The Health Professions Council of South Africa (HPCSA) was established in 2000 as a regulatory body designated to determine standards of ethical and professional practice for registered health practitioners in South Africa. They also have the power to institute disciplinary proceedings against health professionals registered to practise as such in accordance with the rules set by their Professional Board.
In line with these disciplinary powers, the HPCSA may convene a committee of inquiry and investigate complaints lodged against a healthcare professional. These proceedings and investigations before the HPCSA are quasi-judicial and carry the same weight in law as that of magistrates’ courts.
Depending on the facts of each case, the HPCSA can decide to: caution or reprimand; impose a fine between R1,000 and R70,000; prescribe community service; suspend for a period; or remove the person from the register of health professionals and in essence prevent a member from practising medicine in South Africa.
As the only regulatory body for doctors in South Africa, the HPCSA is the only institution that can hold medical practitioners accountable and protect patients from their misconduct.
This is a responsibility that should not be taken lightly in a country where widespread systematic dysfunction, especially in our public healthcare system, leaves patients at a disadvantage and vulnerable to abuse, negligence and malpractice.
Given the state of our healthcare sector overall, it has never been more essential for the HPCSA to fulfil its mandate and carry out its functions in a manner that instils confidence in its members and the public.
Legal services in disarray
As part of the work done by the Women’s Legal Centre (WLC) in ensuring women’s rights to sexual reproductive health, we have been monitoring the HPCSA since the minister of health appointed a ministerial task team in 2015 to investigate reports of widespread dysfunctionality, and it appears that since 2015 very little has changed at the HPCSA.
The ministerial task team’s report of 2015 noted that the HPCSA was failing to carry out its statutory mandate across its five functions of:
- registration of health professionals;
- examination and recognition of qualifications of practitioners;
- professional conduct enquiries;
- approval of training schools; and
- continued professionals’ development.
Investigations into the state of professional conduct inquiries at the HPCSA found that their legal services were severely dysfunctional, mismanaged, and maladministered.
The investigation also found that their legal services were often encumbered by irregularities and undue delays which prejudiced all parties involved in their proceedings. Several recommendations were made by the task team to remedy the problems within the HPCSA, but more than seven years later, we are still seeing the same issues presenting themselves.
Bungled justice: Case of Dr Ganes Anil Ramdhin
In July 2020, the WLC, acting on behalf of Zoleka Helesi, a now-deceased theatre performer, submitted a complaint wherein we detailed the horrific experience that culminated in her death. The complaint was lodged against Dr Ganes Anil Ramdhin, an obstetrician and gynaecologist operating a medical practice from Khayelitsha in Cape Town.
At the time of lodging the complaint, Zoleka was still alive and experienced frustration with the lack of communication and lengthy waiting period from the HPCSA. This initial administrative bungling of her complaint was then followed by a pattern of maladministration, mismanagement and undue delays that accumulated in the withdrawal of preliminary suspension proceedings in 2021.
Due to procedural irregularities by the HPCSA itself, they could not proceed with the suspension of Dr Ramdhin and due to their own misconduct in handling Zoleka’s complaint, Dr Ramdhin could continue to practice medicine despite him facing serious charges of misconduct and having been found guilty of misconduct on other occasions by the HPCSA.
After the precautionary suspension hearing was abandoned in February 2021, the matter was then referred to another HPCSA professional board to determine the way forward, and in December 2021 the HPCSA determined there were sufficient grounds for a professional conduct inquiry and that the matter should be heard before an HPCSA Professional Conduct Committee.
The matter was then postponed multiple times at the request of the still-practising Dr Ramdhin, which led to an entire year of postponements that meant that for 2022 the Professional Conduct Committee made no progress and continued to allow the doctor accused of causing the death of two black women to continue practising.
Over three years since the initial complaint was submitted and two years since Zoleka passed, the final hearing took place on the 30 and 31 May 2023. After considering the accused’s pleas of guilty to both complaints brought by Zoleka and Beauty Mama, the Professional Conduct Committee found him guilty of unprofessional conduct and decided that an appropriate sanction would be to suspend him from practice for a period of one year.
After this period has lapsed he will be allowed to practice once again and see and treat women in South Africa. He will also be on probation for two years and will have to undergo rehabilitative training with an HPCSA-approved practitioner.
This then ends the road to justice for Zoleka and Beauty Mama, two black women whose deaths have now been confirmed to have been caused by Dr Ramdhin and whose cases now form part of both a long list of women that the HPCSA has failed and of persons whose rights Dr Ramdhin has been allowed to violate with devastating consequences.
In addition to showcasing the failures within the HPCSA, this case has also been illustrative of the reality that the HPCSA in its current manifestation is not set up to provide justice for any victim.
Practitioner before patient
As it stands, the processes in place at the HPCSA for investigations into complaints can only be deemed as not victim-centred, exploitative, unkind and traumatic to the very patients that have experienced the violations of their dignity and bodily integrity at the hands of healthcare professionals.
The current system is designed to focus on and protect the rights of the accused as a health practitioner and member of the HPCSA rather than the rights of the victim. In a sector where doctor-patient relationships already suffer from unbalanced power dynamics, where patients historically have less access to formal education and too often experience language and racial barriers in accessing healthcare, not enough is being done to create a more substantively equal process to handle misconduct by healthcare providers in a contextual manner that considers the experiences of patients.
Patients in the HPCSA’s process instead have limited rights as, save for their initial submission detailing a rights violation, they are intentionally excluded from the case going forward. They are unable to determine what charges the medical practitioner faces, are not consulted in the process of determining the content of the charge sheet or whether the practitioner is suspended pending the proceedings.
They are additionally not guaranteed a right to be present at the hearing of the matter, have no automatic right to be informed about the progress of the case and may not even be called to give evidence against the medical practitioner even though the complaint is based on their experience.
Unlike practitioners, patients are also not afforded a choice in their legal representation throughout the proceedings and may only observe the proceedings, having no rights to the evidence, to engage with the evidence, lead evidence or examine any of the witnesses.
In addition to this system being imbalanced and unwelcoming, concerns have also been raised over the conflicts of interest by HPCSA staff and conduct inquiry committee members who are peers of the health professionals being investigated.
Punishments don’t fit crimes
The last and perhaps most appalling issue identified with the HPCSA’s processes is the sanctions imposed as sentences by these committees. An evaluation of historical sanctions shows a pattern of sanctions that are inconsistent, disproportional, and lacking any real form of tangible punishment.
The sanctions being imposed do not serve as a deterrent and have instead, in addition to the other issues identified, made it easier for practitioners to abuse the system and have allowed for serial offenders like Dr Ramdhin to continue offending without fear. Powers that should be used to caution practitioners against misconduct and promote excellence in service delivery instead are now used to provide slaps on the wrist.
The fact that repeat offenders pose a particular risk to women in South Africa is clear and as highlighted by Dr Ramdhin’s case, and black women from lower-income communities will continue to be particularly vulnerable.
Women’s bodies and lives and black women’s bodies and lives in particular appear to be dispensable to the HPCSA and greater intervention is needed urgently to restore faith in our healthcare system and in our healthcare practitioners.
We as WLC thus remain committed to and focused on challenging regressive measures aimed at controlling women’s bodies and hindering their ability to make informed choices. DM