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August 21 2008

'Doc's ditched after undesirable diagnosis'

"When medical specialists diagnosed at least 10 cases of manganese-specific illnesses at a factory in Cato Ridge, KwaZulu Natal, the Assmang manganese company dumped them "like hot potatoes". They replaced them with a new team of doctors that revised the diagnoses to suggest the sick workers might be alcoholics, drug abusers or victims of Aids. . . . Another 27 workers, also earmarked by doctors as possibly suffering from manganism, were also "cleared" by the new team of medical doctors and some were put back to work. . . . Tager said she believed it was unethical to send such a patient back to work and be exposed to further manganese toxins. "

Tony Carnie

When medical specialists diagnosed at least 10 cases of manganese-specific illnesses at a factory in Cato Ridge, KwaZulu Natal, the Assmang manganese company dumped them "like hot potatoes".

They replaced them with a new team of doctors that revised the diagnoses to suggest the sick workers might be alcoholics, drug abusers or victims of Aids.

All 10 workers had also been certified previously by the Compensation Commissioner as being permanently disabled as a result of manganism, an occupational disease caused by exposure to excessive levels of toxic manganese.

Another 27 workers, also earmarked by doctors as possibly suffering from manganism, were also "cleared" by the new team of medical doctors and some were put back to work.

This emerged on Wednesday during the testimony of Dr Susan Tager to the Department of Manpower inquiry into worker sickness and toxic dust exposure at the factory.

Tager, a senior Johannesburg neurologist who heads the movement disorders clinic at Wits University, expressed surprise that Dr Murray Coombs, a new member of the Assmang expert panel, had rubbished her diagnoses - even though Coombs had not seen or physically examined any of the 10 workers and based his opinion on a review of their medical files. Coombs, from Elixir Corporate Health Solutions, is employed by Assmang as an occupational health consultant.

Tager made it clear on Wednesday that she stood by her diagnoses and said she did not think it was "advisable" for anyone - even a highly experienced clinician - to revise a diagnosis merely on the basis of reviewing a patient's medical file.

Richard Spoor, an attorney representing several Assmang workers, also invited Tager to comment on the ethical implications of Coombs suggesting that workers might be suffering from alcohol and drug abuse, Aids, stress, arthritis, diabetes, liver disease, iron deficiency or carbon monoxide poisoning or idiopathic Parkinson's disease - but not manganism.

"Dr Coombs is a general practitioner and to the best of my knowledge has no experience with manganism, so with respect, what are the ethical considerations of a junior colleague making such trenchant criticisms?

He is saying that you acted in an unscientific manner and drew conclusions which were not possible to make. What are the ethics of that?" asked Spoor.

Tager responded that she did not regard Coombs as "junior" to her, "but I would not be so bold in critically assessing his work in the field of occupational health".

Spoor also asked her to comment on suggestions from Assmang's consultants that she might have misdiagnosed some of the workers as having manganism when they actually had Parkinson's disease.

Tager said the majority of patients visiting her Wits University clinic suffered from Parkinson's, so if anyone were to suggest that she confused these symptoms with manganism, "I would strongly object to anyone who made that allegation".

Earlier, Tager said she had been requested to give a secondary opinion on the diagnoses of a number of patients from Assmang and also invited to sit on a panel of experts to review several cases.

The panel was set up because several medical experts felt there was an emerging problem with manganism in South Africa.

Inexplicably, however, in August 2007, she was excluded from conducting further medical examinations of Assmang patients, along with Cato Ridge practitioner Dr Johnny do Vale, Pietermaritzburg neurologist Dr Z Saccoor and Professor David Rees - some of whom are understood to have been part of the first medical assessment team.

So why was she "dumped like a hot potato", asked Spoor. Tager was mystified: "I don't know If someone were to tell me, I would be happy to know."

Spoor said he had been informed that some of the Assmang patients earmarked in medical tests as "possibly" having manganism had been told to return to work, and he asked Tager whether she thought this was wise.

Tager said she believed it was unethical to send such a patient back to work and be exposed to further manganese toxins.

Coombs, who gave evidence earlier in the inquiry, also attended on Wednesday's hearing as an observer - sparking strenuous objections from Spoor, who said his presence was "undesirable". Inquiry chairperson Vuli Sibisi ruled, though, that Coombs could stay.

http://www.int.iol.co.za/index.php?set_id=1&click_id=15&art_id=vn20080821062541328C714705

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