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Kidney docs want justice

(L-R) Dr Mahadev Naidoo, Dr Neil Christopher, Prof Ariff Haffejee and Prof John Robbs

(L-R) Dr Mahadev Naidoo, Dr Neil Christopher, Prof Ariff Haffejee and Prof John Robbs

“I won’t rest until every last one of the surgeons, nephrologists, nurses, transplant coordinators, translators, insurance company managers, HMO (health maintenance organisation) administrators and their international brokers are arrested and charged with organised crime.”1

These are the optimistic words of Captain Louis Helberg, head of the South African Police Services (SAPS) Commercial Crime Unit and head of the sting operation that broke the ‘Kidneygate’ scandal that rocked the South African medical fraternity and made headlines across the globe in 2003.

The organ trafficking operation was run by Israeli broker Ilan Perry, who found Israeli, Romanian and Brazilian citizens willing to sell their kidneys for amounts ranging from $20 000 down to $6000 (as demand increased) to Israeli citizens, who paid $120 000 for them.

At the centre of the scandal was Netcare, SA’s biggest private hospital chain, whose transplant teams in Cape Town, Johannesburg and KwaZulu-Natal (KZN) are believed to have performed over 300 illegal kidney transplant operations between 2000 and 2003.

To Helberg’s list could have been added anaesthetists, cardiologists, radiologists, SA Blood Services and pathologists in each city – teams of up to 40 people who ensured that each transplant ran smoothly.

Yet it was just four surgeons, Profs John Robbs and Ariff Haffejee and Drs Neil Christopher and Mahadev Naidoo, who found themselves at the threshing floor of the scandal at Netcare KZN, also known as St Augustine’s Hospital, having performed 109 transplants there.

They spoke to Medical Chronicle in an exclusive interview and revealed the immense suffering they have endured as a result of what they see as having taken the fall for a country-wide operation run by Netcare.

They are now weighing up the possibility of legal action to clear their names.

The doctors believe when Netcare KZN entered a plea bargain in 2010 without their knowledge, resulting in charges being dropped against Netcare and its CEO, Richard Friedland, they were effectively abandoned and left to pay the price for every illegal transplant that took place in SA during that time.

Not that the surgeons have been found guilty in court. After years of delays, during which the prosecution repeatedly postponed for lack of evidence, the case was finally thrown out of the Durban High Court on 15 December last year. They were given a permanent stay of prosecution and the state was ordered to pay the costs of the application to quash the charges.

The four surgeons have consistently denied professional complicity in the scam, despite numerous attempts to divide them and to get them to agree to a plea bargain, to which they have been unstintingly united in opposition.

In their court papers, they denied any involvement in the screening and administration of the foreign patients, insisting that the thick files of affidavits, translations and other official documentation they were presented with appeared in order. The fact that that they were certified and stamped by the Israeli Consulate, to them, was a final seal of authenticity.

Added to which, they say, the two teams never saw both patients. Prof Robbs and Dr Christopher harvested the kidney from the donor while Prof Haffejee and Dr Naidoo transplanted it into the recipient. All four operated from different hospitals at that time – not one of them practised from St Augustine’s – and so their contact with their patients was limited to visits to their respective wards and theatres.

Cover-up

“Initially, Netcare would consult our lawyers and ours would consult them. However, we were quite adamant that we would accept no deals,” said Dr Naidoo.

“An agreement was reached and a week before we were to appear in court, Netcare went to court to strike a deal and pleaded guilty, without telling our lawyers. A week later, their lawyers started talking to us about a guilty plea.

“What gave them the right to do that?”

The road leading to their predicament is fraught with intrigue and what they see as an elaborate cover-up of Netcare’s wider involvement, and knowledge of the programme stretching as high as government.

They explained how, in 2000, Prof Del Kahn, who was the head of the transplant society at the time and of the transplant team in Cape Town, did the first transplant organised by Perry, who claimed that the operations were being brought to SA because the Israeli system could not cope with the demand. However, Prof Kahn was alerted to certain irregularities and he ceased dealing with Perry, who then approached Netcare.

“The operations started at Netcare in Cape Town, then Johannesburg,” said Dr Naidoo. They also took place at Groote Schuur and the then Johannesburg General hospitals, where the state had started a private section for the transplants to generate extra funds.”

By the time they were approached, there was already a well-established cross-border transplant programme at Johannesburg and Cape Town, both at Netcare and in the state hospitals, he said. “Netcare even built a special wing at St Augustine’s to accommodate the overspill from Johannesburg.”

He added: “Our results were very good. We operated with the same care and due diligence, following protocol in every respect in the same way we did with our local patients.”

In 2001, Prof Kahn wrote a letter to Prof Haffejee, and carbon copied it to the head of Netcare’s Cape Town operations headed by Dr Elmin Steyn and Prof Rene ‘Dokkie’ Botha at the University of the Witwatersrand, stating his concerns, and instructing them to cease doing the transplants.

“He admitted at the time that he had no concrete evidence that money was involved but pointed to rumours and innuendo. He instructed us to stop, but, in his personal capacity, not under instruction from the South African Transplant Society,” explained Prof Haffejee.

“I gave the letter to Netcare authorities. This was their programme, not ours. Richard Treisman, Netcare’s internal legal advisor, wrote to us and assured us that everything was above board. He said they had fully investigated the allegations, and that it had the blessing of the Israeli government as well as the local Israeli consulate here, and that all the documentation was in order.”

DoH closed its eyes

Prof Kahn’s letter was also discussed at a policy workshop on organ transplantation, hosted by the Department of Health in Irene, Pretoria, on 25 October, 2002.

According to the doctors, all major transplant roleplayers in the country (some 48 people) were present. Prof Kahn did not attend.

Netcare was represented at the meeting by Belinda Rossi, who was Netcare’s national transplant coordinator at the time and the National Department of Health, represented by deputy director of the Transplant Unit, Netty Mbatha. Rossi went to Israel to set up agreements with Perry and is married to Prof Russell Brits, who headed up the Johannesburg transplant operation.

“The letter was discussed at length and was vociferously criticised by, among others, Dr Botha, Prof Britz, Dr Steyn and Belinda Rossi. A decision was taken to ignore Prof Kahn’s letter; each centre was told to carry on and to ensure that the necessary documentation was supplied,” said Dr Naidoo.

Minutes of the meeting, which were supplied to Medical Chronicle by Mbatha, do not refer to Dr Kahn’s letter, which the doctors insist was discussed at length, but an excerpt states the following: “(T)here is perception internationally that commercial transplantation is being practised in SA … In response to these allegations all members agreed that … international principles and ethics are accepted and practised in SA.”

According to the doctors, they requested the minutes several times after the meeting but never received them. “Our lawyers were also not given the minutes when they asked for them later, to prepare for our trial.”

Unanswered questions

The case against them may have been dropped, but the four surgeons, whose lives have been turned upside down over the past decade, remain bitter and want answers.

“Why was it that we were singled out? Why is it that four surgeons were held accountable for a national programme that was coordinated by a major blue-chip healthcare provider in this country?” asked Dr Naidoo.

“Did we go to Israel and canvass and make all the deals? How is it that this programme was going on in all those Netcare hospitals and yet neither Cape Town nor Johannesburg is mentioned in any of the charges? Did they escape prosecution as part of Netcare’s plea in KZN? Who else knew about it?

“These were not just the actions of a few ‘errant’ employees at St Augustine’s, as Netcare put it; this had to have been coordinated from the top.”

Prof Haffejee added: “All along, they tell us everything is above board, and now we are errant? That is defamatory. They need to explain that to us.

They also question the mysterious role of Prof Kapil Satyapal, who was one of the initial accused. The doctors question why no testimony from him has ever been revealed. “His statement was also not in court documents when we applied for the case to be quashed,” said Prof Robbs.

“Could he have known something that we did not?”

Prof Robbs emphasised that it gives them no pleasure to raise the names of colleagues in their questions. “But again, we have to ask, why it is that we alone were singled out for prosecution?”

“They haven’t contacted us at all during this whole saga,” confirmed Prof Haffejee.

Devastating impact

The four surgeons described the devastating impact the publicity surrounding the affair has had on them – professionally, socially, emotionally and physically.

Although he declined to elaborate, Prof Haffejee confirmed that it has severely impacted his health. It also brought his academic career to a virtual halt. “Professionally, we were distanced from professional societies. We were previously very active in the academic areas, and had frequent invitations to attend and present at local and international meetings. I personally had to cancel two overseas trips. I’ve been refused my retirement sessions in the department because the university (KZN) said they were awaiting the outcome of the trial. I applied for a readership that Prof Robbs had vacated and never received a response.”

Prof Robbs concurs with Prof Haffejee. “It’s had a huge impact on the past 10 years. I have developed fairly significant cardiac problems as a result of the stress.

“However, the major impact for me has been on academia. The reason doctors continue to work for the university and the state is to make academic impact. I think I still had a lot to do when this thing happened, and all of that was pretty much arrested.

“When this kind of thing happens, your academic life just dies. I was offered an honourary fellowship, which was withdrawn, for example. Invitations to give keynote talks at international meetings are withdrawn, with the explanation that they don’t want to be embarrassed by you.”

The impact on his family has been massive, he says, affecting his children as far away as Australia. The most ‘significant’ memory he has is of his granddaughter, who was eight, who came to him, weeping, saying, “They say you steal kidneys from poor people and sell them to rich people.”

Prof Robbs is scathing as he recalls the attitude of the investigating officer, Helberg, who refused to postpone their arrest for a week, insisting it must be done the day before the commencement of the 2006 World Surgical Congress of Surgery, which the doctors had spent five years organising to bring to SA. “You might run away,” he said of his decision to make the arrests the day before the opening.

The doctors were key organisers, delivering welcoming addresses, chairing sessions and hosting dinners. The news of the arrest, and photos, were in the newspapers early the next morning and the doctors had to endure intense humiliation in front of their academic colleagues from around the world.

At the opening ceremony, the KZN Premier, Sbu Ndebele, noted in his keynote speech that he believes, “There are doctors in this province who are misbehaving and they must be rooted out.”

“We were standing in the audience,” recalled Prof Robbs. “I will never forget that. There are no words to describe the emotion, having worked for so long to bring this important congress to SA.”

Dr Christopher describes his own ordeal: “I feel that I’ve actually lost 10 years of my life, because it came to a standstill in so many ways. I’ve had 10 years of anxiety and God knows how many sleepless nights wondering what’s going to happen; the uncertainty was constant.

“I’m still employed by the state and I don’t have a big bank balanceMy lawyers told me that the trial could take six to nine months. How could I make any kind of financial decisions – even whether or not to renew my daughter’s cellphone contract – with that hanging over my head?”

When his daughter was to travel to Canada on a school trip, she had to admit on her visa application that her father had been charged with offences including racketeering, assault with intent to cause grievous bodily harm, fraud and performing illegal kidney transplants.

His wife, also a doctor, who practices under a different name, went to a number of meetings where people openly talked about ‘the millions that he had been stashing away’.

“Socially, it was very difficult. At school and Rotary events, people would look at me in an embarrassed kind of way. Regardless of what happens, I have lost 10 years of my life.”

Support from colleagues

Dr Naidoo noted: “I’m the youngest of the four of us, but I don’t think I’ve been immune to health problems. In a case like this, we are all bound to have some stress that will have a permanent impact on our health.

“But when this whole thing reared its head, I was just going into practice, beginning my career in the private sector at a Netcare hospital. So it was quite difficult at that time.

“But with support from colleagues and friends, I managed to pull through.”

Prof Haffejee has the look of a broken man as he shakes his head and says: “It has not been the same for me. Although I had support from my colleagues here, colleagues in other academic centres, whom I see frequently, shunned me.”

Prof Robbs has not experienced this isolation to the same extent, and all doctors acknowledge that they have enjoyed the support from several close colleagues who have stood by them during their ordeal.

“The bottom line is that we need closure,” they concluded, adding that they would decide on the way forward, which may or may not include legal action, depending on the answers they receive.

Ironic twists

If Prof Satyapal turned state witness in order for charges against him to be dropped, the doctors say, he must have admitted guilt, since conditions to become a state witness require that the person must admit guilt and implicate others. Having admitted guilt, he should have been investigated by the HPCSA, they point out. However, today, he is a member of the HPCSA’s ethics committee and delivers talks around the country on transplant ethics, among others.

“His job was to deliver the kidneys in a bowl between the theatres. Ironically, he was the only one of us who got to see both patients,” they pointed out, adding: “He billed both parties.”

In another twist, Prof Ronald Green-Thompson, former health department head, urged the HPCSA to investigate Dr Jeff Kallmeyer (who screened the patients, pleaded guilty, paid a fine and left the country), Prof Haffejee and ‘the other doctors involved’, the moment the story broke.

He now stands accused of fraud, corruption and money laundering, related to multimillion-rand tender awards to KZN provincial hospitals.

And, perhaps the greatest irony of all, Netcare’s St Augustine Hospital is described on the company’s website as “The flagship of the Netcare Transplant division’s KwaZulu-Natal region. St Augustine’s offers services across all areas of medicine and facilitates an active kidney transplant programme.” The four surgeons still provide the highly skilled services that enable the division to run.

Reference

1.    Nancy Scheper-Hughes. Kidney kin: inside the transatlantic transplant trade. Harvard International Review 2006;27;4.

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  1. Organ trafficking today is still a protected crime - world.edu - September 3, 2013

    […] professionals were implicated in the Netcare scandal in South Africa after the company entered into a plea bargain and accepted a $1.1m fine. The charges were related to 109 kidney transplants carried out between […]

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