An ambulance base has to comply with a certain set of minimum requirements contained in among others the National Health Act. At the end of last year, the Department of Health published a new set of regulations which detail exactly what the requirements are for an ambulance base.
Spotlight recently sent a photojournalist to four Buthelezi EMS bases. Two in the North West, Klerksdorp and Potchefstroom; one in the Free State, Bloemfontein; and what is suspected to be a central base or headquarters in Eikenhof, Johannesburg.
Images from Bloemfontein and Potchefstroom specifically, show filthy yards, bare insides with no evidence that it is an ambulance base and further evidence that safety and hygiene is not a priority. The images are published alongside our series of investigative articles #Health4Sale.
Buthelezi EMS netted more than R15-million from two suspect back-dated price increases from the Free State Department of Health, apparently without much scrutiny. Documents that Spotlight has had sight of reveal how the increases were signed off during a five-day period, when it seems the Free State Department of Health was temporarily taken out of administration by decree of then Premier Ace Magashule. The Democratic Alliance told Spotlight that they will ask the Public Protector to investigate.
Five days in February
According to a response by the Free State Department of Health to questions posed by Spotlight, the department was under administration by the provincial treasury for almost four years from 17 March 2014 to 15 February 2018. Among others, this means that the accounting officer, the person who ultimately signs off on all health spending, was not the head of the provincial department of health, but the head of the provincial treasury.
Yet, contrary to what the department told Spotlight, this was not the case for
five days in February 2017. In a signed memorandum dated 3 February 2017 seen by Spotlight, then Free State Premier Ace Magashule effectively takes the provincial department of health out of administration for five days by appointing the head of the department of health, Dr David Motau, as acting accounting officer from 6 February 2017 to 10 February 2017. In this five -day window, Motau signs off on what procurement experts describe as two highly unusual back-dated 8.5% price increases for Buthelezi EMS.
When asked about the five days that the Free State Department of Health was taken out of administration, Mariette Pittaway, Democratic Alliance (DA) member of the Free State legislature and spokesperson on Health, told Spotlight: “The DA is fully aware of this. We are in possession of a copy of this appointment letter and are compiling a case docket to submit to the office of the public protector for further investigation.”
Red lights over price increases
The first price increase, signed off by Motau on 10 February 2017 grants Buthelezi EMS an 8.5% price increase for their inter-facility transfer service. Critically, the price-increase is back-dated to April 2016.
Where government contracts allow for back-dating of increases, they typically do not allow for backdating beyond the date at which the increase was applied for. It could be that this specific contract has more flexible conditions attached to it, but in that case the question would arise as to why Buthelezi EMS was granted such an unusually favourable contract.
Free State Department of Health spokesperson Mondli Mvambi has previously said that the Department of Health paid Buthelezi EMS a total of R204 million in the 2016/2017 financial year. It is not clear whether or not this includes the 8.5% increase. Either way, the increase would amount to a back-payment of between R15-million and R17-million. (Spotlight previously reported on how the Free State Department of Health overspent its emergency medical services budget by around 100% during the period in question. It is this budget line that paid for the increases.)
The second price increase relates to a contract between the Free State Department of Health and Buthelezi HEMS, a joint venture between Buthelezi EMS and HALO Aviation. Internal departmental documents show that on 10 February 2017 this price increase is both recommended by Motau in his capacity as Head of the Provincial Department of Health and approved by Motau in his temporary capacity as accounting officer.
This increase is also backdated, but to October 2016. According to internal departmental documents that Spotlight has had sight of, this price increase was only applied for on 27 January 2017.
Also raising red flags, is a letter dated 24 January 2017 in which the departmental bid adjudication committee expresses its support for Buthelezi HEMS’s requested increase. As noted above, according to the department’s own documents this increase was only applied for by the service provider Buthelezi HEMS, three days later on the 27th.
Motivation for increases
While the back-dating of increases raises eyebrows, normal price increases are not straight-forward either. Where government contracts allow for increases, they either happen simply as a matter of course since it is priced into the original contract, or they do not happen as a matter of course, in which case the increase requires a detailed motivation with supporting evidence (as in this case).
Spotlight asked the Free State Department of Health for the full documentary justification for the rate increases given to Buthelezi EMS. The department’s response, signed off by Motau, was simply: “Rate increases are based on the annual Price adjustments and price schedules”. A request for clarification of this answer was not responded to.
Internal departmental documents seen by Spotlight show departmental officials making the case for the increase granted to Buthelezi HEMS (the joint venture) only in broad terms. The key motivation also signed by Chief Director Supply Chain and Asset Management Nelisiwe Phitsane, a senior procurement officer in the department and wife of Tafetso Bernard Phitsane – a senior ANC member in the province and known ally of Magashule – motivates the increase by referring in relatively broad terms to import duties, currency fluctuations, inflation and increases in fuel prices.
The internal departmental documents seen by Spotlight make no reference to any more detailed justification for the increase – as is typically required for such increases in government contracts. There is, for example, no records of specific imported items of which the cost may have increased and how those increases impacted the cost of delivering an aeromedical service to the province. Spotlight asked the Free State Department of Health to share any documentation they may have in support of the increase granted to Buthelezi HEMS (the joint venture). No such documentation was shared by the given deadline.
It emerged last week that Minister of Health Dr Aaron Motsoaledi had asked National Treasury to investigate the Free State’s ground ambulance contract with Buthelezi EMS. In previous articles in the Health4Sale series Spotlight described various complaints about the service provided by the company and various irregularities around the Free State tender. Spotlight also previously published a two-part investigation into similar concerns around Buthelezi EMS in the North West.
Spotlight contacted African National Congress Spokesperson Pule Mabe as well as Ace Magashule’s personal assistant in an unsuccessful attempt to get comment from Magashule. Messages were also left on two different numbers we have for Magashule.
Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
A Gauteng-based ambulance operator, Buthelezi EMS, that is currently the subject of both Hawks and Treasury investigations has scored road and air ambulance contracts in the so-called Premier league provinces amounting to over a Billion Rand since 2013 and they are frontrunners to secure a lucrative new three year tender for Emergency Medical Services in the Free State.
National Health Minister Dr Aaron Motsoaledi last Thursday told Spotlight that he asked Treasury to investigate the Free State and North West’s contracts with Buthelezi EMS. He also made it clear that he did not want the new Free State tender to be awarded at all and that the national department is not in favour of outsourcing ambulance services to private companies. Yet, on Friday afternoon the Free State Department of health told Spotlight that the award of the tender for outsourced ambulance services is going ahead and that the evaluation of bids is at an advanced stage. Free State Health MEC Butana Khompela previously said that he does not want to re-appoint Buthelezi EMS, but he too hasn’t given any indication that the new tender will not be awarded.
The director of a rival ground ambulance company told Spotlight that industry rumours are that another company will front for Buthelezi EMS in the Free State and that such fronting is nothing new in the industry. While Spotlight could not find any evidence of fronting, Companies and Intellectual Property Commission records paint a complicated web of connections. So, for example, Thapelo Buthelezi of Buthelezi EMS and Clifford Mahlo, director of High Care EMS, are also listed as co-directors of two other companies. Both Buthelezi and Mahlo were previously co-directors of ambulance companies with Thomas Maponya, the director of Maponya 911 Rescue.
Several well-placed sources have told Spotlight that Buthelezi has been receiving special briefings from health department officials in the Free State.
Spotlight has also this week visited a smallholding in Eikenhof, Johannesburg, where at least 20 new ambulances appear to be in the processes of being branded as “B EMS” ambulances. These ambulances have Free State number plates and the emergency telephone number on the side of the ambulances is the same as that on Buthelezi’s ambulances in the Free State – and not the same as those seen on ambulances at the Klerksdorp base in the North West. (see pictures)
The Free State Department of Health denies that Buthelezi has been given any advance notice of the outcome of the new tender.
Spotlight has also been told that Buthelezi arrived 15 minutes late for the tender briefing for the new tender in November, but that a senior Free State health official opened the door after he phoned them. Invitations to these meetings explicitly state that the doors will be locked at the starting time and no late-comers will be let in. When Spotlight asked the Department about this, they responded that “No bidder/s was allowed entry after 15 minutes after the meeting has started.”
As it stands, Buthelezi EMS’s previous contract with the Free State Department of Health is being extended on a month-to-month basis until the new tender is awarded or the relevant services is absorbed back into the department.
The controversial rise of Buthelezi EMS
Prior to Buthelezi’s arrival, the Free State was doing remarkably well with their
government-run inter-facility transfer service. In August 2013 Professor Martiens Schoon reported in the South African Medical Journal that maternal mortality in the province decreased from 279/100 000 live births during 2011 to 152/100 000 live births during 2012. The improvement was mainly ascribed to the department procuring 48 new vehicles (18 dedicated to maternity care) and the use of these vehicles to transport women with pregnancy complications. For a while, this state-run programme was held up as an example for other provinces.
Then everything changed when late in 2013 the province decided to outsource its inter-facility transfer ambulance service to a private company. Well placed sources in the province say that this move coincided with the scaling down of the province’s own capacity building efforts in relation to emergency medical services.
The Free State Department of Health claims a tender was advertised, but Spotlight can find no record of this tender advertisement anywhere online or in a newspaper. Netcare 911, a company that would have liked to bid, says they never saw the tender advertisement despite subscribing to various systems that would alert them to such tenders. Spotlight twice asked the Free State Department of Health where the tender was advertised. Both times they dodged the question, merely saying that “The requirement to advertise tenders on-line by law only came into effect in 2016.” They did provide Spotlight with a copy of the province’s tender bulletin, but there is no indication where it was published.
According to Mariette Pittaway, Democratic Alliance (DA) member of the Free State legislature and spokesperson on Health, the DA has also struggled to get hold of documents relating to the tender. “I have requested these documents from the HOD and MEC of Health in a portfolio meeting, when this was not forthcoming, I submitted written questions, which remains unanswered,” she told Spotlight. “There is a general disregard by the FS Executive Council, save for MEC Finance, to answer written questions submitted to them within the stipulated 10 working day period as contained in the Standing Rules and Orders. When questions are replied to, they lack detail and substance, and the tone is generally dismissive. When we raise issues in Committee, which is constitutionally mandated to do oversight, and has the power to subpoena, the ANC uses its majority to protect MECs and dismiss DA concerns. So in effect the legislature is dysfunctional in this regard.”
Buthelezi EMS was awarded the contract in December 2013 – with the contract signed on 20 December, around the festive season. What followed was ballooning expenditure and, according to a range of sources, a decline in the quality of services (see the previous article in this series for details). The Free State and North West are the only two provinces to outsource their ground ambulance service – the North West gave Buthelezi a three-year contract in March 2016.
“The DA is of the strong view that the Buthelezi EMS contract is irregular, over-priced, ineffective and could possibly have links to ANC politicians, since the ANC has been on the defensive over this contract from the very beginning,” Pittaway told Spotlight.
How costs ballooned
Spotlight investigations show that although the North West has been a good source of income for Buthelezi’s EMS operations, his stronghold and springboard into the so-called Premier League provinces (Free State, North West and Mpumalanga) has been via the Free State. We wrote previously about how Buthelezi was awarded a Free State air ambulance contract, that North West, Mpumalanga and Limpopo all piggy-backed on.
Spotlight calculates that Buthelezi EMS has received well over R1-billion in revenue from government contracts, mostly in the Free State and North West, over the last four years – with annual revenue rising sharply over time.
In February Mondli Mvambi, spokesperson for the Free State Department of Health was quoted in the media as stating that the department had paid a total of R613-million to Buthelezi EMS since the 2013/2014 financial year. The breakdown given was as follows:
2013/2014 R4 million
2014/2015 R99 million
2015/2016 R159 million
2016/2017 R204 million
2017/2018 R147 million (Not yet full-year figures)
The year-on-year increases in the above figures raise eyebrows since the service Buthelezi EMS is contracted to provide does not change year-on-year. While some increase from the first to the second year might be explained by teething and scaling-up challenges, the steady increase over multiple years suggest another cause.
Spotlight asked the Free State Department of Health what the budget and what the overspend/underspend on Inter-facility Hospital Transfers was per financial year since 2015. We received the following response signed off by head of department David Motau: “Budget R531 297,000 (Total EMS budget); IFT expenditure R843 132,80 (for both Inter-Facility Hospital and Aeromedical)”
This response is incompatible with the figures previously given by Mvambi. It is also not clear which year it refers to. Spotlight wrote back to the department to request clarification, but the department failed to respond.
Spotlight has however had sight of internal Free State government figures that indicated extreme overspending on the province’s emergency medical services budget:
In 2015/2016 the department spent R152 million on EMS, overspending their budget by R88 million.
In 2016/2017 the department spent R163 million on EMS, overspending their budget by R86 million.
By the time the figures were generated, the EMS expenditure for the 2017/2018 financial year up to that point was R161, already overspending the budget by R117 million.
A pattern of alleged overcharging
The dramatic overspend in the Free State suggests that the province is either being charged more than expected (with invoices inflated as in the case in the North West) or the service is being used much more than anticipated. Almost everyone Spotlight spoke to suggests the former. While Buthelezi EMS’s quoted rates are in line with the industry, it is on the billing side where red lights start going off.
A senior healthcare worker based at a Free State hospital alleges that Buthelezi EMS often transports multiple patients in a single ambulance as part of their inter-facility transfer service. Sometimes as many as five patients will be transported in one ambulance, but Buthelezi would allegedly then bill as if five different ambulances were used and write invoices with five different reference numbers. This pattern was confirmed by more than one healthcare worker we spoke to. (See the previous article in this series for more on the impact this has on patients) At other times, patients who could safely be transported in cars are allegedly transported at great cost in ambulances.
It is also alleged that Buthelezi often charges for distances that are longer than the actual distances travelled. Spotlight was told of a case where a 2km trip was charged for as a 100km transfer. While we have not seen invoices proving such overcharging in the Free State, essentially the same allegations were repeated to us by senior hospital management as well as a well-placed person in the Department of Health in the province. This is also in line with what has been happening in the North West. Part of the problem seems to be that Buthelezi EMS often does not have Advanced Life Support (ALS) capacity in all the districts that they are supposed to – and that as a result ALS vehicles and staff must be sent from other districts – thus increasing both cost and waiting times.
There has also been a shift in the Free State whereby from the 2016/2017 financial year invoices are submitted to the provincial emergency medical services Department in Mangaung, rather than to hospitals as the case was before. According to Motau, the payment of these invoices was at the same time shifted from hospital budgets to the provincial emergency medical services budget. Some senior doctors complain that this shift has made it much harder for hospitals to verify that government is not being overcharged.
Spotlight sent Mr Buthelezi a long list of questions about overcharging and a number of other issues. Mr Buthelezi did not respond to any of the specific questions, but sent Spotlight an e-mail that has been published in full with a previous article in the Health4Sale series which can be read here.
No website, many companies
Despite having had revenues of over a billion Rand in the last four years, Buthelezi EMS does not have a website. The www.ButheleziEMS.co.za domain has been registered, but the site has remained under construction for the more than two years that the company has been on Spotlight’s radar. Some posts are made on the company’s Facebook page, but the kind of information one expects to find on a company with this level of revenue is nowhere to be found online.
In addition, CIPC records and invoices that the company has submitted in North West (see previous article) indicate that technically Buthelezi EMS is sometimes one company, and sometimes another. In the North West the company name on invoices did not correspond to the company registration number on the same invoices.
Thapelo Buthelezi is, or has been, a director of at least six different companies all named as variations of Buthelezi EMS.
Buthelezi EMS CC
Buthelezi EMS (PTY) LTD
B EMS CC (Currently some ambulances are being rebranded as B EMS)
Buthelezi HEMS CC
Buthelezi Helicopter EMS (PTY) LTD
Buthelezi One Stop Emergency Medical Services CC
A number of these companies have been in deregistration due to the non-filing of annual returns. Failure to file annual returns would result in companies not having a valid tax clearance certificate, and thus not be eligible for government contracts. The Free State contracts we have seen do not contain registration numbers – which makes it hard to verify with which of the various companies the Free State are in fact contracted. In the North West, the name of the company on Buthelezi’s invoices did not correspond with the company registration number on the same invoices.
Apart from the above, he is listed as a director of at least 14 other companies, including amongst others Ndizani Funeral Services, TSB Motors, Thapelo Buthelezi Hospital, TSB Medics, Ikanyezi Trading and Construction and Mt Ararat Apostles (a non-profit).
Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
Doctors and nurses in the Free State and North West have accused Buthelezi EMS, the private company contracted to run provincial ambulance services, of operating like a minibus taxi and “drop and go” service. They accuse the company of providing limited medical support and expertise during transport, leaving the desperately sick and injured, including babies, unassisted and putting people’s lives at risk.
Buthelezi EMS has landed lucrative state tenders worth hundreds of millions to run hospital and clinic transfer services in the Free State and North West. Last week Spotlight reported that Minister of Health Dr Aaron Motsoaledi had asked Treasury to investigate the procurement of Buthelezi EMS’s services in the two provinces. This is in addition to a Hawks investigation and a forensic investigation instituted by North West Premier Supra Mahumapelo.
Nurses and doctors have revealed a litany of failures, some life threatening, with common complaints extreme waiting times of up to six hours (even when patients, often babies, are critical), overcrowded ambulances, poor staff attitudes, poorly equipped staff on the ambulances and in the call centres, lack of equipment, extremely poor medical skills, no medical care while patients are in transit and a lack of compassion for patients.
A visit by a Spotlight photographer to the company’s Bloemfontein, Klerksdorp and Potchefstroom ambulance bases, also showed that the services are run from tiny, rented houses with the bare minimum and in some instances dirty, messy yards, not resembling what would be expected of a professional ambulance base (see accompanying photographs).
All the doctors and nurses who spoke to Spotlight asked to remain anonymous for fear of losing their government jobs. Names of specific hospitals have also been omitted as it will make it easy to trace the sources.
Patients squashed into ambulances
A senior doctor based at a Free State hospital alleges that Buthelezi EMS often transports multiple patients in a single ambulance. Sometimes as many as five patients will be transported in one ambulance, but Buthelezi will allegedly then bill with five different patient reference numbers as if five different ambulances were used and five different trips undertaken. This pattern was confirmed by all healthcare workers Spotlight spoke to in both provinces.
One Free State doctor said that it had become the norm for Buthelezi ambulances to arrive at their hospital with several patients squashed inside. “But we are not allowed to complain, if we do it simply goes nowhere or we are harassed by Buthelezi staff and our patients suffer,” the doctor said.
Another doctor said even if there were sick patients who needed to be transferred to a hospital Buthelezi ambulances would not transport the patient, but wait for the vehicle to first fill up.
The overloading of ambulances could also at times place patients at risk and infringe on the dignity of patients. Spotlight was for example told of an instance where a woman with birth complications had to share the back of the ambulance with a male patient not known to her. In another instance a patient with a broken leg had to ride in the front of the ambulance because the back was full. At other times, patients who could safely be transported in cars are transported at great cost in ambulances.
Lack of skills and equipment
A North West trauma nurse said she had a case where two severely ill women arrived in the same ambulance. During the handover Buthelezi staff told the nurse that the women both had bleeding complications from their pregnancies. The nurse conducted a pregnancy test on one of the patients after she suspected something else was wrong. The woman was not pregnant and the problem was completely unrelated to what she was told.
The nurse said lack of equipment was a major problem. She said patients almost never arrived with oxygen, drips or connected to any monitoring equipment. “They mostly don’t have equipment, not IV drips, not drip bags, not saturation monitors (used to measure if patients need oxygen), nothing.”
She said the problem was that Buthelezi staff exercised no medical care or procedures on patients while in transit. “They’re a taxi service and they are always impatient to drop and go,” she said.
Long waiting times
The nurse said a clinic sister recently had to wait four hours for an ambulance to collect a severely ill new-born baby.
“They run a taxi service, not an EMS service,” said a Free State doctor.
All healthcare workers Spotlight spoke to said that they waited hours for Buthelezi to arrive.
One North West nurse in a large town said they waited on average three to four hours for a Buthelezi ambulance to arrive, even though the hospital is not far away. “When we contact the call centre, we are not told how long they will take, we are simply made to wait. The staff also mostly have terrible attitudes when they arrive or when we follow-up with the call centre to find out where they are,” said the nurse.
The service level agreement (SLA) between the North West Department of Health and Buthelezi EMS explicitly states that “The Service Provider must ensure that its call centre gives the NWDoH a reference number and estimated time of arrival of the ambulance for each call.”
The SLA also sets out a schedule of required response times for different levels of emergency. The longest response time allowed for (for the least serious calls) is 60 minutes (measured from when the call centre receives the call). The SLA states that response times in excess of those on the schedule will result in financial penalties against the service provider. As with most aspects of this contract, it appears these penalties has not been enforced.
A North West nurse said Buthelezi’s ambulance staff are not interested in the handover process. “They seem to consider themselves to be a taxi service who simply has to transport the patient. I have very rarely had a Buthelezi staff member show any interest in the patient, put up an IV drip, discuss the patient or even take their blood pressure, they don’t even listen when we do the handover,” the nurse said. She said nobody dared ask for proof of qualifications. This is necessary as certain patients require certain levels of care for example Advance Life Support.
Call centre problems
One nurse said they recently had a new-born baby who was in a critical
condition and in respiratory distress. Despite several desperate calls, an ambulance only arrived after three hours. “When we contact the call centre, they ask us the age of the patient, the gender and what is wrong. I more often than not have to explain to them what the problem is and even then they will tell me they do not understand,” the nurse said.
A doctor said call centre staff often did not understand standard emergency medical terms. When he calls for an ambulance he would as an example not refer to a cranial injury, which is a widely accepted and understood medical term, especially in emergency medicine. “The call centre does not understand that, I have to just say brain injury. I also cannot say Caesarean section, I have to say – we did an operation for a baby – then the call centre agent kind of understands, sometimes,” the doctor said. A nurse had the same experience, saying that even after explaining medical conditions to call centre staff they still failed to understand.
Is the motivation money?
The Free State doctor also said when they called for an ambulance from the provincial government or other private service providers such as ER24 of Netcare 911, it would take 15 minutes to get a reference number as the handover was meticulous, however via Buthelezi the reference number is generated within minutes, adding that the motivation was not patient well-being but money. “We know that 2km trips could be charged at R3 000,” he said, adding that Buthelezi did not have enough ambulances or a presence (with Advanced Life Support paramedics) in sub-districts as required.
The allegation that Buthelezi EMS incorrectly charges thousands of Rands for short trips is confirmed by invoices submitted to the North West Department of Health that Spotlight have had sight of (and previously reported on here).
Sources inside the North West Department of Health confirmed that Buthelezi EMS only has sufficient advanced life support staff based in five of the 19 sub-districts where they are supposed to have such staff according to the service level agreement with the province. Apart from this, resulting in advanced life support often being severely delayed, it is also alleged that Buthelezi charges the province for the extra distance advanced life support vehicles and personnel must travel to sub-districts where there is no advanced life support in place. This state of affairs was confirmed by Free State doctors as well.
Spotlight sent a photographer to Buthelezi’s Bloemfontein ambulance base. The base does not have any external signage. The outside of the suburban house in Bloemfontein was in a shocking state with rubbish, mud and a yard full of ambulances, some seemingly no longer in running order. Aerial photographs show a backyard littered with rubbish and no sign of any waste disposal.
Spotlight asked the Free State Department of Health whether they visited and inspected Buthelezi’s ambulance bases. Head of Department David Motau responded “Sites visits was not a requirement as per the tender document”.
The Potchefstroom “base” is a house which is mostly empty inside, with only a
few bare beds used by staff to sleep in. The backyard of the house has rubbish dumped at the back door. None of ambulance bases appear to have dedicated medical waste areas that are marked biohazardous. Access to these waste areas must be controlled. Unsecured oxygen cylinders are seen lying in the corner of a room. Several horrified paramedics confirmed that oxygen cylinders must be safely locked up and secured. There has to be a sign which cautions that it is pressurized oxygen. The front porch has a derelict bed with no indication that this is a Buthelezi ambulance base. The entrance hall to the house has what appears to be a radio transmitter.
At the Klerksdorp “base” the only sign that it is a depot is two branded ambulances and a car parked in the road.
Mariette Pittaway Democratic Alliance member of the Free State legislature and spokesperson on Health, questioned whether the health department conducted regular checks on Buthelezi operations to ensure compliance with the provision under the National Health Act (No 61 of 2003). Some of these provisions deal with whether an operator is licensed and whether staff are being supervised by a Medical Services Manager. In terms of the base, the Act prescribes that the operator have sluice facilities for cleaning contaminated equipment and linen, have access to washing facilities, including medical-waste traps, have all the relevant equipment listed in the regulations. The Potchefstroom base had none of this. The Act also requires for there to be a log stating how many checks were conducted at the base and what were the findings of each.
Responses from Health Departments and Thapelo Buthelezi
Last week Minister Motsoaledi told Spotlight the following in relation to Buthelezi EMS and the Gupta-linked Mediosa: “On my side as health there is
nothing to investigate in terms of whether it is serving the health needs etc. It is very clear, as clear as daylight, that we do not need this type of service.”
Asked about the complaints from healthcare workers Motau said: “The department is aware of only one formal complaint from Botshabelo and the matter was resolved. The department is not aware of ambulance (sic) being poorly equipped and overloaded.”
The North West health department has declined to comment to Spotlight on any Buthelezi-related matters, saying the matter is being investigated by the Hawks and the Premier’s office.
In addition to a previous round of questions, Spotlight also sent a list of the above allegations and complaints to Thapelo Buthelezi via email. This was his Whatsapp response:
“There isn’t anything I can assist you with. More especially after you have lied to South Africans that you have published everything I said. I spoke about other provinces utilizing aero medical service without any formal contracts and you did not want to say anything about the matter. You are most probably avoiding to talk about that because it will tell South Africa the truth behind all the allegations. It is clear that you are after Buthelezi EMS, hence you can’t talk about other provinces’ aero medical contracts. You may carry on and publish whatever and continue to protect your buddies. This matter is being dealt with from a different platform. I’m also aware that one of your informers, (Spotlight omitted this name) is busy talking to different provinces, recruiting managers to support him in taking Buthelezi EMS down and give you a falsified information. I wish you could report the real events and stop talking to the competitors. It is a common knowledge that the competitors will always give a negative info. However, I still maintain what I said earlier, we are working on publishing the truth and not nonsense you have been telling South Africa. Good luck!!!!!!”
Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
Health Minister Dr Aaron Motsoaledi has asked treasury to investigate the procurement of ambulance services from Buthelezi EMS, a controversial private ambulance company that has been awarded large contracts in the Free State and North West.
Spotlight this week published two articles on alleged overcharging and tender irregularities involving Buthelezi EMS and the health department in the North West as part of our Health4Sale series of investigative articles. Next week we will be turning the spotlight on Buthelezi EMS in the Free State.
Motsoaledi last night told Spotlight that he wrote to the Minister of Finance to request that the Chief Procurement Officer at National Treasury investigates the procurement of services from both Buthelezi EMS and the Gupta-linked Mediosa (also known as Cureva) in both the Free State and North West.
Motsoaledi stressed that the treasury investigation is specifically into the procurement processes and suspected corruption. He also confirmed that the treasury investigation has already started.
Not adding value
In terms of medical need, Motsoaledi said that there is no debate at all and that Buthelezi EMS and Mediosa are not adding value and that they are in fact causing more problems. He also said that it is not national policy to use private service providers for emergency medical services.
“On my side as health there is nothing to investigate in terms of whether it is serving the health needs etc,” he said. “It is very clear, as clear as daylight, that we do not need this type of service.”
A new tender for outsourced private ambulances in the Free State was advertised in October 2017. Spotlight however understands that the award of that tender has been delayed and that Buthelezi EMS continues to be paid on a month-to-month basis.
Motsoaledi told Spotlight that he is in daily contact with Free State MEC for Health Butana Komphela about the situation. “I told him it is wrong for them to privatise ambulance services. They must run them on their own.”
“The plan from my side is that treasury after this investigation must make a clear ruling that the procurement of private ambulance services should not happen,” he said.
No Section 100 intervention
Motsoaledi indicated that a Section 100 intervention whereby the Provincial Departments of Health in Free State and North West would be placed under national administration is not currently being considered. He explained that under section 100 the political leaders in the province stays in place and that national assumes responsibility without authority. He referred to his experience when the Limpopo Department of Health was under Section 100 administration. In that case four provincial heads of department that various National Ministers believed should be removed were not removed because only the Premier of the province had the authority to remove them.
“In Limpopo we were only able to stabilise the finances because of treasury, but the human resources we could not touch because that authority does not lie with us,” he said.
The Head of the North West Department of Health Thabo Lekalakala, implicated in Spotlight’s 2-part investigation into emergency medical services in the province, was suspended yesterday by the embattled North West Premier Supra Mahumapelo. Previously Mahumapelo had refused to heed Motsoaledi’s call to suspend him, placing him on special leave.
Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
Last week whistleblowers told Spotlight that patients with broken legs, arms and other serious orthopaedic conditions are being sent home in the Free State because the buckling health system is simply unable to cope with the numbers. Now the Free State Department of Health has responded insisting that orthopaedic services and surgery in the province is not collapsing. The Department did however admit to a long waiting list at Pelonomi hospital.
“The orthopaedic backlog for today stands at 72 hospitalised patients and 110 patients outside the hospital. On average 1 200 patients are admitted per month,” says Mondli Mvambi, Spokesperson and Head of Communications of the Free State Department of Health.
The hospital does not send anybody home despite our lack of resources at times,” claims Mvambi. “Patients are being sent to Botshabelo hospital on Mondays to the orthopaedic clinic and Tuesdays for surgical interventions. There is currently less than seventy patients awaiting elective surgery at Pelonomi, emergency procedures are done on the emergency list on the day of admission or within a few days of admission.
A healthcare worker whistleblower however told Spotlight that the Orthopaedic department does in fact send patients home without surgery. “On admission it was decided that they will undergo surgery. But due to the long waiting lists for emergency cases it is then decided to treat conservatively,” says the whistleblower, who also questioned how one could allow a waiting list of 70 people. The whistleblower also said that outreach activities are generally not nearly as good as claimed. Photographs sent to Spotlight this week show overcrowded waiting rooms in the hospital with patients sitting on chairs and lying on the floor.
No airconditioning in theatre
In addition to the long waiting list for orthopaedic procedures, Pelonomi appears to be facing a number of additional crises. “Cancer patients who need biopsies are put on a waiting list and reconstructive cases are warned that they may wait up to 5 years for their arthroplasty work,” a well-placed source told Spotlight.
Our sources (who have asked not to be identified) claim that there is a general pattern of poor maintenance and of sub-standard equipment being acquired. This is potentially most harmful in theatre, where sub-standard operating tables and theatre lighting have allegedly been acquired and where new sub-standard and incomplete anaesthetic machines remain unused.
“Chances are excellent that the emergency activities will be completely stopped at Pelonomi due to the air conditioning not working,” a source told Spotlight. “Theatre temperature during day time is 30 degrees and it is unlikely that they will be able to repair it within days. The anaesthetic risks for patients with overheating during anaesthesia is high and sepsis rates are also then very high.”
A critically important hospital
That emergency activities at Pelonomi are of critical importance is not disputed by the Department.
“Pelonomi is a Tertiary Hospital receiving referrals from four Regional hospitals in the Free State,” says Mvambi. “We also receive patients from Lesotho and neighbouring provinces as we are a province at the heart of South Africa and many of the national roads criss-cross our province thus making us vulnerable to many trauma cases. Pelonomi Hospital is also a Trauma Centre for the entire FS Province, also receiving trauma patients from the N1, N3, N5, N6 and N8 including many regional roads. Kimberly and Lesotho do not have a Spinal Surgeon therefore Lesotho and Kimberly patients are referred to Pelonomi. There is a high demand on the system during weekends, month end, holidays and when there are festivals in neighbouring towns as well as casual road users who are passing by. However there are systems that are put into place to manage the challenges, for example we are expanding orthopaedic services to Botshabelo and we also do outreach to regional hospitals in the Province, as well as conducting Blitz on Tuesdays, weekends and public holidays with the help of additional capacity.”
According to Mvambi there are seven specialists and eighteen doctors rotating between Universitas Academic Hospital and Pelonomi as the two function as a hospital complex.
“We are constantly making plans to intervene and cutting the backlog of services. We are appointing professionals especially to the periphery and the sustenance of orthopaedic services to Botshabelo,” says Mvambi. “We also conduct Outreach to Regional hospitals in the province and the procurement of agency services. The hospital is looking forward to expanding services to Xhariep District and an increased utilisation of the newly opened state of the art Albert Nzula hospital.”
One year into his tenure as MEC for Health in the Free State, Butana Khompela
is still to exorcise the ghosts that have made the province one of the worst-performing when it comes to health.
Khompela came into his role in October 2016 – replacing Dr Benny Malakoane, who was moved to the Department of Economic, Small Business Development, Tourism and Environmental Affairs. Malakoane’s exit from the Department of Health was met with relief – pure celebration, even – from activists and many Free State locals, desperate for improvement in the state health services.
Their elation at seeing the back of Malakoane was because his track record in the department was woeful at best. He was routinely and widely called out for abuse of power, and for a leadership and management style that smacked of bullying and arrogance. So bad was Malakoane (who served as MEC even while he faced charges of fraud, corruption and money laundering) that the Treatment Action Campaign (TAC) embarked on the intensive, two-year-long #FireBenny campaign. Finally, Malakoane was removed (albeit only sideways) and sent off with a farcical pat on the back from ANC leadership.
It’s to these choppy waters that Khompela has been brought to steady the ship of an almost wrecked department, which remains under provincial administration. Its one-time top academic hospital, the Universitas Academic Hospital in Bloemfontein, tumbled to the bottom of the pile in the country in the October 2016 findings of the Office of Health Standards Compliance (OHSC).
TAC notes also that a large number of vacancies remain unfilled. The information for appointments and vacancies on the Provincial Department of Health’s website simply shows ‘n/a’ under ‘current financial year information’. Just looking at the available data from the 2015/2016 financial year, however, reveals that there were 20 952 posts approved and 17 810 filled, leaving a shortfall of 3 142 vacancies – about 15% of posts – even in the previous year.
Another lingering issue is the reinstatement of Community Health Workers (CHWs). There remains a black mark against the department for its shameful handling of the protests by CHWs that led to the BopheloHouse94 court case last year, eventually ending with a court ruling in favour of the 94 CHWs.
Also ongoing is the issue of the use of the Buthelezi ambulances and emergency medical services in the Free State, despite the tender granted to the company being irregular, and the services being slammed for their dysfunctionality.
For the 2017/2018 year, the Department of Health was assigned R9.77 billion from the provincial budget. The budget only benefited from a small year-on-year increase of 8%.
In his budget address, Khompela said that “corruption is a cancer”, and promised to root it out – also, to bring down the staff bill from 65.8% to the 60% national target. He trumpeted successes in the province’s HIV programme, despite these efforts falling short of their targets, as well as the acquisition of a helicopter and an additional 12 maternity ambulances for the province.
Delivered in air-conditioned chambers, budget-speech promises don’t always match up to on-the-ground realities. TAC district organiser Mary Nyathi says that under Khompela, little has changed. “We still hear cases every day of someone going to the hospital at 2am to be in the queue, and only seeing someone round about 5pm,” she reports. “We have clinics where the roofs are leaking; and even where they have done upgrades, there are no doctors in the buildings to see to the patients.”
Nyathi routinely hears of scheduled operations being delayed without explanation, and says that while TAC hasn’t had reports of ARV stock-outs, there are routine drug shortages. “I want Khompela to come out of his office and come to the people, so he can understand and see for himself how bad the problems are,” she says.
“It is heartbreaking that things are not changing. For me, in the lower classes of society, I need these hospitals – tomorrow, it could be me.”
Her hope is that Khompela will prove to be a better communicator than his predecessor, and that he will demonstrate a willingness to listen and to collaborate. For Thabo Mahlatse, TAC provincial organiser, poor infrastructure and shortage of medicines and personnel continue to be the bane of the people of the Free State. “We want Khompela to show leadership and accountability, and come up with a plan on implementation – not just what they say in speeches,” he says.
Khompela’s had a mixed response from others, too. Some consider him an approachable man, and a person who is sensitive to the dire health challenges in the province. He gets a thumbs-up even from his political opponents: the Democratic Alliance, the official opposition in the province.
Mariette Pittaway, DA member of the Provincial Legislature, says that in the past year, she’s found him accessible and prepared to help. “I have sometimes had to call him to intervene in very dire cases, and he has always tried to help,” says Pittaway. “The saddest part for him is that he has inherited a mess; and every day I receive another desperate case, or another complaint.”
But another Bloemfontein NGO that’s operated in the HIV/Aids support arena for the past 10 years says Komphela and his team have repeatedly fobbed them off, instead of agreeing to meetings. “There’s a lack of communication, and a lack of good faith,” says the co-ordinator, who did not want to be named. She adds: “There still seems to be a lot of smoke and mirrors in the Department of Health, and no appreciation of the value of what the NGO sector is doing.”
Smoke and mirrors and a desperate need for clarity are features that extend to parts of Komphela’s official Facebook bio page, still active despite not having being updated since 2013. The 53-year-old Komphela was born in Kroonstad and grew up in a farming community, one of 11 children. His brother is the celebrity footballer, coach and Lamborghini-loving Steve Komphela. He is married to Cecilia Nombuyiselo, and they have a grown-up son and a teenaged daughter.
According to the information on the page, Butana Khompela became an activist while just a school pupil. His bio data says he was among those detained along with three teachers during the 1976 uprising – if that timeframe is correct, it would mean he was only 10 years old that June.
The bio write-up goes on to say that as a 19-year old in 1984, he took a job as an admin clerk in the Department of Home Affairs, and later became an interpreter at the local court. But by 1990, Khompela had apparently shot up the political ladder. If his own Facebook page is correct, he was mayor of Kroonstad between 1990 and 1992 (two years before the end of apartheid, and when Khompela would have been just 25).
It must be remembered that Kroonstad in those years was gripped by politically motivated assassinations and violent terror, thanks to the Three Million Gang and the Self-Defence Units (SDUs). Khompela’s name is absent from the story of this period – and the mayor of Moakeng (Kroonstad) at the time was Caswell Koekoe.
His bio information goes on to add that Khompela represented Kroonstad when the ANC held its first conference in Durban-Westville, after being unbanned in 1990. He also took part in the Codesa talks, it says.
What is clear is that Khompela is an ANC party loyalist. By the time democracy dawned in 1994, he had been made a director in special education in the Department of Education. His Facebook page continues to map out a political career trajectory that includes becoming a member of the Free State Legislature, moving up the ladder to a position in the National Assembly before becoming chairman of the Portfolio Committee on Sport.
After 10 years in this post he was back in the Free State to become a member of the legislature once more, before becoming MEC responsible for Police, Roads and Transport and now MEC for Health.
During his time on the Portfolio Committee for Sport, Komphela was outspoken about transformation, and infamously raised the ire of the South African Council of Churches after he took vicious aim at then-Archbishop Desmond Tutu, calling him “treacherous”, and warning him not to confuse transformation with tokenism. He also locked horns with the likes of Moss Mashinini, who headed up SASCOC, and was slated as “slanderous” and “racist” for his take-no-prisoners approach to transformation in sport.
Back then, Komphela earned a reputation for being something of a firebrand and a hothead. Other adjectives linked to the man include ‘irascible’, ‘power-hungry’ and ‘meddling’. But he was unapologetic, putting his outbursts down to being a man who calls a spade a spade, and someone who made transformation in sport a priority.
Since grabbing headlines for his time serving on the portfolio committee, Komphela’s column centimetres have been dominated by his connection to a Robben Island ferry business in which he has ownership. In August 2008 the Mail and Guardian reported on Komphela’s interest in bidding for a ferry business operating from Cape Town’s mainland to Robben Island. It ended in a commercial dispute, said the newspaper, and the vessel involved became a white elephant (not unlike some of the brand-new hospitals in the Free State), stranded in a Cape Town boatyard.
In June this year, Times Live reported that the MEC – who is chairman of Meltt, a business consortium – had bought a R60-million vessel to be a “back-up” ferry for tourists. The concern is that Komphela will have an unfair political advantage over other bidders and operators.
But people waiting for surgery, or desperate to be seen by a doctor or to have an equipped ambulance arrive in an emergency, would prefer Komphela to spend more time getting the health department ship-shape, rather than being focused on cashing in on the tourist spend in Cape Town.
* In May this year, numerous requests were made for an interview of any kind with the MEC. His spokesperson and his communications team responded, saying that they would try to make it happen. Despite much to-ing and fro-ing, with emails, calls and messages, it didn’t. Email questions were also sent to spokesperson Mondli Mvambi – among them, questions asking for clarity on the information on the MEC’s Facebook page, as well details of his plan of action for the Free State Health Department. No response has been received.
The hospital is full. Two young girls lie on trolleys in the main hallway. They are
wrapped in pink blankets; drips come out of their arms and hang on the walls. One looks in severe agony. She calls out for a nurse again and again. Their mother tells us that they arrived at the hospital seven hours ago and have yet to leave the hallway. Laughter comes from the nurses’ break room. It is situated directly opposite their trolleys, but no-one ever emerges to help.
An old man with only one leg sits next to them. His drip is attached to the same set of hooks. He stands in pain. He struggles with his crutches, his drip and his file in order to slowly move down the dusty passage to the toilet. The toilet will not flush, and is dirty after people have tried. A poster haphazardly taped to the wall in the bathroom informs patients that they should “always wash their hands”. Yet the soap dispenser is empty, and there are no taps to provide water. The floor is filthy.
Overcrowding, dirty facilities, bad services and poor attitudes. This is what awaits public healthcare users at Prince Mshiyeni Hospital in Umlazi, the largest township close to Durban.
Treatment Action Campaign branches monitor the state of health care at hundreds of clinics and hospitals across the country. They are the people who need the public healthcare system to work, so they are the first to notice when it does not. Prince Mshiyeni Hospital is not alone in its dysfunction. In recent weeks, a TAC fact-finding mission has showcased the crisis in several public hospitals.
We visited hospitals in KwaZulu-Natal, Limpopo, Mpumalanga and Gauteng. And the situation in each is as dire as it is in the next.
In Limpopo, at Malamulele Hospital, people begin queuing at the old and run-down facility from 5.30am. The corridors are full. At each turn, brightly dressed women fill the hallways. Around 200 people are waiting to be attended to by only two doctors. The waiting is unbearably long. We are told that there has been no constant water supply at the hospital for three years. Patients are unable to wash themselves, and there is only a small amount of container water available for using the toilets. As we walk through the wards during visiting hours, the patients have no privacy. There are no doors or curtains. The wards smell, and the bed linen is dirty.
In Tshilidzini Hospital, more than 75 patients wait for their files. Each time a shrill voice screams out a name, the chain of people patiently moves one seat across. People have been waiting in this queue for over five hours. A few people waiting are already wearing Tshilidzini hospital gowns. One is a young man with an open wound on the back of his neck – the wound and stitches are uncovered, and he uses a wad of toilet paper to stop it seeping. And the file room is only the beginning; once they leave, patients are faced with more long queues to be attended to by a doctor.
In Elim Hospital, patients wait for files for around five hours. After collecting their files, they enter the hospital and join a long queue to be seen by a doctor. In a corridor around 100 metres long, patients on back-to-back benches fill the entire space, waiting to be seen. Those with bad coughs sit with everyone else – in a corridor with windows on just one end. As we walk around, at each turn a new queue appears. More faces are raised in hope at the sight of us. In the main hallway, a man is sitting on a trolley, under a blanket. A drip comes out of his arm. He tells us he was admitted six hours ago, but nurses have yet to find a bed for him to be moved to.
In Mpumalanga, at KwaMhlanga Hospital, the corridors are full. One old gogo
(elderly lady) lies on a trolley in the corridor, in severe pain. She struggles to move, and has not yet been attended to. People in wheelchairs are stacked together, each man’s knees squashed into the chair in front of him. Hundreds of people wait to be seen. Their eyes follow us as we pass through the corridors. One man sits in casualty with a home-made sling on his arm. After being attacked by thugs, he had attempted to access services at the hospital. An X-ray had been taken the night before – yet only a day later, his file has been lost. He is told to go and submit an affidavit at the police station, and return. He has no money, and has received no painkillers. The young man sitting next to him has been waiting for five hours. A baseball cap covers a bloody stain on the back of his head.
In the most well-resourced province, Gauteng, the recently refurbished Thelle Mogoerane Hospital still suffers the same level of neglect as before. Casualty is overcrowded, and the queues last for hours. People sleep in the corridors. Patients bleeding and in critical condition sit with everyone else. A psychiatric patient is seen wandering around the wards. We are told that for days, patients have been fed porridge for every meal. One woman shows us an X-ray of her broken jaw. She had been sent home with just a Panado for the pain. Another woman told us that post-labour, the doctors had sewn her vagina shut – when she returned to question them, they told her she must have been born that way. Another woman explained how, during labour, doctors took another woman into her space in theatre. Eventually, after waiting the whole day to be seen, she gave birth to her baby. The baby was green, and died six days later.
Poor management, budgetary constraints and a lack of care for the needs of patients plague these public facilities. And it is the people who suffer. In order to expose these crises, and hear from the people who need to use these services, TAC will be holding public hearings and showcasing people’s stories in the run-up to World AIDS Day.
As we leave Prince Mshiyeni Hospital through the abandoned trolleys, a woman sits sobbing in a wheelchair. Under a blanket her feet are badly swollen, and she struggles to breathe. We can see the fear in her eyes. She has just been discharged. A nurse leaving the hospital passes by; we try to engage with her to re-admit the woman, but she informs us as she rushes away that she will let the security guard know he must look for the woman’s friend. After TAC intervenes, she is re-admitted. Upon being examined, she is diagnosed with pneumonia and cryptococcal meningitis. She is moved to a cold and overcrowded ICU ward, beds mere centimetres apart. She has not been allowed to keep her blanket, and is visibly shaking when we visit.
When we eventually leave the facility, the young girls cocooned in pink are still where we found them in the dirty corridor, hopeless, still waiting for help.
A litany of atrocities at Prince Mshiyeni Hospital
- A wheelchair lies abandoned on the pavement, and trolleys are scattered across the casualty entrance of the hospital. Dirty rags line the floors as we enter. We are greeted by dust, dirt, and dirty chip packets.
- Family members push patients up and down the hall on trolleys. One patient looks in severe pain, lying on her side on a trolley; she rests her head on a water bottle that acts as a pillow.
- A diabetes patient waits to collect chronic medicines. Last month she waited through the day until 11pm, only to have to return the next day. Before speaking to us today, she has already waited for over eight hours.
- Paper files lie on the unattended counter for anyone to look at. One woman waited for eight hours until they located her file.
- At 4.30pm, more than 100 people still need to be seen. Every corridor of the hospital has more and more patients, sitting, waiting to be attended to.
- One small room has at least 25 beds haphazardly squashed into it. Another has only a few centimetres between each bed. It seems that psychiatric patients have been put next to other patients.
- A woman with her leg in a cast had come to the hospital in agony seven hours prior, in an ambulance. The previous month they had cast her leg without having taken an X-ray. At 4.30pm she is told the X-ray department has closed, and she should return the next day. The doctor has not seen her. As she leaves the hospital in a wheelchair, she is still in agony. In her opinion, coming to this hospital is a waste of time.
- Three people struggle to get an unconscious person – who has been discharged – into the back of a car. They use a piece of material to get the person off the trolley, and eventually, onto the back seat. During this 20-minute challenge, cleaners look on.
- An old man, looking gaunt and sick, leaves the hospital. A pulled-down TB mask rests on his neck.
- A hungry man eventually leaves the hospital by getting a lift with strangers. He has been there for eight hours. He has no money for food or for a taxi.
- A white van emblazoned with a “21st Century Funerals” logo stands outside the accident and emergency entrance. A trolley is carried out of the back and taken inside the hospital. A while later the driver returns, pushing a corpse in a body bag past patients entering the hospital in order to load it into the back of the van.
Whistleblowers say patients with broken legs, arms and other serious orthopaedic conditions are being sent home in the Free State because the buckling health system is simply unable to cope with the numbers. Health workers are told there is no money to bring in outside help to reduce the waiting lists.
A week ago, when a team of outside health workers were paid to work a weekend at Bloemfontein’s Pelonomi Hospital in an attempt to reduce the waiting list, at least 40 patients were sent home because there was simply no capacity to get to them.
“Imagine this, for six weeks these patients have been lying in hospital beds
with well-meaning doctors assuring them that their surgery was imminent, only to be told that you will no longer be operated on and that this means you bones will no re-attach properly or that your ankle will remain partially dislocated,” said a health worker, who asked to remain anonymous for fear of reprisals.
What was more disturbing for the health workers who spoke to Spotlight was the fact that last year there was millions to run a dodgy, illegal stem cell practice in the Pelonomi orthopaedics department, but there was no money to bring in extra health workers to reduce the waiting list.
“It simply cannot continue like this, patients wait for 40 days for simple, straightforward treatment for fractures. Their lives are destroyed, it is an untenable situation,” said a doctor.
The Regenesis scandal
Spotlightreported towards the end of last year that illegal stem cell experimental treatment was being provided at Pelonomi Hospital, a state hospital in Bloemfontein. The issue was also investigated by Carte Blanche who produced an insert.
Shortly after SECTION27 and the Treatment Action Campaign brought details of the Regenesis project to the attention of the national Director-General of Health Precious Matsoso, the Medicines Control Council (MCC) suspended the unlawful stem cell experimentation at Pelonomi.
At the same time the Free State Department of Health cancelled its contract with the stem cell company, ReGenesis Biotechnologies following a list of questions sent by Spotlight in connection with the involvement of controversial Health MEC Dr Benny Malakoane. Before the expose, the Free State department of Health was set to spend tens of millions of Rands on unproven and potentially dangerous stem cell therapies for the treatment of musculoskeletal diseases in its orthopaedic knee patients at two hospitals. The treatment was run by a private company called ReGenesis Biotechnologies and has started on June 1, 2016.
A service level contract (seen by Spotlight) between the Free State Department of Health and ReGenesis Biotechnologies indicated that the service would be provided in Pelonomi hospital in Bloemfontein and Boitumelo hospital in Kroonstad. The department would pay R30 000 per client, with a guaranteed supply of one thousand patients per year. This adds up to R30-million per year and R90-million over the three years of the contract.
MCC Chairperson Professor Helen Rees confirmed to Spotlight at the time that inspectors had been to the Pelonomi site: “Our concern was that the service level agreement made reference to medicines, injections and therapeutic research.”
She said the informed consent documents referred to the patients giving permission for stem cell therapy, permission for stem cells to be removed, concentrated and re-injected and for their stem cells to be given to another person.
The contract at the time stated that the Free State Department of Health and ReGenesis would establish a project management committee consisting of the MEC of Health as Chairperson as well as the CEOs of Pelonomi and Boitumelo hospitals, COOs and representatives from ReGenesis. It reveals that the committee shall meet monthly for the duration of the Agreement to “track progress, resolve pertinent matters to the effective and seamless treatment of patients”.
Days after the revelations Free State Premier Ace Magashule reshuffled his Cabinet and Malakoane was shifted from health. Since then, Spotlight have sent questions to the MECs spokespeople and the Premier’s people. All these attempts have elicited zero responses.
It is crucial to understand where this case is, has there been an investigation, what are the findings, will anyone be charged, was Malakoane due to benefit from this contract, were proper tender procedures followed, and so on.
A well-placed source in the Free State has shared a list of names of relevant persons who needs to be investigated. They include hospital CEOs who allegedly participated in the scheme, hospital managers who requested the waiting lists and who contacted the patients, doctors and their secretaries who played a key role in running this scheme, a doctor who reportedly gave instructions for the order forms to go through, an individual who gave the financial permissions and two heads at Bophelo House (health department head office) who were involved.
A Bloemfontein doctor said they were aware of patients who suffered due to this treatment, with reports of some dying.
Registrar of Medicines, Dr Joey Gouws recently confirmed that Department of Health inspectors have laid criminal charges against Stander “for the sale of unregistered medicine and or conduct of a clinical trial without obtaining the necessary authorization from the MCC.”
Gouws said they were in no position to advise on the status of the police investigation. She also confirmed that the MCC had reported Stander to the Health Professions Council of South Africa (HPCSA). At the time of going to print, the HPCSA had not responded to queries requesting an update on the charges.
Collapse of orthopaedics
More recently Spotlight has received information that orthopaedic services in
the province are in a state of collapse with a running surgery waiting list at Pelonomi Hospital of over 130 patients (excluding those who have lost faith, packed up and returned home, despite the consequences), on most days.
There are adults with trauma fractures, children with broken limbs and elderly patients with fractured hips. They are lying in overflowing hospital beds and in the passageways on trolleys and on the floor (see photos).
A health worker said that young doctors are facing abuse from frustrated patients who are in limbo, waiting for surgery which does not happen.
This is not the first time the province has faced this problem. In the past the province has been able to reduce the waiting lists significantly by buying in locums at a cost of about R6-million per annum. This is small change compared to what the province was prepared to fork out for the illegal and dangerous Regenesis project.
The domino effect of long waiting lists for orthopaedics is more complications, septic bed sores for the elderly, children left disabled and adults losing their jobs.
A doctor explained that Pelonomi is facing increasing pressure as peripheral hospitals no longer have skilled specialists to do the surgery. The hospital is also taking in referrals from the Northern Cape and Lesotho.
Sources allege that the hospital CEO, Ms Ramadula (a nursing sister) is not disclosing the current state of affairs to the provincial government for fear of reprisals.
“Hospital management are misleading their heads who in turn mislead the national Director-General, who because of incorrect information, misleads the national health minister,” a health worker added.
Stander still practicing
Dr Wian Stander, the controversial owner of Regenesis, the company that entered into a questionable partnership with the Free State Department of Health to conduct unlawful stem cell experimentation at Pelonomi hospital in Bloemfontein is still practicing and active.
This is despite charges with the South African Police Services and the Health Professions Council of South Africa.
Registrar of Medicines, Dr Joey Gouws has confirmed that Department of Health inspectors have laid criminal charges against Stander “for the sale of unregistered medicine and or conduct of a clinical trial without obtaining the necessary authorization from the MCC.”
She also confirmed that the MCC had reported Stander to the Health Professions Council of South Africa (HPCSA).
Calls made by Spotlight to Stander’s Integrated Medical Centre in Bryanston and his Slimming Clinic in Pretoria were unsuccessful. Both landline numbers were not working, even though the websites advertising everything from weight loss to integrative cancer treatment, botox and the sale of vitamins were still live.
A further search found a GP practice in Pretoria where a woman answered stating that it was the rooms of Dr Stander. She said he only consulted at this Pretoria practice on Tuesday. She indicated that he consulted at the Centre of Advanced Medicine in Sandton every second Wednesday.
Stander’s active Facebook page reveals that he has among others been a speaker at a business breakfast in the Free State. He continues to share events linked to his slimming clinic which has the same address as the Centre of Advanced Medicine.
A further search on the Centre of Advance Medicine website (a practice with various specialists listed), links to Regenerative Medicine which in turn links to a ReGenesis page. A search also reveals that ReGenesis continues to be a co-sponsor in a popular train run series in and around Bloemfontein.
For a long time, South Africa has been a country where charlatans are able to flourish and peddle dangerous remedies for all kinds of ailments.
Take a trip on a public train or a walk down a road in our city centres and you will easily find pamphlets marketing remedies for anything, from enlarging penises to bringing back lost lovers. Even more seriously, the city lamp poles are plastered in posters offering cheap pregnancy termination services. Poor people stand on street corners for hours offering pamphlets and directions to the closest ‘doctor’. All illegal, all dangerous, but almost all operating with impunity.
The reasons these quacks proliferate are many. Not so long ago we had a president and health minister who created an enabling environment for them. President Thabo Mbeki questioned the efficacy of lifesaving anti-AIDS medication, told people they were toxic, and dragged his feet when it came to signing into policy the rollout of these medicines for the thousands who were suffering and dying.
His Health Minister, a medical doctor, Dr Manto Tshabalala-Msimang spoke often and passionately about the so-called healing properties of beetroot, garlic, lemon and olive oil. People sniggered, referred to her as Dr Beetroot and shook their heads.
But what Mbeki and Tshabalala-Msimang had done successfully, was to sow seeds of doubt. Many, many people living with HIV, desperate for a remedy not only to control the virus, but to exorcise it from their battered bodies, turned to the quacks, who promised to do so. What was criminal was that these ‘doctors’ were operating with the tacit support of the leaders who had the power to close them down.
They included the likes of German multi-vitamin peddler Matthias Rath; KwaZulu-Natal truck driver and seller of a concoction called uBhejane (the recipe of which he said was revealed to him in a dream by his ancestors) Zeblon Gwala and the likes of Tine van der Maas a barefoot Dutch nurse who pushed lemon, garlic, beetroot and olive oil concoctions at the behest of the health minister, or Belgian eccentric Kim Cools who continues to claim that he had injected himself with the HI virus but remains negative due to his remedies (see previous Spotlight).
Activists told stories and journalists wrote articles of the heartache these people had caused – the undignified deaths of mothers who left families orphaned as they dumped their antiretrovirals for Rath vitamins, the fatal and excruciating suffering of the much-loved DJ Khabzela after the health minister sent Van der Maas to heal him, or the illegal Rath clinical trials conducted on poor people, made to strip, have their photographs taken and give their blood.
And then there was Virodene – a powerful chemical detergent peddled by a bunch of crazy scientists as a cure for AIDS, which had as its cheerleader President Mbeki.
Mbeki and Tshabalala-Msimang were not alone in the rejection of proven treatments. Tshabalala-Msimang’s MECs either turned a blind eye to the fact that people were being used as guinea pigs, or did everything in their power to deny poor people access to lifesaving drugs.
Sibongile Manana was the MEC of Health in Mpumalanga at the height of the denialism years from 1999 to 2003. Now she is a Member of Parliament. As MEC she gave the Greater Rape Intervention Project (GRIP) in Nelspruit hell. She bullied Rob Ferreira Hospital’s Dr Thys von Mollendorff, a gentle caring doctor whose only crime was to try and help rape survivors. He offered them a dignified, safe space in his hospital where they were given the option of accessing legal, tested antiretrovirals to prevent infection. But Manana hounded Von Mollendorff and GRIP out of the hospital and treated them like criminals, dragging them to court and evicting them from the hospital.
Penny Nkonyeni, MEC for Health in KwaZulu-Natal during the Manto years, often rolled out the red carpet for her Minister. She printed quack pamphlets for distribution, hounded doctors who dared to offer pregnant mothers the option of treatment to prevent transmission of HIV to their babies, and she was a willing partner in finding crooked NGOs prepared to run illegal clinical trials using quack concoctions. Nkonyeni was later the speaker in the provincial parliament and Education MEC before being removed in a Cabinet reshuffle earlier this year. She indicated she was joining the private sector.
The examples are many and for those who were there, these memories are painful. Those who were there made a pact saying, never again.
Fast forward to 2016
Dr Benny Malakoane is a medical doctor and was until recently Health MEC in the Free State. Over a three-and-a-half year period he oversaw the collapse of the public health-care system in the province, and turned the state machinery on elderly community health workers who were asking inconvenient questions, while facing multiple charges of fraud and corruption (these cases are still ongoing due to continued delays).It now appears that, much like Manana and Nkonyeni, Malakoane enabled a quack to operate with impunity in a state hospital, using unsuspecting state patients as guinea pigs in an illegal stem cell trial. In fact, this operation had been signed and sealed in a three-year contract which was due to further impoverish the Free State health system and enrich the shareholders of ReGenesis Health with millions of rands.
Questions must be asked over the enthusiasm of the MEC in signing this contract and personally overseeing its implementation. One has to ask how the MEC could be so enthusiastic in rolling out an untested stem cell intervention in the Pelonomi hospital’s orthopaedic department while his health system is collapsing and failing to get basic medicines to clinics and hospitals.
The Medicines Control Council led by Professor Helen Rees intervened within days of health minster Dr Aaron Motsoaledi becoming aware of this contract. It is refreshing and heartening to know and see in action the difference an ethical, incorruptible and no nonsense health minister and medical doctor can make. If only we had someone like Dr Motsoaledi in the early 2000s.
The MCC swiftly closed the ReGenesis operations at Pelonomi and have made it clear that according to the information they have, an illegal trial was being conducted, using an untested intervention.
For now, the operations have been brought to a halt and the Free State Department of Health has cancelled the contract. The MCC has sent ReGenesis a comprehensive list of questions, and Free State Premier Ace Magashule has been left with the task of holding his MEC accountable. Don’t get your hopes up.
Within a day of the information being revealed by Spotlight and the investigative television show, Carte Blanche, Free State premier Ace Magashule shifted his Health MEC to Economic and Small Business Development, Tourism and Environmental Affairs, and installed his former Police, Roads and Transport MEC Butana Kompela as the health custodian.
However, we cannot allow another quack enabler to get away without being held accountable.
The Free State Department of Health and Premier Magashule have to provide answers to some very serious questions. For instance, why did the Free State Department of Health publish a tender for stem cell therapy in the first place? On what basis was ReGenesis appointed in June? Why was Malakoane so closely involved with the project, chairing the board that would provide oversight of the work and research done by ReGenesis?
Simply shifting Malakoane to another post doesn’t make these questions go away. For there to be any accountability we need answers to these questions. The people of the Free State are not guinea pigs. They are not pawns in an alleged scam to enrich charlatans.
Not on our watch. The ball is in your court Premier Magashule.