implemented an AI strategy.

Strategies need to include ethical considerations

CompuGroup Medical South Africa, (CGM SA), a leading international MedTech company that has spent over 20 years designing software solutions for the healthcare industry, has identified one main area that seems to constantly be the topic for ethical consideration.

This is the sharing of patient electronic health records or EHR’s. On one hand the wealth of information provided in each EHR – from a patient’s medical history, demographics, their laboratory test results over time, medicine prescribed, a history of medical procedures, X-rays to any medical allergies – offers endless opportunities for real time patient care. On the other hand, there seems to be a basic mistrust of how these records will be shared and stored, no one wants their personal medical information to end up on the internet.

But there’s also the philosophical view that although you might not want your info to be public record, it still has the ability to benefit the care of thousands of people. If we want a learning AI system that adapts as we do, if we want a decision making support system that is informed by past experiences, then the sharing of data should be viewed as a tool and no longer a privacy barrier.

Admin can cause burnout

Based on their interactions with professionals, CGM has informally noted that healthcare practices spend 73% of their time dealing with administrative tasks. This can be broken down into 38% focusing on EHR documentation and review, 19% related to insurance and billing, 11% on tests, medications and other orders and the final 6% on clinical planning and logistics.

Even during the consultation doctors can spend up to 40% of their time taking clinical notes. Besides the extra burden that this places on health care practices, this also leads to less attention being paid to the patient and still requires 1-2 hours of admin in the evenings. (Admin being the number one cause of burnout in clinicians and too much screen time during interactions being the number one complaint by patients.)

The solution

The ability for medical practitioners to implement valuable and effective advanced technical software, such as Autoscriber, will assist with time saving, data quality and overall job satisfaction. Autoscriber is an AI engine designed to ease the effort required when creating clinical notes by turning the consultation between patient and doctor into a structured summary that includes ICD-10 codes which is the standard method of classification of diseases used by South African medical professionals    

It identifies clinical facts in real time, including medications and symptoms. It then orders and summarises the data in a format ready for import into the EHR, creating a more detailed and standardised report on each patient encounter, allowing for a more holistic patient outcome. In essence, with the introduction of Autoscriber into the South African market, CGM seeks to aid practitioners in swiftly creating precise and efficient clinical records, saving them from extensive after-hours commitments.

Dilip Naran, VP of Product Architecture at CGM SA explains: “It is clear that AI will not replace healthcare professionals, but it will augment their capabilities to provide superior patient care. Ethical considerations are important but should not override patient care or safety. The Autoscriber solution provides full control to the HCP to use, edit or discard the transcribed note ensuring that these notes are comprehensive, attributable and contemporaneous.”

‘Gang Culture’ at NHS Hospital Neurosurgery Department, Doctor Alleges

Photo by cottonbro studio

A neurosurgeon alleged during his employment tribunal that a “gang culture” exists within the neurosurgery department of an NHS hospital already beset by claims of a toxic culture and investigations into negligence.

As reported by the BBC, Dr Mansoor Foroughi was dismissed from University Hospitals Sussex in 2022 for misconduct. At a separate employment tribunal, Krish Singh, the former clinical director for general surgery, claimed that rota changes reduced the number of “safe” consultants, putting patients at risk.

Four whistleblowers had also told the BBC of a “Mafia-like” culture, where patients had died unnecessarily and others “maimed”. These new allegations came to light as the BBC and The Times fought a nine-month court battle to have the employment tribunal documents unsealed.

Dr Foroughi alleges that one colleague was signed off to do complex spinal procedures despite lacking training, another performed procedures with a “disproportionate” mortality rate, and yet another took on private work while on call to the NHS – a serious breach of conduct.

University Hospital Sussex encompasses several hospitals, which includes Royal Sussex Country Hospital, which has been the source of many complaints, and a history of poor service delivery, which was put into special measures between 2016 and 2019.

At least 105 cases of alleged medical negligence from failings at the hospital’s neurosurgery and general surgery departments are being investigated by police. According to court documents, there was “serious dysfunctionality in the neurosurgery department” with “stark divisions between colleagues”.

An investigation by the Royal College of Surgeons found that “a culture of fear” existed in the hospital’s surgery department, and that senior staff were “dismissive and disrespectful”. Two staff were allegedly assaulted.

In a statement, the trust said: “The trust will vigorously contest these claims at the Employment Tribunals, which we are keen take place at the earliest opportunity so they can be examined properly and fairly.

“Dismissing anyone, or removing someone from a leadership role, is an absolute last resort and we would always seek to avoid this outcome if possible.

“In both of these cases, due process was followed, and we are confident we did the right things, in the right way, for the benefit of our patients, their care and safety.”

“Anti-vax” Doctor’s Disciplinary Inquiry gets Underway

Shankara Chetty is accused of failing to act in the best interests of patients

Photo by Tingey Injury Law Firm on Unsplash

By Tania Broughton for GroundUp

The disciplinary hearing against “anti-vax” doctor Shankara Chetty got underway in Durban this week, after changes to the charge sheet were made.

This comes after Chetty asked that the charges be dismissed or revised – or he would approach the high court for relief.

The charges are based on allegations by Francois Venter, a medical professor at Wits University who was at the forefront of Covid research in South Africa. He said Chetty was practicing “pseudo-science” at the height of the pandemic, with Chetty claiming that vaccines made no sense.

Chetty’s argument, in the main, focusses on his right to freedom of expression and claims that expressing a view is not a violation of the ethical guidelines of the Health Professions Council of South Africa (HPCSA).

His lawyers argued that the charges should have been dropped. Instead, the disciplinary committee ordered that they be amended.

The revised charge sheet contains four charges of unprofessional conduct.

They include that he contravened norms and standards by using unproven and unrecommended health technologies, namely Chetty’s “8th day” protocol, and that he failed to act in the best interests of patients by prescribing ivermectin, corticosteroids, and hydroxychloroquine for Covid, which were not approved by the South African Health Products Regulatory Council for this purpose.

He is also charged with casting aspersions on expert health care professionals who were authorised to provide advice and develop protocols, by stating that they engineered protocols in hospitals to “cause death and damage” to Covid patients.

The final, and fourth charge, is based on allegations that he “mischaracterised the cause and identification of the Covid illness, spike proteins and the toxicity of the virus”, which was not in line with the tenets of science.

In his complaint to the HPCSA, Venter said Chetty had made unprecedented claims in a video regarding the toxicity of Covid vaccines and that they were a “deliberate mass poisoning and planned to kill billions”.

He said Chetty, on his own website, had also made “outlandish physiological claims” which undermined the most basic tenets of accepted science about the vaccines, and advocated outpatient remedies of his own.

He said the video and the website “were more than enough evidence of gross misrepresentation of the vaccine programme: anybody watching would be justified in being severely alarmed at the prospect of mass poisoning”.

Chetty’s narrative, Venter said, went against the Department of Health, local experts, and international guidelines.

“This level of pseudo-science within the profession needs to be firmly and quickly clamped down on. The HPCSA must do its duty in protecting the public and discipline Chetty.”

In his written response, Chetty said the video was taken at a three-day Caribbean Summit held by the Word Council for Health, which brought together experts in various fields to share opinions and insights on the pandemic. (Wikipedia describes the World Council for Health as a pseudo-medical organisation dedicated to spreading misinformation to discourage COVID-19 vaccination and promoting fake COVID-19 treatments.)

The summit was not open to the general public and was a behind-closed-doors robust discussion.

Chetty said he did not consent to any recording being shared with the public.

He said he was not an “anti-vaxxer” but he was of the view that the vaccine technology had been rushed to market, with poor safety surveillance by clinical trials, and with a disregard for informed consent and individual choice.

In a written response, Venter said Chetty’s right to freedom of speech did not absolve him of his ethical duties.

This included not posting opinions on the professional reputations of their colleagues on social media “lest the public lose faith in the healthcare profession”.

Chetty is expected to plead not guilty to all the charges. According to the minutes of a pre-inquiry conference, both the HPCSA and Chetty intend to call expert witnesses.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Are Brain Organoids Derived from Foetal Tissue Ethical?

Image from Pixabay.

Brain organoids (BOs), though often referred to as “mini brains,” are not truly human brains. But the concerns over these lab-grown brain tissues, especially when they are developed from human foetal tissues, can be very human indeed.

In a paper published in EMBO Reports, researchers from Hiroshima University offer valuable insights into the complexities inherent in brain organoid research, highlighting often-overlooked ethical dilemmas for better decision-making, especially for foetal brain organoids (FeBOs).

Brain organoids are three-dimensional human brain tissues derived from stem cells. They replicate the complexity of the human brain in vitro, allowing researchers to study brain development and diseases.

Traditionally, brain organoids (BOs) are grown from pluripotent stem cells, an especially potent sub-type that is typical of early embryonic development, but new technologies now make it possible to generate these organoids from human foetal brain cells.

The research comes amid increasingly heated debates over human BOs. Central concerns are that lab-grown BOs might achieve consciousness and the ethical implications of transplanting them into animal models. The discourse includes matters of consent, commercialisation, integration with computational technologies, and legal ramifications. In addition, the public perception of BOs, often shaped by inaccurate media depictions.

Issues of consciousness arising and transplantation into animal models are particularly morally sensitive for tissue donors, and so rigorous informed consent is needed. With FeBOs, these become even more important. FeBOs, for example, can grow past the developmental stage of the initial foetal donor tissue.

“Our research seeks to illuminate previously often-overlooked ethical dilemmas and legal complexities that arise at the intersection of advanced organoid research and the use of foetal tissue, which is predominantly obtained through elective abortions,” said Tsutomu Sawai, an associate professor at Hiroshima University and lead author of the study.

The study highlights the urgent need for a sophisticated and globally harmonised regulatory framework tailored to navigate the complex ethical and legal landscape of FeBO research. One example is the 14-day rule used in embryo research, as neurogenesis does not occur in embryos prior to 14 days post-fertilisation. Using FeBOs derived from 12-15 week old foetuses therefore raises significant ethical questions, especially as there is a proposed 20-week ethical boundary.

The paper emphasises the importance of informed consent protocols, ethical considerations surrounding organoid consciousness, transplantation of organoids into animals, integration with computational systems, and broader debates related to embryo research and the ethics of abortion.

“Our plan is to vigorously advocate for the development of thorough ethical and regulatory frameworks for brain organoid research, including FeBO research, at both national and international levels,” said Masanori Kataoka, a fellow researcher at Hiroshima University.

“Rather than being limited to issues of consciousness, it’s imperative, now more than ever, to systematically advance the ethical and regulatory discussion in order to responsibly and ethically advance scientific and medical progress,” Sawai said.

Moving forward, the research duo plans to continue supporting the advancement of ethical and regulatory discussions surrounding brain organoid research. By promoting responsible and ethical progress in science and medicine, they aim to ensure that all research involving brain organoids, including FeBOs, is conducted within a framework that prioritises human dignity and ethical integrity.

Source: Hiroshima University

Opinion Piece: Ripples of Change toward Building a World of Water Equity and Unity

By Robert Erasmus, Managing Director at Sanitech

Photo by Hush Naidoo Jade Photography on Unsplash

World Water Day 2024 resonates deeply in South Africa, where access to clean water remains a significant struggle for many. Recent protests sparked by water scarcity highlight the urgency of this issue, reminding us that water is not just a resource, but a fundamental human right.

This year’s theme, “Leveraging Water for Peace,” calls for unity and recognition of water’s universal significance. As we face the reality of inequality, it is important for us to renew our commitment to equitable water access for all, by fostering dialogue and taking action that is deeply rooted in empathy and ubuntu. Every drop should bring not only sustenance, but also the promise of peace and prosperity.

Connecting local struggles to global issues

South Africa’s water challenges mirror broader global concerns. Ranked a worrying fifth in global water risk, we share these strained resources with our neighbours. This interconnectedness cannot be ignored, and neglecting this truth is likely to fuel regional tensions. Instead, by highlighting our shared challenge, we can strengthen our position and emphasise the need for collaborative solutions. The depth of South Africa’s water scarcity isn’t just a domestic issue – it’s a regional one. Our ranking among the world’s worst puts us alongside stressed neighbours, suggesting the potential for cross-border conflict over shared resources.

Internally, competition between formal and informal users already creates friction, amplified by seasonal rainfall and inadequate infrastructure. To make matters worse, poor sanitation further contaminates water sources, escalating the crisis. The Institute for Security Studies’ Public Violence and Protest Monitor shows that in South Africa, community frustrations with water and sanitation delivery failures resulted in 585 cases of public protest between January 2013 and April 2021, of which incidents, 65% escalated into violent protests.

Aligning with the water rights framework

Although South Africa boasts a progressive water rights framework, our efforts must align with this framework, ensuring that the fight for water equity remains central to our pursuit of peace. Empowering communities with access to clean drinking water and sanitation and upholding water rights are essential steps toward conflict prevention.

Raising awareness is essential, but tangible action holds the key to progress. Businesses can play an important role in acknowledging South Africa’s water scarcity and investing in corporate social responsibility (CSR) projects that focus on addressing sanitation and water quality in the communities in which they operate. From an individual perspective, it is important that each citizen does their part to conserve water, while supporting organisations that work on improving water access, and raising awareness of related issues within their communities. At a government level, it is critical to prioritise infrastructure maintenance, address sewage contamination, and collaborate with regional partners and industries on sustainable water management strategies, to prevent civil unrest by addressing water equity issues.

Tapping into Ubuntu and empathy

Ubuntu, the South African philosophy of shared humanity, encourages us to understand and share the experiences of others. Cultivating empathy across communities, businesses, and government fosters inclusive dialogue and collaborative solutions. With the principles of ubuntu in mind, it is critical to address sewage contamination to preserve our scarce water resources. It is essential for municipalities and provincial governments to invest in infrastructure upgrades to reduce water loss and improve delivery.   Businesses operating within the sanitation and water treatment sectors have the potential to empower communities by providing filtration and treatment solutions for local water sources. Moreover, the broader private sector can contribute to corporate social responsibility (CSR) initiatives aimed at enhancing sanitation and water quality in vulnerable communities.

Amplifying voices through collaborative communication

Empowering community voices is vitally important. This can be achieved through increased awareness on water scarcity and its impact, as well as by supporting local initiatives that improve water access and quality. Based on the principles of ubuntu, we must advocate for the facilitation of open communication between communities, businesses, and government. Water advocacy groups such as South African Water Caucus (SAWC), and water project NGOs such as the Mvula Trust must continue to advocate for increased funding for water and sanitation projects, by holding the government accountable for meeting water rights and supporting regional cooperation on water management.

Uniting for peace and prosperity

In this way, individuals, organisations, and governments can turn the promise of World Water Day into tangible progress by working together. In prioritising equitable water access, addressing underlying challenges, and fostering collaboration, we can build a future where every drop flows towards peace, not conflict. Remember, water scarcity and strife does not have to be our inevitable future. Through collective action and commitment, we can ensure that this precious resource serves as a bridge to peace and prosperity for all.

Pretoria High Court Judgement On COVID-19 Vaccinations

Photo by Bill Oxford on Unsplash

On 05 January 2023, the COVID Care Alliance NPC and other applicants brought an urgent court application against the South African Health Products Regulatory Authority (SAHPRA), including the President of the Republic of South Africa and others to prevent people from being vaccinated.

The applicants wanted the court to order that all COVID-19 vaccines programs must be stopped and that all COVID-19 vaccination sections in healthcare facilities in South Africa must be closed, and the effective withdrawal from circulation of the vaccines. The applicants also sought an order interdicting the approval of vaccines for emergency authorisation or registration.

On 27 February 2024, the Pretoria High Court dismissed with costs an application filed by the applicants on the grounds that the applicants do not have the right to prevent others, who do not share in their beliefs or opinions, from being vaccinated.

SAHPRA submitted evidence to the Court to show that the applicants’ attempt to prevent government from using vaccines to address the COVID-19 pandemic was misguided, and the applicants heavily relied on hearsay and speculation, as well as supported their arguments with the opinion of persons who were not experts.

Source: SAHPRA

Global Health Photographers Navigate Murky Ethical Waters for Clients

Photographers report moderation, enhancement, and staging of global health images to meet the marketing goals of clients – while photographers react to these practices with resistance and routinely push back, the problem persists as the demand for global heath visuals continues

Photo by William Bayreuther on Unsplash

Global health photography is often caught between photojournalistic intentions of accurately reflect local communities, and marketing directives to create attention-grabbing imagery, according to a study published February 14, 2024 in the open-access journal PLOS Global Public Health by Arsenii Alenichev from Oxford Population Health, the University of Oxford, United Kingdom, and colleagues. Standing at such representational crossroads, photographers are forced to engage with numerous – and often unresolvable – ethical and practical dilemmas.

Photographers are often commissioned by non-governmental organisations and agencies to document the pain and empowerment of others, with a goal to yield donations and attract attention to issues in communities. While photojournalism is often framed as objective, simply by being present, photographers interfere with local communities and can face challenging ethical dilemmas. To better understand how global health photographers operate and ethically obtain consent from subjects, the authors interviewed 29 photographers reflecting the demographic realities of the field about the moral and practical challenges they face on the job. The authors identified common themes across the anonymized interview transcripts to highlight major issues faced by global health photographers.

The authors found that in the current global health landscape, organisations often direct photographers to quickly create attention-grabbing marketing images to compete with mainstream ads. Photographers typically have to work with client-created ‘briefs’ detailing what images they need to take, and with limited time and resources. In practice, it pushes photographers to increasingly sanitise, sensationalise, or stage scenes to produce the desired image – misrepresenting the realities of local communities, especially in the Global South, to which photographers react with resistance. Acquiring ethical consent from subjects is also complicated by power imbalances, language barriers and illiteracy, and misplaced fear and trust in both the photographer and the legal documents they are asked to sign. Given these emergent themes, the authors argue that organizations should push for a more photojournalistic approach to the creation of global health images, weighing ethical clarity over potential economic sacrifice. While their sample of respondents may have been biased towards critical perspectives, the authors believe that this broad overview of tensions will equip other researchers to conduct future studies of more localised, nuanced experiences.

The authors add: “Decolonisation of global health and its visual culture will prove impossible without taking the ethical experiences of photographers seriously, especially the local ones. Global  health images should  not be understood as neutral depictions of interventions – they are in fact political agents participating in the formulation of stereotypes about people and entire communities.”

Murder-accused Paediatric Surgeon Advised that Procedures Were Unnecessary

Photo by Tingey Injury Law Firm on Unsplash

A state witness in the trial of murder accused Dr Peter Beale has testified that colleagues advised him against a procedure which led to the death of a three year old patient.

Paediatric surgeon Beale is charged with three counts of murder, as a result of deaths from unnecessary surgeries over 2012 to 2019. He is also charged with two counts of fraud. He was first arrested in 2019, with his trial date postponed multiple times and only getting underway this week Monday in Johannesburg. His co-accused, anaesthetist Dr Abdulhay Munshi, was shot dead in 2020. As a result of the case, some have voiced concerns over what could lead to criminalisation over deaths resulting from unavoidable errors and systemic failures.

Two of the three deaths stemmed from laparoscopic Nissen fundoplication, a complex and costly procedure that is usually used to treat GERD by tightening the junction of the oesophagus and stomach.

According to the indictment, Beale is accused of “unlawfully and intentionally” causing the deaths of a three-year-old boy in 2012, a 21-month-old girl in 2016 and a 10-year-old boy in 2019 after he had operated on the children.

The state contends that Beale performed these unnecessary procedures as he needed money to recover from heavy financial losses incurred in a failed investment in the 1990s.

News24 reports that, based on a rectal biopsy, Beale believed that the three year old boy had Hirschsprung’s Disease, requiring surgical intervention. As reported in Beeld, Beale said in his plea explanation that he “misread” the patient’s biopsy results and did not deliberately misrepresent the biopsy results to the parents.

The parents sought a second opinion, the state alleges, and the second doctor was hesitant about carrying out the procedure. Beale was able to convince the other doctor that the procedure was necessary based on the biopsy results. Beale also explained in his plea deal that there was a variant of the disease, and the treatment was the same. His counsel, Advocate Ian Greene, also pointed out that the pathologist testified at a disciplinary hearing that the biopsy did not exclude the variant even if it did not exclude Hirschsprung’s Disease.

According to News24, a state witness, who is another paediatric surgeon who remains anonymous at the court’s order, stated that Beale had tried to recruit him to a Ponzi scheme. The scheme had a joining fee of R1 million.

The witness, who had know Beale since 1996, said that in 2009, the accused had also confided in him at a conference that he had suffered significant losses in an investment. The witness was also on the committee at the Healthcare Practitioners’ Council of South Africa disciplinary hearing over the three-year-old’s death. Beale has since been struck from the HPCSA.

The South African Medical Association released a statement urging that, while tragic, the case highlights laws that criminalise and punish individuals instead of taking into account the various organisational failings that can lead to patient deaths and can in no way prevent “unavoidable errors”.

Note: this article has been updated to correct the number of laparoscopic Nissen fundoplication procedures and to add more information about the Hirschsprung’s Disease diagnosis.

Male Murder Rate is a National Health Priority, say Researchers

Photo by Maxim Hopman on Unsplash

By Daniel Steyn

study by researchers at the South African Medical Research Council (MRC) recommends that the murder of men in South Africa deserves an urgent national response.

Richard Matzopoulos of the MRC’s Burden of Disease Unit and his team, which included scientists from the UCT School of Public Health, studied postmortem reports from 2017 to compare murders of women and men. Among the factors looked at were cause of death, age, geographic location and whether alcohol played a role.

The study, published in PLOS Global Public Health, found that 87% of people murdered in 2017 were men. The authors note similar percentages in 2009 (86%) and 2000 (84%). 

According to the researchers, this is the first study on male murders in South Africa. Previous studies have focused mainly on femicide (the killing of women). The study focused on 2017 to coincide with the third national femicide study (previous femicide studies were in 2000 and 2009).

The researchers faced challenges getting the paper published in a peer-reviewed journal. Dr Morna Cornell, one of the study’s authors, told GroundUp that men’s health is generally understudied. Cornell believes “we are living in an outdated paradigm which regards all men as powerful and able to navigate health systems etc, and therefore less deserving of care”.

The most common causes of death among male murder victims were sharp stabbings and shootings. For people between the ages of 15 and 44, rates of male murders were more than eight times higher than female murders. The Western Cape has the biggest gap between male and female victims: for every female killed, 11.4 men were killed.

Male murders peaked over December and weekends, suggesting the role alcohol plays.

The study aims to challenge the idea that men are “invulnerable”.

“The fact that men are both perpetrators and victims of homicides masks the strong evidence that men are extremely vulnerable in many contexts,” the study reads.

Murder in South Africa is concentrated in poor neighbourhoods where the effects of poverty and inequality are most significant. According to the study, “violence has been normalised as a frequent feature of civil protest and political discourse”.

High levels of firearm ownership and imprisonment also contribute to violence in South Africa.

“Men are socialised into coping by externalising through anger, irritability, violence against intimate partners and others, and increased engagement in risk-taking behaviours. This, alongside the high levels of violence to which males are exposed across [life], [causes] a continuous, and often intergenerational cycle of violence,” the study says.

While the study acknowledges that “violence against women is endemic in South Africa, with rates almost six times the global figures”, it argues that “men’s disproportionate burden of homicide has not resulted in targeted, meaningful prevention”.

Interventions recommended by the researchers include stricter control of alcohol and firearms, programs to address societal norms that drive physical violence, and efforts to overcome the root causes of poverty and inequality.

Professor Richard Matzopolous, the main author of the study, told GroundUp that more research is needed to understand risks and interventions, especially in a South African context.

“Phase 2 of this study will explore victim/perpetrator and situational contexts,” said Matzopolous.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Cracking the Whip on Fraud, Waste and Abuse at This Week’s BHF Forensic Unit Indaba

Photo by Jp Valery on Unsplash

A realistic update on the amount of funds lost to fraud, waste and abuse in the South African healthcare environment as well as a special address dedicated to the value and protection of whistle blowers will lead discussions during the annual Board of Healthcare Funders (BHF) Healthcare Forensic Management Unit (HFMU) Fraud, Waste and Abuse (FWA) Indaba at The Houghton in Johannesburg on Wednesday, 22 November.

Convened to coincide with International Fraud Awareness Week and to be moderated by BHF Forensic Unit chair, Dr Hleli Nhlapo, the Indaba spotlight will be on “Strengthening a Culture of Integrity and Accountability – New Strategies for a Corruption Resistant Future “ – subject of the keynote address.

The event will once again endorse the BHF’s representative role as a guardian of the interests of medical schemes, administrators and managed care organisations not only in South Africa but also Lesotho, Zimbabwe, Namibia, Botswana, Mozambique, Malawi and eSwatini.

To this end an unprecedented feature this year will be a panel discussion by Southern African Development Community (SADC) members on strengthening anti-corruption efforts in the SADC Region with cross-border co-operation.

“Promoting the culture of whistle blowing and the protection of whistle blowers” will be a significant key point on the Indaba agenda with the promise of a lively discussion on the encouragement of whistle blowing with the non-negotiable proviso that specific mechanisms should be put in place for corruption reporting without repercussions. 

Until last year fraud, waste and abuse losses in South Africa were generally estimated at just under the R30-billion mark, but as pointed out by the Special Investigating Unit’s Advocate Andy Mothibi at the BHF Conference earlier this year, this figure was likely to be a lot higher.

Fraudulent activities relating to false claims was still a major contributing factor to these losses, he explained, alluding to an observation that anything between 5% and 15% of all medical aid claims could include elements of FWA.

Spurious activities in this regard will no doubt emerge in some of the answers to the Indaba agenda question “Is there ‘Rent Seeking’ in our Healthcare System?” – “rent seeking” being an economic term for an individual who or an entity which seeks to increase their own wealth without creating any benefits or wealth by activities which aim to obtain financial gains and benefits through the manipulation of the distribution of economic resources.

In the same vein, the discussion on “Cracking the Code: Uncovering and Combating Organized Crime Networks in Healthcare”, should shed light on current FWA challenges followed by collaborative measures to counter these such as the use of the HMFU FWA portal introduced four years ago with the prime objective of combating healthcare fraud, waste, and abuse.

Another important element of FWA which has risen to the fore particularly since the successes of the SIU, has been the recovery of lost funds. This will be the focal point of a presentation “Navigating the Road to Restitution: Strategies for Successful Civil Claims Recovery in Healthcare” during which a series of steps to recover losses from wrongdoing or fraud in healthcare are scheduled to be presented.

Going by previous deliberations on the topic, these are likely to emphasise the need for a dedicated legal team with healthcare law and fraud recovery expertise and a commitment to justice for fraud and misconduct victims.

The day’s proceedings will conclude with the SADC member panel discussion on “Cross border Co-operation: Strengthening Anti-Corruption Efforts in the SADC Region”.

Members are expected to deal with important issues such as, not least, the protection of whistle blowers, as well as encouraging healthcare workers in their specific countries to report corruption risk-free with the promotion of law enforcement capabilities and related awareness campaigns.