FORENSIC PATHOLOGY, THE DEPARTMENT OF HEALTH AND THE MORTUARY MAFIA

In a severe blow to the training of doctors, and to the cause of justice  in KZN, Prof Steve Naidoo, Chief Specialist (Forensic Pathology) and head of Forensic Medicine at the Nelson R Mandela Medical School in Durban, has resigned from his university post. He is unable to effectively carry on teaching undergraduate medical students and postgraduate registrars (trainee specialists) because of the untenable situation at the Magwaza Maphalala (Gale Street)mortuary, which is a consequence of the failure of the Department of Health (DOH) to deal with the mortuary mafia. While he has not been personally threatened – although there have been attempts to sabotage his work – Naidoo has been warned by concerned insiders that he may jeopardise his personal safety by continuing to work there. Naidoo’s resignation is a symptom of the terminal decline into which mortuary services have fallen since being taken over by the Department of Health from the SAPS.

In terms of breadth of experience Prof Naidoo is the province’s leading forensic pathologist. He enjoys international recognition, and has extensive experience in the field of forensic pathology applied to human rights, including his work with the TRC in South Africa and with the United Nations in the identification of genocide victims in Bosnia, Croatia and Kosovo. He is currently Chair of the Academic Sub-Committee of the Department of Health’s National Forensic Pathology Service Committee. He is also Chair of the continent-wide African Network of Forensic Medicine and a member of the Forensic Advisory Group of the International Committee of the Red Cross  (ICRC. There is a dire shortage of forensically trained doctors in the province, and Naidoo is the seventh to have left the service in the past two years. The former Chief Specialist of the KZN DOH Forensic Services also left the service following harassment by mortuary workers and lack of support from provincial management. The blame for this state of affairs lies squarely with the MEC and staff of the Provincial Department of Health, who have apparently taken the side of unqualified, ill-disciplined mortuary staff (some of whom are guilty of criminal activities) against highly qualified professionals, who they have continued to undermine. A perceived manipulation of the health department’s management by the industrial union/s representing the mortuary technical workers needs to be investigated.

Magwaza Maphalala Street mortuary

Criminal activities by staff at this and other mortuaries hit the headlines in 2010 and early 2011 when, during illegal strikes and go-slows (they are classified as emergency workers) workers sabotaged operations by switching off fridges, muddling bodies, hiding dissection tools or gluing shut cupboards in which they were kept. Their grievances stemmed from not being paid on the same scale as workers elsewhere in the country – the reason being that most have no real qualifications for the jobs they are doing. The Department of Health is, in fact, breaking the law by employing people without the requisite qualifications in the positions they occupy (and there is no shortage of properly qualified personnel). These mortuary workers have now been given the increases they were demanding, and to which they, lacking qualifications, are not entitled. If it is true that mortuary technicians are now paid Level 7 salaries it is an insult to those health professionals (e.g. nurses, paramedics) with degrees and diplomas who receive a Level 6 salary. The current go-slow or strike at Phoenix morgue this past week is again evidence of the attitude of morgue technical staff who are prepared to subject the community to such inconvenience and travail where the next-of-kin cannot receive the bodies of loved ones for funerals, now on the basis that they have not been paid for their overtime claims.

Even when they were not striking the workers behave in a generally ill-disciplined manner – arriving late for work, coming and going as they pleased, and refusing to take instructions from doctors. Proper procedures for the identification and release of bodies are not necessarily observed, facilitating irregular disposal of unclaimed bodies and opening the doors to insurance fraud, and possibly to illegal trade in body parts. National protocols relating to the treatment of unidentified bodies are not adhered to. Appeals to the DOH for errant workers to be disciplined have fallen on deaf ears. Given the lack of proper management, and the failure of the DOH to ensure adequate maintenance, there are serious concerns about health and safety levels to which those who work in the mortuary – including trainee specialists and medical students – are exposed. The arrogance of the workers has extended to their objecting to the teaching of medical students at the mortuary. What the University of KZN is doing about this appalling state of affairs, given the crucial repercussions for the training of doctors, is unclear. The HPCSA has already noted the inadequate exposure of undergraduate medical students at UKZN to autopsies. Attempts by Prof Naidoo to insist on acceptable standards at the mortuary had led to the staff claiming that he is ‘harassing’ them. He has noted that some of the goings-on could amount to a violation of human rights of not only families of the deceased and members of the public in most cases, but also of those innocent and hardworking staff members belonging to the health establishment and police.

For the past few years the DOH had been made aware of the conditions at the mortuary, including the contents of a detailed internal audit done in January 2008, and have been apprised about what steps are necessary to rectify matters. Their response has been for from instructive, for it suggests contempt for professional staff and support of the ill-disciplined workers. For example, when it spoke of ‘re-structuring’ it was the mortuary technicians, not the doctors, who were consulted. In November 2009 a memo to the Health Dept by the mortuary staff questioned Prof Naidoo’s position, claiming he had no authority over them because he was employed on university conditions alone. However, the position he occupies is, in fact, a joint University of KZN/Department of Health one. In June 2010 Naidoo was effectively removed from exercising any control over the mortuary and medical functions by a senior employee who has since left the DOH under a cloud. He was not afforded the courtesy of being informed about this move, made in a letter from Dr SSS Buthelezi to Dr Sageren Aiyer, Naidoo’s colleague and deputy head, appointing him as caretaker manager for Clinical Forensic Pathology services in the province.

A province-wide crisis in mortuary services

Mortuary services all over the province have gone from bad to worse since being taken over by the Department of Health in April 2006. There is a lack of qualified staff at all the mortuaries, and their failure to follow proper protocol in the identification of bodies has been reported. Unnecessary trauma is caused to bereaved relatives by the way they, and the bodies of their loved ones, are treated. At Port Shepstone, for example, if cleaning is taking place an exterior door is left open so, if the cold room door is opened the bodies which are piled up there, which are not necessarily shrouded, are clearly visible to passers-by. This not only impugns the dignity of the dead, but is potentially very traumatic for those in the vicinity, especially children.

Most mortuaries lack essential equipment and even when new mortuaries are built they are not properly equipped and lack trained staff. The new Pietermaritzburg Fort Napier morgue does not have an x-ray machine, nor the services of a specialist pathologist to perform autopsies. Controls over equipment are lacking. According to an eye witness, new body trolleys at Fort Napier were being sold, by staff, to undertakers.

The neglect of forensic services : Defeating the ends of justice?

The services provided by government mortuaries play a vital role in providing evidence in court, but the way they are currently being mismanaged by the DOH, which has had every opportunity to fix the service, could be construed as defeating the ends of justice.

Its failure to provide up-to-date x-ray machines at all mortuaries, which are
essential for x-raying the bodies of gunshot victims, means that bodies from
most other parts of the province have to be brought to Durban – which, given
the logistics, generally does not happen, even when the circumstances of the crime make it imperative for this procedure to take place. Failure to X-ray bodies where deaths have occurred in certain circumstances such as gunshot injuries and child abuse cases, among others, also constitutes a miscarriage of justice.

The lack of training plus the bad attitude of mortuary workers – and the absence of any proper supervision – has potentially dire consequences for the handling and storage of evidence. Bodies are supposed to be sealed in decent quality bags and not opened until the doctor is about to begin the autopsy, and the proper handling of the deceased’s clothing is also very important. Evidence is easily contaminated when (as often happens) these procedures are not observed, or when tissue samples taken are not properly stored. The failure of the DOH to employ properly trained and supervised staff means that valuable evidence is routinely lost to the court.

The shortage of properly qualified doctors is critical, yet the Department seems to value the services of its ill-disciplined and unqualified work force above those of the highly trained forensic specialists it has lost in the past two
years. Autopsies, especially in rural areas, are frequently performed by doctors who have little or no forensic training, with potentially serious consequences for evidential purposes.

The Premier of the province had been apprised of the seriousness of the situation, yet nothing appears to have been done. There is clearly a need for intervention by the National Department of Health – possibly in consultation with the Department of Justice which is a key stakeholder – to ensure that the problems relating to staffing and equipment are sorted out immediately. Also
needed urgently is an audit into how the considerable amount budgeted for
the takeover of the mortuaries by the health department has been spent.

Long-term, there is need for informed debate aboutwhether the Department of Health is a fit and proper body to retain control over these facilities.