On 23 August 2018, Health Ombudsman Professor Malegapuru Makgoba released his report on an investigation into allegations of patient mismanagement and patient rights violations at the Tower Psychiatric Hospital and Psycho-social Rehabilitation Centre.
But the Rural Health Advocacy Project, the Treatment Action Campaign and Section27 are concerned that the focus of the report on the complainant, Dr Kiran Sukeri, will dissuade other health care professionals from coming forward to speak out about their concerns with health care service provision and perceived violations of the rights of patients.
The report describes a litany of problems at Tower Hospital and in relation to the Eastern Cape Health Department’s handling of mental health services. In particular, the report finds that the use of old and ill-equipped seclusion rooms to be a human rights violation. It finds further that there are serious management, infrastructural, security, human resources, food management and consequence management problem at Tower Hospital and makes a long list of recommendations directed at the National and Eastern Cape Health Department. The Ombud found that “the (Tower Hospital) outburst was just the needed lightening rod and representative of a broader systemic and prolonged poor-quality service delivery for mental health care users (MCHUs) in the EC.”
The report also makes a series of serious findings against the complainant, Dr Kiran Sukeri. Indeed, in his presentation of the report, the Ombud focussed on these findings, including that Sukeri was a poor witness, was incorrect in his statement of the number of deaths that had occurred at Tower Hospital, breached his duty of care and confidentiality and brought his profession and the nation into disrepute. The Ombud recommended that Sukeri be suspended from practice and be subjected to a hearing before the Health Professions Council of South Africa, and that he issue various apologies, among other recommendations.
We are concerned that the findings against Sukeri and the focus on those findings in the Ombud’s report and presentation thereof will significantly hinder other health care professionals from coming forward to speak out about their concerns with health care service provision and perceived violations of the rights of patients.
We note that the Protected Disclosures Act protects whistle-blowers from occupational detriment (being fired, demoted etc) when they blow the whistle on conduct that is prejudicial to the public interest. The Act envisages that whistle-blowers try first to disclose to their employer, then to a regulatory or independent body and, where the impropriety is of an exceptionally serious nature, no action has been taken within a reasonable period, or there is reason to believe that evidence will be concealed or destroyed, to disclose externally, including to the media.
Not only is a health care worker protected from occupational detriments when they speak out, but the Code of Conduct for the Public Service requires that they do so, stating “An employee, in the course of his or her official duties, shall report to the appropriate authorities, fraud, corruption, nepotism, maladministration and any other act which constitutes an offence or which is prejudicial to the public interest.” A guide for health care worker activism can be found here: http://www.rhap.org.za/wp-content/uploads/2017/05/RHAP-Voice-Manual-V2_2017-1.pdf.
While the Health Ombud found that Sukeri had not followed all internal complaints procedures, that he was incorrect in many of his complaints, and that he should not have approached the media, we are concerned with the excoriating treatment that Sukeri received in the report and have requested a meeting with the Health Ombud to discuss the matter.
It is vital that health care professionals raise their voices when they see systems or other failures that impact on the health and lives of patients. Health care worker advocacy has a proud history in South Africa and patients desperately need allies in their nurses, doctors, occupational therapists and psychiatrists. We trust that this proud tradition can continue.