Western Cape Health's callous treatment of terminal patient and family

This post contains previously posted information. Links provided.

It is custom that when a person dies the community, even those who didn’t know the deceased, show empathy and respect to the family. People express sympathy – “sorry for your loss” and “condolences”.

The cultural tradition is as old as civilisation. It’s rooted in our humanity and basic decency. Even enemies put aside their rhetoric for a while. The Western attitude to death is influenced by Greek and Latin/Roman cultures and Christianity. The other is Persian which too has ancient roots.

Death is an inevitable part of life and is cause for reflection. What happens after is unknowable and so it’s treated with reverence. And to honour the life, achievements and new generation the departed contributed to. The loss is felt closest to the deceased, but the impact ripples to the wider community, more or less, depending on the contact the deceased had with them.

My mother died at Groote Schuur Hospital in 2017 aged 91, a month before her 92^nd birthday. Before and after she died the family were shockingly treated by the doctors and hierarchy of the hospital and Western Cape Health Department and province (for a full account see here.)

The evening of her death we were shocked to find her on a ventilator – when we visited that morning she wasn't and no one had informed us. She was stable, though unconscious. Two doctors, Ahmed Al Sayari and Mohammed Mayet, were rude, abusive and uncommunicative to the family. Ungraciously Mayet told us she was “improving”, but only after he refused to provide information of her condition. A few minutes later he shouted at and chased us out the ward.

We were confused and offended by their attitude because we had done nothing to deserve it. Unlike the noisy, laughing foursome visiting another patient, we were quiet and respectful of the place, a high care ward. They weren’t evicted, though. We suspected, apart from the doctors being naturally rude and arrogant, they wanted to avoid questions, one of which was if they had punctured my mother's lung causing it to collapse while inserting the breathing tube. We never got answers, though. 

Two hours later, without our knowing or seeking consent, they took my mother off the ventilator, which caused her death. We were called 90 minutes later. We found her already wrapped in plastic, ready for the morgue, on a stretcher at the end of the corridor among cleaning materials. 

Mayet gave us minimal information, was evasive and abrupt. He was disrespectful and condescending, his mind elsewhere or pretending it was. He refused to tell us the circumstances of her death like who gave the order to remove the ventilator, who did it (we later indirectly learned it was a combination of Mayet and/or Al Sayari, Marcelle Crowther with unsupervised intern Mikhail Botha performing the coup de grace) and if she would have lived if they hadn’t.

The post-mortem revealed she died of respiratory and cardiac arrest as a result of oxygen starvation, exacerbated by diagnosed but untreated anaemia. She was possibly in pain.

The head of department and hospital CEO, Prof. Andrew Nicol and Bhavna Patel respectively, were uncommunicative, or did so reluctantly, combative and condescending. Patel got personal. All because they refused to give a written report as they must per hospital and health department policy and national law and I insisted they do. We don't know what happened to my mother except her condition at death from the pathologist.

The doctors and management involved violated medical, ethical and legal provisions. They were disrespectful to my mother, the family and lacked compassion. There were no consequences for them. They were not held to account. Instead, a cover up began immediately that included health department head Dr Beth Engelbrecht, premier Helen Zille and Health Professions Council of South Africa.

Zille, police and NPA refused to open investigations and dismissed the charges. Zille directly interfered with the NPA and police which they facilitated. They ignored our complaints about irregularities.

The HPCSA’s inquiry board never conducted a proper investigation. One of its members, Prof. Elmin Steyn, has an ongoing professional/business relationship with Nicol whom the panel gave extraordinary leeway, beyond regulations governing inquiries, to present his case. They accepted his and his co-respondents’ accounts despite salient parts fabricated – documents and events[1]– and hearsay. 

Former health minister Aaron Motsoaledi described the HPCSA as dysfunctional after an inquiry found widespread malfeasance.

While bureaucracies are indifferent to personal circumstances, they too can be callous. The alleged conduct of Steyn, Zille and others, including NPA and pathologist for giving confidential information to outside parties, fall within definition of corruption and other criminal conduct.

But the status quo must be maintained and office bearers’ reputations protected. Not even the sanctity of death can withstand that urgent drive.

Endnotes

[1] In their combined statement (an esteemed, published professor threw in his lot with a 27 year-old intern) to the inquiry board, Nicol and his co-accused fabricated evidence, which contradicted our account and the hospital record, that the board didn't interrogate. They claimed that earlier the day before my mother died, staff phoned one of my sisters (name mentioned) at 5pm, as proven by a nurse's note in my mother's record. 

But that was impossible because until I gave our names in my statements (to hospital, police and HPCSA) weeks and months later, they didn't know who we were. The only names and phone number the hospital had on record at the time of my mother's admission, the ones they would have used, was my other sister who accompanied her, and my name when I took the call at midnight after she died.

The purported report of the 5pm phone call was not in my mother's record when I requested it in August 2017 but mysteriously appeared a year later in time for Nicol's et al defence. Had it existed, they would have given it me to prove everything was in order. 

The conclusion is it was fabricated. This was a major part of their defence, their only really. The other was hearsay from a partly named source the panel accepted in contravention of the hearsay rule. Disprove that, as I did in my response to the HPCSA (no reply), and their story collapses. Nicol is the only one, and who has the most to lose, who has the authority (he's head of department) to allegedly insert into the record after the event a note that supports their story. He proves even the mighty can fall.

They never responded, though, to the key issue why they removed the ventilator that resulted in my mother's death. The inquiry board never asked Nicol et al and never responded to our question why they didn't ask them. Uncomfortable truths are best left unexplored especially when they implicate the guilt of associates.