Concern about the viability of a national health insurance (NHI) plan often focuses on SA’s imperilled finances. But a recent labour court decision highlights another problem with wrecking potential. It concerns Dr Roger Walsh, former CEO of Fort England psychiatric hospital in Makhanda (previously known as Grahamstown). The hospital is home to about 300 patients with mental disorders, some "extremely disturbed" and in need of constant supervision. It has a maximum-security unit that manages SA’s most dangerous state patients. Walsh found the hospital in crisis, with administrative chaos, rampant absenteeism, "financial interactions" between staff and patients and a level of clinical care that was cause for great concern. But his vigorous cleanup ran into trouble with union members. Unauthorised strikes and protests followed, with serious consequences for the hospital, staff and patients. Shop stewards led mob disruption at the hospital, targeting certain staff for intimidation and ...

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