A silent internal battle “for the soul” of the South African Medical Association (Sama) has been raging for more than two years. It’s about to come to a head as doctors face unprecedented medico-political and regulatory pressures.
Sama, with just over 12,000 members out of 35,000 registered doctors, is the largest doctors’ organisation in the country. At the heart of its dispute is a complaint by the association’s Cape Western branch, which regards the Sama board as illegally constituted. This view has been upheld by the Companies & Intellectual Property Commission (CIPC) and the Companies Tribunal. The CIPC ordered the Sama board to convene a council meeting within 20 days but has suspended its decision after the board appealed to the high court to overturn the two rulings.
In turn, the board convened a disciplinary hearing in February of all 13 of the Cape Western branch council members and found them guilty on five counts of improper use of Sama funds. The Cape Western branch spent R200,000 on legal opinion on the constitution of the board, subsequently launching its successful formal challenges.
Two years ago, upon hearing of the spending on legal advice by the Cape Western branch, the board put all the branch’s members on “precautionary suspension”, banning them from using the Pinelands offices in Cape Town and warning administrative staff not to communicate with those members. Those Cape Western branch council members serving on Sama board committees were also suspended. The board followed this up by laying a complaint of embezzlement with the police in Pretoria.
One veteran Sama source says: “This is about shutting down the whistleblowers — the rest is all detail.” Another says the charges and countercharges represent “a battle for the soul of Sama” and of the democratic representation of members. Others claim the Sama executives are “ANC acolytes”.
Sama members outside the Cape Western branch have raised questions about first-class trips by board members to attend World Medical Association meetings, and Sama’s funding of a gym in Mthatha.
The Cape Western members claim to have been refused sight of financial books detailing Sama’s spending R4m on the gym and R16m worth of rental guarantees as part of a Sama Fitness subsidiary. The Sama Fitness website says a string of fitness centres is envisaged “in the hope that they could be used as a recruitment and retention mechanism for members of the shareholder (Sama)”.
Sama’s subsequent membership losses are illustrated by the statistics. In 2013 it had 6,000 private sector doctors and this year just over 4,000
The board says in a statement that Sama executives flew globally on four economy-class tickets last year, not six first-class, as alleged. It says Sama Fitness (Pty) Ltd was not set up by Sama NPC (not-for-profit company). Instead, Sama Fitness was a 100% subsidiary of Sama Cape Property Holdings (Pty) Ltd, a profit-generating company that invested in Sama Fitness. No Sama NPC funds (membership fees) were used to support Sama Cape Property Holdings in setting up Sama Fitness, it says.
This was reported in the consolidated financial statements in line with reporting requirements to show activities between subsidiary companies, the statement says.
Those opposing the deals say the subsidiaries were set up with member funds. The board had changed its modus operandi from members electing it (and all its committees) through the triannual Sama council meeting to the board having sole control — with the exception of an online annual general meeting.
Sama lost specialists in bulk in 2009 after then chair Kgosi Letlape described private practice as “running on the coattails of the Medical Schemes Act” and threatened to cut up his medical aid card because of treatment and access inequities.
Sama’s subsequent membership losses are illustrated by the statistics. In 2013 it had 6,000 private sector doctors and this year just over 4,000. In the public sector it had 5,500 doctors in 2013 — down to 2,500 this year. The rest of the professional groupings are split into the breakaway South Africa Medical Trade Union, with about 8,000 members, and the South African Private Practitioners Forum (3,000 specialists, plus 3,500 others, including GPs and ancillary health-care practitioners). Other doctor cohorts include the South African Academy of Family Physicians (525 paid-up members), several independent practitioners’ associations, specialty societies and managed care outfits.
In another development, the board recently released a statement apologising for an editorial in its South African Medical Journal headlined “Israel, Gaza and moral equivalence”, after e-mails from pro-Palestinian readers to its editor, Bridget Farham. The board met later to discuss “closer editorial oversight” of the journal.
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