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Arbitrary actions.

To the Editor: Several recent events at a provincial and local institutional level have raised the issue of arbitrary actions; specifically, the impact of such administrative actions on personnel and, ultimately, service delivery. These events relate to the decision by the MEC of Health in KwaZulu-Natal to suspend and discipline Dr Colin Pfaff (who subsequently left KZN to work in Mpumalanga, and is currently at the University of the Witwatersrand), and the more recent 'suspension/redeployment' of the CEO (Dr Arthur Manning) of Chris Hani Baragwanath Hospital. In both cases, the credibility of a respected member of the medical community was brought into question. In neither case were satisfactory explanations offered for the actions. In the former, a letter was written to the MEC by the Professional and Ethical Standards Committee (Faculty of Health Sciences, University of the Witwatersrand); in the latter, a letter was written to the Gauteng Department of Health by the Dean of this faculty.

Neither letter was acknowledged, let alone responded to. It may be that the authorities concerned do not deem it fit to respond to a Committee or a Dean. Potentially, it is simply a case of actions having been taken, and concerns from interested parties (with vested interests in the outcomes) are irrelevant. Such interests would relate to patient care, professional reputations and the profession in general.

As colleagues of the aforementioned parties, and members of the same public health care system, should our concerns be ignored (one should not forget other incidents of a similar nature involving Drs Blaylock and von Mollendorf)? More specifically, if suggestions of impropriety are the basis of bureaucratic action, then surely it is in the best interests of all if the concerns are addressed rather than ignored. The lack of response is troubling as it seems to imply a lack of accountability or a lack of awareness of the seriousness and implications of such actions.

Clinicians are at the coalface, but to render an effective service it is essential that appropriate administrative structures and processes operate. Arbitrary actions create distrust and uncertainty and ultimately undermine morale. In any system, this is dangerous; in a resource-constrained environment, it is potentially catastrophic. If colleagues have conducted themselves in either an unprofessional or an unethical manner, no-one argues a need for action. So far, there is no convincing or objective evidence that this was the case in either instance. As a committee that deals with issues of professional and ethical standards, we would expect the relevant authorities to respond to concerns raised in a forthright and transparent manner, as a general principle. Certainly in Gauteng Province it is hoped that the recently signed Memorandum of Agreement between the Gauteng Department of Health and the Universities of Limpopo Medunsa Campus, Pretoria and Witwatersrand will ensure a collaborative approach to issues of mutual interest.

While it could be anticipated that the authorities concerned may raise an objection to our approaching the 'media', it should be borne in mind that this communication--such as it is--is one directed at colleagues in the profession based on our choice of publication and, further, that it follows approaches to the respective authorities that appear to have been overlooked.

Christopher P Szabo

Chair, and on behalf of, The Professional and Ethical Standards Committee

Faculty of Health Sciences

University of the Witwatersrand

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Title Annotation:Correspondence
Author:Szabo, Christopher P.
Publication:South African Medical Journal
Article Type:Letter to the editor
Date:Apr 1, 2009
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