DESCRIPTION 

HPCSA ‘OMBUDSMAN’ 

HEALTH ‘OMBUD’ 

Definition 

“ombudsman” means a person appointed by the Council to mediate in the case of minor transgressions referred to him or her by the registrar for mediation. 

Ombud means a person appointed by the Minister in consultation with the Board of the Office of Health Standard Compliance. 

Establishment of the Office 

Established in terms of Regulation 3 of the Regulations relating to the Conduct of Inquiries into alleged unprofessional conduct under the Health Professions Act 

Established in terms of Section of section 81 of the National Health Amendment Act 

Function 

Mediate in the case of minor transgressions referred to him by the registrar 

Investigate and dispose of written or verbal complaints relating to norms and standards  

Jurisdiction 

Complaints against health practitioners registered with the HPCSA 

Complaints against health establishments including persons employed by health establishments, which may include health practitioners registered with the HPCSA 

Powers 

To consider the complaint and make a determination which is only binding if agreed by both parties 

To investigate the complaint and make findings & recommendations which are binding 

Referral powers 

To refer matters falling outside the jurisdiction of HPCSA to relevant bodies and matters that matters that could not be mediated to the Professional Boards for preliminary investigation through the Registrar. 

The Professional Boards have no duty to report progress to the Ombudsman  

To refer matters to other bodies and such bodies have a duty to report progress to the Ombud 

Independence 

Independent from the Professional Boards and reports to the Council through the Registrar 

Independent from the Department of Health and CEO of OHSC AND reports to and accountable to the Minister of Health 

Although either party may seek legal advice or support, legal representation is not required for matters referred to ombudsman for mediation. Therefore, any communication with the Ombudsman must be in the first person (the parties themselves). 

7. What are the common complaints that are referred to ombudsman? 

The most common complaints mediated by the ombudsman are related to: 

• Communication 
• Informed Financial Consent 
• Billing practices 
• Accounts 
• Medical Reports 

The ombudsman may consider any other matter depending on the outcome desired by the complainant when lodging a complaint with council, professional board and/or the Registrar. 

8. What is the proportion of complaints referred to the Ombudsman for mediation? 

Currently, 39% of complaints received by the HPCSA are referred to Ombudsman for mediation

9. What is the mediation success rate? 

On average, 96% of complaints are successfully mediated of 48% resolved telephonically with the parties including teleconferences, 43% resolved by electronic communication with the parties, and 9% resolved through contact mediation. 

10. Can the ombudsman impose a penalty in terms of section 42(1) of the Health Professions Act. 

The Ombudsman does not make a guilty finding and does not impose any penalty in terms of the Act. The Ombudsman can only make a determination which is only binding if agreed by both parties. 

11. Can I lodge a complaint directly with the Ombudsman? 

No. Complaints are lodged with the Registrar who in turn refer complaints of minor transgression to the Ombudsman for mediation. 

12. Can a complainant request that his or her complaint be referred to ombudsman for mediation? 

Although a complainant can make a request that his or her complaint be referred for mediation as the desired outcome when lodging a complaint, the decision to refer the complaint to the Ombudsman for mediation still lies with the Registrar. 

13. Can a practitioner request that a complaint against him/her be referred to the Ombudsman for mediation? 

 No. This can only be decided by the Registrar and/or the Professional Board Concerned. 

14. Does a determination by the Ombudsman constitute a record of previous conviction ? 

No. The determination by the Ombudsman does not constitute a previous conviction on the practitioner’s certificate of status with Council 

15. What are some of the matters that were successfully mediated by the Ombudsman and the outcomes thereof?  

15.1. A death Notification completed wrongly.  This was a case of a male who was injured on duty and was admitted at the hospital he passed away after three months of admission. The medical practitioner who completed the death notification forms registered the cause of death as “natural”. The effect of this was that the family could not receive the benefits of a death due to an injury on duty. A complaint was lodged twelve(12) years after the incident. Hospital records could not be found. The only relevant document found at the Department of Labour was the Final Medical Report of the deceased which indicated that he died of nosocomial infection. The medical practitioner acknowledged his error in writing which was accompanied by the letter from the Ombudsman to the Department of Labour and the case was re-opened, and the family received what was due to them twelve years after. This matter was resolved through a contact mediation 

15.2. Wrongful use of Co-Payment. A practitioner charged the patient a Co-payment without informing the patient about the cost of services to be rendered and how much the medical scheme would cover for such costs. Information received revealed that the practitioner in fact charges a flat co-payment of R2000 for every patient. The practitioner was assisted to understand the application of co-payment in terms of Regulation 8 of the Medical Schemes Act Regulations and the patient was refunded the money paid as co-payment. This matter was resolved through a mediation by electronic communication. 

15.3. Unprofessional Communication. A practitioner had an altercation with the parents of the child who was his patient and in the process told the father of the child that “you are acting like a monkey”. The complainant wanted the practitioner to apologise for using such words and not only to him, but also to the nurses who were present at the time he uttered such a statement. This matter was resolved through a contact mediation and the practitioner acknowledged that it was wrong of him to utter such a statement and a meeting was arranged with the hospital manager for the practitioner to apologize to the nurses who were present. 

15.4. Claiming for services not rendered. A physiotherapist employed other physiotherapist in terms of Rule 8 of the Ethical Rules of Conduct under the Health Professions Act. After the physiotherapists rendered a service a claim was submitted to the medical scheme. On receiving the statement from the scheme, the patient disputed some of the items charged for  and after failing to resolve the matter with the employer, a complaint was lodged with Council and referred to ombudsman for mediation as the complainant desired outcome was that the physiotherapist should reverse the items charged for services not rendered. This matter was resolved through a contact mediation and the physiotherapist reversed the claim for services not rendered. 

15.5. Informed financial consent. An anesthesiologist failed to inform his patient about the cost of anesthesia and also of the fact that he does not belong to the designated service provider network for the patient’s medical scheme. After the medical aid paid there was a shortfall which the practitioner demanded from the patient. The matter was mediated electronically through email communication and the practitioner offered to write off the outstanding account as a way of resolving the matter.