The reaction to the parole ruling of Jackie Selebi has shown the shadow of Schabir Shaik is still haunting South Africa's medical parole procedure.
Selebi was paroled on Friday, after serving only two years of his 15-year jail sentence for corruption. The disgraced former police chief, who has final stage renal failure and requires dialysis, is gravely ill but he has by no means been "sent home to die", as some have claimed.
James Smalberger, chief deputy commissioner for corrections said Selebi had been released in terms of section 79.1 (a) of the Correctional Matters Amendment Act.
"The expectation or requirement is not like the previous act, that you need to die tomorrow," said Smalberger.
The Act states that a prisoner may be considered for medical parole if he or she is "terminally ill or physically incapacitated as a result of injury, disease or illness, so as to severely limit daily activity or inmate self-care".
Selebi falls into the latter category.
Although medical parole may be cancelled under certain conditions, an improvement in health is not one of these conditions.
"If he recovers, the family will be happy," he said. "Let's hope that all those who are released at least find themselves recovering to a stage where they can have a decent [quality of] life."
Selebi was one of six offenders released on medical parole by a new medical parole advisory board, which was set up to address what the department calls the "inconsistent implementation" of medical parole procedures.
The medical parole system was criticised after convicted fraudster Schabir Shaik, the former financial advisor of President Jacob Zuma, was released in 2010. Shaik was released on the bases of a report to the parole board, drawn up by a correctional services doctor, which showed he was in end stage multiple organ failure and terminal illness. But its accuracy was later called into question. The doctor did not examine Shaik herself but based her findings on recommendations of Shaik's private doctors.
Months later, a seemingly healthy Shaik was seen driving himself around Durban, got into a physical altercation with a congregant at the local mosque, and allegedly assaulted a reporter who interrupted his game of golf.
The Act was overhauled last year to standardise the process and make it more transparent. Under the new rules the treating doctor assesses the inmate and makes a recommendation to the medical parole advisory board, which assess the evidence independently. The board may call for additional information and test results, and visits the inmate in person to assess their health before providing an independent report to the parole board.
Dr Marna Stoltz, a member of the board and a senior member of the South African Medical Association, said the board had found that Selebi was "really ill" and that she had no doubts about whether he should have been released.
"His disease is not reversible. If you're diagnosed with end stage renal failure, 85% of those patients die within five years," she said.
Dr Sagren Naidoo, a nephrologist and senior consultant at Charlotte Maxeke Johannesburg Academic Hospital, said patients in end-stage renal failure could remain on dialysis for four to six years, provided there are no complications.
Although the illness need not be debilitating if treated properly, it requires constant care. Some patients are required to go to hospital two to three times a week to receive four-hour long dialysis sessions, while others, like Selebi, are taught to perform the procedure themselves at home. This takes half an hour to forty minutes and must be repeated four times a day. Selebi is currently in care at the Steve Biko Academic Hospital and it's unclear when exactly he will be released. Smalberger said he would be transferred to the community corrections system, which would decide the conditions of his release.
In keeping with the regulations of the Correctional Services Act, Selebi will be subject to supervision and will be placed under house arrest until he completes his sentence.
Opposition parties still sceptical
The Democratic Alliance's spokesperson for correctional services James Selfe called on Minister Sibusiso Ndebele to give the public assurances correct procedure has been followed.
"Given the huge degree of public scepticism about medical parole, it is essential that the government comes entirely clean about Mr Selebi's medical condition and the procedure that was followed in determining that he is indeed terminally ill. There cannot be one law for the politically connected and another for the rest of us," he said.
Cosatu spokesperson Patrick Craven said that the anger over Shaik's release was precisely why the public needed further clarification on Selebi's case.
"The Schabir Shaik case has made it more difficult for anybody else who may be genuinely sick to be released on medical grounds," he said.
Craven said that if Selebi is genuinely sick then his release was reasonable and humane.
The ANC welcomed the decision and said it was satisfied that the parole was granted on merit.
"Those who are doubtful about the correctness of the decision to release Selebi on medical grounds can indeed access the records of the medical parole board," it said.
But Clare Ballard, an attorney at the Civil Society Prison Reform Initiative, said that while the medical parole advisory board had brought an element of transparency to the medical parole process, the case highlights the problem of inequality that exists in access to healthcare among prison inmates
Ballard said that while people like Shaik and Selebi can afford private doctors to assess their health and argue their case for parole, poor prisoners who are genuinely sick have to rely on state doctors who overworked.
"It raises questions about whether genuinely sick prisoners are getting the kind of treatment that high profile people are," she said. "My concern is that their cases aren't being heard in the same way simply because they don't have the same kind of money."