IZINDABA

'Populist politicians' take aim at 'soft-target' doctors

Politicians responsible for healthcare delivery, especially those who are medically qualified, should stop 'playing to the crowd' by making irresponsible and premature statements about doctors who sometimes fail to save lives in an underequipped and dysfunctional public health system.

Both national health minister Dr Aaron Motsoaledi and his KwaZulu-Natal (KZN) counterpart Dr Sibongiseni Dlomo publicly slammed three doctors who they summarily suspended in June and July in Mpumalanga and KZN when they failed to save the lives of a critically ill pregnant mother, her unborn child and a car crash victim. The entire leadership of the South African Medical Association, (SAMA) bristled at the way in which the politicians, as SAMA deputy chairperson Dr Mark Sonderup put it, 'played judge, jury and executioner, with flagrant disregard to due process'. 'We're alarmed and concerned that in both instances the politicians climbed into the fray very quickly with comments about criminal activity and suspensions. You need to be very cautious - professional conduct is not within their ambit - it's not their role. Their role is to follow proper process, establish the facts and allow the proper authorities to deal with it. We expect them, both qualified doctors, to know better.' His chairperson, Dr Mzukisi Grootboom, promptly e-mailed Motsoaledi asking for an explanation and set up urgent meetings with the minister, KZN Health MEC Dhlomo and the chief executives of the two hospitals. Said Grootboom: 'We're appealing for a measured response. The best thing they could have said is "We're extremely concerned and will deploy all our resources to get to the bottom of it."' He said that continuation of such political behaviour would result in a slow erosion of respect for healthcare professionals and a loss of faith in the public health system. 'Once that attitude sets in, it's very difficult to reverse,' he warned.

Motsoaledi brings criminal charges

Motsoaledi set in motion criminal proceedings against the two Evander Hospital doctors in Mpumalanga, saying they had 'a tendency to disregard instructions with impunity', after they performed an emergency caesarean section on 15 June on a 37 weeks pregnant girl whose heart stopped during an eclampsia episode in a labour ward. He said that in his 32 years in the medical profession he had 'never seen such an operation done on a young girl outside theatre'. In stark contrast, Prof. Guy Richards, Academic Head of Critical Care at the University of the Witwatersrand and Director of the Department of Critical Care at Charlotte Maxeke Academic Hospital, said that the doctors, one with 15 years of experience and teacher of a course on obstetric emergencies, should be 'praised for their heroic actions in trying to save the baby's life'. Richards said they had very little time before the baby suffered brain damage. The interventions failed to save the baby, and the teenage mother died 10 days after being transferred to a private hospital. SAMA's own unofficial preliminary probe concluded that an emergency C-section was necessary to save the baby's life, presenting the only chance of stopping the mother's seizures. There had been no time to transfer the mother to the theatre on the far side of the hospital, and a helicopter initially called to transfer her to a bigger hospital arrived only 3 hours later. Dr Cedric Sihlangu, Deputy Chairperson of the Junior Doctors Association of South Africa, said an urgent call was made to the theatre for equipment to be taken to the labour ward where the operation was conducted. The mother's heart stopped at one stage while oxygen was being administered, but she had stabilised after the delivery. 'In their hearts and minds the doctors were doing all they could to save the mother and child - for people to turn around and call them names is pretty disheartening,' Sihlangu said.

Mahlane Phalane, Mpumalanga public sector doctor and Secretary-General of SAMA's public sector trade union, said that the initial SAMA probe showed that the doctors had acted correctly. He labelled Motsoaledi's comments 'reckless, premature, misguided and irresponsible'.

The second death, in mid-July, occurred at Osindisweni Hospital near Verulam on the KZN north coast after pedestrian Revishan Pandather, aged 19, was hit by a car in nearby Canelands. A private security guard, Prem Balram, alleged that he bled to death on a stretcher without being given medical attention. Shortly afterwards, KZN Health MEC Dhlomo went on television (prior to any probe being conducted), saying he was 'appalled' by the incident. The distraught doctor who had attended to Pandather appealed to SAMA for help when she was summarily suspended before being called to a formal inquiry by the region's district health manager. Izindaba has established that paramedics delivered the patient (who had been fitted with a manual breathing assistance device) to the doctor, who tried to suction and clear his airway before realising that there was no laryngoscope in the hospital. She reportedly remonstrated with the paramedics for bringing the patient to an inappropriate and under-equipped facility, and he was then rerouted to the Mahatma Ghandi regional hospital. Grootboom said it was established from the hospital manager that Osindisweni had 'not had a laryngoscope for a while'.

How it should be done ...

Grootboom said that proper inquiry procedure would have involved the doctor's senior consultant or line manager asking for and recording a full report, which they would then hand over to the hospital CEO or general manager, before any official internal local probe was launched. Instead the district manager suspended the doctor and the MEC made public pronouncements a full day before the probe. Sonderup concluded: 'This is not the way the game is played. We ask the politicians to please stay out of it - let the proper people deal with issues of professional conduct. We'd perhaps understand if the MEC was a teacher or something, but he's a doctor and should know better. They should try not to be populist about these issues.'

Dr Norman Mabasa, Chairman of the National Convention on Dispensing and an executive council member of the Society for General/Family Practitioners, said that such 'demoralisation of doctors' was now happening with 'monotonous regularity'. 'Doctors seem to be under siege, and this must be condemned. The ministry is supposed to regulate, not disorganise and demoralise. The message must be to follow due process without fail.' Mabasa is a former SAMA general manager, chairperson and president and a former Limpopo Health MEC.

Chris Bateman

chrisb@hmpg.co.za