Thieves of the state – a response

To the Editor: ‘Thieves of the state’ – what a marvellous turn of phrase, damning and straight to the point. Dr Goldstein must be commended on her excellent letter.1 She has done what so many of us, her colleagues, have not had the courage or energy to do: stick out our necks and expose this shameful blot on South Africa’s medical landscape.

Our citizens, whether they are the poor or those who pay the taxes, should be shown exactly how they are being screwed. Management-level public hospital consultants (principal specialists, in pre-OSD terms) receive a package in excess of a million rand annually, with full benefits, including a lifelong pension after 10 years’ ‘service’. Yet these and other ‘full-timers’ do unlimited private practice simultaneously. They are so conspicuous by their absence: late or non-attenders at meetings, never respond to emails, unavailable for outreach – 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, despise them and are bitter about the situation.

Everyone knows about it, but no one blows the whistle. This is the most ominous aspect of all. In our province RWOPS (remunerative work outside the public service) was precipitately banned. This is unrealistic, as some RWOPS is entirely 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 double or 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 job?

The health system would fall apart if they were to leave. I doubt it: the benefits and security of salaried employment have much to commend them. Put it to the test. Issue an ultimatum: stop private practice in 3 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? I know a couple of lawyers who have gone to prison for embezzlement of trust funds. Are we not looking at heinous betrayals of similar culpability?

It would be interesting to know the take of the national and provincial ministers of health on the matter. There is no problem in identifying the perpetrators. They have consulting rooms with phone numbers in the directory. One can make appointments.

Thieves of the state. Yes indeed. These are not derring-do cat-burglars or romantic Robin Hoods. These are the hoods who rob the poor to satisfy their greed. Nail them.

Robert Ian Caldwell

Hilton, KwaZulu-Natal

ric@caldwells.co.za

 

1. Goldstein LN. Thieves of the state. S Afr Med J 2012;102(9):719. DOI:10.7196/SAMJ.6165

S Afr Med J 2012;102(10):775. DOI:10.7196/SAMJ.6301