Robbers in white coats

2013-05-02 00:00

SOMETHING is rotten in the state of Denmark. Indeed, the rot is at home in South Africa, including KwaZulu-Natal, right here in Pietermaritzburg, and in Durban. We have “thieves of the state” in our midst, as Lara Nicole Goldstein, writing to the South African Medical Journal last year, so aptly named them, when referring to doctors employed full-time in the public service who are pursuing unlimited, illegal private practice.

RWOPS — or remuneration for work outside the public service — is not the issue. This is a concession which may or may not be granted, and which may or may not be abused. The problem is illegal private practice, breach of contract, the flouting of sections 30 and 31 of the Public Service Act of 1994, which begin thus: “(a) every officer and employee shall place the whole of his or her time at the disposal of the state; (b) no officer or employee shall perform or engage himself or herself to perform remunerative work outside his or her employment in the public service, without permission granted by the relevant executing authority or an officer authorised by the said authority.”

South African citizens, whether poor or tax paying, need to know exactly how they are being screwed. The care of public-sector patients, most of them indigent, is sadly compromised. These doctors are full-time state employees and their primary obligation is to these patients. Yet they do unlimited private practice simultaneously: they run full-on single-handed practices, complete with medical aid pay-outs and practice numbers. They are not just moonlighting, they are daylighting, too. Management-level public hospital consultants receive a package in excess of a million rand annually, with full benefits, including a lifelong pension after 10 years’ “service”.

They are so conspicuous by their absence: unsupportive of their department and its head, neglectful of junior doctors, late or non-attenders at meetings, never respond to e-mails, unavailable for outreach to peripheral hospitals — what specialist with sick private patients wants to leave town for the day? The example they set to their juniors is followed. Surprise, surprise: the next generation of specialists qualifies and does the same thing: gets a full-time consultant post and opens a private practice. Their peers, both genuine full-timers in the public service and specialists in private practice, with whom these thieves are competing unfairly, despise them and are bitter about the situation.

Recent press reports from Gauteng, where RWOPS is being reviewed, suggest resignations en masse and that the health system would fall apart if these doctors were to leave. I doubt it: the benefits and security of salaried employment, with a pension to follow, have much to commend them.

“Everyone knows it, but no one blows the whistle,” wrote Goldstein. This is the most ominous aspect of all. In our province, RWOPS was precipitately banned a couple of years ago. This is unrealistic: RWOPS, if not abused, may be justifiable and advantageous to the state: research, additional teaching, etc. Private practice, not RWOPS, should have been forbidden: alternatively the limited private practice facility previously allowed should have been strictly monitored and enforced. Instead, there is less than lip-service to a non-existent embargo. What is going on here? Is there a hidden agenda? Is there collusion? This is big-bucks business: are there backhanders, is money changing hands? Is it dangerous? Could a whistle-blower stop a bullet, never mind lose a job?

Yet the national Minister of Health has been quoted in the South African Medical Journal thus: “Patients are actually dying because of specialist greed ... high mortality rates at certain hospitals correlate alarmingly with high RWOPS abuse … would ‘far rather’ struggle to fill specialist vacancies caused by a clampdown on RWOPS than employ dishonest professionals who are never there anyway … here you have professionals stealing from the public and the nation …”

But who is going to wield the axe, and when will it fall? Apparently, some of these practitioners are under investigation. Put them to the test. Issue an ultimatum: stop private practice within three months or resign from the full-time post now. Go further. These are criminals. Stick a couple of them in jail. That would stop the rot overnight. Am I being harsh or over-dramatic? Maritzburg knows a couple of lawyers who have gone to prison for embezzlement of trust funds. Are we not looking at heinous betrayals of similar culpability?

What about the South African Medical Association (Sama)? Sama has said that it “upholds the principles of honesty, integrity and patient-centredness and does not condone any unethical practice by its members”. This is reassuring but should go without saying for a nation’s official professional body. Therefore, the same Sama’s strident objection to the Free State government’s withdrawal of approval for RWOPS during office hours is rather surprising. Surely, the very principle of RWOPS is that the work is pursued outside office hours? Sama does not seem to have applied too much thought, pro-activeness or responsibility to the larger implications of this awful blot on our medical landscape. And the SA Medical Journal has published letters and provided news commentary, but a strong opinion from its new editor is overdue.

What ails the press? This should be their meat and drink. Newspapers must have investigative journalists, would-be Woodwards and burning Bernsteins, who could blow this Croesus-gate wide open. There is no difficulty in identifying the perpetrators. They have consulting rooms with phone numbers in the directory: one can make appointments. Something for Carte Blanche to sniff out perhaps?

So why am I blowing the whistle? Well, I am out in the open. I am not going behind anyone’s back. I have expressed these views face-to-face with some of the perpetrators, and have provided the documentation of what is already in the public domain insofar it concerns me. And I was inspired to respond to Goldstein’s courageous letter to the SAMJ, titled “Thieves of the state”. This is a young doctor who possibly stood to lose a career in the public service by “going public”. I have nothing to lose. I have been greatly encouraged by the support for my stance, either in writing or in person, by colleagues, in both public and private sector, some of whom I don’t know from a bar of soap. Having been qualified for 42 years and having been in private specialist practice for 25 all-consuming years, then in fulltime state employment as a consultant, and currently in sessional state employment, I think I know what I am on about.

Maybe one would feel less vindictive if one thought that the perpetrators were ignorant of their transgressions or even vaguely remorseful. This is far from the case, even though some claim to be pure as the driven snow. These are the hoods who rob the poor to satisfy their greed. Perhaps public opinion is required to nail them. Remember this, public-sector patient; recall this, fellow-taxpayer: we are being screwed.

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