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As a neurosurgeon practicing in Johannesburg, having recently had a run-in and case/enquiry with the HPCSA, I realised that there was a need for such a website. The website is there for two reasons: I need a forum and a place to state my point of view in relation to the recent HPCSA enquiry, because it is very difficult to get one's point of view across in the press and media. One notes that not only has the case been prominently reported in newspapers, SAMJ etc, but is prominently displayed on other websites, including the HPCSA website, the website of the Radiological Society of South Africa (there may be more websites I have not yet come across). The HPCSA website displays the results of the so-called "kick back" enquiry, the verdict and the judgment quite prominently, notwithstanding that many other practitioners, who have worse "transgressions", or who have partaken of acts which would be deemed, by the everyday common person, to be far worse than anything that we were accused of, are not prominently displayed and discussed on the website. Therefore, I felt that I needed a forum or a website to explain my point of view and my position, to hit back at them on a public basis, to protect my reputation. Therefore this website includes documentation with respect to various letters and articles that I have written to the press and media, which were not published in the press and media, or which were published in a fore-shortened form, and it also includes letters and testimonials to me, written by patients and colleagues (names and addresses of these patients and colleagues have been blacked out to protect these patients and colleagues, who have not given permission for their names and addresses to be used on the website). These testimonials and letters exist, but were never released by the HPCSA, even though they had sight of all of these letters, were never released by the media, even though the media had sight of all of these letters. The website, therefore, is an attempt to justify and explain myself to practitioners, the public at large, to explain my side of the story, but is also meant to be interactive in the following way: 1. Anyone may contact me and one can show them the correspondence, including the names and addresses of the persons who wrote the letters. 2. As stated in my open letter to the editors of various newspapers, any member of the public, or any practitioner, is welcome to approach me and discuss the merits of the case and enquiry, because it is very difficult to do this on the open air or on the open website given that the evidence and record of the enquiry runs into thousands of pages. One will appreciate that I had an extensive and lengthy interview with the Star and the Beeld and, despite this interview with them, my comments, criticisms, queries and problems were never raised or represented fairly in the press and media. The only articles the press (see my open letter) was the standpoint of the HPCSA and what they had to say about me, and any comments or queries which I gave to them, in an interview lasting over 1-1½ hours, were brushed aside and were never reported. I wrote an article to the SAMJ, published in January/February 2003 protesting the one- sided reporting of the case. The SAMJ, to their credit, published my letter and attempted to correct the situation by reporting my evidence in detail in the June issue of SAMJ, i.e. they reported the evidence of April so that their reporting of events was two months old, and unfortunately further evidence and/or points in favour of my case were not reproduced by them, although I accept their bona fides and they have, since my letter, attempted to faithfully reproduce and present our side of the case. A long open later sent to the SAMJ was not printed, but I did receive a supportive and apologetic letter from the editor, noting that he was aware of my position with respect to this enquiry and the judgement against us, noting that my letter was far too long for him to publish, that they don't publish letters of more than 400 words (my open letter is 3,000 words and even this does not do justice to the case), noting that, in any event, for him to publish would probably not be correct as it would represent my standpoint of the case and would represent comments which would be difficult to prove. Nevertheless, one accepts, to repeat, their good intentions and bona fides and the letter was appreciated. I wrote a letter to the Citizen after their article appeared, in relation to so-called "fraudsters" and, to his credit, the editor of the Citizen, Martin Williams, did give me space on the leader page, 2-3 weeks ago, and I published my version and standpoint but even that was seriously shortened and edited, by myself, because they did not want more than 600-700 words. The Medical Chronicle, thankfully, agreed to publish my side of the story in an article of 600-800 words but, once again, the article had to be foreshortened and edited considerably and, therefore, many of the points raised by myself can't be put across in such a shortened article. I went on E-TV and a 1½ interview was shortened to 20 minutes of speaking time. I am grateful to E-TV and think they did the best that they could in the allotted time (a 20-30 minute program - a tape of this program and interview is available) but recognise that many of the points that were made and discussed had to, of necessity, be left out in the 20-30 minute program. Therefore, my side of the story, i.e. articles and points which I need to raise, for myself, and for the profession at large, i.e. letters and testimonials which were never brought to the attention of the public, via the press, even though the press was given the complete text of all of these letters, needs to be on this website to redress the imbalance. To repeat, I would regard this website as being interactive, and any practitioner or member of the public is welcome to write to me regarding the points and issues raised in this section of the website and I will do my best to answer their questions and/or queries as honestly as I can. There is a further rationale for the origin and beginning of this website which is as follows:- One would hope, in view of problems raised in relation to the enquiry, that matters may be streamlined and improved, that the HPCSA may ultimately be changed, perhaps by force of public or medical opinion, to a new improved, more relevant HPCSA. I had started off with anger and frustration, at the antics and unfair handling by the HPCSA. Much of this anger has not yet abated, because I consider that I was grossly and unfairly dealt with (see my open letter) but a lot of the anger and frustration has been supplanted by a desire to see an improved HPCSA, one which would have more relevance to problems and difficulties which assail the profession as a whole, and which involve the public as a whole. More importantly, this experience, and the experiences I have outlined in trying to communicate with the press, media and public in general, has shown me that it is very difficult for practitioners to get their points across, in relation a number of matters and problems, and that practitioners, in fact, need a forum to address these issues. Therefore this website is not only or specifically about "kick-backs" or the "kick-back" enquiry so to speak, but is open to any practitioner or member of the public, in relation to issues and problems which concern and worry them in the wider and more general sense. Offhand, I can think of many problems which involve the profession and public on an ongoing basis, and will list some of those, although I am sure that subscribers and members to the website (subscription is the wrong word, because the website is free) might wish to raise other problems. Hopefully, the website could then be used in a meaningful way to generate opinion and/or decisions and/or policy making changes in relation to matters which affect our daily lives. Here are but a few of the problems that worry me (and perhaps worry you, and I am sure you would wish to comment on them):- 1. The tariff structure and the type of tariff system that we are going to have in this country, on a long term basis, are matters and issues for concern. As a specialist, I find tremendous difficulty and inequality in relation to tariffs for complex cranial and vascular procedures, with these tariffs proportionately much lower than tariffs which affect other practitioners who perform simpler and much less complex procedures, but earn proportionately much more for those procedures., i.e. prices charged for cerebral aneurysms (5-6 hour operations with numerous hours of after-care, looking after and ICU interactions) vs. wisdom teeth and/or other similar procedures. This is not to state that only neurosurgeons are specifically affected by these inequalities, this is one example which I have picked up, which I have noted over the past 10-12 years of private practice and nobody seems able to, or willing to, address the issue. In the same way, the tariff book seems not to change year after year, i.e. "pudendal neurectomy", "stereotactic biopsy 2nd sitting" are meaningless procedures which are hardly ever done yet they remain in the tariff book year after year after year (certainly since 1990, when I first started private practice) and no one seems to change them. It is common knowledge that fees are too low on a medical aid rate basis but it is equally common knowledge that MASA fees are, perhaps, too high and unreasonable, i.e. can patients or will patients really pay R600, R800 or R900 per consultation, as is suggested in some of these tariffing price structures, therefore the issues surrounding fees and tariffs needs to be addressed seriously. 2. The question of perverse incentives. What can practitioners and specialists take or not take, what interactions can they enter into, is still clouded in murkiness and mud and, to my way of thinking, there are still no clear guidelines. 3. Problems with "doctor bashing" in the media, problems with patients having unrestricted access to the media whilst the practitioners are prevented by their lawyers from speaking to the media, at least until after a trial or enquiry has finished, needs to be addressed. Patients are free to speak at will to the media (which can virtually destroy a practitioner's practice) but the doctor and the lawyer seem to be hide bound and stuck behind a mountain of tape and can't get their point across. 4. Issues in relation to public and provincial hospitals are especially important. The times that I go to the provincial hospitals, the times that I receive patients from provincial hospitals, leaves me amazed in terms of the significant disadvantageous working conditions of practitioners at these provincial hospitals. Their working conditions are curtailed and restricted in terms of equipment, in terms of payment and salaries, in terms of resources and logistics. The situation seems to go on year after year, has been deteriorating since 1986 (when I was a consultant at Johannesburg and Chris Hani Baragwanath Hospitals), seems to be getting worse year by year and there seems to be no end in sight. Therefore, just as the private practitioners and private sector has issues in relation to tariff structures and fees, the provincial sector has issues which are no less serious and no less pressing and we should try and address these issues and decide what needs to be done to get matters right. Two examples suffice: a) A young person with a huge subdural haematoma was left sitting in the provincial hospital until friends and/or relatives pushed the patient into the private arena where surgery was performed which undoubtedly saved the patient's life. b) In addition, I noted a patient with clear evidence of a subarachnoid haemorrhage who was given Aspirin and discharged from the provincial hospital only to have surgery and clipping of the aneurysm at a later stage in the private sector. These are but two examples but many more examples spring to mind with respect to problems in the provincial sector. One has to be very clear, once again, that it is very difficult to blame the actual practitioners, doctors and frontline members on the ground. As stated, they already suffer from severe lack of resources, money, logistics and time and, in addition, of course, regrettably, they suffer, to a certain extent, from disordered and inadequate training at the present time, from disordered and inadequate supervision, and these issues need to be addressed. 5. Of course, from all of this follows the fact that there ought to be a much better union of private and public practitioners in a practical, legal and moral sense and, perhaps, the website could be instrumental in getting this started. More and more issues come to the fore. It has to be emphasised that this website can only work if practitioners, doctors, other paramedical professionals and the public write in, voice their opinions, discuss their problems so that a consensus can be achieved in relation to something which encompasses us all (after all, we all get sick, we all have to attend hospitals and clinics at some stage in our life. This is something which is unavoidable and is a bridge and barrier which we will all have to cross one day, no matter how well and how healthy we are at present). This website needs to be truthful, hard hitting but also needs, equally as much, not to be over sensationalized. The object and aim of this is to get sober, realistic practical alternatives and decisions in regard to problems. Note that I have not even touched the MEDICAL AID SITUATION which assails and afflicts private practitioners on a daily basis, as the medical aids run our lives, even interfering in ethics and clinical procedures on the basis of money saving objectives. However, merely to bash the medical aid, merely to bash the HPCSA, is not going to solve the problem. This is thus not just a forum to let off steam but, to be realistic and successful, needs to be a forum which actually arrives at concrete answers and solutions to these problems.
PERCY MILLER
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