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Doctor wants to obey Hippocrates not government policy

Written by Health-e News

The case of dismissed Mpumalanga doctor Malcolm Naude could have wide implications for all doctors working in the public sector.

Dr Malcolm Naude wants government to recognise that doctors have the right to follow their consciences when treating patients, and that they are guided by the Hippocratic Oath rather than changing government policy.

Dr Naude is pursing a case of unfair dismissal against the Mpumalanga Health Department after being fired from his position as a medical officer at Rob Ferreira Hospital in 2001.

Naude believes that he was fired for supporting a programme called the Greater Nelspruit Rape Intervention Programme (GRIP), which had started offering antiretroviral medication to people who had been raped to reduce their risk of HIV infection.

‘€œDoctors, no matter who they work for and what kind of environment they’€™re in, should be able to make decisions that have their patients’€™ best interests at heart,’€ Naude told Health-e this week.

‘€œIf that’€™s in contradiction to national policy or a regional whim, doctors should be able to make decisions that look after their patients and make sure that they have the best possible medical care,’€ he added.

His case, which has taken six long years to get to the Labour Court, was postponed to 6 December.

Naude’€™s, attorney Dan Pretorius, says her client is pursing the case as a matter of principle.

‘€œI think it is an issue for us now that there seem to be a number of reprisals, almost, by the Department of Health against people who speak out and who obey their consciences and who feel forced to think about what would be best for their patients,’€ said Pretorius.

‘€œWhat we’€™re looking for is an acknowledgement that doctors have to obey their own consciences; that doctors have ethical responsibilities; that doctors should put the interests of their patients first. The ordinary way to look at those is by saying that any civil servant must obey the Batho Pele principles.

‘€œWhen it comes to doctors, the main code of ethics is the ancient Hippocratic Oath. So far, we haven’€™t managed to get the Department of Health to sign an acknowledgement to say this applies to doctors in state hospitals. That’€™s a settlement that we’€™ve got and they haven’€™t agreed to make that settlement.’€        

The Hippocratic Oath requires doctors to do no harm and act in the best interests of their patients.

While the Mpumalanga department has yet to respond to Naude’€™s settlement offer, national health ministry spokesperson Sibane Mngadi said it did not pose a problem for government.

‘€œThere is no need for contradictions to arise between Hippocratic Oaths and the health policies of a democratic government. Both health policy and practice of doctors should be guided by the desire to provide best possible care available to all patients,’€ said Mngadi.

Naude’€™s dismissal came during Sibongile Manana’€™s reign as Health MEC. In 2000, Manana gave a speech condemning ARVs as being a plot to undermine President Thabo Mbeki. At the time, the Mpumalanga Department of Health had issued an instruction that hospital doctors were not permitted to prescribe anti-retroviral drugs.

‘€œRound about October of 2000, the MEC started taking exception to doctors who were prescribing antiretrovirals as part of a post-exposure prophylaxis programme to these survivors,’€ said Naude.

‘€œIt eventually led to the eviction of GRIP in February of 2001 from the Rob Ferreira Hospital, and thus limiting the effectiveness of the whole rape crisis intervention. Basically, that led to me signing an affidavit in June 2001 [in support of GRIP], and a couple of weeks after that I heard via the grapevine that I was not in the employ of the Department anymore. It took another five months to get an official answer from the Department of Health that I was not employed anymore. ‘€œ

Rob Ferreira’€™s hospital superintendent at the time, Dr Thys von Mollendorf, was also fired at the same time. He too challenged his dismissal and although he reached an out-of-court settlement with the Mpumalanga Department of Health, he has yet to receive  the financial compensation he was promised.

‘€œI’€™m trying to make it easier for doctors who get into my position later on not to have to go through the same thing,’€ said Naude. ‘€œNot to fear a reprisal that they might lose their job; that they might lose a promotion if they are going to differ from their employer on an ethical or a medical issue like this.’€                          

After his dismissal, Dr Naude went to work overseas but is now back in South Africa working with rape survivors in the private health sector. ‘€“ Health-e News Service.

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