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Archive for the ‘Health Professions Council of South Africa (HPCSA)’ Category

protecting the public and guiding the professions

SA radiologist Dr L. Darius Tsatsi suspended in Saskatchewan

Posted by Mlungisi Dlamini on May 29, 2009


Dr L Darius Tsatso radiologist Saskatchewan Canada work questioned (3)

 

 

 

 

 

 

 

 

 

May 27 2009.  SASKATCHEWAN, CANADA. Dr L. Darius Tsatsi, 52, pictured, a University of Cape Town-trained radiologist who worked for the SA government for several years and was a professor of radiology at the Medical University of South Africa  –  is in trouble in Canada. Questions have been raised about his ability to ‘correctly read scans’.  More than 70,000 scans he has analysed since 2004 now are being reviewed… see

Joe Kirwan, CEO of the Sunshine Health Region in Saskathewan, Canada, said ´as soon as we heard about potential misinterpretations identified in this review we took action… all exams being questioned will be reviewed. Patients will be made of aware of their exams and their family physicians will be notified.´

The issue of medical errors was placed under intense focus in this Canadian province following the disturbing news that Saskatchewan’s Health Ministry also ordered a review of more than 70,000 diagnostic images — X-rays, mammograms, CT scans and untrasounds — that had been interpreted by the South African-born radiologist whose skills were being questioned at Yorkton hospital ever since 2006. Dr. L. Darius Tsatsi’s hospital privileges were suspended this month by the Sunrise Health Region pending investigations and a competency hearing by the College of Physicians and Surgeons. Tsatsi has worked for Sunrise since 2004, writes the Leader Post newspaper in Saskatchewan.  http://www.leaderpost.com/Health/When+lives+stake+there+room+error/1619319/story.html

Toll free number for patients

A special toll-free number, 1 877 854 4424  has been set up for worried patients in the region. More than 70,000 of Dr Tsatsi’s scans are now being reviewed for accuracy. Sharon Tropin, their director of communications, can be phoned by the news media at 306 786 0144.

The Yorkton based Sunrise Health Region announced that it suspended Dr Tsatsi on May 14 after ´serious problems were found in cases he had been involved in. ´Dr Tsatsi reportedly welcomed the review, and has agreed to stop practicing medicine while it was underway.`

One patient who publicly expressed concern was Joanna Sigurdson from Canora in east/central Saskatchewan, who told CBC News that she had contacted the toll/free information line to learn more about two mammograms performed on her in September 2008.

  • Tsatsi had examined her test results and determined that there ´had been nothing to be concerned about´. However she said she now was ón ´pins and needles´ while waiting for the results of the review of her scan.

KnifeInHead_TraumaSocietyOfSouthAfrica_TraumaLogThe College of Physicians and Surgeons of Saskathewan said in a statement that it had first reviewed 103 scans that Tsatsi had done last year after problems arose from 2006. Their interpretation of these scans differed from his on too many occasions, the health alert was then raised, and he was suspended.

Diagnostic errors

`The amount of times where diagnostic errors could have “disastrous” consequences for patients was “worryingly” high´, said the college. `There were at least five cases where patients were at risk´, it was reported from Canada. A committee was also appointed to hold a hearing to establish whether Tsatsi’s skills are satisfactory.

According to the college, ´shortcomings in Tsatsi’s skills had first been detected during a routine check of his work in 2006.

  • `There was concern over his ability to spot abnormalities on scans. The college’s council suspected that Tsatsi perhaps did not have “sufficient skills and knowledge” to do his work, and wanted to subject him then already to a “competency hearing”.

Refresher course

  • Tsatsi undertook via his lawyer to do refresher courses and managed to avoid the hearing, it is alleged.
  • He completed a refresher course at the McMaster University, but the college was still not satisfied and 103 scans were re-evaluated.

When did he graduate?

  • It would appear that Tsatsi moved to Canada in 2004. He qualified as a radiologist at the University of Cape Town in 1976 according to most news reports, but according to his own Facebook page, he graduated in 1982.

He was born on 29 March 1957, again according to his brief Facebook profile –  so he could not possibly have graduated in 1976 because he would only have been ten years old at  the time.

Beeld newspaper has also established that in May 2004, he was still the head of radiology at Dr George Mukhari Hospital in Ga-Rankuwa when the hospital had opened a R11-million angiography unit. He was also a professor at Medunsa.

Bertha Scheepers of the Health Professions Council for South Africa told Beeld newspaper on May 27 2009 that ´they ‘had no records of any complaints against Tsatsi.´  And the local health authority in Canada also said the qualifications and testimonials with which Tsatsi had arrived in the country  were “impeccable”.

Posted in Health Professions Council of South Africa (HPCSA), Radiography | Tagged: , , , , , , , , , , , , , , | 3 Comments »

Consumer protection and the hospital patient relationship

Posted by Mlungisi Dlamini on May 20, 2009


No express provisions for exclusion of liability of a supplier of services

The Consumer Protection Act, not yet in operation, significantly affects the hospital/patient relationship. The Act’s broad definition of consumer services means that a patient will be considered by the Act to be a consumer for the purposes of legislation.

 Services includes but is not limited to work or any undertaking performed by a person for the direct or indirect benefit of another and irrespective of whether the person promoting or offering to provide the services participates in, supervisors or engages directly or indirectly in the particular service.

The purpose of the Act is to promote and advance the social and economic welfare of consumers in South Africa.

The member of the Cabinet responsible for consumer protection matters may prescribe a category of consumer agreements that are required to be in writing. Whether hospital/patient agreements will fall within that category remains to be seen.

Where there is an agreement in writing as prescribed or on a voluntary basis, that agreement:

  1. Applies whether or not it is signed by the patient. The patient must be provided with a free copy of the agreement.
  2. Must set out an itemised break-down of the patient’s financial obligations under the agreement;
  3. Must be in plain language, if no form has been prescribed for the agreement. The Act says that an agreement is in plain language if:
    1. It is reasonable to conclude that an ordinary consumer of the class of persons for whom the notice, document or for whom the agreement is intended, with average literacy skills and minimal experience as a consumer of the relevant services, could be expected to understand the content, significance and import of the notice are of the agreement without undue effort, having regard to:
      1. Context, comprehensiveness and consistency;
      2. Organisation, fall, form and style thereof;
      3. Vocabulary, usage and sentence structure;
      4. The use of illustrations, for example, headings or other aids to reading and understanding. 
    2. Guidelines may be published in respect of the above. 
    3. Where an agreement is not in writing, a hospital will have to keep a record of the transaction entered over the telephone or on a recordable form, as prescribed. 
    4. We will wait and see whether a hospital/patient contract is required to be in writing. If not, doctors who, nevertheless, voluntarily contract in writing need to ensure that the contract complies with the provisions of the Act and the regulations, referred to above.
  4. Any agreement with the patient whether in writing or not, may not purport to:
    1. Limit or exempt the hospital from liability for any loss directly or indirectly attributable to gross negligence of the hospital or any person acting on their behalf;
    2. Constitute an assumption of risk or liability in that regard;
    3. Waive or deprive a patient of a right in terms of the Act;
    4. Avoid the hospital’s obligations or duties in terms of the Act.When a hospital undertakes to provide any services, the patient has the right to the:
  5. Timely performance and completion of the services;
  6. Timely notice of any unavoidable delay in the performance of the services;
  7. Performance of the services in a manner and quality that patients are generally entitled to expect;
  8. The use, delivery or installation of goods that are free of defects and are of a quality that patients are generally entitled to expect of the goods are required for performance of the services. 
  9. The latter is of significance in the case of medical implants and the right to the use of safe medical equipment in any treatment. 
  10. If the hospital does not perform a service to the standards contemplated above, then the patient may require the hospital to remedy any defect in the quality of service performed or refund to the patient a reasonable portion of the price paid for the services performed (and any goods supplied), having regard to the extent of the failure.

It is debatable whether many provisions of the Act are appropriate to the doctor/patient relationship.

The Act does allow for a regulatory authority such as the Health Professions Council of South Africa to apply to the relevant Minister for an industry-wide exemption from one or more provisions of the Act on the grounds that those provisions overlap or duplicate a regulatory scheme administered by that particular authority in terms of other national legislation.

Doctors should consider, perhaps via the representative bodies, whether any regulatory schemes overlap or duplicate the provisions of the Act to found a basis for successful applications for exemption.

Of particular significance in the context of medicines, prosthetics, implantations and the use of medical equipment are the provisions of the Act which now impose a no-fault regime of product liability.

The Act does provide that in the case of goods supplied within the republic to any person in terms of transaction, even if the transaction is exempt from application of the Act that the goods of the importer, producer, distributor and retailers of the goods would still be subject to the no-fault regime provisions.

It is likely for example that an exemption from provisions of the Act is obtainable insofar as disciplinary procedures under the Health Professions Act and its regulations in respect of doctors who already provide an appropriate forum for professional complaints.

In terms of those provisions, the producer, importer, distributor or retailer of any goods is liable for any harm caused wholly or partly as a consequence of supply and any unsafe goods, product failure or defect or hazard in the goods or inadequate instructions or warnings provided to the patient pertaining to any hazard arising from or associated with the use of any goods.

That is irrespective of whether the harm resulted from any negligence on the part of those persons.

A supplier of services (such as a doctor) who in conjunction with the performance of the services applies, supplies, installs or provides access to any goods is regarded as a supplier of those goods to the patient for the purpose of the section.

The significance of this recordal is not clear. Presumably, the intention is to indicate liability on the part of that supplier, equivalent to the no-fault liability imposed on a producer, importer, distributor or retailer.

The Act, however, defines a supplier as a person who markets any goods and services producers, importers, distributors and retailers are separately defined, which definition includes for some of the persons the promotion and supply of goods as understood by the term market.

If a Court interprets the concept of supply of services in the context of the no-fault provisions to attract a liability equivalent to that of producers, importers, distributors or retailers, then for example, in the case of a medical device implanted in a patient which is defective and causes harm to the patient, the patient has the right to recover not only on a no-fault basis from the producer, importer, distributor and/or retailer of that particular medical product but also the surgeon who implanted the product.

All the patient need do is prove the harm as defined to have been caused by the defective implantation. It would not be necessary to prove negligence on the part of the surgeon or any of the other role-players.

There are only limited grounds of exclusion of liability.

There are no express provisions for exclusion of liability of a supplier of services, unless one considers the supplier’s position to be analogous to that of a distributor or retailer. In that situation, in the case of a surgeon, liability may be avoided if it is unreasonable to expect the surgeon to have discovered the unsafe product characteristic, failure, defect or hazard, having regard to that person’s role in marketing the goods to the patient.

Depending on a doctor’s/hospital’s role in supplying a particular product, the doctor may of course be classified as a distributor or retailer as defined by the Act.

Hospitals/doctors also need to be aware of the over-booking prohibitions under the legislation.

A hospital/doctor may not expect payment or any consideration for services if the doctor has no reasonable basis to assert an intention to supply those services or intends to provide services that are materially different from the services in respect of which payment for consideration is accepted.

If a hospital/doctor makes a commitment or accepts a reservation to provide the services on a specified date or time (the situation most commonly arises in the case of the surgeons’ list) and on the date and time contemplated fails to because of insufficient capacity to supply the services or similar services or same or better quality, class or nature, then the doctor must:

Refund the patient the amount of money paid in respect of the commitment or reservation together with interest at the prescribed rate for the date at which the amount was paid to date of re-imbursement;

In addition, compensate the patient for costs directly incidental to the hospital’s/doctor’s breach of the contract, except in circumstances where shortage of capacity is due to circumstances beyond the hospital’s/doctor’s control and the hospital/doctor took reasonable steps to inform the patient of the capacity problem as soon as practical in the circumstances.

While the particular section records as a defence to any alleged failure to supply services an offer to procure another person to provide the patient with comparable services, and the offer is accepted, or unreasonably refused, in the circumstances of a patient/doctor relationship the identity of the particular doctor would most likely be significant to the patient.

Accordingly, while there may be another surgeon available to provide the surgery a parties’ refusal to undergo surgery by another may not be unreasonable.

In those circumstances, there will still be exposure of the doctor to the claim for, not only the refund of any fees paid, but for compensation for costs directly incidental to the breach.

Those incidental costs would include, for example, loss of income, where a patient has taken off work to undergo surgery which is then cancelled.

The good news for doctors is that section 17 of the Act provides that while a patient has a right to cancel any advanced booking or reservation for services, the patient who does so and makes the commitment may be required to pay a reasonable deposit in advance.

The hospital/doctor may also be entitled to impose a reasonable charge for cancellation of the order or reservation. That cancellation fee cannot be imposed if the patient cannot honour the booking because of death or hospitalisation.

The cancellation fee would be unreasonable if it exceeds a fair amount in the circumstances, having regard to the nature of the services reserved, the length of the notice of cancellation and the reasonable potential for the hospital/doctor acting diligently to find an alternative patient between the time of receiving the cancellation notice and the time of the cancelled reservation and the general practice in the relevant industry.

The no-fault provisions of the Act will certainly facilitate litigation in the medico-legal field.

Previously, patients had the hurdle of proving negligence of the product supplier and that is now removed. In those circumstances, successful claims and litigation against manufacturers and suppliers of pharmaceutical products, for example, are likely to increase.

Those role-players in the medical industry which have a significantly increased exposure to liability in consequence of the no-fault provisions of the Act will need to ensure that by have in place appropriate product liability insurance to cover both the risk events and the quantum of damages of claims which may arise.

The question of claim, for example, for serious neurological injury caused by defective medication to a young middle-class patient who is rendered unable to care for themselves, or to earn an income, would be in the region of R10 million to R20 million excluding legal costs.

It is important to ensure that having regard to the limits of indemnity of any insurance, that the insurance provides adequately for legal costs both in respect of any claimant and defence costs.

On a similar basis, doctors need to review their medical malpractice insurance and ensure that it includes appropriate cover for the product liability exposure which is now created under the Act.

Donald Dinnie is a Director, Deneys Reitz Inc

Posted in Health Professions Council of South Africa (HPCSA), Human Anatomy and Physiology | Tagged: , | 2 Comments »

SANDF deploys doctors to state hospitals

Posted by Mlungisi Dlamini on May 6, 2009


Written by defenceWeb   
Tuesday, 28 April 2009
The South African Military Health Service (SAMHS) has deployed doctors and supporting personnel to the Dr George Mukhari hospital in Pretoria to assist the National Department of Health during a salary strike by its doctors.
A source says the SAMHS has deployed just over 20 doctors and supporting staff, which includes operational emergency care practitioners (“ops medics”) and nursing staff.
 
The Pretoria News reports more than 336 doctors from Dr George Mukhari Hospital and 24 from Jubilee Hospital have ignored a court interdict issued on Friday barring them from striking.

 
The doctors are demanding occupational specific dispensation (OSD) payments, which then Health Minister Manto Tshabalala-Msimang promised in June 2007 would be implemented in 2008.
 
The health department asked the Department of Defence on Friday to “assist with ensuring that all critical health care requirements are met at those Provincial Hospitals affected…” the defence department said in a statement.
 
Deputy Minister of Defence Fezile Bhengu said “the Department of Defence, in keeping with its Constitutional mandate … to preserve lives, has acceded to the request and will deploy members of the SA National Defence Force to ensure that all critical health care requirements are met at those Provincial Hospitals affected by the labour action of doctors”. 
 
“This contingency planning is taking place in close co-operation with the National Department of Health as the lead department in this regard.” 

The SANDF and the SAMHS in particular performed a similar function during the 2007 public service strike to high popular acclaim.

The Gauteng Health department has threatened the doctors with dismissal and is mulling reporting them to the Health Professions Council of South Africa for going on an unprocedural strike.

Posted in Health Professions Council of South Africa (HPCSA) | 1 Comment »

Shaik doctors acted professionally – HPCSA

Posted by Mlungisi Dlamini on April 29, 2009


By Angela Quintal

There was nothing untoward, unethical or unprofessional in the conduct of any of the doctors involved in the care in jail of Schabir Shaik, or in the reports which led to his medical parole.

This was the finding on Monday of the Health Professions Council of South Africa, announcing there was no evidence to suggest that any of his doctors misstated, misrepresented or falsified his condition.

Nor were they “unduly influenced” in any way, or influenced by Shaik’s relationship with ANC President Jacob Zuma, HPCSA registrar Advocate Boyce Mkhize said on Monday.

This was after a HPCSA investigation by its committee of a preliminary inquiry into whether any of the doctors involved acted unethically or improperly and should face charges of misconduct.

The HPCSA said the clinical reports, as well as the medical reports it had access to, revealed a “gravely serious medical condition of Mr Shaik”.

The council’s Committee of Preliminary Inquiry – consisting of independent medical experts – was satisfied that the medical reports by various doctors were not exaggerated, misrepresented or falsified.

The council said that while the initial complaint by the DA focused on three doctors, the council found that several medical practitioners had in fact treated Shaik during his incarceration.

The Daily News established last month after a two-week investigation that at least 14 medical practitioners had treated or diagnosed Shaik since he was jailed for corruption and fraud in November 2006.

Durban psychiatrist, Professor A E Gangat, cardiologist Dr Sajidah Khan and correctional services practitioner Dr Ngenisile Mbanjwa, were the last to interact with the patient.

The parole board met Mbanjwa and Gangat – who had previously stated that Shaik was suicidal – on February 26, and Khan on March 1.

In its statement, in which it did not name the practitioners involved, the HPCSA said:

  • There was no evidence to suggest that any of the practitioners involved in Shaik’s treatment or compilation of medical reports were unduly influenced in any manner;
  • There was also no evidence that any of the practitioners misstated or misrepresented or falsified or exaggerated Shaik’s medical condition in order to influence or procure an inappropriate release on medical grounds;
  • None of the reports by the practitioners involved was as a result of a political consideration or relationship or status of Mr Shaik to the president of the ANC, Mr Jacob Zuma; and,
  • To the contrary, the reports were a true reflection of pure clinical observations and records which were not susceptible to manipulation or misstatement.

    The HPCSA said that in consulting the Department of Correctional Services, it was clear that the parole board could not and did not act on the basis of a single medical report.

    “We were advised that Mr Shaik’s medical parole came before the attention of the Parole Board around November 2008 and the Parole Board deferred its decision and recommended that the matter be reconsidered around March 2009.

    “We were further advised that the Parole Board took this decision in order to adopt a much more cautious approach in order to satisfy itself that the condition of Mr Shaik indeed warranted the granting of medical parole.

    “Clearly, this is a decision that could not have been based on one medical report.”

    The HPCSA said it had access not only to the medical reports compiled by a number of doctors on Shaik’s condition, but also his voluminous clinical records obtained from Inkosi Albert Luthuli hospital.

    “We have established that all the medical reports compiled by all practitioners involved in the Shaik matter were consistent with one another in that the diagnosis and prognosis of Mr Shaik was similar.

    “We have further established that Mr Shaik’s condition and its gravity was confirmed by an independent specialist outside of KwaZulu-Natal, based in the University of Cape Town, which rules out the possibility that there may have been some collusion between the doctors.”

    The HPCSA had also established that the medical reports compiled were consistent with the clinical records which were computer generated based on the medical condition of the patient. The HPCSA said it was important to emphasise that the doctors involved in report writing did not have any decision making powers to grant medical parole.

    •  
      • This article was originally published on page 3 of Daily News on April 20, 2009
  • Posted in Health Professions Council of South Africa (HPCSA), Human Anatomy and Physiology | Tagged: , , , , , , , | Leave a Comment »

     
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