TRC Final Report

Volume 4

Chapter 5

Subsection 1

■ HEALTH WORKERS WITH DUAL OBLIGATIONS

10 Many health professionals find themselves in situations in which their primary obligations are not clear. This is particularly true when they are employed to provide health care services for a clientele, organisation or institution whose primary function is not the provision of health care. The difficulties and challenges faced by district surgeons illustrate this clearly.

District surgeons

11 Of all the health professionals in South Africa, district surgeons working under the apartheid government probably had one of the most difficult jobs in terms of upholding medical standards and human rights. On the one hand, they were under a statutory obligation to provide medical care for prisoners and detainees, to record information on the mental and physical health of inmates and to ensure that proper health conditions existed in terms of basic sanitation, food and general health care. On the other hand, there was (and perhaps still is) great pressure on them to support the police and prison authorities for ‘national security’ reasons.

12 One of the most infamous cases involving inappropriate and negligent care of a detainee by district surgeons was the death of Stephen Bantu Biko.

The death in detention of Stephen Bantu Biko³

Stephen Biko was a prominent leader of the Black Consciousness Movement in the mid-1970s. He was detained by Eastern Cape security police in August 1977 and kept at Walmer police cells in Port Elizabeth. From there, he was taken regularly to security police headquarters for interrogation. The two district surgeons responsible for his medical care were Drs Benjamin Tucker and Ivor Lang.

On 7 September 1977, Stephen Biko sustained a head injury during interrogation, after which he acted strangely and was unco-operative. The doctors who examined him (naked, lying on a mat and manacled to a metal grille) initially disregarded overt signs of neurological injury. They also failed to record his external injuries or insist that he be kept in a more humane environment (at least that he be allowed to wear clothes). When a physician was finally consulted, a lumbar puncture revealing blood-stained cerebrospinal fluid (indicating possible brain damage) was reported as being ‘normal’, and Biko was returned to the police cells.

Finally, on 11 September 1977, Stephen Biko lapsed into semi-consciousness. Dr Tucker recommended his transfer to a hospital in Port Elizabeth, but the security police refused to allow this. Subsequently, Dr Tucker acquiesced to the police’s wish to transfer Biko to Pretoria Central Prison. Stephen Biko was transported 1 200 km to Pretoria on the floor of a landrover. No medical personnel or records accompanied him. A few hours after he arrived in Pretoria, he was seen by district surgeon Dr A van Zyl, who administered a vitamin injection and asked for an intravenous drip to be started.

On 12 September, Stephen Biko died on the floor of a cell in Pretoria Central Prison, naked and alone. The post mortem examination showed brain damage and necrosis, extensive head trauma, disseminated intra-vascular coagulation, renal failure and various external injuries. The medical treatment was subsequently described by a judge of the Supreme Court as having been “callous, lacking any element of compassion, care or humanity”.

The magistrate referred the inquest findings to the SAMDC on the grounds that there was a prima facie case of professional misconduct and/or negligence against the doctors involved. The SAMDC took two and a half years to respond. They initiated a preliminary inquiry in which it was found that the doctors had no case to answer. The full Council ratified this decision.

Despite an outcry from doctors both locally and internationally, the SAMDC adhered to this decision. It was supported by the Medical Association of South Africa (MASA), which even went so far as to imply that those doctors calling for the case to be re-opened were politically motivated.

The reversal of the SAMDC decision took years and was the result of the committed efforts of Drs Ames, Veriava, Jenkins, Mzimane, Wilson and Tobias. These doctors took the issue to the Supreme Court, which ordered the SAMDC to re-examine the case against Drs Tucker and Lang. As a result of this, a disciplinary enquiry was held in 1985, eight years after Stephen Biko’s death. Dr Tucker was found guilty of improper and disgraceful conduct on three counts and was struck off the role of medical practitioners (although he was reinstated some years later). Dr Lang was found guilty of improper conduct on five counts and was suspended for three months (ironically, this suspension was conditionally suspended for two years and so had no impact on Dr Lang’s practice of medicine). Dr Lang continued to be employed as a district surgeon by the Department of Health and was, in fact, promoted to chief district surgeon in Port Elizabeth in Dr Tucker’s place.