Over a year after complaints arose from staff, patients and humanitarian organisations regarding alleged medical misconduct by a Messina Hospital doctor, Allick Msebe Dube has finally been dismissed by the Limpopo department of health.
There have been a litany of complaints against Dube, who acted as Messina's clinical manager and later as senior clinical chief executive officer – the hospital's highest position. Staff, patients, and the nongovernmental organisations Médecins Sans Frontières (MSF) and Aids Free World had all voiced concern over Dube's refusal to give adequate medical treatment to some rape survivors, and xenophobic treatment of foreign staff and patients, among other issues.
A Bhekisisa investigation also found that Dube had been convicted of involuntary manslaughter in the US state of Georgia, and was barred from practicing medicine in the country. In Georgia, there is currently a warrant out for his arrest, as Dube is in violation of parole.
In May 2013, staff at the hospital went on strike to bring attention to Dube and hospital mismanagement more generally. Additionally, MSF and Aids Free World both filed complaints with the Health Professionals Council of South Africa (HPCSA), which is responsible for registering doctors, and with the Limpopo and national health departments.
For months, however, Dube continued to work at the hospital unimpeded, being given paid leave while an investigation into the complaints was undertaken.
While several staff who helped to lead the May 2013 strike were dismissed at the conclusion of the investigation, Dube was promoted to senior clinical chief executive officer. The dismissed staff members have appealed. A hospital staff member with access to administrative information told Bhekisisa that Dube made R75 000 a month as senior clinical chief executive officer.
Involuntary manslaughterAfter evidence was brought to the HPCSA's attention that Dube had been convicted of involuntary manslaughter in the United States and barred from practicing medicine there, in February the council found that Dube had submitted false or inadequate information upon applying for his medical license. He was stripped of his license.
Yet, despite the HPCSA having informed both Dube and his employer that he no longer had a valid medical license, he continued to work at Messina Hospital. In April, Adele van der Linde, media liaison officer of the Limpopo health and social development department, told Bhekisisa that a hearing had to take place before action could be taken, and that Dube's position as chief executive did not require him to have a medical license.
The hearing was meant to be held mid-May.
On Monday May 19, a staff member at Messina Hospital contacted Bhekisisa with information that Dube had been dismissed. On May 21, van der Linde confirmed in an email, "Dube has been dismissed on grounds of being deregistered by the HPCSA, as a medical practitioner. The dismissal came after… 30 days of suspension." Van der Linde said that Dube was dismissed on May 15 and an acting chief executive and clinical manager will be appointed soon.
Dube's dismissal has been met with a mix of relief and consternation from hospital staff, MSF and Aids Free World. "We're pleased that the health department has finally taken the right step and removed Dube from his position at Messina Hospital," said Seth Earn, legal advisor for global advocacy at Aids Free World.
"We will, however, continue to try and find answers as to how he was granted a license without the HPCSA performing even the most cursory of background checks and why complaints regarding his behavior went unanswered for so long."
"We welcome the dismissal of Dube," said Gilles van Cutsem, medical coordinator for MSF's operations in South Africa and Lesotho.
"This is good news for patients, who won't have to be exposed anymore to bad treatment from a doctor who should never have been allowed to practice in South Africa. We remain shocked that he was registered at all, and the amount of effort it took to obtain his dismissal. One would hope that the health department and council would act swiftly and vigorously to protect patients, yet it took more than a year, official complaints of many civil society actors and a high court application before they took action against Dube, despite overwhelming evidence.
"This begs the question of how well these institutions are really protecting the public and the need for increased civil society monitoring."
One hospital staffer, who asked to remain anonymous for fear of retribution, said the Dube case highlighted inaction, impunity, and misconduct from the Limpopo health department.
"[Dube] was only dismissed based on the fact that the [HPCSA] removed him, but there is a list of fraudulent activities that this man has done, and up until this day the department does not want to look at that. The department was comfortable with this dubious character leading the hospital.
"The staff member noted that while justice had finally been served for Dube, the dismissed striking staff continue to wait for their appeal to be heard. [Hospital staff] are relieved, but we're still very anxious because anything can happen to us."
Larger questions of accountability of and action by the HPCSA and provincial department of health aside, the immediate question at hand is whether criminal charges will be pressed against Dube, as it is a criminal offense to practice medicine without a license in South Africa.
Staff at Messina Hospital, MSF and Aids Free World all say that Dube continued to see patients long after his license was revoked, despite the provincial department of health having been informed by the HPCSA of the revocation.
"We think that Dube and the department of health should be held accountable for allowing Dube to continue to practice without a license," said Earn. "When we tried to file a criminal complaint against Dube the police indicated we needed to have personal knowledge of his misdeeds. We're hopeful that some witnesses may come forward, or patients who he illegally treated, who would be willing to file a criminal complaint …
"We are in the process of a [Promotion of Access to Information Act] request to obtain documents related to this case from both the Limpopo health department the HPCSA … If the health department knew that Dube's license had been revoked, and allowed him to continue to treat patients, they are certainly guilty of horrible mismanagement and possibly more. Whether or not that also amounts to criminal conduct is something our attorneys will try to determine based on the evidence we obtain."
In April, advocate Tshepo Boikanyo, chief operations officer of the HPCSA, said that a case would be opened with the South African Police Service against Dube, as "it is now a criminal matter".
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Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.