Special Hearings — Health Sector Hearings — 1997-06-17

UNKNOWN: I am surprised at your surprise because we both belong to the largest group of oppressed people in the world.  (General laughter). So we should identify more readily with the suffering.
 Thank you for letting me speak. I am one of the six doctors out of a total of about 15,000 registered medical practitioners who, in 1984, obtained an order from the Transvaal Supreme Court compelling the South African Medical and Dental Council to discipline the district surgeons who had been accused of improper and disgraceful conduct in the medical management of the death in detention of Steve Bantu Biko, aged 30 years.   This doesn't mean that other doctors were not concerned.  They were but they were reluctant to take the final drastic step of going to the Supreme Court.
 My own personal involvement in the Biko saga began in June 1980, almost three years after he had died.  Like the MASA, which is the trade union of doctors, I had abdicated responsibility for medical ethics to the South African Medical and Dental Council and seldom even bothered to exercise my vote for some of the members of this powerful statutory body.
 Biko was the 46th political detainee to die in imprison.  We had omitted to act in the face of all these deaths because of our unquestioning acceptance of the authority and integrity of the South African Medical and Dental Council whose stated function was to protect patients from improper or negligent medical conduct.  
 The only members of our profession who had access to prisoners were district surgeons who were often poorly trained and believed that their primary responsibility was not to their patients but to the Security Police.  The South African Medical and Dental Council had not corrected this erroneous impression, so there was undoubted ambiguity about their role.
 Until 1980 I was unaware of these facts, until I was pushed and shamed into action by UCT students.  They invited me to join a panel to address a public meeting held at the Medical School to protest against the refusal of the South African Medical and Dental Council to discipline Drs Lang and Tucker who had been accused of improper and disgraceful conduct during the public inquest into Biko's death.  
 I accepted their invitation and was surprised when some hours before the meeting I was summoned by the Superintendent of Groote Schuur Hospital.  He told me that head office had phoned him to tell me that I was a provincial servant and forbidden to participate in political activities.  
 My account of this interview, fortified by Burke's memorable comment, "that for evil to succeed it is sufficient for good men to be silent", received wide publicity and committed me to five years of intermittent struggle.  
 The Press pursued the Biko affair relentlessly.  It would have been quite impossible for any individuals to have done this and to have mobilised effective public indignation.
 Further threats from head office followed.  They were always verbal, usually telephonic, and related to dismissal from my job.  Every effort was made to avoid depicting me in a favourable light by the Press.  
 About this time a group of us from UCT and Wits, having taken legal advice on how we could act, met to discuss strategy.  To my astonishment my colleagues, all male, decided not to pursue the matter because it was not considered ethical to crucify our colleagues.  Sympathy for the district surgeons in their ambiguous situation was expressed.  I was confused by this development which seemed to indicate that it was more important for the medical profession to close ranks than to protect the health of detainees.
 Further defection of sympathisers followed later, predominantly because of financial concern about our legal costs.  Eventually two groups decided to pursue the matter.  It was unfortunate that there were two groups, but these finally amalgamated in our submission to the Supreme Court.
 In February 1982 we lodged our two separate complaints requesting the Council to hold a full, proper and preferably public inquiry.  The group to which I belonged paid our attorney about R6 000 to draft our petition.  We waited over a year before the South African Medical and Dental Council replied rejecting both petitions.   We realised at this stage that if we were going to be involved in further legal costs we would have to be more practical about the situation.  Professors Jenkins, Tobias and I requested donations from sympathetic colleagues by personal letters.  Bill Hoffenberg, who had been forced to emigrate to the UK because of the severe restrictions placed on his academic career, appealed in a British Medical Journal for financial support for us.  The South African Press regarded this as news and published it.  Eventually about 20% of our total funding came from overseas and we had about 34, R35 000.  
 Two advocates, Mr Sydney Kentridge and Dr D P de Villiers offered us their services pro amico.  Namda, an organisation formed in 1982 to represent health workers, encouraged their members, of which I was one, to support us financially.  The MASA, to which I also belonged at that time, did not.  And when I happened to meet the President of the World Medical Association, who was visiting South Africa, I asked him whether he did not agree that the MASA should contribute to the fund, he said that no medical association in the world would challenge a statutory body such as the South African Medical and Dental Council.
 The overseas funds were not released to us for some time because we were accused of having violated the Fundraising Act.  
 In 1980, because of our disillusionment with the South African Medical and Dental Council, some of us at UCT and Wits realised the need for establishing local ethical medical committees which could offer immediate advice and support to doctors and have faculty status.  We wrote to the other five medical schools suggesting this, none of them replied.
 The UCT ethical body was named the Professional Standards Committee chaired by the Dean, had five faculty members and two student members.  A major achievement of this body was to badger the MASA to examine the ethical issues arising from the medical care of detainees and to organise their submission of their ad hoc committee.
 The students were concerned about the rule that when they graduated they would swear an oath which included a clause to the effect that they would treat all race groups equally.  So they brought this problem to the Professional Standards Committee for discussion, and we ruled that it was correct to drop it.
 After a year of serving on this Committee I was dropped and apparently rumour had it that this had been organised.  You couldn't rely on Frances Ames to behave like a gentleman!!!  (General laughter)
 When we, much to our surprise, when we won our case in the Supreme Court we were left with R34 000 which we divided between the two medical ethical committees.  
 In November 1984 the Supreme Court ruled that the Inquiry Committee and Medical Council had failed to apply its mind properly at all to the Biko affair and ordered them to discipline the doctors.  
 So during July 1985, almost eight years after Biko's death, a disciplinary committee of the Council charged the two doctors with disgraceful and improper conduct.  Dr Lang was cautioned and reprimanded.  Dr Tucker was initially suspended for three months, later removed from the role of practitioners and later still reinstated.
 The South African Medical and Dental Council remained graceless throughout.  The doctors received virtually token punishment for serious offences.  It never apologised or admitted guilt and indeed it was rumoured that it planned to take the case to the Appeal Court.  Although the extreme generosity of our two advocates had relieved them of paying their costs they refused to pay the airfare of Dr de Villiers who had had to fly from Cape Town for the trial.
 In their final issue before they disbanded, which was published in November 1994, the South African Medical and Dental Council congratulated itself on its proud record of service.
 I have been asked to reply specifically to several questions.  
 How did I feel about blowing the whistle on colleagues?  Obviously I didn't enjoy this.  All of us saw the Medical Council as the chief culprit, but we were unable to deal with their guilt without approaching it through reviving the case against the doctors.  
 I was particularly upset that Dr Hirsch and Mr Keeley, neither of whom I thought had behaved unprofessionally, also had to be included in our submission because there had been some discrepancy in the evidence given by the doctors.  This doesn't mean that I approve of doctors closing ranks.  I condemn it vigorously.  Doctors should see themselves as primarily serving patients and not their fellow doctors.
 Another question was, what support or lack of support did we get from various bodies like UCT and the Medical Faculty and what domestic support did I get?
 UCT supported us in encouragement and advice and finance, but did not join us in appealing to the Supreme Court.  Some members of the Medical Faculty supported us, others derided us and some made strenuous attempts to stop me personally, on the grounds that I was damaging UCT Medical School.  Students gave virtually unqualified support.  
 My mother supported me but stipulated that I should not spend any money on the battle on the grounds that that money should be kept for my boys - (general laughter).  For a widow with four sons this was a consideration, but I disobeyed this maternal injunction.
 Some of my own sons were concerned about my safety, advised me strongly never speak to the relatives of detainees or other people on the phone because it was almost certainly bugged.  I had acquired the reputation of being the prisoners' friend so was subjected to many inquiries and appeals.
 Was I victimised?   
 Probably, but I have no hard evidence for this.
 Did we think we would win?
 I certainly didn't and I think the fact that we were advised to have two advocates indicated the reluctance of our legal advisors to really encourage us that we would be successful.  Once of course we had won we acquired many friends.  Nothing succeeds like success, but I am sure if we had failed we would have been ridiculed and derided by many people.
 Did this take a lot of time?
 It took an immense amount of time, and that of our secretarial staff.  Professor Jenkins' secretary meticulously kept a record of all donors and the amount donated and kept both our local and our overseas funding separately.  Constant discussion between ourselves, our lawyers and the Press fragmented our time.  Our post was interfered with.  On one occasion a registered letter sent to Mr Kentridge disappeared for six weeks. 
 What are the memories that stand out?
 My main one was the discovery of the extent of submissiveness to authority.  An alarming number of people were prepared to obey orders from the authorities and to jettison principles.  This is of course is not unique to South Africa, or unique to the medical profession.  One of the most constant excuses for the Nazi and other atrocities was that individuals were only obeying orders.
 I was ruefully confronted with my own Achilles Heel.  I reacted with terror at the possibility of punishment for stepping out of line when my third son, who was doing his army service, telephoned me to say he was being posted to Angola.  The possibility that he might be deliberately exposed to danger because of his mother unnerved me. 
 The other memory that stands out is my dismay and surprise that senior colleagues could, at one stage, refuse to pursue the fight because of their reluctance to crucify their colleagues and their feeling that they should close ranks.  
 What are my recommendations for safeguarding behaviour in the health profession in the future?
 I think preventing submission to authority and absolving oneself from blame by saying that one has to obey orders is widespread.  It starts in childhood in the second year.  I have been encouraging my grandchildren, every time they challenge their parents to be rewarded. (General laughter).  Perhaps it's not surprising that their parents have emigrated.  (More laughter).
 I think all medical students should be taught about the research on submissiveness being a key etiological factor in the perpetuation of atrocities. They should be fully familiar with Milgrim's work and reflect on Hannah Ahrens Concept of the Banality of Evil.  I would certainly restrict the power of every senior member of the Medical Faculty and restrict administrative power by the Heads of Departments.  Students should have effective representation at every level and should serve on every single committee.  Historically students are always in the vanguard of progress. 
 The Professional Standards Committee should become a vibrant force at the Medical School.  None of its meetings should be held "in camera".  There should be a lawyer on the Committee.  Medical doctors are the most ignorant of all professionals outside their own narrow field.  And the Committee should liaise freely with the Press.
 I think that prisoners are the most badly treated and vulnerable of all our patients, and the doctors who serve them should be properly trained, especially in neuro-psychiatry and should receive status and adequate remuneration.  Their work and prison activity in general should of course be open to scrutiny.
 Do I regret the stand I took?
 No.  I learnt a great deal and don't regret it, even the suffering that it's inherent in all important learning.  I do, however, wish we had achieved more.  The exposure of the tarnished image of our noble profession damaged our reputation profoundly.  We can only regain it by wholehearted commitment to minister to the health needs of all South African students both now and in the future.