/ 22 November 2013

Dr Death close to patients’ hearts

When Sharon Rudman* had a massive heart attack just after 8pm on a Sunday evening in January last year, immense panic descended on her family. Rudman lived in Calvinia in the Northern Cape and was visiting her family in Durbanville, north of Cape Town. Her own doctor was 360km away. 

Rudman's daughter rushed her to the nearby Mediclinic where she was admitted and sedated for the night. 

When she awoke on the Monday morning, she was "angry and aggressive", as heart attack patients often are. 

The cardiologist on duty was waiting next to her bed, speaking Afrikaans.

"I yelled at my child: 'I don't think I'm going to get on with this guy. I don't like Afrikaans doctors! They're bossy.'"

Her daughter was annoyed. "Have you any idea who this is?" she snapped. "It's Wouter Basson. He's hands-down the best cardiologist on the planet! So, you're going to behave, and not tick him off." 

Rudman's child had heard of Basson's reputation from her mother-in-law, a nurse specialising in heart conditions.

"What? Isn't he 'Dr Death'?" asked Rudman.

"Yes," her daughter confirmed, "But don't ever say that again." 

Rudman said that, at the time of this exchange, Basson "just stood there, listening, calm and collected. I remember feeling soon afterwards that I was in incredibly safe hands".

Rudman was transferred to Panorama Hospital, about 15km away, for intensive heart surgery. She said Basson told her: "We're going to do a five-way bypass, because that's what you need. We're not going to try this and that and then revert. We're going to do the whole thing and you're going to be fixed up and it's all going to be good." 

When she left for Panorama, Basson looked at her and said he'd see her within an hour. 

"And there he was in the ward waiting for me when the ambulance arrived. I've had doctors who have kept me waiting for hours. He's not a bit like that. He treats you as an equal and doesn't think he's deputising for God. He makes your anger and fear go away, and puts you at ease." 

Rudman recovered within a few days. "I was in the intensive care unit for the shortest time of everybody who had had surgery at the same time as me, and it's thanks to Wouter Basson. In terms of my heart surgery, I think he's the greatest thing since sliced bread." 

Basson's past: Dr Death
Would you trust Wouter Basson to fix your heart? The former head of the apartheid government's chemical and biological warfare programme – the former South African Defence Force's Project Coast – has been accused of serious crimes. These include making lethal drugs for biological warfare and of providing tranquilisers to aid cross-border kidnappings of activists perpetrated by the apartheid government's security forces. Many of the activists were subsequently killed.  

For all of this, the media dubbed him "Dr Death". (See "Soldier first, doctor second".) Several of Basson's peers consider him "evil" and unfit to practise as a doctor. In fact, they would like to see him struck from the medical roll on December 18, when the Health Professions Council of South Africa (HPCSA) will rule whether he is guilty of unprofessional conduct, after a hearing that has taken six years to conclude. 

"Because of his past, we obviously need to ask ourselves whether he is trustworthy," said Ames Dhai, the director of the Steve Biko Centre for Bioethics at Wits. "I've attended some of his hearings and the degree of arrogance that he displays and his lack of understanding as to what ethics entail tells me we can't trust him. 

 "The council's decision should not be overshadowed by the fact that he is technically competent. I'd definitely not trust him as a doctor." 

But Basson, in an email interview with the Mail & Guardian, said Dhai did not know him, and that it was "presumptuous and dicey" to make such a statement. 

"She's got no grounds, and, as the chairperson of the South African Medical Association [she was elected last weekend], I expect her to practise more caution. I remember the day when she sat behind me [at the hearings] well. She was noisy and made constant sounds that distracted me and my advocate and compelled us to ask her to be quiet. I participated in my hearing throughout."         

Basson's skills "exceptional"
Basson said his ethical approach with regard to patients was simple: "It's based on absolute honesty, transparency and personal involvement in the patient's problem. My aim is to make the patient part of the decision-making and problem-solving process." 

Rudman, meanwhile, is not alone in ascribing medical "greatness" to Basson. The South African Heart Association, which represents the professional interests of cardiologists in the country, considers his skills to be "exceptional". 

According to the organisation's president, Adriaan Snyders, who has known him for 20 years, there is "no doubt" that Basson is "one of the top cardiologists in South Africa, – and his scientific knowledge is outstanding". 

Snyders pointed out that the country has a drastic shortage of cardiologists, particularly in the state sector. 

"We produce only between six and 10 cardiologists a year and about a third of them go and work elsewhere. Provinces such as Limpopo, Northwest and Mpumalanga don't have a single cardiologist in the government sector." 

In this context, he argued, it would be "dumb" not to make use of Basson's knowledge "in some way". 

If Basson is barred from practising as a doctor, he would have to close his thriving private cardiology practice in Durbanville,  one that he says served more than 12 000 patients. "My patients display the demographics of Durbanville. Most of them are white, coloured and Indian, but I've also got many black patients," he said.  

Said Rudman: "Look, I know he has a past, but I hope the council does not make our loss somebody else's gain. He's such a technically sound, amazing doctor, and I'm sure there would be many overseas countries that would love to have him. There are a lot of people who are doctors and who should not be. He is not one of them." 

                                                                                               (Delwyn Verasamy)

Implications of a guilty verdict
However, Basson may find it very difficult to practise elsewhere in the world if he is found guilty of misconduct next month. 

"What normally happens if you go and work abroad is that the country requests a certificate of good standing from the local registered body," said HPCSA spokesperson Bertha Scheepers. "Countries base their decision to accept a doctor on that."  

Dhai said she doubts whether Basson's patients who eagerly praise him are aware of what he allegedly did on behalf of his apartheid masters, and whether they would experience "mental wellbeing when they're with him" if they possessed that knowledge. "Essentially, he used his medical knowledge against the laws of humanity. He's not the only cardiologist in the country. I would not go to him. Full stop." 

But Rudman, a lawyer, disagrees: "I understand the law and I know about Basson's past. But we lived in a very different time 30 years ago. Robert McBride was responsible for deaths in the Magoo's bar bombing in Durban. He is now seen as a fit person to be the head of a police watchdog. Both Basson and McBride were soldiers in a war situation. In these situations, it's not fair to say, 'You committed a crime and must now be punished because you were on the wrong side of the conflict.' War is war and you take your orders from the people above you." 

Not "merely a soldier"
However, Chandré Gould, a senior researcher at the Institute for Security Studies and a former investigator for the Truth and Reconciliation Commission, who investigated Project Coast and later wrote a book about it, maintains  this argument isn't applicable to Basson. 

"He wasn't merely a soldier following orders in extraordinary circumstances," said Gould. "Basson had a meteoric rise through the ranks of the defence force, becoming a brigadier at a very early age [30]. He had an unusual degree of latitude in relation to his own actions and the direction of the programme [he headed]. He had access to the chief of the defence force, the defence minister and even the president. At all times, he had access and influence over the highest echelons of apartheid decision-making."

According to Gould, serious questions remain about what kind of a person Basson is, despite his apparently excellent medical skills. She refers to his interview with independent filmmaker Bob Coen, for his documentary Anthrax Wars, which was screened in South Africa in 2009. Coen tells Basson: "There was talk about an ethnic weapon Project Coast was working on that was called the 'black bomb' [a biological weapon that would kill only black people]". Basson responded: "That was great, ja, that was the most fun I've had in my life."

A "chatty" guy
"I never really gave any thought to whether Basson would harm me or not because of his past," said Sean Giffard* (64) from Durbanville. "I went to him for the first time six years ago because my GP referred me after I complained about chest pains. She said he was the best person to go to." 

Giffard said that, when he and Basson first met, he couldn't resist commenting: "I thought you were Dr Death, and here I am asking you to save my life. That's quite strange!"

Giffard said Basson smiled broadly and laughed, "in a friendly way". 

Giffard said he had heard about Basson's alleged "crimes", but had never followed the doctor's truth commission hearing. 

"I don't know much about his past. All I know is [that] he is quite a chatty guy. I'm into cars, and he drives a high performance Subaru WRX. He likes speed, if you know what I mean."  

Giffard said one of his friends, "a police colonel" who had previously worked with Basson, told him: "You're lucky to have him as your doctor; that man is one of the most intelligent people in the world." 

The patient said: "I also heard Dr Basson was earning R50 000 a month from the army [after leaving it] without the state even knowing! And Dr Basson has told me directly that all his present and future legal bills will be paid by the state." 

Giffard, too, praised Basson as highly professional. "The man looked like he knew what he was doing right from the start. This huge calmness came out of him and made me calm as well." 

Other questionable apartheid-era doctors
Basson is not the only doctor in South Africa who has been accused of unethical behaviour linked to the country's apartheid past.  

On September 12 1977, black consciousness activist Steve Biko died in police detention. In the mid-1980s, Yusuf Veriava and six other doctors took the then South African Medical and Dental Council to the Supreme Court to force it to institute proceedings against the two district surgeons regarded as partly responsible for Biko's death. 

Dr Ivor Lang was cautioned and reprimanded for failing to examine Biko properly and Dr Benjamin Tucker was struck off the medical roll for three months for allowing a semicomatose Biko to be transported naked in chains in the back of a Land Rover from Port Elizabeth to Pretoria. When Dr Tucker applied for readmission, he said: "I came to realise that … I had gradually lost the fearless independence that is required of a medical practitioner when the interest of his patient is threatened. I had become too closely identified with the organs of the state … A medical practitioner … cannot subordinate his patients' interests to extraneous considerations."  

It is exactly this type of admission, that he put the apartheid state's interests above his duty as a doctor, that Basson's complainants (see side bar) want from him. 

"From the HPCSA's ruling, it must become clear that no doctor should be allowed to participate in biological warfare," Veriava said. "The importance of the hearings is actually no longer under which circumstances' participation is allowed, but rather that it should never be allowed." 

Veriava pointed to a more recent case that was thrown out of court last year, but had not yet been referred to the HPCSA: the so-called "Kidneygate" affair.  

Between 2000 and 2010, about 200 Israeli patients with kidney disease were brought to South Africa to receive organs from living donors who were falsely presented as their relatives. The donors were, in fact, poor Brazilians, Israelis and Romanians who were recruited by international organ traffickers and paid a relatively modest sum to give up a precious kidney – a criminal offence under South African law. 

"I would see him as unfit to practise"
At the centre of the scandal is South Africa's largest private hospital chain, Netcare. "We need to seriously ask ourselves: Would we feel safe to be treated by doctors involved in organ trafficking?" Veriava said. "So, it's not just Basson who might have acted unethically in this country." 

Should Basson be struck from the roll? "He is accused of very serious crimes," said Veriava. "I can't comment on him personally, but I can say that any doctor who is found guilty of participating in what he allegedly [participated in], I would see as unfit to practise, irrespective of his medical skills."

During last week's final arguments at the HPCSA hearing, Basson was reading a book. "It was a book about the history of sport in South Africa; I like reading books about history," Basson said this week on the phone from Germany. "It was a better use of my time than listening to arguments that I already know, not because I was disinterested in the proceedings." 

Does he think he will be struck off the roll? "I'd be absolutely gobsmacked if that happens. There are no legal grounds for it. I've never hurt anyone." 

* Names have been changed                                           

Lizzie Sefolo says her husband, Harold, was killed by the chemical weapons allegedly developed by Wouter Basson – see "Why did he do those terrible things?"

Soldier first, doctor second

In 2000, two of Wouter Basson’s peers, Ralph Mgijima, the then superintendent general of health in the Gauteng government, and Leslie London, a professor in public health at the University of Cape Town, filed complaints of professional misconduct against Basson with the Health Profession’s Council of South Africa (HPCSA). London’s grievances were signed by 40 other doctors.

The inquiry, which started seven years after the complaints were filed, has been running for six years. Final arguments were heard last week, and the council’s ruling is slated to be announced on December 18. 

The grievances relate to Basson’s conduct as the former head of the apartheid defence force's chemical and biological warfare programme, Project Coast, in the 1980s and early 1990s. He is alleged to have developed life-threatening substances for use on the "enemy" during the former government’s war on "terrorism".

According to Chandré Gould of the Institute for Security Studies and the author of a book on Project Coast, the council should hold Basson accountable, as a medical doctor, for being the head of a programme "that developed assassination weapons and sought to produce biological and chemical agents that would kill without leaving any trace". 

Basson is also being accused of providing tranquilisers to aid the cross-border kidnapping of people, weaponising mortars with teargas, manufacturing drugs and teargas on a large scale for use as crowd-control agents, and providing cyanide capsules for South African troops to use to commit suicide if they were captured by enemy forces.

During the HPCSA's hearings, United States medical expert Steven Miles argued that Basson's conduct had caused "death, imminent death and brain damage" when "the ethical core of medicine is to promote health". Basson’s lawyers, on the other hand, argue that, as a defence force employee, he was merely following orders "under extraordinary circumstances".