As a result of the piece that appeared about the Health Professions Council of SA in nose122, noseweek was alerted to another fascinating story. It involves a complaint lodged at the HPCSA by a 46-year-old Johannesburger, whom we’ll refer to as Gerda (not her real name).
The complaint concerns Dr Percy Miller, a neurosurgeon with rooms at Bedford Gardens Hospital, Johannesburg and Life Fourways Hospital, Sandton (which featured in “Why did Zenande have to die?” in nose123).
Gerda makes some serious allegations. For starters, she claims that Dr Miller messed up a spinal operation that he performed on her, on 9 January 2008, in that he incorrectly positioned a screw. As a result of this error, she says, he had to perform a second operation on 19 January 2008. 
Gerda claims that she was in so much pain after the second operation that she had to admit herself to the Netcare Milpark Hospital, where a doctor told her that she was a “piece of scrap” and that he couldn’t help her, and that she should go back to Dr Miller and demand that he “correct his mess”.
Gerda did go back to Dr Miller but, as a result of all the treatment she received, she was off work for some two months, which caused her financial hardship. She also claims that she still suffers from serious pain in her liver, back and legs, so that she finds it difficult to sleep. This, she says, has had a negative impact on her relationship of 13 years. She goes on to complain that Dr Miller charged her private rates rather than medical aid rates as agreed, and that Miller’s wife (who apparently acts as his bookkeeper) agreed to accept R8,000 to settle a R18,000 debt.
She also claims that Dr Miller works 14-hour shifts – doing hospital rounds at 3.00am and then again at 9.00am the same morning – with the result that he is “making a killing in money”, but “loses the ability to take proper care of his patients”. Lastly, she claims that she has established that Miller “has a bad record from a website that rates and archives info on doctors”.
Miller came back fighting. He submitted a lengthy response, to which he attached voluminous medical documentation, in order to show that “the patient’s complaints were not taken lightly, that a huge amount of activity, tests and consultations and diagnostic attempts were made to settle the patient’s problems”, problems that included “a certain amount of instability on the part of the patient on a psychological basis”, and which required the prescription of anti-depressant and psychogenic medication.
As regards the actual operation, Dr Miller declares: “It is quite correct that on review, I found that one of the screws was misdirected. The screws, by the way, are not inserted by myself but are inserted by the orthopaedic member of our operative team, namely Dr J Preddy, and it is perhaps to my credit that on a rapid basis I could find and diagnose one of the causes for the patient’s pain and do what could still be considered a minor spinal revision operation ... That is not something which can be used in argument against me, namely the fact that when the patient complained, we had a look at the patient and did some more testing, found the misdirected screw and rapidly replaced and/or corrected the misdirected screw. [...] It is a matter of the greatest irony that I am now before the HPCSA, having always treated the patient very reasonably, very easily and very considerately, no matter what her complaints were, whether physical [or] psychological [...] whereas the doctor that the patient saw at Milpark Hospital treated her abominably.”
As regards the fees, Miller says that Gerda knew he didn’t charge medical aid rates, and goes on to say that, although he did offer a R10,000 discount on the R18,000 bill, the offer was withdrawn. Why? Because “in the end, we were prepared to brook no compromise, once the patient started throwing around blackmail efforts, i.e. – ‘dispense with the account or I will go to the HPCSA’. This makes one see red or makes one very angry to a certain extent, and both my wife and myself have it as our policy, on these occasions, when patients start throwing around the threat of going to the HPCSA, to tell them to do what they must, cut off negotiations and we are then not interested in discussing with the patient any further and/or final accounts. I don’t like to be blackmailed.”
On the issue of his earnings and working hours, Dr Miller says: “One would like to laugh at the patient’s last paragraph with respect to working 14 hours per day, making a ‘killing’ in terms of money etc, but one ought not to do that, notwithstanding the fact that it is the product of a bankrupt, jealous, sick and petrified mind. It is true that I work 14 hours a day and in fact even more than 14 hours a day. [...] the patient, in all of her ‘stupidness’ (please excuse the word because it is not used lightly), does not understand that if one is working hard and one was tired and one did not do the round and missed out the patient, that would be negligence and a matter for concern. I think my standard of patient care is very high indeed and to a large extent the majority of my practice works out very, very successfully.”
And as regards his alleged bad record, Miller says: “I receive many more of my patients than other practices do, on a word of mouth basis [and] my practice is thriving, therefore the reputation and the record can’t perhaps be as bad as the patient makes out. [...] the patient, once again, I’m afraid, is talking absolute nonsense...”
Now whatever you may think of this – there’s one thing you can’t deny: Miller’s letter is not by any stretch of the imagination an admission of liability. So one can only wonder why the HPCSA chose to respond by saying: “The Committee resolved that an inquiry into your conduct be held by a disciplinary committee [...] you will be allowed, if you so wish, to pay an admission of guilt fine of R10,000 without appearing at an inquiry.” To which the feisty surgeon responded: “I’ve done nothing wrong, so I won’t pay the fine. I’d rather have the enquiry, in fact I insist/demand an inquiry into my conduct at this stage. The crookedness, corruptibility of you trying to make R10,000 out of me prior to any enquiry will be gone into and debated at a later stage, when I have had an opportunity to seek some advice on the matter. I’m happy to face you on the subject any day.” As he put it to noseweek on the phone, it’s a bit like a traffic cop who pulls out his ticket book before saying “slip me R500 and this will go away”.
In fact Dr Miller raises an interesting point – why, when a doctor denies liability, does the HPCSA invite him to avoid a bothersome enquiry by paying a fine (a relatively small one to a high-earning surgeon with better things to do)?
(Miller told noseweek that he knows surgeons who have paid rather than appear.)
How on earth does an admission of guilt fine benefit anyone? It certainly doesn’t benefit the complainant, who knows full well that the doctor doesn’t really accept responsibility, and has simply paid his way out of a sticky situation. And it certainly doesn’t benefit the public, which has a very strong interest in having complaints properly investigated, and in having appropriate sanctions imposed (like the suspension of a negligent doctor).
The HPCSA’s legal chief, Advocate Boikanyo, promised to answer noseweek’s questions but he didn’t. Perhaps he can’t. | 
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