Article from the December 2013 issue of Noseweek Magazine.
Senior officials shrug off torrent of complaints
The scalpels are out in an almighty row involving heart surgeons, anaesthetists, hospital management, the Health Professions Council, a few heart patients who barely survived surgery in the Port Elizabeth Provincial Hospital – and some who did not.
In short, at various times over the past ten years various surgeons and anaesthetists have lodged formal complaints and drawn up reports about the allegedly “terrifying” incompetence of two of their colleagues, doctors Hamid Munir and George Mphahlele.
Both men are certified to practise as cardiothoracic surgeons by the Health Professions Council of South Africa (HPCSA).
Dr Munir received his first medical degree from Punjab Medical College in Pakistan, then emigrated to South Africa, where he proceeded to the Free State University School of Medicine to specialise in cardiothoracic surgery.
He was awarded the degree after five years there. In that time, he claims to have done well over 1,000 open-heart operations. This is put in contention in reports submitted to the Port Elizabeth hospital authorities by several of his senior colleagues.
Dr Mphahlele obtained both his undergraduate and specialist qualifications from the University of Cape Town Medical School at Groote Schuur Hospital. He took up his appointment in Port Elizabeth shortly after graduating in 2006.
The two have hit back by describing their critics as patronising racists and accusing two of them of earning secret commissions on medical supplies ordered by the hospital.
The Eastern Cape Department of Health eventually asked the Health Professions Council of South Africa (HPCSA) to do competency assessments of both surgeons, but (no surprise to Noseweek) the department hasn’t heard from the council in a year.
In March 2004, just three months after Munir’s appointment, the highly regarded founder of the Department of Cardiothoracic Surgery at the Port Elizabeth Hospital, senior cardiac surgeon Dr Mervyn Williams, reviewed a number of Munir’s mismanaged cases and then wrote to the hospital’s chief medical superintendent Dr Freddie Rank: “Dr Munir was trained in the academic unit in Bloemfontein. He has not acquired the necessary skills to act as a consultant heart surgeon… It is my recommendation that Munir return to the unit responsible for his training.”
In November 2004, Williams wrote to the CEO of the hospital about Munir: “Despite this period of training [his seven years at Bloemfontein in which he claimed to have performed more than 1,000 open-heart operations], he has demonstrated on a number of occasions that he is not able to operate within safe time limits. To allow him to operate with pulmonary bypass is to jeopardise the lives of the patients. The suggestion [by the hospital’s then CEO, Mr P G Zitumane] that he assist with an open-heart operation twice a week for a period of six weeks, in the hope that this will improve his speed is absurd.”
In April 2005 another senior cardiac surgeon, Dr Sonja van Riet, submitted a report on 20 cases mismanaged by Munir, suggesting general, serious incompetence.
Instead, the hospital then elected to sponsor Munir to spend a year in the cardiac unit of a hospital in Malaysia, where, presumably, there were no such sensitivities as described by Williams. Munir returned in 2007, upon which Van Riet, then head of cardiothoracic surgery, made a note in a report to hospital management that “[Munir] does not appear to have learnt too much”.
The competency assessment of the two doctors was repeated in 2008, with the same outcome: inaction by the hospital authorities.
By November 2008 matters had deteriorated to the point where Van Riet insisted that the hospital’s senior medical superintendent, Dr W L Maqagi formally order her, in writing, to give Munir open-heart surgical cases before she was prepared to do so. On 17 November Maqagi issued such a “lawful instruction” in writing.
The inevitable consequence is that the hospital itself is now liable for anything Munir has done, so they dare not concede his incompetence – or their knowledge of it.
As another senior doctor declares in a report seen by Noseweek: “The authorities would not admit to wrongly appointing the man [Munir] and they are now too terrified to dismiss him since they may be taken to court.
“I now realise that patients in the public sector have no rights and politicians feel nothing for their wellbeing.”
An “in-house” competency assessment was done of both Munir and Mphahlele in 2011 by three senior heart surgeons. Williams was one of them. (With his qualification from the University of Edinburgh, he uses the title “Mr”.)
In his report, Williams recommended that Munir should not be allowed to do heart surgery at all, while Mphahlele was only to be allowed to do the simplest of procedures “but only with an experienced surgeon assisting him or in close proximity”. The other two senior surgeons involved in the assessment, doctors Jakob Oosthuysen and Rashoek Sewsunker agreed.
Nothing changed.
An indication of the scale of the risk the hospital has brought upon itself: last year Munir accidentally stabbed a patient’s heart with his scalpel. The patient died. It can safely be assumed that the patient’s relatives were not told.
In March this year, specialist anaesthetist Dr Adrian Wentzel finally lost it and wrote to the hospital management demanding that both Munir and Mphahlele should immediately be suspended. This was after he walked in on them in the operating theatre on 22 February and found them watching cricket on television midway through a major open-chest operation.
(He quotes the patient’s name and case file number.) “This is not only dangerous and negligent and shows no respect for the patient and anaesthetist, but also sets a poor example for the nursing staff,” Wentzel says in the letter.
Disputing Mphahlele’s claim that his “mortality and morbidity” record is good, Wentzel referred to various operations performed by Mphahlele that went wrong and where the patient died or was rescued by the emergency intervention of another surgeon.
Among them is the case of a Mrs Cassim, where Mphahlele performed a sternotomy (an incision of the breastbone) with a surgical electric saw and skewed the cut, ending up with “a rack of ribs”, having sliced a major vein in the chest as well as the tube administering the anaesthetic to the patient. A senior surgeon had to step in hurriedly to repair the damage.
In the 2011 case of a Mr Nqayi, Mphahlele took eight hours to perform a bypass operation that normally takes little more than two hours. By the time he completed the operation, the patient had a “stone” heart and died.
“I have numerous other cases, from flagrant untamed blasphemy in theatre; failure to examine and manage patients appropriately; blackmail of staff who had resigned; performing a thoracotomy (cutting open the chest) on the wrong side; frequent misdiagnoses; inability to interpret X-rays…
“I trust that these two gents will immediately be dismissed so that the department can be rebuilt…” Wentzel wrote.
“Dr Mphahlele’s claim that it was I who made the call to stop him operating unassisted by a senior is untrue. All consultants doing cardiac anaesthesia were consulted and it was decided unanimously that this action should be taken to safeguard patients.
‘I trust that these two gents will immediately be dismissed, so that the department can be rebuilt’ – Dr Wentzel
“Dr Mphahlele’s allegations that I showed ‘complete arrogance, natural hatred… utter disrespect… and am preoccupied with politics of white supremacy is… racist in the highest degree.
“I am happy for you to discuss these allegations with my fellow black doctors and black patients.”
Port Elizabeth Hospital Complex chief executive officer Dr Kobus Kotze confirmed this week that he would not suspend the pair while the HPCSA’s assessments were under way.
HPCSA spokeswoman Bertha Scheepers said a medical negligence complaint was filed against Munir last year but it had been deferred after it was decided to consult with him first.
Shortly before Noseweek went to press, Eastern Cape Health Department spokesman Sizwe Kupelo said the department was well aware of the complaints.
“The matter has been referred to the HPCSA for competency checks,” he said.
“The department relied on the doctors’ HPCSA registration when recruiting. It is the HPCSA’s job to make sure doctors are properly qualified.”
Kupelo said there had been no formal investigation into the complaint lodged by Wentzel and no hearing. CEO Kotze had dismissed the complaint after speaking to a nurse.
Munir declined to respond to questions from Noseweek.
Mphahlele ignored efforts to obtain his comments.
Kupelo said Health MEC Sicelo Gqobana did not want to comment.
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