Doctors fret while government drags heels.

IZINDABA 78 The office of President Thabo Mbeki took nearly 3 months merely to acknowledge an urgent letter from the South African Medical Association, pleading with him not to sign into law 'draconian' measures dictating where doctors may practise in future. Confirming this early in January, SAMA chairperson, Dr Kgosi Letlape, said doctors were in the 'catch 22' situation of being powerless to take legal action countering the measures until Mbeki signed the Certificate of Needs bill into law. 'If he signs without giving us a hearing that will be a clear message that he agrees with it and we can then bring our Constitutional Court challenge,' Letlape said. Letlape is on record as saying that the new bill threatens the 'very existence of private medicine in South Africa and will undermine rather than bolster the nation's health care delivery'. The law means that if a doctor wants to establish a practice or join an existing one, he or she will have to apply for a Certificate of Need (CON). It gives unfettered powers of final arbitration to the Minister of Health and allows the nine provincial directors general to decide where and under what conditions private doctors may practise. A clumsy if well-intentioned attempt to create a more equitable spread of health care across the country, the bill has created an uproar among doctors, most of whom agree with the principle but not the effect. Letlape said he left several messages on the cell phone of Mbeki's legal advisor, advocate Mojanki Gumbi, whom Mbeki had instructed to approach the Department of Health to elicit a response to SAMA's concerns. Attempts by the SAMJ to contact Gumbi and spokespersons for the president proved fruitless. Letlape said the 'main point is that it's possible to sort it all out before the President signs and to avoid the legal hassle — but we will take legal action if he signs'. The biggest bone of contention was that a grandfather clause was in the regulations but not the actual bill — giving little legal protection to doctors in existing practices. The way the bill is drafted, the Minister of Health can change the regulations or form new ones at will. Including the grandfather clause in the actual bill would prevent the government from tampering with existing practices (applying the CON retrospectively), instead of just dictating to new graduates where they may practise. Letlape …