Groote Schuur's doctors remove patient's life support. Family lays charges

My late mother, Helen, 91, died on July 7, 2017 at Groote Schuur Hospital, Cape Town.  She was admitted to the hospital’s Trauma Unit on July 6 after falling at home. It was discovered she broke her femur. Despite her age, she was fit to be candidate for surgery the following day as part of a world-wide trial.

But overnight her breathing worsened and we were summoned to the hospital. But beyond the doctor’s immediate concern for her breathing, her life was not in imminent danger. She was stable and breathing unaided, on morphine for pain, but unconscious.  One of my sisters remained with her until midday and later reported that according to the doctors, she was “holding her own” and could recover.  

However, unbeknown to us, during the second half of July 7 her condition worsened. On visiting her that evening during visiting hours, we were shocked to discover her on life support (intubated), comatose and her condition very serious. We had not been notified of the dramatic change in her status, which had happened hours before. 

The senior attending doctor we designated "M" because we never caught his name (afterward hospital refused to give us the names of the doctors who attended my her but I later obtained their names under access to information; it was extraordinary and indicates their opaqueness and associated guilt about the matter) told us her lung had collapsed, but after they had removed a clot of phlegm, she was “looking better”.  He didn't say why her lung collapsed (a nurse told my sister the doctors allegedly punctured it). His attitude was strange - he was rude, abrupt and reluctant to brief us about her status. And he made us feel unwelcome, telling us he "cannot brief every family member" and “family cannot hang around the unit” despite other visitors obtrusively visiting another patient en masse at the same time. 

At midnight we were summoned and he informed us mom had died after they removed her breathing tube.  He said it was removed because she could breathe without it but refused to say whose decision it was – he claimed he was not present and another doctor (no name or rank provided - I subsequently found out who the doctors were).  He was uncomfortable, unable to meet our eyes, vague and evasive about the facts, unsure about the time of death (later, we learned the time he gave was incorrect) and other details despite having two and half hours to prepare. He cut short our questioning stating he was busy and hurriedly left the room. Her body was already wrapped awaiting transportation to the mortuary at the end of the corridor among ward paraphernalia.  To date the hospital has refused to give us explanations and answers.

His and other staffs’ was unprofessional, unethical and illegal.  The head of the Trauma Unit Prof. Andrew Nicol and chief executive Dr Bhavna Patel promised to investigate our concerns – Nicol stating he was “disturbed” to hear about our experience. But against established Western Cape health department procedures, he refused to provide a written report stating he only does “verbal” reports.  Only after I threatened to lay a complaint with the health department did Patel reluctantly provide one. 

But her one-page report lacked substantive detail and provided little new information.  Patel, who nominally took over the investigation only three days before because Nicol was excused, clearly wrote it in a hurry and was unfamiliar with the facts, making a basic error.  She is not a trauma or emergency medicine specialist.  Her report was inadequate, incomplete and not up to the standard of a medico-legal report, perhaps deliberately so. 

Despite clear violations of the National Health Act, Health Professions Act and professional conduct and ethical guidelines, Patel exonerated hospital staff.  Those laws and regulations stipulate precise and inviolable procedures regarding a patient’s, or if the patient is incapacitated and unable to be part of decisions about her treatment, her family’s informed consent.  They must be consulted about treatment options and the risks and benefits of each option.  The rules are clear about withdrawing and withholding treatment, including that doctors must obtain second opinions from specialists and not act in haste. But this did not happen and for unknown reasons the doctors removed her breathing tube without informing us, which resulted in her death. 

In communicating with me, the head of the Western Cape Health Department Dr Beth Engelbrecht pre-emptively exonerated Patel and thereby hospital staff without full knowledge of the facts of the case and applying her mind to them and before an independent investigation could be conducted. But under pressure, on August 6 she reluctantly referred our complaint to the province’s Independent Health Complaints Committee (IHCC).  Over the following month and a half she and her deputy, Anne-Rita Koen, confirmed it was proceeding.

But on September 20 Engelbrecht informed me that due to alleged “logistical” reasons regarding the “appointment of members” to the IHCC she will not refer our complaint to it. Aside from the fact they had already broken the Promotion of Access to Justice Act and civil procedure, which the IHCC and department are bound to, this was nonsense because in terms of IHCC’s founding provincial act, Engelbrecht and the health MEC (Nomafrench Mbombo) appoints its members and must provide the IHCC with administrative support.  Also, this was arguably an irregular, fraudulent statement because the act makes no provision for withdrawing a complaint once it is lodged.

The pathologist Dr Gavin Kirk stated the cause of death was ischemic heart disease, congested lung disease and anaemia.  She had had “breathing difficulties” because of “thick mucoid material” in her airways, which resulted in a lack of oxygen to the heart muscle.   Also, the anaemia (treatment withheld) aggravated the effect of coronary artery disease and ischemic heart disease.  These were treatable and/or preventable, at least in part.  She “likely” died in “distress” (pain). 

There is a causal link from the doctors violating legislation, regulations and procedures, to withholding and withdrawing treatment for the ongoing anaemia to removing the life-sustaining breathing tube that directly resulted in her premature, wrongful death.  The doctors and Patel played up her fall but the pathologist found her death was not the result of complications thereof. 

Mom died after the doctors’ contravened legislation and medical procedures.  And because they violated the law, they lost the shield of their profession and laws that death, especially for elderly, infirm and critically ill patients, is a “natural process that must follow its course” (Health Professions Council of South Africa, Booklet 7).  They lost the shield, such as it is, of mere “medical misadventure or professional error of judgement” (Carstens, 2006, “Medical negligence as a causative factor in South African criminal law”, SACJ, pp192-211, https://repository.up.ac.za/handle/2263/3244).  Her death was not inevitable if the doctors strictly adhered to the profession’s guidelines, rules and codes. 

As her children and carers, we better than anyone knew her frailties.  But as her GP’s examination the day before she fell found, she was in good shape for a 91 year-old.  That day she prepared the evening meal.  Until the end she managed the household’s affairs and “was still in charge”. 

Had this not happened we do not know how much longer she would have had.  But her family and friends who loved her were robbed of a chance to spend a little more time with her (she died four weeks before her 92^nd birthday), and the chance to properly say goodbye. Groote Schuur’s doctors were hurried, incompetent, negligent and carelessly indifferent to her and our needs and best interests.  And the hospital and department’s administrators refuse to acknowledge serious, systemic defects of patient care and system and are determined to avoid responsibility and publicity at all cost even by suppressing the truth. 

Since my mom’s death we’ve heard of anecdotes of disturbing things at Groote Schuur including unqualified staff working without supervision.  Last year a similar thing happened to a neighbour’s teenage daughter. After returning from scans and tests, she fell into a coma and never recovered despite having been relatively fine before.  She died a few days later.  Her death was ruled “unnatural causes”.  Like with us, the hospital allegedly refused to give the family full disclosure.  The case is still unresolved. 

A bowel cancer patient’s chart indicated he must eat fluid meals only but was given chicken.  He ate and suffocated on his own vomit. Last month a Cape Town magistrate told me the Woodstock police investigator handling hospital cases is the “busiest because of Groote Schuur”.  I should have asked what she meant.  Clearly, the state of the public health system, including in the Western Cape, has become horrendous.  Is Groote Schuur the Cape’s Life Esidimeni scandal?

In September I laid charges of culpable homicide and violation of the National Health Act and other laws, and later added fraudulent misrepresentation regarding the cancelled IHCC investigation against the doctors and hospital and health department staff.  

Note of particular concern is that Groote Schuur Hospital and Western Cape health department management, by refusing to properly investigate our complaints and pre-emptively exonerating staff, has condoned these violations. It ought to make the public very concerned this is happening in an allegedly well-run province, as the Western Cape government would have us believe. According to Premier Helen Zille's frequent statements and articles on governance, she's committed to accountable, transparent and corrupt-free government. In a comment to my challenge in her Daily Maverick column, Zille promised to "get to the bottom" of specific health problems I raised - not our case (see above) - if I gave her the details. I emailed her, reminding her of my mom's case. She promised to track down my comprehensive statement, which I had sent them two months before along with numerous emails (obviously, she had not looked at it before). 

In November her office instructed an advocate in the administration's employ to review the status of the police investigation, after which Zille's personal assistant emailed that she cannot get involved in a criminal case, which is what her legal representative had already done, interfering in a police investigation. This is why I find Zille dishonest and like most politicians cannot be trusted.

In November 2017 I laid professional and ethical complaints against the doctors with the Health Professions Council of South Africa.

Minor updates 15/04/2018. For developments of this case, see further posts on my blog Letters from the Cape and this one.