Nearly a year after initial complaints were filed with the Health Professionals Council of South Africa (HPCSA), outlining alleged medical and other misconduct by the senior clinical chief executive at Messina Hospital, Dr Allick Msebe Dube, the council has stripped him of his medical licence, finding that it was obtained fraudulently.
The Mail & Guardian previously reported that Dube was found guilty of involuntary manslaughter in the US state of Georgia for illegally prescribing painkillers to drug addicts. Two of Dube's patients died, and he was banned from practicing medicine in the US for 10 years. Despite this, he was registered by the HPCSA and placed first in KwaZulu-Natal, and then in Musina, with the help of the national department of health and the nongovernmental organisation Africa Health Placements. Dube left the US for South Africa before completing his parole, and a warrant for his arrest was issued in in Georgia, in the US in July 2013.
While at Messina Hospital, Dube allegedly harassed foreign doctors, chasing them away from the already-understaffed hospital, and provided inadequate or poor treatment to patients. One woman, Reinetha Cecilia Liebenberg, said Dube handed her a knife when she was suicidal, and said "cut your own throat".
In May 2013, hospital staff went on strike to highlight Dube's mistreatment of staff and poor clinical care. Additionally, the NGOs Médecins Sans Frontières (MSF) or Doctors Without Borders and Aids Free World – both do work in Limpopo – individually filed complaints with the HPCSA about Dube's actions.
Despite this, in October 2013, Dube was promoted from clinical manager to senior clinical chief executive officer.
Now, Dube's time in Musina may finally be coming to a close. In a letter dated February 19 2014 and obtained by the M&G, Dr B Mjamba-Matshoba, registrar and chief executive of the HPCSA, informed Dube that the council's executive committee found that he did not declare his US criminal record or the fact that his medical licence was revoked when applying for a medical licence. "Had you advised the board of your previous transgressions," reads the letter, "[the committee] would not have registered you to practice as a medical practitioner … It [the board] therefore found that your registration was … in error or through fraud.
"You are therefore informed that your name has been removed from the Register of Medical Practitioners with immediate effect. You may therefore not perform any act pertaining to your profession as a medical practitioner. The registration certificate issued to you by the council is hereby revoked."
While the letter was sent to Dube in February, this information was only made publicly available when Aids Free World filed for a judicial review of the HPCSA's handling of the Dube case on April 3. Dube was still listed in the HPCSA's public database of health professionals in early April.
He was also still working at Musina Hospital as of last week. On April 10 2014, Adele Van Der Linde, spokesperson for the Limpopo health department, commented on his employment via email: "We have been informed about the de-registering, by the HPCSA. Processes are being followed by our human resource and labour units in terms of the way forward in light of his de-registering. He is currently the [chief executive] of the Messina Hospital."
"The HPCSA is not aware that he is still practicing," said advocate Tshepo Boikanyo, chief operations officer of the HPCSA, noting that "his employer has been duly informed" of Dube being de-registered. "If [he is working as a doctor], it is considered a criminal offence. A case will be opened with the SAPS [South African Police Service] as it is now a criminal matter," said Boikanyo.
Finally, on April 17, Van Der Linde said that Dube was suspended with pay while awaiting a hearing on the matter, meant to take place in mid-May. When asked why Dube was not dismissed given that he was de-registered by the HPCSA, his criminal past, and the slew of allegations against him, Van Der Linde responded that Dube was not only employed at the hospital as a doctor, but also as a chief executive, which does not require a medical licence. "According to labour law, he is going to get his chance to a fair hearing," she said.
While both MSF and Aids Free World welcomed Dube's de-registration, they are each concerned about the slow pace of the response. "HPCSA mistakenly provided Dr Dube with a licence to practice and since then has acted unacceptably slowly in response to the evidence presented to it," said Dr Amir Shroufi, deputy medical co-ordinator for MSF South Africa and Lesotho, who noted that Dube was de-registered nearly a year after MSF filed its initial complaint with the HPCSA. "The department of health allowed for Dr Dube to continue to practice despite several complaints of malpractice. The unresponsiveness of the department of health and the HPCSA have resulted in patients receiving bad-quality care from a doctor who should never have been registered in South Africa," he said.
HPCSA may need reforms
Shroufi noted that the HPCSA may need internal reforms to ensure a similar case did not happen again. "One could look at whether they [HPCSA] need increased capacity [quantity and quality of staffing] or whether better governance – with clear targets that staff are responsible for delivering to – would help."
"We have heard from multiple sources that he has continued to treat patients since his suspension in February, which would constitute criminal behavior," commented Seth Earn, legal advisor for global advocacy at Aids Free World. "We believe it's self-evident that a convicted felon, with an arrest warrant in the US, who has been found to have perpetrated fraud against the HPCSA, is unfit to be the [chief executive] of a hospital. We will petition the [health department] to end Dube's paid vacation as soon as possible. We will urge them to terminate his employment as soon as possible, and consider whether criminal charges would be appropriate."
Earn also noted that the HPCSA may need to be reformed. "The fact that this case is so egregious, that it was so immediately obvious that Dube should not have been granted a license, raises obvious concerns that the failures in the licensing procedures could be widespread and systemic," he said. "To that end, we are going to formally request that the HPCSA share the documentation they received from Dube when he applied for his medical license, in order to try to ascertain how this could have occurred. If the HPCSA fails to supply us with this information, we will lodge a request under the Promotion of Access to Information Act. We're hopeful that this information may shed some light on whether this was a one-off case, or is symptomatic of a larger problem."
The HPCSA's Boikanyo said: "The council believes that the current requirements and processes are sufficient", noting that, among other documents, applicants have to "complete a declaration form … that he/she has never been convicted in a country of any offence against the law or been barred from practice".
Despite repeated requests to the national department of health's communications team, no response was given. Dube could not be reached for comment.