Following on from their article about the correct use of the title 'locum', Dr Yash Naidoo, Case Manager at Medical Protection, shares a real-life case where the innocent misuse of the word led to a complaint at the HPCSA.
Dr X and Dr Y were partners in a private GP practice. Patient numbers at the practice were steadily on the rise, and a decision was taken by Drs X and Y that an additional GP was needed. After an interview, Dr Z was employed.
It was agreed that Dr Z would work morning shifts on all but one weekday, and that she would receive a fixed monthly salary. At first, the duration of Dr Z’s appointment was unspecified and the agreement was that that the length of her tenure would depend on the operational requirements of the practice. After a while, Dr Z was offered and accepted a permanent position as an associate of the practice. Terms dealing with annual and sick leave, among others, were agreed.
Two medical certificates issued from the practice were the catalyst for the case that followed. The certificates – both for a single patient – were submitted by the patient to their employer. The employer’s human resources officer deemed the certificates to be contradictory and contacted the HPCSA’s inspectorate office to verify the validity of the certificates.
An investigator from the HPCSA conducted an unannounced visit at the practice and introduced himself to the receptionist. The receptionist informed the investigator that Drs X and Y were not available; however Dr Z, a locum who worked at the practice, could assist. Dr Z was then called to meet with the investigator, and she confirmed that she had been working as a locum at the practice for a few years. Dr Z then verified the medical certificates (which were the reason for the investigator’s visit in the first place).
Following his visit, the HPCSA investigator produced a report in which he cleared the medical certificates in question as being valid but recommended that Dr X and Dr Y be referred to the HPCSA’s complaints department for employing Dr Z as a locum for more than six months, in contravention of the HPCSA’s ethical rule 9.
Dr X and Dr Y were thereafter notified by the HPCSA of the complaint lodged against them by the investigator. They were required to provide a formal written explanation to HPCSA, regarding the allegation that they broke the rules by employing a locum for more than six months.
How did Medical Protection assist?
All three doctors sought the assistance of Medical Protection. Because the complaint was directed at Dr X and Dr Y, Medical Protection appointed a firm from its panel of attorneys to assist the members with the preparation and submission of a letter of explanation to the HPCSA. Having considered the agreement between the practice and Dr Z, it was clear to Medical Protection and the attorneys that Dr Z was in fact employed by the practice as an associate, and not a locum. This was made clear in the letters of explanation drafted on behalf of Dr X and Dr Y, and submitted to the HPCSA.
In the process of formulating the letter of explanation, Dr Z was asked by the practice to confirm that she was not employed as a locum but was in fact an associate. Dr Z was apprehensive about doing so, because she laboured under the misapprehension that she was in fact a locum. To be fair, Dr Z cannot be blamed for this misunderstanding; there is a common misconception in South Africa that a locum is someone who works at a practice but is not the owner of the practice. We have written about the issue in detail here.
As a result of her apprehension, Dr Z contacted Medical Protection for advice. Because there was no formal complaint against Dr Z before the HPCSA, Medical Protection did not need to appoint attorneys to assist with a formal response. Instead, Medical Protection advised Dr Z and clarified with her the meaning of the term locum, and confirmed that based on her description provided it would appear that she was not a locum but rather an associate of the practice.
Outcome
The HPCSA’s preliminary committee of inquiry considered both letters of explanation submitted on Dr X’s and Dr Y’s behalf by the firm of attorneys appointed by Medical Protection. The HPCSA accepted the members’ explanations and agreed that Dr Z was not employed as a locum, but rather as an associate of the practice. The matter was promptly closed.
Learning points
Rule 9 of the HPCSA’s Ethical and Professional Rules states that a locum may not be employed for a period exceeding six months. A locum is a practitioner who takes the place of another practitioner for a short period, such as when the latter is on leave due to illness. Employing someone as a locum for longer than six months contravenes the HPCSA’s rules and may lead to sanctions by the regulator.
While it may seem like semantics to distinguish between a locum and an associate, it is important for all members of a practice (including the administrative staff and receptionists) to understand the difference and appreciate that using the term incorrectly could have serious consequences for practitioners.
If an investigator visits your practice purporting to be from the HPCSA, remember to ask them for proof that they have been authorised to conduct their investigation, in the form of a certificate issued by the registrar of the HPCSA.