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The doctor pleaded guilty at his disciplinary hearing, but claimed it was conditional on his belief that medication caused his behaviour.
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A Western Cape doctor accused of treating patients while under the influence of cocaine has suffered a blow after the Labour Court found his dismissal was fair.
Dr A Kleynhans was fired after reportedly arriving at work on three separate occasions in August 2019 while intoxicated.
His dismissal was initially overturned following an arbitrator’s finding that it was procedurally unfair and awarded him six months’ remuneration.
However, the Labour Court ruled in favour of the Western Cape department of health after a review application was lodged.
Western Cape doctor charged with misconduct
Kleynhans was initially charged with two counts of misconduct, but the second — related to a wrongly inserted drip into a patient’s arm — was withdrawn.
He pleaded guilty to the remaining charge but claimed he had been under the influence of prescription medication for epilepsy and a mood disorder.
A nurse testified during the arbitration hearing that she had to stop Kleynhans from performing a lumbar puncture on the wrong patient.
She also recounted a day when the doctor confused patients’ prescriptions and attempted to send patients back to the clinic, insisting there were 24 waiting when only six were present.
An expert witness argued that the medication Kleynhans cited would not have caused drowsiness even when taken with another drug.
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It was also heard that Kleynhans had admitted to occasional cocaine use.
Furthermore, a nursing manager at Uniondale Provincial Hospital testified seeing Kleynhans unsteady on his feet, confused, with dilated pupils, slurred speech and a white substance around his mouth in two separate incidents.
She said the doctor never told her his condition was due to medication and on three other occasions, he was required to sign a leave form and sent home after being deemed unfit to work.
Dr H Louw, the medical manager for the George sub-district, recounted how two patients complained about Kleynhans’s conduct, saying he appeared unsteady.
It was alleged that a clinic doctor was asked to take a blood sample, but Kleynhans refused.
When asked about the white residue, the doctor claimed it was from peppermints.
Kleynhans testimony
Meanwhile, Kleynhans testified that he had previously been medically boarded from the navy due to epilepsy.
He blamed sleep deprivation from weekend shifts for his confusion and claimed his medication caused a dry mouth, which led him to chew mints.
The doctor admitted to mixing up patients but said he had followed the nurse’s advice and avoided further mistakes.
He confirmed he pleaded guilty at the disciplinary hearing, but claimed it was conditional on his belief that medication caused his behaviour.
Kleynhans denied being under the influence of illicit substances at work, but he also did not dispute to once using cocaine at home.
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He, however, conceded he had not been truthful when stating he had never taken a habit-forming substance and failed to present any corroborating medical documents for his prescriptions.
His refusal to take a blood test, Kleynhans contended, was because there were no illegal substances in his blood.
The doctor further acknowledged all the symptoms noted by colleagues.
He agreed with Louw’s testimony that his hygiene had deteriorated and that she had repeatedly offered assistance and suggested rehabilitation if he needed it.
Kleynhans also referred to a prior verbal warning issued by Louw in 2017.
Arbitration hearing
The arbitrator concluded the testimonies of the witnesses showed that Kleynhans was using cocaine and inferred that he was “most likely intoxicated during the incidents of 2019”.
The arbitrator noted that he had refused a drug test, failed to produce medical proof of his conditions or prescriptions and accepted expert testimony that his prescribed medication would not have caused intoxication-like behaviour.
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While the arbitrator acknowledged the seriousness of Kleynhans’ role in the hospital’s emergency ward and his own admission that he posed a danger to patients, she considered mitigating factors.
These included Kleynhans’s clean disciplinary record — apart from the unrecorded verbal warning — and his performance after being allowed back to work after his suspension was lifted.
Despite this, the arbitrator ruled in February 2020 that dismissal was too harsh and awarded six months’ compensation.
Labour Court ruling
The Western Cape department of health later took the matter to the Labour Court, where the review application was heard on 19 June 2024.
Judge Robert Lagrange agreed with the department, stating that Kleynhans’s conduct posed “an imminent threat to patients, the liability of the department and himself”.
“It is untenable on the evidence of the high risks Kleynhans posed, that the arbitrator could have formed a view that Kleynhans’s conduct was less serious than that and that dismissal was an unfair sanction for the department to impose,” he said.
Lagrange dismissed Kleynhans’s claim that he hadn’t received a formal dismissal letter, finding no reason to doubt the finality of the disciplinary process.
“In any event, it was clear he did admit to having been under the influence of an intoxicating substance, but qualified his admission by stating it was his prescription medication which was the cause of his condition,” the judgment delivered on 2 April read.
The judge concluded that the arbitrator’s ruling on both the procedural and substantive fairness of the dismissal was unreasonable and set it aside.
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