Steeped in Blood (36 page)

I am not here to win favour, and I have never been afraid to speak my mind. I have always believed in honesty and in the truth, and in saying things that others think but are too afraid to say openly, perhaps. There are always two or more opposing versions of the facts: I believe in slicing through all the confusion and evaluating the evidence from a purely scientific point of view. In some cases this is easy; in others, not so. Whatever the situation, however, I will investigate and present the facts as I find them.

The media has not always been kind to me, and in the early 2000s I crossed swords with Robert Kirby, the playwright and columnist. The battle started out innocently enough, with Kirby writing a few articles about my interest in the
Helderberg
plane crash in the
Mail & Guardian
. I replied to his allegations, and the war became
personal. He took great pleasure in lampooning my name and labelling me a conspiracy theorist. In one particular article, which related to the tsunami tragedy of 2004, he blatantly made fun of me, referring to me as ‘David Glutzow’ (see
Appendix J
).

I was not afraid to speak my mind in the race debate over blood donation, something that drew even more negative press my way. The incident occurred a few years ago, in 2004, when Thabo Mbeki donated blood but failed to complete the relevant blood-donation questionnaire. As a result, a full unit of blood was not drawn, and that which was taken was discarded. Manto Tshabalala-Msimang, who was Minister of Health at the time, became distressed, saying that the non-use of the blood amounted to racism. This sparked a heated political debate over whether the South African National Blood Transfusion Service (SANBS) should be classifying blood from black donors as high-risk blood, which it was doing at the time.

In the
South African Medical Journal
(
SAMJ
) of April 2004, it was reported that the chief executive officer of SANBS said that the average risk of a black South African being HIV-positive was at least 100 times greater than that of a white compatriot. This is fact, not fiction. Because black donors were such a high-risk group, the race question was asked in a questionnaire prior to donation to protect the recipients of donated blood. This is not a situation unique to South Africa: the officials at the French Blood Transfusion Service were prosecuted at one point for allowing high-risk groups to donate blood.

I made the points publicly that race had nothing to do with this issue, and that while around 15 to 20 per cent of blood donors are black, the vast majority of recipients are also black. We know that the overwhelming majority of people infected with HIV are found in sub-Saharan Africa, an area that comprises 17 per cent of the world’s population. To put the whole population at risk for a political gesture is plainly irresponsible.

The onus is on the medical profession to ensure that the blood given to recipients is as safe as possible – from a medical rather than a political standpoint. At that stage, the RNA fingerprinting technique – a complex process that had to be conducted on an individual basis – was not available in an automated form. SANBS was simply acting in the best medical interests of its patients.

What really upset me at the time was that nobody would support me. The
SAMJ
article stated that asking for the race of blood donors had nothing to do with racial stereotyping. Many of my colleagues supported the article off the record, but would not do so openly. I took a lot of criticism over this issue at the time, as did the head of SANBS, Anton Heyns, but it was necessary to say what needed to be said, despite the consequences.

Another matter about which I have always been outspoken is the government’s interference with medicine. I would venture to say that the ANC-led government has managed to damage the state of medicine in this country significantly. It has interfered with the forensic science laboratories to the point that they have become non-functional. There are very few handwriting experts in South Africa today, and few people are skilled in fire investigations. I know of no other independent forensic practices that operate like mine in bringing together a number of branches of science and basic medical knowledge of anatomy and physiology.

The state forensic laboratories are now largely defunct as a result of the increasingly poor training of analysts. As an upshot of this, the backlogs in analyses are having a massive negative effect on the work of the law courts. Delays become so excessive that the state is often forced to drop charges – many judges are expressing concern over this situation.

One of the main problematic issues in the field of medicine is that admission to study medicine is based on demographics. The secondary and tertiary education systems are so flawed that many of the graduates do not receive a decent education. Standards, in
my opinion, have dropped, and I would not feel comfortable with anyone who graduated from medical school post 1994 treating me. (Similarly, I have seen attorneys who have graduated in recent years who are functionally illiterate – they cannot string a coherent sentence together. The level of university education is poor, to put it mildly.)

A solution to our shortage of doctors has been the ‘importing’ of foreign doctors. I recently heard from a very reliable source – a surgeon and good friend – of a Cuban doctor in South Africa who had performed a tonsillectomy through the front of the patient’s throat. What is normally a minor routine procedure was turned into a major operation with huge risks and a lengthy recovery time. This is but one example of the type of medical care that patients are receiving in South Africa at present. The state-run medical services have had to pay out billions, literally, in compensation for botched medical procedures.

Political interference in the medical system extends beyond issues of admission to the study of medicine. Once students graduate, they are sent to areas often fraught with problems and where there is little equipment. I have been outspoken about the amount of damage to which this is giving rise, as well as the harm being caused by the HIV/AIDS situation (provoked, in part, by Thabo Mbeki’s incorrect views on HIV/AIDS).

The result of all of this is that young doctors, once qualified, seem to be leaving the country in droves. There is no motivation for them to stay, and this has a sad impact on health care in our country.

What really bothers me is the tragedy of all of this. Thirty or forty years ago, the education system was not good at all and needed improving, but the medical system was not bad. As I mentioned in
Chapter 1
, I was mentored as a young man by a district surgeon in Standerton. He was a rampant National Party supporter, but a good doctor nevertheless. I accompanied him on many of his rounds late at night to treat the sick, most of whom were farm workers.
This level of mentoring and education for prospective doctors is simply not available today.

Our problems arise from the fact that there has been political tampering with systems that work. I do not condone the idea of a central system that controls every aspect of state functioning, including police stations, hospitals and district administration. As mentioned in
Chapter 4
, central government control is never a good thing, whether it is over medicine, commerce or forensic matters. Some clients of mine have tried to control the outcome of my investigations by either inferring or directly requesting that I alter my reports, but this is a practice that I will not follow.

In 2002, a large blue-chip company found that someone was imitating their products and packaging and selling them off as the real thing. They were losing a significant amount of money, and they called me in to investigate.

I was provided with samples of the imitation products to analyse and compare to the original products. I requested the company’s records of the exact ingredients contained in the original products, including the perfumes, so that I could compare the samples.

The company had no records of the exact organic compounds used in their original products. All I could compare the imitations to were the current products of the company, which may have differed from the original products in make-up. I explained to the attorney who had briefed me that my test results would not help very much, as I could not compare the imitations to the originals.

The attorney handling the case was from a well-known law firm that dealt primarily with copyright issues. He was not happy with the fact that I could not vouch for the samples being significantly different, and suggested that I omit that particular piece of information from my report.

If I did this, I would be misleading the court. I remember saying to him, ‘So you want me to give a false report under oath?’ He replied, ‘Yes, because it’s not going to go to court. You won’t be cross-examined.’

This was not the point at all. There was always a possibility in the future that this report may be referred to in another case and that my credibility would be at stake. I refused to omit the information. He was not impressed, and the company concerned was angry that I was not prepared to perjure myself. They were paying me, and they expected me to follow their ‘suggestions’, regardless of the fact that that would compromise the practice of ethically sound forensic science.

I found myself in a similar situation in 2004, when I was working on a case involving a baby who had been born brain damaged at a private hospital in Hermanus, in the Western Cape. The highly distressed parents wanted some recourse, as they felt that the hospital was to blame for the baby’s medical condition. It was not a straightforward matter at all, and I was called in on behalf of the hospital’s insurance company.

The mother had gone into labour, and the staff, it was alleged, had allowed the labour to go on until the uterine membranes ruptured. As a result, pressure had been placed on the baby, which caused foetal distress. The baby was born brain damaged, and the parents were naturally devastated and angry. Their first path of recourse was the gynaecologist and the nurses. The gynaecologist said that he had instructed the nurses to administer a drug that causes increased contractions to the uterus. This drug was a synthetic version of the pituitary gland, hormone oxytocin, which makes the uterus contract faster and harder. The problem was that there was no fluid in the uterus, so it pressed against the baby’s head and affected the heartbeat. The real question came down to whether the increased uterine contractions and the brain damage to the baby were a direct result of the administration of this drug.

I was called in to calculate how long it would take for the drug to get from the saline bag through the tube and into the patient. That sounds easy, but it proved not to be. The drug is put either into the bag or into the drip itself via a drip port – I didn’t know
which it had been. The solution then drips into a drop counter, a small transparent reservoir, and affects the concentration of the solution in the drop counter. Each drop that runs through the tube mixes with the other fluid in the tube, and the walls of the tube affect the rate of the flow, making it a complicated calculation.

A number of elements influence the calculation, including how the nurse administers the drug, how long it takes for him or her to get it into the patient, and how the nurse mixes it in the bag – some give the bag two squeezes, others take the bag off and mix it properly, and so on. The actual process of drug administration therefore makes a vast difference to the calculation. I couldn’t get an answer for the length of time it would take for the drug to reach the patient until I had answers about how the drug had been administered.

With the knowledge of the advocate and the instructing attorney, I went to the hospital to observe how all of this is done. I then did the calculations, and concluded that the expert for the plantiff was right in his calculations: the drug had caused faster contractions and given rise to foetal distress. The advocate was furious and said to me, ‘I don’t want you to go out there and do all that
Quincy
stuff,’ once again a referral to the popular TV programme from many years ago.

He was unhappy with the factors that I had taken into account in my calculations. I asked him if he wanted me to get into the witness box and say that I had performed the calculation based on the limited number of factors
he
wanted me to use. Had I done so, I would have undermined my integrity and credibility as a professional forensic scientist.

I have been in many situations in which lawyers have said to me, ‘Thank you, this is a nice report, but will you alter it, please?’ My reply to them is always an emphatic
no
, and consistently they respond with astonishment: ‘We’re paying your bill; why won’t you do this?’ My answer is very simple: if they bring me new evidence
that will motivate me to change my view legitimately or recant on something I’ve said, I will put it in my report as an addendum. That way, whoever evaluates the report can follow my path of reasoning and, in particular, the reasons for my change of mind.

Were I to modify a report for a client, that client would be in possession of two differing reports of mine. If there hadn’t been a good reason for my altering them and that client one day ends up on the opposing side in another matter in which I am involved, they could discredit me with one question: ‘Have you, Dr Klatzow, ever altered a report at the behest of your client?’ If I say no, I am immediately discredited for being dishonest – they have the reports as evidence. If I reply that I
have
revised reports in the past, that in itself destroys my credibility in front of the judge.

In the tragic case of the brain-damaged baby, as in so many others, the client wanted me to find only what would benefit their case. I am not prepared to do that. Instead, I will do all the ‘
Quincy
’ work until I am satisfied with the answer: I will forever remain true to my craft.