On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.100 n.7 Cape Town Jul. 2010
Gauteng MEC shifts corruption focus to health care workers
As the Hawks Special Investigating Unit last month began probing nine suspect contracts worth almost R1 billion awarded by Gauteng's Health Department, its Health MEC, Qedani Mahlangu, singled out rogue health care workers.
In an exclusive interview with Izindaba, Mahlangu claimed syndicates involving doctors, nurses and others workers were bleeding her budget via a variety of scams ranging from 'pirate' surgery to wholesale trading in life-saving commodities.
Mahlangu, incumbent since 8 May last year after her predecessor, Brian Hlongwane left under a tender-awarding cloud, initiated a separate five-pronged police probe into systemic staff-related corruption about which she said she had 'volumes of documentation'.
A team of detectives had worked on some cases for 6 months and were 'close' to making arrests in what she believes is a doctor syndicate performing lucrative operations on foreign patients, claiming them to be indigent. Qedani says the patients turn out to have visas and to have paid for their flights to South Africa. The pirate surgery could involve 'the heart or brain or be more routine hip replacements', with doctors pocketing money for what is recorded as free state-funded operations. 'We've discovered it's a huge set-up - we can't quantify yet - but at say, R200 000 per surgical procedure you can imagine...,' she added.
Senior surgeons take exception
Her claims angered senior surgeons working in top Gauteng hospitals who, while not ruling out the possibility, accused her of undermining dedicated professionals without whom the current dysfunctional administration would have collapsed the entire sector.
Known for her sometimes abrasive attitude to senior clinicians whom she has in the past accused of being 'under-committed', Mahlangu, an economist, has in turn been blamed for disempowering and undervaluing her clinical and professional staff.
She said another syndicate about to be cracked involved unqualified outsiders paying well-placed hospital staff thousands of rand to place them in health care jobs, a perilous practice so rewarding that several would-be whistleblowers had 'mysteriously died'.
Asked to explain, she said: 'If I as Dorothy went to tell David that so and so is selling jobs, a few weeks down the line Dorothy is dead, someone just kills her outside a taxi rank'. For R3 000 an unqualified outsider could land a job requiring specific skills, with R1 000 going to the 'fixer' and R2 000 going to the staffer who placed the applicant.
The MEC refused to disclose the names of individual hospitals, saying the corruption was 'all pervasive, ranging from tertiary to district hospitals and clinics'. Soon after taking office, Qedani tasked all hospital CEOs with identifying wastage of resources in all operational areas and claims that as a result, the rot began emerging.
Maintenance contracts on 'ghost' equipment
For example, accountants asked departmental heads to physically identify equipment which the province was paying service providers to maintain. Alarmingly, in several cases the equipment was missing, with detectives firmly believing it was redirected onto the black market by syndicates. 'People say there's no money for equipment maintenance, but in fact there's no equipment!' she complained.
Vital medication was also being redirected onto the black market, as were large quantities of fresh meat and vegetables intended for hospital kitchens, Qedani said.
She claims to have documentation pointing to outsiders 'placing orders' at hospital kitchens for both perishables and non-perishables.
'The other area is consumables like ICU equipment. For example, paper for ECGs - only X amount will be delivered and the rest will be shared between the clinician concerned and somebody else on the other side of the road'.
When Mahlangu first hinted at the extent of the corruption she told Izindaba that some of her CEOs were 'living under siege because they introduced measures to combat fraud and corruption (like stealing consumables in theatre) and now staff are prepared to let patients die because you've killed their markets'.
Qedani said she was confident that 'we'll get to the bottom of this - we're checking up with relatives and associates of the suspects to see where the money goes'.
Whistle blowers 'murdered'
She claimed 'three or four' murders were linked to the job-selling scam, an indication of how far syndicate chiefs were prepared to go to protect lucrative income streams.
Asked for examples of dishonesty in clinics, Qedani said some nurses were selling baby formula milk and charging patients to perform abortions, both vital free services.
Professor Martin Veller, Chairperson of the Association of Surgeons of South Africa (ASSA), said it was 'invidous' to make such strong allegations in the media 'without a burden of proof'. While unaware of any such 'pirate' surgery currently taking place, he would be 'deeply uncomfortable' but support the MEC fully if anyone was found guilty. 'It it's true let's catch whoever it is - any moves to reduce overall endemic corruption are very welcome,' he added.
Like other surgeons Izindaba interviewed he was upset by the sweeping nature of Mahlangu's allegations. 'Someone in that kind of leadership is extremely dependant on the goodwill of health care practitioners,' he said.
One rogue surgeon 5 years ago - ASSA
Veller added that he was aware of only one case where a Gauteng colleague took money to operate on two patients in a public sector hospital, some 5 years apart (in 2000 and 2005). This had resulted in an adverse event and the surgeon making a substantial payment to one patient, plus facing professional misconduct penalties.
Professor Martin Smith, head of surgery at Chris Hani Baragwanath Hospital, said ongoing doctor rotations and plenty of junior staff at tertiary hospitals meant greater openness, better scrutiny and much less likelihood of syndicates forming. 'There may be other cases she's aware of but there's also a whole lot of hospitals where peer review is incredibly limited and anything could be happening,' he added.
He objected to the entire profession being tarred with the same brush and said the only reason Gauteng's health department functioned at all was because of doctor and nurse commitment.
Smith said doctors were not responsible for determining where patients came from or checking the validity of patients claiming to be foreign citizens or refugees. 'That is the responsibility of the hospital administration and patient affairs - you have to be careful when you are accusing doctors of actively bringing patients in and treating foreigners for personal gain,' he added.
His view was that the endemic corruption centered more on hospital food, drug and equipment supplies being redirected prior to reaching their legitimate destination. He questioned whether data existed to show that hospital security checking car boots at access points was resulting in convictions or playing a preventive role.
A spokesperson for the Health Professions Council of South Africa (HPCSA), Bertha Peters-Scheepers, said that the moment any perpetrators were identified, the HPCSA would investigate 'as a matter of extreme urgency' because patient lives were at risk.
Corruption not the whole story - SAMA
South African Medical Association (SAMA) chairperson, Dr Norman Mabasa, welcomed Qedani's probe and said a priority must be to establish whether patients' lives were endangered in any way. 'If any of our members are involved, they should be reported to the HPCSA and/or the police - we won't protect anyone found to be wrong,' he added.
He cautioned however that corruption alone could not be blamed for the 'appalling state of the health care sector', and warned that 'there are many other factors that must be looked at very carefully and addressed'.
In May Health Minister Dr Aaron Motsoaledi told Parliament that the Treasury hired private forensic auditors last August to probe the Gauteng Health department after it overspent by R722 million, but still had bills of R573 million to pay in 2008/09. He said R36 million in contracts was awarded without competitive bidding, and nearly R1 billion was spent on consultants.
Forensic investigators found that the department 'did not follow proper procurement processes for a number of significant contracts', that the department could not account for R62 million in assets. Procedures were bypassed to favour certain contractors.
Deputy President Kgalema Motlanthe signed the proclamation authorising the Hawks investigation with instructions to prosecute individuals implicated. Motlanthe ordered the unit to investigate any serious maladministration, unlawful or irregular appropriation or expenditure since 2006 and to try and recover losses.