Compensation for injury from medical treatment is a social justice obligation.

advice or treatment has not received attention from South African researchers. Consequently, the extent of serious harm to patients from medical intervention remains anyone's guess. But if the epidemiology of adverse events in clinical practice elsewhere in the world is anything to go by, it is safe to assume that medically caused injury, disability and death are not uncommon occurrences in our country. Medical malpractice or negligence is described as the failure of a practitioner to act in accordance with the accepted norms and standards of care, or to foresee and therefore prevent adverse consequences that a professional person with the necessary skills and training should foresee. The definition must also include the practitioner who exposes a patient to risk by knowingly providing treatment or performing a procedure beyond his or her scope of professional competence. The hallmark of a negligent adverse event is that the event is independent of the pathology under treatment. Importantly, though, negligence is not the one and only cause for medically related injury or death. Writing in the BMJ, Calinas-Correira, 1 a crusader for action to reduce iatrogenic harm, cites large studies to support her assertion that 'major USA and UK hospitals kill one for every 200 hospitalised patients', but cautions that 'large numbers of patients are killed and injured by perfectly sound and proper medical interventions' owing to such mishaps as unanticipated drug reactions, instrument malfunctions and systems failures. It is her view that the latter causes receive far too little attention in the discourse on medical injury. Major studies into iatrogenic harm conducted in a number of countries point to incidence rates of between 3% and 16%, depending on the methodological criteria. The pioneering 1991 Harvard study 2 by Brennan et al. found that 3.7% of patients admitted to New York acute care hospitals sustained medical management-related injury that prolonged hospital stay and/or caused permanent disability. Extrapolating from existing literature, Weingart et al. 3 reach the staggering conclusion that 'In the United States, medical error results in 44 000-98 000 unnecessary deaths each year, and one million excess injuries.' An Australian investigation 4 modelled on the Harvard study found that an adverse event occurred in 16.6% of admissions, resulting in permanent disability in 13.7%, and death in 4.9%. A recent New Zealand study 5 found that the elderly, people of colour, and patients in particular clinical disciplines were at higher risk of injury …