Beth Engelbrecht replaced as head of WC health after unresolved allegations

Dr Beth Engelbrecht pushed off a 'burning platform'

Dr Keith Cloete replaced Dr Beth Engelbrecht as head of the Western Cape Health Department (WCHD) on 1 April 2020. He was formerly the deputy director general of the department. No reason for the change was given.

Engelbrect replaced Prof. Craig Househam in 2015. She was the then premier Helen Zille’s appointee. He was in the job since 2002. Engelbrecht’s short term in this plum post, particularly after her position was affirmed after the DA was re-elected in the May 2019 general election, is curious.

I dealt with Engelbrect since 2017. I frequently contacted her after my mother died under suspicious circumstances at Groote Schuur Hospital in July 2017 seeking answers (see in this blog). And later, the last time in November 2019, occasionally emailed her with thoughts, suggestions and complaints about the care I received as a patient at WC’s public health facilities.

While she was approachable in that she at least personally replied, I was dissatisfied with her indifference and absence of sympathy to patients’ plight and concerns about the standard of the department’s service. She was like her predecessor (both had academic positions at the University of Free State before the Western Cape) – technocratic, disingenuous, arrogant and ignored or indifferent to the patient-centred approach which the department adopted years ago but failed to take to heart.

Househam was among WCHD's and Groote Schuur's officials who covered up for the British visiting doctor, Christopher Hobbs, who misdiagnosed me in 2001 and was unregistered.

In my opinion she was out of her depth and arguably lacked managerial and strategic competencies. This was evident October last year when she told the WC legislature, public and me that for the past four years the department’s budget had decreased year-on-year and patient numbers drastically increased. A quick review of the department’s finance summary on their website and annual report showed this was  false – the budget had increased every year above inflation and net patient numbers (in and out-patients) only by 3%, the same as staff.

We will never know how she, the department’s CEO, could state this. Either she deliberately lied or was incompetent, both which exclude her from senior positions in government, or the private sector for that matter. Lying to the legislator is an offence.

I wrote a report wherein I broke down the budget for the previous five years. Engelbrect stated they were under fierce financial pressure but it's well-funded and receives almost 40% of the province’s total budget. Over 50% of its expenditure is to the 30 000 staff (capital expenditure declined to 4% in 2018/19 financial year).

I emailed the report to her, Premier Alan Winde, director-general of the WC and the DA spokeswoman in the legislature. I suggested her falsehood – I can’t believe any manager would make such an obvious mistake – may be grounds for the auditor-general, which had given the department a clean (unqualified) audit[1] about which they and DA had crowed, to re-open the year-end financial audit.

There was no response. But this was no surprise because the DA don’t practice what they preach about good and ethical government.

That was not the only trouble she was in. In November, the same month as my report, lobby and activist group AfriForum laid criminal charges against Engelbrecht under offences in terms of the Public Finance Management Act, 1999.  They allege the department’s annual report they “incurred irregular expenditures of more than R23 million in the 2017/2018 financial year”.

While this is a technical charge, few if any accounting officers have been prosecuted for it. A more serious charge is lying to the legislature.

But perhaps the complaints against Engelbrecht had become too serious and numerous to ignore and the DA waited a decent time to shove her aside and insulate themselves from her. We can speculate.

I'm a user of the WC's public health service and frequently clashed with Engelbrecht. In 2017 I laid criminal charges with the police and professional complaints to the Health Professions Council of SA (HPCSA) of fraud and medical malpractice-contributed culpable homicide against her, Groote Schuur's CEO Dr Bhavna Patel, head of trauma department Prof. Andrew Nicol and attending doctors after my mother died at the hospital under suspicious and still unexplained circumstances. 

SAPS never opened a criminal docket or investigated (they opened an inquest docket, though, but didn't investigate there either). The DPP declined to prosecute. Then premier Helen Zille also refused to investigate and preemptively exonerated Engelbrecht et al (she intervened with the DPP who later declined to prosecute). The DPP denied political pressure.

Last year the HPCSA dismissed our complaint of poor "communication" (sic), which was only one of many charges, under the National Health Act and Health Professions Act, including culpable homicide, lack of informed consent, unprofessional conduct and fraud/misrepresentation. (They didn't follow regulations for assessing complaints and drawing up a charge sheet, failed to review all information we supplied and gave respondents up to a year and more to respond, and more than one chance too. They've refused to provide copies of their deliberations. I complained about these to the registrar.)

Two professors, a book and corruption charge

I later found out one of the preliminary inquiry board members Prof. Elmin Steyn, a Stellenbosch University and Tygerberg Hospital head of surgery, is a professional and for-profit partner with respondent Nicol - they co-edited a medical handbook that's still in publication (last edition 2017). SAPS and DPP declined my August 2019 criminal charge under the Combating of Corrupt Activities Act. I resubmitted my affidavit to the DPP in March. No word from them.

After my mother’s death Nicol, Patel and Engelbrecht brushed us off and refused to explain how and why she died. After Nicol and Patel refused to investigate that and conduct of medical staff, Engelbrecht, after initially stating she stood by Patel and doctors, gave in to pressure and agreed to refer the matter to the WC’s Independent Health Complaints Commission (it’s not independent but a tame poodle of the head of department’s).

But after a month with the investigation not having started, she promised to look into it. But without warning two days later, said the commission would not due to unexplained “logistical” reasons. Since she had ultimate authority over the IHCC, I understood she had changed her mind, which contravened WC legislation governing the IHCC, which was fraudulent conduct by her.

Only last year did I see a media report that IHCC members had resigned. No explanations were provided. A likely reason was my mother’s case was politically sensitive and Engelbrecht and Zille didn’t want their and Groote Schuur’s guilt revealed. I had insisted the IHCC investigate her conduct too.

So it’s ironic and risible that with the allegations against Engelbrecht and WCHD staff, she wrote this article “Keep criminal hands off our emergency medical staff”. She describes how Emergency Medical Services, responding to a call in Gugulethu, “were caught in crossfire between SAPS and criminals. Still in shock and traumatized, our staff braved the bullets and still provided medical care to the injured and transported them to nearby medical facilities”.

“When this type of information reaches me, it causes me to lie awake at night [] because it is so shocking.”

Putting aside she was typically oblivious of the circumstances township residents daily live with, it’s hilarious and dishonest she’s “shocked” by this event when she personally, her staff and department allegedly broke the law and ethical and professional rules of conduct many times without thought and covered it up and didn’t apologise for the pain they cause.

Like her former DA masters Engelbrecht is the archetypal politician – unaccountable with one rule for them and another for everyone else. Tom Mctague in The Atlantic puts it so: “Politicians’ professional calculations and personal dilemmas might have altered in their specifics, but in their base nature, they remain remarkably unchanged.”

Perhaps she left for personal reasons, though. Or perhaps she was pushed when her lack of competence and scandals around her became too much for even the indulgent DA who themselves never prosecute errant members, except petty charges for those who break political ranks.

Whatever the reason, I’m glad she’s gone. Like her co-conspirators in my mother’s case, she will never face justice and accountability, but losing the prestige of her former post may be a small token punishment.

Footnote:

[1]. AIDS activist and editor of Daily Maverick Citizen site wrote an uncritical interview and report praising Engelbrect and WCHD's unqualified audit. The article was titled 'Managing a burning platform' after her words. He said he lacked information to question her positive account of their performance and self-assessment. However, information revealing problems with the service – “it's failing the people it serves” (TAC) –  is publically available including from Heywood's former organisation, Treatment Action Campaign. His report was a whitewash.

DM did not publish my right of reply. 

See in this blog for accounts of my mother's unresolved case and contact with Engelbrecht.