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The HPCSA's competency is now being investigated by Health Minister Aaron Motsoaledi.

[From our archives] Comment: Headache a day helps HPCSA keep media at bay

Mia Malan
The council issued an incorrect media statement on its Tim Noakes hearing on Friday. But its media blunders are not new.

On March 10 Health Minister Aaron Motsoaledi announced that a “high-powered” team will investigate the “governance, efficiency, effectiveness and sometimes even competence” of the Health Professions Council of South Africa (HPCSA).

Complaints about the ineffectiveness of the council have filled newspaper pages and the airwaves for decades. Now specialists in law, IT and administration will scrutinise the statutory body that is supposed to regulate health professionals to “protect the public”, as stated on the council’s website.

“After 18 months of waiting, documents getting lost, over 50 unanswered emails and even more unanswered calls, I really don’t see any other way [I can] put pressure on these people,” Dutch physiotherapist Liesbeth Raymakers told the Mail & Guardian in February 2014. She is one of the many foreign health professionals who South Africa needs to supplement its severely understaffed public health system, and who have had protracted battles to register with the council to work in the country.

When Bhekisisa reporter Amy Green asked the council to respond to Raymakers’s case, she received no response. Like Raymakers, she sent email after email and phoned the council’s communication department several times, to no avail.

Frustrated patients
Complaints about the council are not restricted to health professionals. Patients who need the HPCSA to investigate complaints they lodged about alleged unethical behaviour of doctors often wait for years before the council starts to investigate, if it does so at all.

In August 2013, Western Cape businessman Jasper Hoon, who had filed a complaint two years prior to that date and had spent more than a million rand in medical and legal costs, wasn’t any closer to getting reparation. Hoon believed his doctors had misdiagnosed him, and consequently provided him with the wrong treatment, because they failed to perform thorough medical examinations. Hoon almost lost his foot in the process.

He told the M&G: “The HPCSA was dodging and diving away and are making it so difficult for patients to file and follow through on complaints that many people give up.”

In his announcement, Motsoaledi warned that the “weight of the [HPCSA] issues” under investigation is such that he believed “an outside independent process will be more appropriate [than an internal committee the council attempted to set up]”.

The investigating team, led by Bongani Mayosi, the head of the department of medicine at the University of Cape Town, will have to dissect the governance responsibilities of the council, allegations of maladministration by staff who have resigned and determine the “fitness” of the chief executive, Buyiswa Mjamba-Matshoba and chief operations officer, Tshepo Boikanyo. The team has to decide whether “the state of affairs” at the council has affected its effectiveness and efficiency and whether it has negatively influenced the training of health professionals and the registration of foreign health professionals.

Incompetence revealed 
Many health professionals and patients will shout a clear “yes” to those questions. But the incompetence of the council is also unmistakably exposed when journalists attempt to obtain information.

On Tuesday March 17, at 9.45am, I emailed HPCSA communications manager, Priscilla Sekhonyana, with four pressing questions. I was working on a story on Dihlabeng Regional Hospital in Bethlehem in the Free State, where doctors complained that staff levels were so low that it forced them to allow medical interns to work unsupervised, often resulting in the interns running casualty units or giving anaesthetics without any oversight. This situation obviously compromised the safety of patients.

Doctors were concerned that Dihlabeng could lose its hospital training status and that the council would revoke their medical licenses if it paid Dihlabeng an unexpected visit.

The medical officers also cautioned that they had heard rumours that Bongani Regional Hospital in Welkom had been told it risked losing its training accreditation status.

But was it true? And, if so, what process would the HPCSA follow to address the situation at Dihlabeng and Bongani?

Damned: Bethlehem's regional hospital Dihlabeng, where interns are allegedly allowed to work with no supervision. The M&G received no response after repeated requests for comment from the HPCSA. (Fredrik Lerneryd)

Frustrated journalists
In addition to interviews with patients and doctors, I needed official comment from the national and Free State health departments and the HPCSA. I sent the council questions pertaining to the legal implications of interns attending to patients without supervision, the required intern-supervisor ratio for a training hospital and inquired whether the council had indeed warned Bongani Hospital that it could lose its training status, and, if so, how the process would work.

My story was to be published on Friday, March 20. As the questions were relatively simple, and all but one about general procedures, which I assumed the HPCSA would have in a manual accessible to its communication department, I asked Sekhonyana if she could give me feedback by the end of the day. Before I sent my email, I called her to first discuss the issue. I also followed up with a call in the afternoon.

But by the end of the day I had received no feedback.

After calling her the next morning, Sekhonyana sent me an email: “The matter will be discussed at the subcommittee meeting for undergraduate training, education and training on Thursday, March 19. I can only have a response ready for you by Friday, March 20, once the subcommittee has reviewed the matter.”

The council was obviously not going to meet the deadline for my story, so I resorted to incorporating its response into a story for the following week.

Escalating frustration at coucil
Yet the Free State health department’s spokesperson, Mondli Mvambi, responded to seven detailed questions, that required him to provide me with numerous figures, as well as reaction to the doctors’ claims, within eight hours. National health department spokesperson Joe Maila responded within a day and a half to my questions.

On the Friday morning, I called Sekhonyana again. There was no answer, so I left a voice message on her cell phone and sent her an email. No response.

By 11.46am I got so frustrated that I called the council’s chief operating officer, Tshepo Boikanyo, whose competency is now being investigated by Motsoaledi.

Shortly thereafter, I received a call from Sekhonyana saying she would get the information in time for my story the next week. An official from Boikanyo’s office also called to confirm that I would get the answers by the Monday.

But Monday, March 23, arrived without any answers. Sekhonyana emailed me to let me know that she had “escalated my enquiry to the chairperson of the committee” because the person who is supposed to provide her with the information had been absent from work since the previous Friday.

Tuesday, March 24: no answers.

By the Wednesday, when I called Boikanyo again, he put me through to the council’s senior public relations manager, Charmaine Motloung, who (surprisingly) told me that she would escalate my request to the chairman. “But had Sekhonyana not already done that the previous week?” I asked. Motloung simply ignored my comment.

On Thursday morning, March 26, Sekhonyana phoned to tell me she had received the answers.

Responses lacking
But her replies only arrived in my inbox five days later, on March 30. The responses had clearly not been checked by the communications department. To my question, “has any hospital in South Africa’s training status been revoked? If so, which hospital(s) and when did it happen?” the council’s answer was: “Hospitals have lost accreditation status for internship training. Undergraduate and postgraduate facilities could be warned if possible withdrawal is envisaged.”

To my question, “[Has] Bongani Regional Hospital in Welkom been issued with an ultimatum from the HPCSA to meet minimum standards, or risk losing its accreditation to employ and train interns? [If so], when was this ultimatum issued and when is the deadline for the hospital to meet the minimum standards?” the council responded, “Veli can provide some info on the specific status of Bongani Hospital.”

I had no idea who Veli was. So on the same day I emailed Sekhonyana to ask for the missing information. But almost three weeks later I am no closer to clarity because Sekhonyana has not responded to my email.

I’ve given up. I simply don’t have the energy and time left to deal with this kind of incompetence. For the record, it’s not the first time.

Lost confidence 
In 2014 I contacted Motloung for comment on a story about Wouter Basson, whom the council found guilty of unprofessional conduct in December 2013. Basson was a doctor while heading the apartheid government’s chemical and biological warfare programme from 1981 until 1992. As Basson could potentially be struck off the medical roll, I wanted to know how many doctors had lost their licences. Almost a year later, after numerous phone calls and emails, I still don’t have an answer. At the time, when I called Boikanyo to find out why I wasn’t receiving any answers, his response was: “Motloung is new. She’s still learning.”

In its governance statement on its website, the HPCSA declares that it “recognises its responsibility to conduct its affairs with prudence, transparency, accountability, fairness and social responsibility”. It goes on to say that “through the confidence of the public and the profession in our system of regulation, we can continue to effectively deliver our mandate”.

Along with the doctors and patients the M&G has spoken to over the years, I’ve lost my confidence in the HPCSA. Information that the public should have access to, through the media, is simply not available. I have no doubt that it’s not always Sekhonyana’s or Motloung’s fault, but rather the overall incompetence of the council is to blame.

Motsoaledi’s investigations team has 60 days to present its findings, but “may ask for an extension if they deem it necessary”.

I hope its deadlines are viewed with more urgency than ours.

Mia Malan is the Mail & Guardian’s health editor and director of the M&G Health Journalism Centre, Bhekisisa

[This story was first published on 14 April 2015]

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Health Professions Council of South Africa (HPCSA)