Minister of Health, Dr. Aaron Motsoaledi
Deputy Minister of Health, Dr. Joe Phaahla
Director-General of the Department of Health, Ms. Malebona Matsoso
Hon MA Dunjwa, Chairperson of the Portfolio Committee on Health
Members of the Ministerial Advisory Committee on Mental Health
OHSC Board Members
OHSC Chief Executive Officer, Dr. Siphiwe Mndaweni
Members of the media
Distinguished Guests, Ladies and gentlemen
1. William Osler- When Osler made this statement below, the importance of the art of medicine was high; the ‘biological revolution of monoclonal antibodies, DNA and the internet were not yet games in town, and the importance and rising influence of science on the understanding of disease and practice of medicine has since grown in leaps and bounds.
‘There are only two sorts of doctors: those that practice with their brains, and those that practice with their tongues.’
2. Medicine and science are interdependent and both are anchored and governed by the search for the truth and the practice of ethics to advance and improve human kind and the human condition.
3. Modern medicine and science are very important in the wellbeing of nations; they are the cornerstones for economic development; they are necessary for vibrant and successful democracies; they are important for national reputation and the comparisons of nations globally. The integrity and quality of any National Health System in an internet-connected world is thus critical for the life of a nation particularly its education. That is partly why society places such trust, high prize and pride on health professionals and scientists. We are the trusted seekers of the truth, the ‘brains trust of the nation.
4. The integrated integrity of the practice of science with the art of the practice of medicine, the ethics underlying both and the truth have guided my report. Embedded in every finding runs the blood of science and its ethics.
5. In preparing the report on an investigation into allegations of patient mismanagement and patient rights violations at the Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre, I tried very hard to ensure that every word has a place and meaning but that reading the report would be enjoyable. I was acutely aware of the complex, diverse and active compatriots for whom this Report was addressed to (‘Active Citizenry in National Development Plan’ speak). So, I went over 40 drafts of the Report before this final one. If I did not succeed fully, it is not for lack of trying.
6. The interim draft Report was circulated and shared with those concerned at the Eastern Cape Department of Health (ECDoH), Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre (TPHPRC), Eastern Cape Technical Task Team (EC TTT), Dr. Kiran Sukeri and the OHSC investigators for their inputs, comments, corrections and critique. I am grateful for these inputs. Some statements were revisited with witnesses for verification and confirmation and these were incorporated following their comments to produce the final Report. This important process has strengthened the Report.
7. Since Suzanne Venter of the Rapport newspaper broke the TPHPRC story on 4th March 2018, there has been a lot of ‘noise’ almost of ‘orchestra proportion’. The nation has been baffled or bewildered, at times shocked and many innocent people left in pain and with shattered reputations, particularly so soon after the Life Esidimeni tragedy.
8. For those who listen to or follow Jazz, the legendary Miles Davis once remarked: ‘In playing with an orchestra, it may be simpler or better still to play above rather than against the orchestra. You are likely to be heard playing above rather than against as the orchestra noise will simply drown you. This is my paraphrase and interpretation of the legendary trumpeter. A lot of ‘noise’ has been playing since the 4th March 2018 in the media with articles and documentaries.’
9. Hopefully trough this Report one can play above the ‘noise’ of the orchestra and be heard without disappearing into the clouds or without being drowned.
10. Hopefully the Report provides a balance and a melody to the ‘noise’ you have all heard so far.
There are four themes that emerged out of the investigation, evidence, analysis and consolidation.
a) The complaint was very important and unique for the ECDoH;
b) This was the first complaint lodged by a senior health professional consultant psychiatrist against his employer, TPHPRC and ECDoH;
c) The complaint was described as ‘coy and complex’. Coy meaning ‘subtle’ and at times ‘evasive’.
d) Dr. Sukeri made the following telling statements:
a. Almost every witness conceded that Mental Health and its services were not a high priority within the ECDoH.
b. The ECDoH was the cause of all the woes with Mental Health Care Services.
c. The ECDoH failed to guide and support TPHPRC.
d. It has a long history of failure to implement or action plans supported by well-researched studies.
a. The management was in total disarray and engaged in ‘power struggles’.
a. Nothing was recorded for his h-index;
b. He released unverified, false, exaggerated and damaging death statistics into the public;
c. He violated his professional oaths and his employer’s confidentiality contractual clauses;
d. No amount of anger or frustration could be an excuse for a senior professional to behave this way and violate his professional and contractual oaths, ethics and codes of practice;
e. Everybody disagreed totally with the manner and ways in which Dr. Sukeri raised the complaint; and
f. He irretrievably broke trust and the confidence of his colleagues.
a. As South Africans, we are not a nation of Human Rights violators. In a 124-year old, 400-bedded chronic mental health institution and Rehabilitation Centre (TPHPRC), at Fort Beaufort, the Health Ombud could only identify and confirm one unquestionable instance of Human Rights violation, following a detailed and systematic evidence-based analysis of Dr. Sukeri’s complaint.
b. This violation was agreed by all stakeholders and all witnesses interviewed. There was thus no prima facie evidence of systematic, deliberate or systemic Human Rights violations found nor was there evidence found of a culture or intent to violate Human Rights by staff at TPHPRC.
c. There were no other ‘degrading and inhumane treatments’ observed or found as alleged by Dr. Sukeri. This finding was corroborated by evidence from the Office of Health Standards Compliance (OHSC) investigators, the Mental Health Review Board (MHRB) Central Region, the Eastern Cape Technical Task Team (EC TTT) and evidence from research and the 34 witnesses interviewed by the Ombud.
d. Dr. Sukeri’s coy complaint was primarily about chronic systemic failures and neglect of the ECDoH on Mental Health Care Services (MHCS) with pernicious systemic effects and the power struggles for change. It was not about Human Rights violations primarily as initially alleged and peddled in the media.
a. Dr. Sukeri failed to conduct credible studies, research or audits with rigorous verification of the information, data or figures available before making false and damaging pronouncements to the public through the media. This was a grave error.
b. Over an 8-year period, 68 MCHUs had died at TPHPRC and not the falsified and exaggerated total of 90 deaths as reported in the media with Dr. Sukeri’s collaboration.
c. These total deaths translated into approximately 8.5 deaths/year or 0.71 deaths/month in a 400-bedded hospital. Therefore, the notion by Dr. Sukeri that ‘an alarming number of patient deaths at the hospital in recent years had gone unrecorded’ and without proper research and evidence must be regarded as false, untrue and must be eschewed.
d. For Dr. Sukeri to release such ‘shoddy’, poorly-researched, falsified and exaggerated patient’s vital statistical information into the public via the media, amounted to ‘scientific misconduct or fraud’, a cardinal sin in science.
e. He had told Dr. Snombo he was conducting ‘research’ and had found a ‘goldmine’ while discussing the Death Register.
f. He was in ‘Violation of Generally Accepted Research Practices – that included ‘improper reporting of results to present a misleading outcome’ and the ‘Falsification of Data’ – rather than manipulate the experiments or the data to generate preferred results, this transgression simply fabricates the data entirely (https://www.enago.com/academy/10-types-of-scientific-misconduct/).
g. From this low averaged total death estimate of 0.71 deaths/month and an overall performance score of 89% in the National Core Standards assessment, it must be safe to conclude that TPHPRC would rank and compare favourably with the best health establishments of its kind (Weskoppies and Sterkfontein in the country) in the world and must be regarded as such (Khamker N et al 2010 and Walker et al 2013).
a. Dr. Sukeri’s complaint was depicted and portrayed in the media as another ‘Life Esidimeni saga’, even by Dr. Sukeri as alleged in certain sections of the media such the Rapport, City Press and the eNCA TV programme, Checkpoint. The reported death of 90 MHCUs became etched in the public’s mind, reinforced by the reported statement by Dr. Sukeri saying ‘the government did not seem to have learnt any lessons from Esidimeni’ and another documentary flighted as ‘The next Life Esidimeni to air on eNCA by Health-e News and Grocott Mail, 11th June 2018, all taken together, created this copy-cat phenomenon comparison. Dr. Sukeri would have been fully aware at this time of the final total of 144 deaths recorded at Life Esidimeni over a period of one year during the ‘Marathon Project’ (Robertson & Makgoba 2018).
b. This Life Esidimeni comparison has had the effect of:
c. There was thus a 17x fold increase of deaths at Life Esidimeni compared to deaths at TPHPRC (12/0.71).
d. There was no link between the 68 deaths with the alleged Human Rights violations, unlike the 144 deaths in Life Esidimeni.
e. The Life Esidimeni tragedy was a once-in-lifetime event with no precedent recorded in the history of medicine and has thus become a landmark case study for quality healthcare, health professionals, politicians, lawyers, ethicists, actuaries and constitutional lawyers and the TPHPRC story is hardly ever likely to reach this status.
f. The scale/extend and degree of Human Rights violations at TPHPRC were very few, isolated and secondary and not comparable to the litany of Human Rights violations found and catalogued for Life Esidimeni (supported by medical, forensic and post mortem evidence), which were primary as detailed in the Ombud’s Report (Makgoba MW, 2018, www.ohsc.org.za), elaborated and aired during the Alternative Dispute Resolution (ADR) testimonies (published in full in Timeslive 20th March 2018) and (http://www.gauteng.gov.za/government/departments/office-of-the-premier/Pages/Life-Esidimeni.aspx).
g. Therefore, to compare and label Dr. Sukeri’s complaint at TPHPRC as ‘another Life Esidimeni’ in scale/magnitude or any dimension was both misleading and false.
h. Despite Dr. Sukeri admitting under oath that he was wrong in this comparison and having made the corrections and admission of ‘statistical miscalculations’ to the Ombud, followed by a written apology to the National Health Minister, Dr. Aaron Motsoaledi and copied to the Health Ombud on this grave error, the reputational damage to the country was done; he has yet to succeed in correcting these in the media and the publics’ mind.
i. This Life Esidimeni comparison was not only factually inaccurate and far from the truth, but also ill-informed, poorly researched, unscientific, false, exaggerated and based on inaccurate statistics. This incidence at TPHPRC was no Life Esidimeni.
j. Dr. Sukeri has conceded under oath the following:
k. It is therefore my appeal that the media that participated in peddling these falsities (The Rapport, City Press, The Daily Dispatch, Grocott’s Mail, eNCA Checkpoint and others) should consider withdrawing these articles and documentaries and joining Dr.’s Sukeri in tendering a public apology. It cannot be acceptable and be ethical in a Constitutional Democracy and a ‘knowledge society’ that the public is informed and educated on proven and acknowledged wrong scientific facts. We cannot create a successful non-racial, non-sexist and equitable society on the basis of lies and untruths.
a) ‘Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.
b) Doctors are under both ethical and legal duties to protect patients’ personal information from improper disclosure. But appropriate information sharing is an essential part of the provision of safe and effective care. Patients may be put at risk if those who are providing their care do not have access to relevant, accurate and up-to-date information about them’(https://www.gmcuk.org/Confidentiality_good_practice_in_handling_patient_informatio…).
c) Dr. Sukeri violated his professional codes of practice and ethics and breached his confidentiality contractual obligations with his employer, TPHPRC and the ECDoH. By sharing the death register (with personal patient’s information) with the Rapport newspaper and subsequently on public national television (TV) with eNCA’s Checkpoint reporters, Dr. Sukeri violated one of the cardinal rules of the health profession’s practice, which is confidentiality. This violation was in breach of the National Health Act.
d) By violating patient’s confidentiality, he violated patient’s dignity. Dr. Sukeri acted in the most unprofessional way for a senior health professional, in a ‘noble profession’ steeped in centuries of values, traditions, ethics and codes of conduct to advance and improve human life, protect and do no harm to humankind; he simply and consciously ignored all these. He has so far showed very little remorse for his actions; and he lied under oath.
a. In the progress report provided by Dr. TD Mbengashe, the SG on 21st August 2018 to the Health Ombud, following the recommendations of the EC TTT and the findings of the OHSC investigators showed that Dr. Sukeri had indeed discharged patients without proper authorisation and ensuring social circumstances of the users. This item in the original Report is item 4.15.1 on page 48. This version represented an update.
b. Follow up of the users discharged revealed the following:
a. Dr. Sukeri has irretrievably lost the trust and confidence of the TPHPRC Board, the Mental Health Review Board (Central Region), Dr. TD Mbengashe, the Superintendent-General, Dr. PP Dyantyi the former Health MEC, the Management team at TPHPRC (Ms. NE Ngcume, Dr. Snombo and Mr. Baart) and other colleagues at TPHPRC and other officials within the ECDoH; his complaint has had the effect of dividing the psychiatric professionals in the South African Society of Psychiatrists (SASOP) National versus the SASOP EC and between members of SASOP within the EC. Ka Sepedi ‘Ba re O nyetše sediba’ meaning ‘he pooed into his water well’ and in Japanese he committed a ‘Hara-kiri, Seppuku or Kamikaze’. He has irretrievably destroyed trust and confidence across a range of stakeholders by the manner in which he went about his complaint. He disregarded all possible and available processes to him.
b. Dr. Sukeri claimed in some of his media quotes in City Press newspaper (04-03-2018) that: ‘I know what I’m going to tell you will jeopardise my safety, as well as that of my family, but I don’t care. Those patients urgently need to be helped’. ‘He was aware that he had not followed due processes’; He did not care anymore as he ‘could no longer keep quiet or remain silent’ about these ‘inhumane conditions’; He showed Rapport newspaper copies of the ‘lost’ register indicating at least 90 patients at the institution since 2010 and four patients died in January alone.’‘ We’ve been struggling with the same kind of problems in the Eastern Cape for years. I ‘ve been fighting for the rights of psychiatric patients for 12 years’, said a tearful Dr. Sukeri to the Rapport newspaper.
a. Dr. Sukeri’s complaint whilst important for Mental Health Care Services in the EC, it is equally injurious to the health’s professions reputation, integrity and the quality of the health system and its professionals.
b. Consequently, Dr. Sukeri has single-handedly brought disrepute to our country, its health system and its health profession and professionals at enormous human and financial costs by the manner of his actions; the processes he chose to articulate his complaint; surely this conduct and consequences thereof calls for something at the highest level to be done i.e. when a nation or society can no longer or loses trust its ‘brain trust’, something profoundly faulty has taken place.
a. Available evidence gathered and corroborated by several independent research reports, showed that ECDoH:
b. The TPHPRC 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.
a. The National Health Minister must evoke the appropriate and relevant Sections of the Constitution to appoint an Administrator with respect to Mental Health Services in the ECDoH. This must be done within 90 working days through the appointment of an Administrator.
b. This Complaint has re-emphasised the urgent need to review the National Health Act (NHA) 2003 and MHCA 2002 that took away the powers of the President, the National Minister of Health and Magistrates in addressing issues of Mental Health nationally. Locating Mental Health Services at the Provincial sphere of government in the so called ‘concurrent competence’ has created difficulties rather than solutions to Mental Health Care Service. This competency must revert back to the National Health Minister (Health Ombud Report page 54-55 item 14).
c. Dr. Sukeri should be reported to the Health Professions Council of South Africa (HPCSA) as a matter of urgency for serious professional misconduct and violations of ‘codes’ of health practice identified in the report. The rationale for the recommendation is:
d. The HPCSA should consider the immediate suspension of Dr. Sukeri from any practice pending a process to assess his ‘fitness for office’ as proposed out below, to safeguard the wellbeing of patients, protect him and the integrity of the profession.
e. Disciplinary proceedings must be instituted against Dr. Sukeri in compliance with the Disciplinary Code and Procedure applicable to Senior Management Services (SMS) members in the Public Service. This should follow a fair, transparent and due process.
f. Dr. Sukeri should be charged for gross misconduct and incompetence based on the findings in this report especially the violation of patients’ confidentiality and for committing what amounted to scientific misconduct.
g. The HPCSA must consider the appointment of a panel of 3 independent members, Chaired, by a senior psychiatrist to speedily resolve and finalise Dr. Sukeri’s ‘fitness to hold office’, for his professional and ethical violations, broken relationships, misconducts and incompetence. Alternatively, the Minister should set up a special ad hoc panel to address the ‘fitness to hold office’ of Dr. Sukeri.
h. Dr. Sukeri must, in addition to making an apology to the National Health Minister and copied to the Health Ombud (page 61 dated 12th July 2018) and sending a correction to the Rapport Ombudsman, should make a public and unconditional apology in writing to the nation, to his peers in psychiatry, to the medical profession, to the staff at TPHPRC and the ECDoH and to the many patients and families whose lives he compromised through peddling false and exaggerated information.
i. He must acknowledge the pain inflicted to many persons and the reputational damage caused. This apology must be widely publicised and accorded the same weight by the media as they have done with the complaint. SASOP must as a professional body take appropriate actions with regards Dr. Sukeri.
j. The Management at TPHPRC was so dysfunctional and riddled with dead-end power struggles, it must be overhauled with ‘new blood’. This must be done through the SG’s Office and the proposed Administrator.
k. All the recommended internal disciplinary decisions already identified were upheld and must be completed speedily following due processes and in accordance with fair labour practices.
In one of his progress report forwarded to the Health Ombud on 15th August 2018, Dr. TD Mbengashe highlighted a number of activities taking place at TPHPRC starting to address
some of the concerns raised by various witnesses. He also provided an update on the
disciplinary processes already underway.
In his input Dr. Sukeri indicated that following our visit, positive progress was already taking place at TPHPRC. All these bodes well.
Advocacy for patients is a well-recognised phenomenon within the Health System and is
However, health professional must observe and practice the highest ethical standards, must respect the truth and be truthful at all times an advocate with integrity.
There is no place for advocacy through unethical conduct, or through lying or peddling untruths or through the disrespect for tried and tested professional complaints processes.
There is equally no advocacy through bringing disrepute to a profession, to a health system, to a nation and fellow professionals and other innocent human beings.
I hope through the findings and recommendations in this Report, the ECDoH and the Mental
Health Professionals in the EC can work together to create an attractive working environment and services, which are in the best interest of the MHCUs.
MB.; ChB.; (Natal); DPhil.; (Oxon); FRCP (Lond); FRS (SA); MAS(SA); FCP (SA) ad eundum;
Foreign Associate Member of the National Academy of Medicine (USA)
Fellow of Imperial College (Lond) (Health Sciences Faculty)
Health Ombud: Republic of South Africa
For more information, please contact: Mr. Ricardo Mahlakanya; Director: Communication & Stakeholder Relations; Tel. 012 339 8631; Mobile. 079 769 7955; Email. firstname.lastname@example.org; Websites. (www.ohsc.org.za) or (www.healthombud.org.za)