Moonlighting Public Doctors Cash-In at Private ERs

When you have to visit an Emergency Room at a private hospital, would it ever occur to you to question the qualifications of the individuals who are impressively adorned in doctors’ coats with stethoscopes around their necks? And even if they are suitably qualified, what if the cost you’re about to pay for their attendance to you has already been covered by your taxes?

These questions should have been raised at least two years ago. They weren’t raised, because an opposition political party’s spokesperson for health allegedly convinced one of the sources to call-off the story as his party wanted to use the information for their own political leverage. So who gets to decide whether information that is truly in the public interest should be told or not?

Now, investigation by this journalist has revealed that some of those ‘doctors’ in private ERs are either not properly certified to be there or are illegally moonlighting at the expense of public hospitals and taxpayers. 

Since the spiking of that report in 2012, we have heard of several patients who have been turned away from public hospitals with fatal consequences in some cases. What we aren’t told is that the doctors who should have been attending to those patients are either too tired to do so after having been moonlighting at private medical hospitals the previous night, or they have taken ‘sick leave’ to serve elsewhere as locums.

Last March (2014), it was exactly five years since Ntombizodwa Mali, a Cape Town grandmother, had to start living with the tragic death of her one-year-old grandson, Unabantu Mali. After the little boy had allegedly been denied treatment at three public health facilities in the Cape, the grandmother had strapped him onto her back and commenced the two-hour walk back to their Nyanga shack. When she got there, she discovered that little Unabantu had died sometime during the journey.

A Cape community newspaper, The Post, was the first to point out that little Unabantu’s case wasn’t an isolated one. For weeks after the small boy’s death, several more cases of avoidable deaths of young children were reported around the country, attributed each time to a shortage of doctors to service the public health facilities.

The Western Cape provincial government’s investigations into Unabantu’s death rushed to absolve of any responsibility the three health facilities where the granny and her charge had been denied treatment. The underlying issues were hardly mentioned. Shortages of medical professionals in the country aside, are those who are available adequately utilised? And could the claimed shortages actually be due to the pursuit of profit, both by private corporations and by some doctors themselves?

To address the shortage of medics, health minister Dr. Aaron Motsoaledi has been on a drive to motivate medical schools to admit more students. However, the results of this investigation paint a picture of a department that is incapable of managing its resources – resources that include the doctors it employs. Furthermore, it’s a Department that turns a blind eye to private corporations who are openly stealing the services of those doctors already paid for by our taxes.

In November of 2012 this journalist drew the attention of the Department once again to a scheme they have been aware of, through the Health Professions Council of South Africa (HPCSA), for years. A Cape Town-based locum placement company, Mouldmed Locum International Exchange (Pty) Ltd., has turned the already over-stretched public health facilities into recruitment zones for their private clients.

It would be perfectly acceptable if the recruited doctors were to resign from their public positions to take up any new appointments. However, the fact that these doctors sign up for odd shifts (nights, weekends and public holidays) at private hospitals while still in the employment of the department, negatively affects their productivity and impacts on their dedication to patients of the public facilities.

Nobody cares to stop them

While locum doctors should be temporary workers who can be called upon to stand in for regular doctors, most positions being placed for by Mouldmed at the various private hospital groups (Medi-Clinic, Netcare, Medi-Cross, Life Healthcare among others) around the country have never been filled on a permanent basis. In fact, a confidential source at one of the Western Cape private hospitals openly referred to them as ‘agency doctors’. This takes the issue of labour brokerage to a new low.

Apart from surgical theatres, the greatest money-spinners for these institutions are trauma units (ERs). With huge revenue being minted from medical insurance companies, including the Road Accident Fund, private hospitals cannot afford to close their trauma units at nights, over weekends, or during public holidays. That’s when Mouldmed steps in to supply them with doctors. 

One of Mouldmed’s key people overseeing all placements is Joseph Maarman, a ‘National Consultant’ who is believed to be a Grade 12 graduate with no medical background. According to sources at Mouldmed who confidentially spoke to this journalist, as soon as Maarman receives requests from the private institutions he starts making calls to his list of doctors, most of whom are fulltime employees of the Department of Health.

This list, a copy of which we have obtained [uSpiked has removed personal cellphone numbers of doctors on the list], is also dangerously flawed. It contains indiscriminate and personal details of everyone who has ever attended a medical school – from student doctors and those with foreign qualifications (people falling into both these categories are regarded as interns and are legally required to work only under supervision at public facilities) to academics with other medical qualifications such as microbiology.

But that’s not all. Going through the list, which is arranged alphabetically, this journalist identified several individuals who have been previously suspended or deregistered by the HPCSA, as well as practicing general physicians (GPs) who don’t hold the Trauma Certificates, which are a mandatory requirement for ER doctors.

With the demand from private institutions outstripping availability, and ‘agency fees’ of R45 per hour per placement, Mouldmed doesn’t seem to care about appropriate qualifications, and the institutions themselves don’t appear to question them either. [It would likely be possible for this journalist to craft a CV claiming to be a doctor and Mouldmed would gladly find a well-paying graveyard shift at any of the private ERs. uSpiked]. 

It appears that the private hospitals are willing to pay premium to keep their ERs open – costs to them work out to a minimum of R330 p/h for a 12-hour night shift (R3,960); R412.50 p/h for every 12-hour weekend shift (R4,950); or R580 p/h for public holidays.

Mouldmed also collects VAT on the hourly rates payable to the ‘locums’ by the private institutions. While it is understandable that VAT would be levied on their agency commission, it’s not clear how remunerations can be considered VATable.

According to a local tax consultant, VAT would be included if the client (the private hospital) wanted to make the transaction appear in their books as a service rendered by Mouldmed rather than by an individual locum doctor. This would also reduce the responsibilities and liabilities carried by the contracting private hospital should anything go wrong during the shift.

Of all the questionable placements encountered during this investigation, none was as disturbing as that of Dr. Valerie Thandi Manda. Originally from Zambia, Dr. Manda had ‘locumed’ in the casualty departments of Medi-Clinic, Netcare and Life Healthcare.

However, this highly-qualified professional with multiple academic degrees should never have been allowed to examine a patient let alone be left in charge of a casualty department at any hospital: until mid-2011, she was working as a medical microbiologist (pathologist) and had no practical medical experience. Regardless, Mouldmed’s timesheets and invoices in our possession place her in several of the Cape’s private hospitals’ ERs where she regularly locumed as a trauma doctor.

How many other ‘Dr. Mandas’ could be out there, in the emergency rooms of our private hospitals, when they’re actually qualified instead to be examining biological specimens under microscopes, or undertaking research that could discover the next wonder drug?

After the microbiologist discovered how lucrative it was to ‘locum’ through Mouldmed, she sought to regularise her position as a professional medic. That required at least a year-long internship under supervision, which she undertook at Tygerberg Hospital for the year ending July 31, 2012. But despite being an intern, Dr. Manda continued to accept numerous locum postings throughout that period at various private hospitals around the Cape.

At one point, Mouldmed, in a rare display of professional compliance, delayed remittance of her remuneration due to her failure to produce her practicing certificate. She blamed the delay on having changed her surname, and Mouldmed duly put payment through to her and continued assigning her to trauma-room gigs.

Sources at Mouldmed told this journalist that in a further questionable move, during her last month as an intern at Tygerberg Hospital (July 2012), Dr. Manda filed for a month-long sick leave, and immediately took up a well-paid month-long locum assignment at Life Healthcare, Claremont. [Her fulltime presence at the private hospital in the month of June/July 2012 has independently been confirmed to uSpiked].

The Western Cape department of health declined either to confirm or deny the sick leave due to confidentiality. After all, she was still an intern who shouldn’t have been allowed to work without supervision let alone to venture out of the public hospital where she was officially based.

Mouldmed’s scheme that allows individuals without practicing qualifications or trauma certificates to be assigned such responsibilities is not only life-threateningly hazardous, but also has serious financial implications.

When a medical-aid patient visits a trauma unit manned by people who should technically not be there, there arises an issue of possible insurance fraud as the insurance companies are effectively paying for ‘services’ rendered by unqualified or unauthorised individuals.

[uSpiked can confirm that one such medical aid provider, Metropolitan Life, has raised this issue with the Department of Health with little action being taken].

Further, the recruitments of public doctors locum at private hospitals could well be a contributory factor in cases such as that experienced by the family of Unabantu; a situation where doctors, paid for by our taxes, are more focused on their lucrative moonlighting stints than they are on their primary obligations.

The number of public patients they are able to see is limited by how time-consuming or how tiring the ‘private nightshift’ engagements have been for them. But even that’s not all. Since they are already being remunerated from public coffers, when they attend to patients in private arrangements, the subsequent medical tax claims filed by the patients would be like multiple-dipping from the public coffers, aiding and abetting in tax fraud.

Most worrying of course are the instances where the individuals being entrusted with our health at private hospitals are sometimes not fully qualified nor certified. Such was the case on the night of September 11, 2010. A young UCT student, Nishlen Govender, who had injured his leg while playing soccer on campus, was rushed to the Life Healthcare hospital in Claremont, where he had the misfortune of being attended to by Dr. Nseabasi Lilian Mark-Johnson.

Dr. Mark-Johnson was a practicing public doctor with foreign qualification (Foreign Regulation 2(4)) at the time, meaning that she required supervision. However, after examining the x-ray images, she misdiagnosed the injury as a fracture and prescribed a plaster cast for the boy’s entire left leg. He was also made to purchase a set of crutches to aid his mobility.

When Govender returned to the hospital the next day for a follow-up examination, a Dr. Gareth van Niekerk of Life Healthcare, Claremont, voiced his reservations about the previous night’s diagnosis. When the boy later told his parents about this, they immediately flew to Cape Town from Durban to seek a second opinion.

The parents engaged the services of Dr. Damien Thomas, an orthopaedic surgeon who examined Govender and the x-ray images from Life Healthcare, and declared the injury to have been a mere sprained ankle.

The student’s parents lodged a complaint with Life Healthcare, who passed it on to Mouldmed. This resulted in the following response from the company’s general manager, Marlene Mouton: “I refer to the date of 11 September 2010 where Mouldmed Locums was asked to supply your institution with a locum doctor. The date given by your institution was on short notice and Mouldmed had no other locum available to do the shift. Dr. Mark-Johnson was the only available locum and she lived around the corner, so this suited her perfectly.

“…Mouldmed cannot be held responsible for the medical decision each locum makes.”

That could certainly be true, considering that the company’s national consultant responsible for placing the doctors, Joseph Maarman, is not himself qualified to assess and assign suitable personnel.

While Dr. Mark-Johnson could indeed have been the only locum available at the time, she was attached to the Department of Health, and her services shouldn’t have been at the disposal of Mouldmed to assign and re-assign at all. This could perhaps explain why the hospital group very promptly opted to enter into a settlement with the family without any further contestation.

When this journalist spoke to Nishlen’s father in Durban, he confirmed that they had settled the matter with Life Healthcare and wouldn’t want to pursue it any further. However, there could be other victims out there who aren’t as lucky. There could even be those whose lives have been lost due to absenteeism of public doctors or fatigue of those doctors as a result of their taking on extra workload to line their own pockets.

The HPCSA has failed even to acknowledge receipt of this journalist’s written concerns. uSpiked is in possession of copies of communication between several affected individuals and the HPCSA that raise the issue of the ‘poaching’ of public doctors to work as locums in private hospitals. There have also been several exchanges on issues of deregistered (suspended) doctors as well as of interns in Emergency Rooms around the country carrying out treatments for which they’re not qualified.

As long as the parties involved continue to operate with such impunity, those relying on public medical institutions will continue to die due to lack of access, and the public treasury will continue to haemorrhage funds in multiple dipping schemes.