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
“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
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
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. - The Witness
Why does someone become a doctor? Because of all the money they can make! Sure, a million years ago it was because they wanted to help people, but that's not how the world works anymore. If you want to survive in this world, you have to be ruthless, you have to think only for your own needs and comforts. Thinking about other people is what will get you POOR - and you don't want that.
When you look at a country like South Africa and the government of that country what you see and hear coming from the government and all their pretty white papers is very different to their actions and permissions in the real world. The government talks about change, equality, accountability, stamping out corruption, acting in the best interests of the citizens, blah blah blah - well, talk is cheap. Government parties and private jets are not.
Sure, we could blame the doctors, or society, or the hospitals, or money, or even the government. I think though, that blame is just a scapegoat - making real changes based on honest and unbiased evaluations of the world is what is hard. It is hard because it would mean changing everything about the way we live - maybe it is too hard, maybe we will simply never be willing to change for the betterment of humanity and life on Earth. I have certainly seen enough nasty talk coming from people who are violently opposed to change.
So, back to sunny SA - the rainbow nation. How many speeches does it take to change a country? How many white papers does it take to build houses for the homeless? How much should the minimum wage be to guarantee that every person is employed? How many qualifications does it take to provide decent healthcare to a nation?
Apparently a whole hell of a lot more than we've got now.
There is no accountability. There is no sense of responsibility. There is no shame. There is nothing holding those with power back from just taking whatever they want. They have most definitely taken advantage of this.