Human Rights Commission slams serious lack of KZN cancer care

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FocusOncologyDhlomoKwaZulu-Natal Health MEC Sibongiseni Dhlomo will have to explain the deaths of hundreds if not thousands of cancer patients who were left to die without having received any treatment at all, reports IoL. A damning report by the South African Human Rights Commission (SAHRC) has revealed that cancer patients at government facilities in KZN have to wait at least five months before getting to see an oncologist.

The report reveals that if cancer radiotherapy is the recommended course of treatment, patients admitted to a KZN Health Department hospital will have to wait a further eight months – meaning that it will be 13 months from diagnosis before a patient receives cancer radiotherapy.

The provincial Health Department has seen an exodus of experienced oncologists ever since it decided not to pay a maintenance contract for two state-of-the-art cancer radiotherapy machines at its Addington Hospital in Durban in 2012.

First to quit after 30 years of service was Professor Amo Jordaan, the head of oncology who was instrumental in obtaining the two Varian Rapid Arc Linear Accelerators, which cost R120million to install at Addington. The two machines had brought waiting periods for radiotherapy down from five months to two weeks.

International guidelines recommend that patients receive treatment within 28 days.

The SAHRC has ordered the department to immediately repair the two machines and clear the existing backlog of treatment – how it will do this is unclear, given that the department no longer has any oncologists in Durban and only two in Pietermaritzburg.

The SAHRC report follows a complaint that was lodged February last year by DA shadow MEC for health Dr Imran Keeka. The four respondents to the complaint are Dhlomo, Addington Hospital, Inkosi Albert Luthuli Hospital (IALC) and the KZN Department of Health, headed by Dr Sifiso Mtshali.

According to the report, the provincial Health Department sees about 2,500 patients annually. How many of those failed to get to see an oncologist or cancer radiotherapy treatment timeously is not known.

The SAHRC also recommended that an investigation be conducted by the Health Ombudsman and that KZN Premier Willies Mchunu determine whether “the MEC (Dhlomo) as the accountable authority has responded adequately in the provision of interim, short term and long-term measures in the performance of all functions of the executive that the constitution and legal frameworks assign to him”.

The investigation saw the SAHRC team visit both hospitals, speaking to staff and patients. None of the staff were prepared to be named, out of fear of victimisation and only one of the patients that the SAHRC team spoke to were prepared to be named.

 

The SAHRC’s 68-page report found that “the delays in the provision of‚ and in some cases the denial of‚ oncology services to cancer patients‚ some of whom are destitute and in need of healthcare‚ affects them in a most fundamental way”, reports BusinessLive.

“It poses a serious threat to the patients’ lives and the enjoyment of other rights. It cannot be denied that the rights to life and human dignity‚ which are intertwined in our Constitution are intertwined in this matter.”

The commission’s investigation followed a complaint lodged by the DA’s Dr Imran Keeka‚ a member of the provincial legislature‚ in February 2016. He complained that a dire staffing crisis affecting oncology specialists and other medical staff‚ coupled with insufficient and nonfunctioning oncology machines and delays in treating patients, was adversely affecting cancer patients in the province.

The damning report, released in full by the DA on Monday afternoon‚ found that there was “no doubt that the shortage of staff and nonfunctioning equipment adversely impact … the rendering of oncology services at the two hospitals”.

The Human Rights Commission has recommended that KwaZulu-Natal premier Willies Mchunu investigate the role of embattled provincial health MEC Dr Sibongiseni Dhlomo — who is already facing calls for his removal — in the current oncology crisis.

Interviews with patients and staff at the affected hospital revealed that there had been an increase in incidents of cancer in the province and that on average patients waited for about five months before seeing an oncologist and about eight months for radiotherapy. This means they are unable to detect cancer at an early stage or delay its progression‚ despite the World Health Organisation’s (WHO’s) findings on the importance of early diagnosis and treatment.

The Cancer Alliance told the commission that cancer cases and subsequent deaths could be reduced by prevention activities — if these were actually carried out.

The commission said the department “failed to allocate necessary and appropriate human and technological resources for oncology services”.

“Accordingly the department of health both nationally and provincially failed to take reasonable measures to progressively realise the right to have access to healthcare services in the KwaZulu-Natal province.”

The study found that while the investigation was confined to a few key hospitals‚ they believed that a comprehensive investigation was required throughout the province and reserved the right to initiate such a probe.

The department of health was ordered to immediately repair oncology machines and within 10 days devise a plan to deal with the backlog of patients and the staff crisis. They were also ordered to provide a detailed list of patients awaiting treatment as well as a list of patients who had died while waiting for treatment‚ including the cause of death.

 

The unfolding oncology crisis in KwaZulu-Natal is so dire that it can be likened to the Life Esidimeni tragedy which resulted in the death of more than 100 mental health patients under the ANC government in Gauteng. The DA’s Imran Keeka said this after a SA Human Rights Commission investigation found the KZN Department of Health had failed its cancer patients, reports The Times.

The 68-page SAHRC report following a complaint by Keeka in February last year found that “the delays in the provision of‚ and in some cases the denial of‚ oncology services to cancer patients‚ some of whom are destitute and in need of health care‚ affects them in a most fundamental way.

“It poses a serious threat to the patients’ lives and the enjoyment of other rights. It cannot be denied that the rights to life and human dignity‚ which are intertwined in our constitution, are intertwined in this matter.”

On Monday, The Times writes, Keeka wasted no time in calling for an urgent snap debate in the KwaZulu-Natal legislature over the issue. “As in the case of the Life Esidimeni tragedy this KwaZulu-Natal crisis highlights the ANC-government’s failures and shows zero accountability or care on the part of the ANC.

“It proves its disdain for some of the most vulnerable South Africans – those who suffer from serious conditions and rely on the state for their care‚” said Keeka.

He said that up until now Premier Willies Mchunu‚ Health MEC Sibongiseni Dhlomo as well as national Health Minister Aaron Motsoaledi have simply ignored the plight of thousands of cancer patients across the province as cancer treatment in KwaZulu-Natal’s health department all but ground to a halt.

“In a blatant example of how little the ANC cares for the most needy people in our society‚ there has been zero accountability from any of them‚” said Keeka.

The report says he called for Mchunu to fire Dhlomo for allowing the department to “deteriorate into such a disastrous state and allowing hundreds of cancer patients to be compromised”.

ANC secretary in KwaZulu-Natal Super Zuma said while they will discuss the issue‚ the ball is also in the national government’s court to discuss the issue at cabinet level. “Yes we did an assessment of the MEC and all other MECs last year. We had no problem with him except pointing to a few areas of improvements to all the MECs. We haven’t assessed him this year‚” he said.

Keeka said in the report that it was unlikely that the department would heed the report from the SAHRC. “We therefore urge the commission to begin legal consultation immediately in anticipation of this and advise that they ensure through courts‚ if it comes to that‚ that the interests of the people of our province are placed first. They must be prepared to initiate prosecution if the MEC and his department create delays or even disregard this report‚” said Keeka.

The report says Dhlomo and his department are now required to report to the Commission‚ within 10 days of receipt of the report on its investigation. “We expect nothing but denials‚ obfuscation and more failures of accountability‚ as this is the pattern set in stone in the ANC government‚” said Keeka.

Health activist Mary de Haas said the report findings were fair but failed to take into account the reason for the non-functioning machines, especially at Addington Hospital, which has massively contributed to the patient backlog.

“There has been much controversy about the machines at Addington hospital which were not serviced after the supplier wasn’t paid. We are aware that the department claims there were irregularities around this process‚ but there is no reason to stop servicing the machines and punish innocent patients.”

The report says the DA’s recommendations to the KZN Health Department are: a special committee must be established in KZN to oversee the findings of the Commission. The committee must include the Premier‚ the MEC and opposition spokespeople on Health.

This committee will be responsible for implementing the following short-term solutions; retired oncologists can be approached to consult for the state‚ for a necessary period‚ until the oncology crisis is resolved; specialists in the private sector can be requested to locum in state hospitals and compensation for the difference in rates could be in the form of a tax rebate/discount; the Provincial Health Department can go into a partnership agreement with private practices‚ allowing the state to send patients to private practices where the state will pay at a negotiated rate; and the National Health Minister‚ Aaron Motsoaledi‚ can exercise the right to fast track registration for foreign doctors in the Health Professions Act so that talented oncologists can be brought in from other countries urgently.

 

“The report has confirmed what the DA has been saying all along, namely that equipment vital for screening and treatment is either broken or non-existent, that there is a shortage of staff, and that there is a massive backlog which is resulting in curable cancers rapidly becoming incurable,” Keeka is quoted in an IoL report as saying.

“We express our gratitude to the SAHRC for being one of the few remaining Chapter 9 institutions seemingly not under state capture. Our country is currently treading a fine line in its first attempt at democracy and we are in a race against time to ensure that it succeeds. The DA remains committed to this project,” Keeka said.

The SAHRC said the complaint, received on or about 19 February 2016, raised a number of problems regarding the provision of health care services to oncology patients in KwaZulu-Natal.

“The complainant alleged that there were insufficient radiotherapy treatment devices and facilities in the province of KwaZulu-Natal, which had a negative impact on the treatment of patients living with cancer in the province. The radiotherapy machines used for radiotherapy treatment at Addington Hospital were not working.

“This therefore resulted in delays in the treatment of oncology patients which the complainant attributed to the shortage of functional health technologies. The complainant further alleged that the department of health in KwaZulu-Natal was failing to provide oncology patients with adequate health care services,” the SAHRC said.

“The extensive investigation initiated by the commission found that the respondents, being Addington Hospital, Inkosi Albert Luthuli Central Hospital (IALC Hospital), the department of health KwaZulu-Natal, and the MEC of KwaZulu-Natal health, have violated the rights of oncology patients at the Addington and IALC Hospitals to have access to health care services as a result of their failure to comply with applicable norms and standards set out in legislation and policies.

“The commission’s binding recommendations in terms of section 13 (1) (a) (i) of the SAHRC Act are that the respondents are required to immediately take steps to repair and monitor all the health technology machines regardless of contractual disputes yet to be finalised through the courts; that a management plan be adopted to deal with the backlog through, among others, entering into interim public/private partnership arrangements with private oncologists, medical officers, radiotherapists, and oncology nurses, and that an interim referral management plan be developed to facilitate the referral of patients to private service providers for screening, diagnosis, and treatment of cancer.

“The respondents are required to report to the commission within 10 days of receipt of the report into its investigation,” the SAHRC said.

 

Dhlomo faces more calls for his removal, with the ANC in the province set to study a report by the SAHRC report.

“We raised some concern over his performance last year when we did an assessment of all MECs after we took office as the new administration. We gave him the opportunity to resolve the challenges we identified and have not done another assessment since then,” ANC provincial secretary Super Zuma is quoted in a Sunday Tribune report as saying.

“We have not seen the report from the commission, so we will need to study its findings before the party decides on how it wants to address the issue.”

The report says the Health and Other Services Personnel Trade Union of South Africa (Hospersa) welcomed the commission’s findings, but said it did not go far enough.

“The report vindicates our call that Dhlomo should resign immediately. It is also not correct to state that there is a shortage of oncologists. The truth is oncologists are refusing to work in KZN public hospitals. We identified the problems way back in 2009 and nothing was done about it,” said Hospersa spokesperson Noel Desfontaines.

The National Education Health and Allied Workers Union (Nehawu) said it had raised its concerns with provincial health head of department Dr Sifiso Mtshali at a recent meeting. “We understand they are facing budget cuts and want to give them an opportunity to resolve the issue, but we will also be marching to the premier’s office next month to raise our concerns.

“If the department does not address the matter then, we will call for the dismissal of the entire top leadership of the department, including MEC Dhlomo,” said Nehawu provincial secretary Phakama Ndunakazi.

Mtshali is quoted in the report as saying that the department welcomed the commission’s report. “We are already implementing some of the recommendations and will submit these to the commission as part of our response. Our primary concern is to ensure services for our oncology patients are implemented through our agreement with the private sector,” said Mtshali.

Dhlomo did not respond to requests for comment on the findings against him, the report says.

SAHRC report Report on the Independent Online site Full report on the BusinessLive site Report on the TimesLive site

IoL report
Sunday Tribune report

Statement by Imran Keeka, DA KZN Spokesperson on Health, 19 June 2017

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