Health4Sale: Spotlight: North West pays double for dubious private ambulance service (Part 2)
The North West health department has effectively outsourced the bulk of its emergency medical service to a private ambulance company which is submitting hugely inflated invoices every month with very little appetite by officials to stop the looting. Anso Thom and Marcus Low join the dots in this two-part investigative feature, Health4Sale.
See Part 1 here:
North West’s health services have been in the spotlight for alleged corrupt practices involving health care delivery since February when details were revealed of a R30-million pre-payment to Gupta-linked health care company Mediosa with another R150-million to follow. The “contract” involved the delivery of primary health care services that the province had the capacity to deliver internally.
Health Minister Dr Aaron Motsoaledi visited the province in early March where he described the contract between the North West health department and Mediosa as nothing but “an ATM card for the Guptas to withdraw money from the department”.
However, documents seen by Spotlight reveal that Mediosa may not be the only company using the North West health department as an ATM.
Private ambulance company Buthelezi EMS, which operates under variations of this name including more recently B EMS, have held a contract with the North West Department since March 2016.
Buthelezi is being paid between R600,000 and R1-million a day to mostly deliver inter-facility hospital transfers in the province. Inter-facility hospital transfers are the transport of patients by road ambulance from one health facility to another, either for specialist consultations or because they need a more specialised level of health care. It also works in the reverse with some patients sent to a lower level hospital once they respond to specialist treatment. This service is provided by the provincial health departments in most provinces.
Popo Maja, spokesperson for the national health minister was adamant that the current public emergency medical service has the capacity to undertake inter-facility transfers.
“In the rare situation, where there is an urgent inter-facility transfer and all ambulances are engaged in EMS responses, there is provision for the EMS manager to engage the services of a private EMS provider. This option should only be in exceptional circumstances,” said Maja.
The North West Health Department has over 60 ambulances on the road, but an official told Spotlight that the HOD and his supporters had “created a hole for Buthelezi to fill”.
Not a single ambulance post has been filled in at least three years and money earmarked for the purchase of new government ambulances was redirected to other areas.
Buthelezi EMS invoices on average well over R20-million per month, amounting to in the region of R3,000 per patient allegedly transported.
Figures seen by Spotlight reveal that Buthelezi EMS submits hugely inflated invoices for almost every patient they transport, overcharging on average a staggering half a million Rand per hospital per month.
As an example in several instances Buthelezi charged in excess of R10,000 per patient, while the correct cost was closer to R1,000. This was a pattern in most of the invoices at one hospital alone. At another hospital as an example a trip was charged at close to R5,000 instead of just over R1,000. The charges are quite complex as variables such as time and distance travelled as well as the level of care required impact on the costs.
Efforts by some health officials to put a stop to this looting has not had an effect with the head of the provincial department of health Dr Thabo Lekalakala sending out an instruction that all Buthelezi’s invoices be submitted to and paid via his office. This meant that no invoices could be checked or corroborated by Treasury or Department of Health officials in line with good governance practices and the law.
Buthelezi was awarded the contract after the initial tender specifications were apparently illegally adjusted when the tender was awarded to expand Buthelezi’s scope from only supplying P1 services to the more lucrative and higher volume lower level P2 and P3 services which require intermediate and basic life support services.
P1 is very serious, potentially life threatening; P2 means the patient needs to go to hospital, can become life threatening if not treated; P3 is minor injuries; and P4 refers to a deceased patient.
Discrepancies between the original tender and adjusted tender indicate that the tender specifications, which originally only covered transfer between hospitals, were expanded to include clinics and Community health care Centres when the tender was awarded. The province was already providing a service to clinics and community health care centres – shifting this work to Buthelezi EMS allowed the company to increase their volumes significantly.
In addition, the tender required that the successful bidder have a presence (ambulance, response car, advance life support paramedic) in each sub-district. It is a known fact among health care workers and departmental staff that the Buthelezi company does not have such a presence in all districts they service and for example patients requiring trauma care in Wolmaransstad have to wait for an ambulance or paramedic to arrive from Klerksdorp 80km away.
There are reports from various health care workers that the service provided by Buthelezi is not good.
A private health care provider who works at trauma scenes in North West said they never saw Buthelezi paramedics at emergency scenes.
“I have never seen them on a scene around Potchefstroom or Klerksdorp, in fact it is often private providers who do not have contracts with the department who will be the ones treating indigent patients on the scene, stabilising them and taking them to hospitals,” the person said.
A paramedic alleged Buthelezi was often not interested in sticking around when there were dead patients as they “not keen on doing the paperwork”.
A visibly angry Motsoaledi demanded during his visit in early March that Lekalakala be removed from his post with immediate effect.
“I want him (Thabo Lekalakala) to face charges. I don’t think he is fit to work anywhere in the public service, least of all as an HOD. Lekalakala is hired by the premier of the North West. The premier must start taking steps to remove him,” Motsoaledi told journalists.
Lekalakala has not been suspended by the Premier Supra Mahumapelo, who appointed him, but the Health MEC Dr Magome Masike has placed him on special leave.
Various entities have called for Lekalakala to be suspended including trade union Nehawu, who have embarked on protracted labour action to force the HODs removal. This action is now leading to drug stock outs and patients arriving at health facilities with no nurses on duty.
Tebogo Lekgethwane, spokesperson for the MEC confirmed that the HOD was “still on special leave, not yet suspended”.
Lekalakala was a controversial appointment from the start with reports that the Economic Freedom Fighters and the Young Communist League criticised his appointment claiming that Mahumapelo has simply brought him in to rubber stamp tenders.
They also claimed his appointment was irregular and that he did not have the required experience as stated in the job advert. Many were surprised when Lekalakala was appointed HOD from the National Department of Health where he occupied a low-level Director position.
Spotlight sent a number of questions to Buthelezi’s CEO Thapelo Buthelezi. He failed to provide a response to any of the questions, but sent a letter instead in which he among others accused Spotlight of “probably doing this to me because I’m a black businessman and you are indirectly promoting a white monopoly capital and unhappy with a black successful business”.
Buthelezi added: “Please assist NPA and the Hawks by giving them every single evidence on (sic) your possession so that they can quickly finalise the investigations, I can’t wait to have my day in court! NB: Buthelezi EMS is contracted to Department of Health and therefore, I’m only answerable to them.” (See his full response below.)
Questions directed at the North West Health Department were also not answered, despite several attempts. Spokesperson Tebogo Lekgethwane said: “The management of the department has looked into all the questions posed. The department has also considered the fact that Buthelezi EMS and a number of other contracts are a subject of investigation by the Hawks as well as a forensic (sic) initiated by the premier's office. In the light of these developments, the department feels that the investigations should carry on and a response will then be issued afterwards.”
Spokesperson for the Hawks in the North West Captain Tlangelani Rikhotso confirmed that they were investigating the contract between Buthelezi EMS and the North West Health Department, but “we cannot divulge any more information in relation to the case”.
Tapelo Buthelezi’s response to Spotlight’s questions:“I feel victimised by yourself because it's not the first time you asked such irrational questions, I suggest that you let your informers continue to feed you with wrong info. You are probably doing this to me because I’m a black businessman and you are indirectly promoting a white monopoly capital and unhappy with a black successful business.
“Non (sic) of the province is not currently utilising the services of private ambulance companies. Buthelezi EMS is not the only or first company to do IHT’s, this has always been there. To my surprise, you have been doing everything in your capacity to spoil and ruin my reputation as a black South African businessman.
“This is clearly about racism. To support my statement, the (sic) are currently provinces working with other private ambulances (rendering road and aero medical devices) without any formal contract, they are white owned and you have never said anything about the irregularities currently taking place. Buthelezi EMS must be asked all sort of questions because I’m black.
“You never have the same approach with white companies.
“Please assist NPA and the Hawks by giving them every single evidence in your possession so that they can quickly finalise the investigations, I can’t wait to have my day in court!
“NB: Buthelezi EMS is contracted to Department of Health and therefore, I’m only answerable to them.
While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council