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

UNKNOWN: (duly sworn, states)

ADV POTGIETER: Thank you very much, you may be seated.  Professor Folb you are a professor of Pharmacology at the University of Cape Town Medical School, is that correct?

UNKNOWN: Yes.

ADV POTGIETER: You are also the Chairperson of the South African Medicines Control Council is that correct?

UNKNOWN: Yes.

ADV POTGIETER: And you are also the Director of the World Health Organisations Collaborating Centre for Drug Policy?

UNKNOWN: Yes.

ADV POTGIETER: You have come to present testimony on a very well-known case, that of Mr Steve Biko, is that correct?

UNKNOWN: Yes.

ADV POTGIETER: I am going to ask you to take us through your testimony.

UNKNOWN: Honourable Commissioners, I am deeply moved to have this opportunity to make the submission to the Truth and Reconciliation Commission in the presence of Mrs Ntsiki Biko, the widow of Steve Biko, and Mr Kaya Biko, his brother.
 My sole qualification for doing this is that, at the time, hundreds of students, colleagues, lawyers, clerics, journalists and international experts in ethics and medicine visited me to seek advice or make points and left with me, in the process, more than 2,000 documents relating to the death in detention of Steve Biko, which are now part of an archive that will form part of the proceedings of the Truth and Reconciliation Commission.
 The death in detention of Steve Biko and its aftermath ironically and tragically provided unique insight into what I shall refer.  
 I shall start by a short excerpt from the inquest into the death of Steve Biko.
"Mr Kentridge, for the family:  In terms of the Hippocratic Oath to which I take it you've subscribed, are not the interests of your patient paramount?

DISTRICT SURGEON: Yes.

MR KENTRIDGE: But in this instance they were subordinated to the interests of security?  Is that a fair statement?

DISTRICT SURGEON: Yes.  I didn't know that in this particular situation one could override the decisions made by a responsible officer".
 Both district surgeons involved in the medical management of Steve Biko in his final days gave the same answer at the inquest.
 The narrative account is well-known to many if not all, and I shall repeat it only briefly.
"On the 19th of August 1997 Steve Biko was placed in detention under Section 6 of the Terrorism Act which allowed him to be held indefinitely.
 On the 6th of September he was moved to Security Police Headquarters for interrogation.
 On the 7th of September, during and around interrogation he sustained head injury, following which he acted strangely and was uncooperative.  He was examined repeatedly by district surgeons and there was external evidence of injury.  He was examined by doctors, the doctors, lying on a mat manacled to a metal grille.
 A medical certificate, written at the request of the head of the security police was falsified as was the medical record, The Bed Letter.
 There was evidence of severe brain injury which was initially disregarded by the doctors.  The doctors accepted police refusal of transfer to hospital.  The district surgeon described, in the record, the abnormal cerebrospinal fluid which indicated damage to the brain as being normal.  After tests showing brain injury the doctors authorised the patient's return to the police cell.
 On the 11th of September the patient collapsed.  The doctor accepted police refusal to transfer to hospital and agreed to Mr Biko's transfer 750 miles to Pretoria at the back of a Landrover, on the floor, unaccompanied and without a referring letter.
 On the 12th of September, six hours after arrival in Pretoria, Steve Biko died on a stone floor, on cell mats, in Pretoria Central Prison, unaccompanied.
 The post mortem examination showed brain damage and necrosis; head trauma - extensive; disseminated intra-vascular coagulopathy as a result of the shock and the assault; failure of the kidneys and external injury to the chest.
 The medical treatment was subsequently described by a Judge of the Supreme Court, and by distinguished physicians, on review, as having been callous, lacking any element of compassion, care or humanity".
 The inquest proceedings were referred, by the magistrate, to the South African Medical and Dental Council on the grounds that there was a prima facie case, a completely apparent case, against the doctors involved in the case of professional misconduct, and/or negligence in the performance of their duties.
 The response of the South African Medical and Dental Council and the Medical Association of South Africa, representing the group interests of South African doctors was as follows:
 The South African Medical and Dental Council took two-and-a-half years to respond.  In a preliminary inquiry it was found that the doctors had no case to answer, not even the falsification of the medical record or the flagrant disregard of the patient's elementary needs. That decision was ratified, confirmed, by the full Council.
 The Medical Association of South Africa, after perfunctory, superficial examination of the ethical issues declared that the South African Medical and Dental Council had been correct in its findings, and that doctors and others who thought differently were politically motivated.
 The reversal of the South African Medical and Dental Council decision took years, and was the result of unremitting and determined efforts of Drs Ames, Veriatha(?), Jenkins, Mzimane, Wilson and Tobias.
 Was this an aberration in an otherwise proud, if not excellent South African Medical profession, or was it inevitable?  The truth is that it was the latter.  
 It was the culmination, as I have no doubt we shall hear -
of apartheid discrimination in health facilities and provisions of care at all levels;
 - salaries discrimination whereby doctors who were not White earned half of what White doctors did; 
 - conditions in South African jails and the hostile response, even of the medical profession, to colleagues who attempted to expose these; 
 - the lack of response to children in detention and their treatment; 
 - the failure of the medical profession to respond to the banning of colleagues such as Dr Hoffenberg and others; 
 - the lack of interest of the medical profession in corporal punishment; 
 - the lack of understanding or training in even the most elementary aspects of medical ethics, and the lack of support and special training of district surgeons and others working in prisons.
 There was in this case, as there had been in others, abject acceptance by individual doctors and by their organised profession of interference by the State and by government and by the police in the conduct of their professional activities and their institutions.
 Steve Biko was a medical student and under ordinary circumstances he would today have been a practising doctor.  His legacy to South African medicine has to be thoroughgoing correction of those issues in this story that might conceivably ever allow it to happen again.
 I now wish to, in conclusion, address some personal words to the family of Steve Biko, his widow, brother and children, and to extend to them, as far as I am able, and on behalf of every doctor who feels this way, an apology, to state that this is an auspicious opportunity to do so.  And to give you an undertaking that those ethical and human issues, neglected in the case of Steve Biko, will be remembered and continue to be addressed and corrected to the best of our abilities and to express, Mrs Biko and your family, our understanding of how, even until today, you must feel.
 Mrs Biko I have composed, for this occasion, a short poem, a haiku which I dedicate to you and the family of Steve.  It is my first haiku to have been translated into Xhosa.  It reads as follows:
" A sombre duty describing the country's loss before his loved ones".
Thank you.