Groote Schuur Hospital, Western Cape Health Department and NPA cover up death of patient
Groote Schuur Hospital's CEO Dr Bhavna Patel retired after 13 years. A public health specialist, she's credited with improvements to the hospital. That may be true.
But there's a cold, cynical side to Patel that the fulsome news reports (IOL, News24) do not speak about. Patel retired leaving controversy behind that to an extent insulates the hospital and Western Cape Health Department (WCHD) from the fallout. This is the kind of story, in general and what follows in particular, the media do not publish.
In 2017 Patel, Trauma Centre head Andrew Nicol, senior medical officer Ahmed Al Sayari, registrar Marcelle Crowther, junior officer (27-year-old) Mikhail Botha, registrar Mohammed Mayet, and WCHD head Beth Engelbrecht were variously accused of assault, culpable homicide, fraud and violations of national and provincial health laws and policies for the death of a 91-year-old patient on July 7, 2017.
The patient, my mother, was admitted to the Trauma Centre after falling at home. But complications ensued. A day later she died of respiratory arrest (suffocation) followed by cardiac arrest after the breathing tube (intubation) keeping her alive had been removed. Early that day her anaemia treatment - blood packs - had been discontinued. Anaemia contributed to her weakened heart.
Her family, I among them, were not informed of any of this, which is required by law ie informed consent.
Effectively, the doctors euthanized her, in secret, rather than continue providing high care. A ward nurse only called the family one and a half to two hours after she died around 10.30pm.
When we arrived, her body was on a gurney, wrapped in plastic, waiting to be transported to the morgue. Mayet, who at visiting time earlier the evening had been uncommunicative and rude to the family, brusquely gave us basic facts. When we asked him about the circumstances of her death, including who authorised the tube's removal and how long she would have lived had it not been, he said he knew nothing and literally fled from the family room (a neglected space with broken furniture).
The morning she died a doctor (not one of the above) told us my mother was not deserving of an ICU or high care bed because she was elderly. That was, and is, a hospital directive and not national or universal health policy because there is no guideline or law that prevents a patient receiving care on the basis of age, gender, race or religious belief. Since there was no medical reason, it was unethical, illegal, discriminatory and unconstitutional. And malpractice.
That day the Trauma Centre was not excessively busy and there were free beds. There was no health emergency or resource crisis that forced staff to make hard decisions about whom to treat. As the family observed, the directive – euthanasia, violation of bodily integrity and informed consent, cessation of treatment, homicide, call it what you will – did not apply to other patients in the ward. It had nothing to do with medical reasons but to free beds for what they considered deserving cases like the usual alcohol and self-inflicted trauma admitted to South African hospitals.
In the same ward at the same time as my mother, there was the comatose young white man who had fallen while thrill-seeking mountain climbing and the comatose young black man who might have been a victim of township violence. They were deemed worth saving but not her because of her age.
Earlier, as the day progressed, her condition improved – responding to treatment and “looking better” the doctors said. Her medical record during those final critical hours did not indicate that prognosis was worsening.
Therefore, she was not “terminal” despite Patel, Nicol and others afterwards claiming so, their defence being she died of age-related natural causes. However, they contradicted each other about her collapsed lung, which that evening a nurse whispered to my sister had happened during intubation. Mayet and Al Sayari were silent about it but later Patel inadvertently confirmed it to me in rushed and rambling emails (she even got the time of death wrong) it had happened - lungs do not collapse by themselves so this fact was meant to be their big secret.
They never explained why my mom's lung collapsed. While age was a factor to her overall medical condition, the cause of death was not natural but the result of gross negligence, violation of health prescripts at many levels and assault.
The end stage of her life began with her lung collapsing during intubation, probably carelessly, hurriedly or inexpertly performed. It ended when an inexperienced doctor, 27-year-old Mikhail Botha, who, alone, without supervision, prematurely removed the breathing tube that was keeping her alive.
Pneumothorax is a serious condition, particularly in a compromised elderly patient. Recovery from its presentation takes more than the twelve or so hours the Trauma doctors allowed. Extubating when they did was an irrational, flawed decision and, therefore, medical negligence. This includes leaving Botha, essentially an intern, doing it without supervision. Because my mother died, it was culpable homicide.
To the family, Mayet, who was Botha's on-call supervisor, later denied any responsibility in her care. But he, Crowther, Al Sayari and Botha were her doctors during the critical, final four hours of her life.
It's difficult to say that if one or the other event had or had not happened she might have survived what with all her other conditions. While we not informed her lung had collapsed at the time it happened or afterwards (Patel's email admission about 20 days later was inadvertent and under pressure), we ought to have been informed the tube would be removed. That we weren't is entirely Botha's, Mayet's, Al Sayari's and Crowther's fault, and by extension, the hospital's and WCHD's.
Management - Patel, Nicol and Engelbrecht - too refused to comment or explain how and why the succession of mistakes and lapses of medical procedure was allowed to happen. Health laws and regulations - National Health Act and Health Professions Act - are very clear about care protocols in various situations. The only conclusion is there were failures at many levels and continuous lack of accountability, a fact in SA's public sector.
The hospital and WCHD hierarchy, viz Nicol, Patel and Engelbrecht, were evasive, obstructive and allegedly committed fraud to cover up. They refused to investigate, or said they would as they must per departmental policy and health laws, but refused to release a report to the family. Likely, no internal investigation was ever done. (In a different case I was told about, Groote Schuur's outpatient urology department treated a patient for an illness she did not have. The medicines caused, among other things, diabetes. But all the hospital was concerned about was whether she'd sue. No sincere apology, though.)
Patel refused to instruct Nicol to issue the report, who first said he would then baulked, despite it being WCHD policy. She condoned Nicol's failure to comply with policy and health regulations.
Similarly, Engelbrecht avoided us. She denied our requested meeting with her and health MEC Nomafrench Mbombo (a DA drone with no power, she ignored the family’s communications and played no part in the affair) saying it was "inappropriate". How can wanting to know what happened to a loved one, a parent, be inappropriate?
Yet later, to rationalise their conduct, she and Patel argued we never contacted them again when that was all we were doing. All they wanted was to cover themselves personally, and not even unselfishly, their departments.
The hospital's information officer, Dr Tunc Numanoglu, too behaved improperly although he had no direct connection to the matter. He ignored our request for my mother's medical records and refused to provide the names of her treating doctors and their practice numbers, which is a legal right. I had to submit an access to information request to force him to comply which he did up to three months later. And then he only gave three doctors' names - Crowther, Al Sayari and Botha - keeping us in the dark about the rest.
I suspect Engelbrecht disbanded WCHD's Independent Complaints Commission - she had reluctantly agreed to an investigation after family pressure - rather than have it investigate the matter, her conduct included.
The hospital and WCHD gaslighted and victim-shamed us. Contrary to the glowing picture the media portrayed on her retirement, Patel was among the worst with Mayet, Nicol and Engelbrecht, not counting Botha and the others who directly cared for my mom. She was aggressive, bullying, condescending, manipulative and rude, particularly in the circumstances of our grief and shock. Like her colleagues, she had no compassion and professional and human decency.
Unfortunately, this type of conduct runs rampant at WCHD and WC Government and in SA government. (Incidentally, the DA stridently claim they’re against bad governance.)
Politicians rush to sympathise with victims of tragedies when it's not their fault, but are scarce when it is.
When approached, then premier Helen Zille refused to investigate as she was obliged to under the National Health Act as ultimate head of WCHD, but instead stated her a priori confidence in Engelbrecht et al whom she had appointed.
She went further, though, and interfered in the police’s and NPA's Cape Town office Director of Public Prosecution’s pro forma “criminal investigation/inquest”. This was illegal. The police and DPP's Adv. Nadia Ajam gave Zille’s representative, Western Cape government advocate J Gerber, information that ought to have been confidential. Worse, it was given to the accused: Western Cape Government officers. This was defeating the ends of justice.
They got preferential treatment and direct access to police and NPA which is denied the public including victims/complainants for whom NPA is the pro forma advocate. Equality before the law does not apply as they practise it. Also, it’s unheard of for anyone - complainant, accused or third party - to be given information except basic status reports because it may hinder or compromise the investigation.
But the public know the police and NPA are corrupt and inept.
It did not end there. The state pathologist Dr Gavin Kirk gave postmortem findings to Andrew Nicol a couple of weeks after the postmortem despite by law (National Health Act regulations and those applying to officers of the court) it's privileged and can only be released to the police, prosecutor and court, and family of deceased. Kirk himself reiterated this obligation to the family at the time. The NPA were informed of his action but did nothing nor did it influence their confidence in him.
A pathologist's competence is limited to gathering evidence on the causes of death from the corpse, not events while the deceased was alive of which he has no direct knowledge. In this matter, Kirk told the family he had no remit over the patient’s treatment at hospital before her death.
Instead, over our objections and pleas to consult an independent expert, the NPA commissioned Kirk to make a medical negligence finding that, unsurprisingly, exonerated Nicol et al.
Kirk had obtained details about the deceased’s hospital care from Nicol and her medical file. Probably when he and Nicol met or spoke, Nicol told Kirk what he, DPP and their political masters and co-accused – Zille and WC Government – wanted to hear: that there was no medical negligence, no foul play, thereby exculpating himself and their mutual employer, WCHD, of responsibility.
Kirk and Nicol are senior members of UCT Medical School and WCHD, a conflict of interest they and NPA chose to ignore. NPA accepted Kirk’s finding there was no medical negligence.
Strangely, in his emailed postmortem summary to the family, Kirk said my mother's lungs showed no external trauma or signs of having collapsed. We suspect, though, her lung collapsed during intubation which would leave signs. It caused acute stress that compromised her system. That's why extubating her after less than a day made no medical sense.
The inconsistency of Kirk's finding to the medical facts lends support to the theory he modified his official findings, and subsequent unofficial medical negligence finding, to spare his WCHD and UCT colleagues Nicol et al. Bear in mind, he and Nicol spoke about the postmortem a week or two after it was done. It's easy to accept Kirk would have been influenced by Nicol's presentation and their collegial relationship especially since he - Kirk - had so easily broken regulations in giving an unauthorised third party, and one accused of serious malpractice and the law, postmortem findings.
Oddly, two years later police told the family medical negligence shall be covered by the still unscheduled inquest. There has been no contact from either NPA or Cape Town Inquest Magistrate Court, though, despite our annual requests for information.
In 2019 then recently appointed head of WCHD, Dr Keith Cloete, claimed in an email he was unaware of the case. It's hard to believe, though, because given Engelbrecht's, Zille's and the Independent Complaints Commission's involvement, the matter would have been on WCHD's agenda which Cloete and senior managers must have been aware of. Engelbrecht, who Cloete replaced, served only one term.
The Health Professions Council refused to investigate complaints against Patel and other doctors mentioned here. In addition to its well-known dysfunction and incompetence, it violated Health Professions Act regulations regarding inquiries.
It's hard not to conclude there was tacit collusion among NPA, police and WCHD to bury the case. This is their modus operandi. In 2003 the NPA told me it was "unfair (sic)" to prosecute Groote Schuur hand registrar Dr Christopher Hobbs, a British citizen training there, after I laid charges against him for practising without registration. Hobbs had misdiagnosed an injury that left permanent damage. It was then I discovered his unlicensed state which the hospital and WCHD knew but denied. Hobbs did not miss a day's work, he and his superior Dr Mike Solomons harassing me when I attended the clinic.
Initially, partly deliberate collusion and partly incompetence, NPA said there was no criminal case despite the law being clear. After I pressured them, though, they admitted Hobbs had acted illegally. But it was too late. By then Hobbs had returned to England, after the hospital and WCHD protected him. The NPA said they'd apply for a bench warrant but never did.
This how the NPA considers crime in general and crime by government officers in particular. Then HPCSA declined to charge Hobbs or the implicated WCHD officers.
Postscript
From information I obtained in 2019, I believe document(s) were placed into my mother's medical file after the event to support the doctors' and hospital's version of events that exonerated them. These relate to supposed communication with the family they claim met their ethical requirements. But it could not have and never happened - we were never contacted when they say we were, and the family member they claim they spoke to telephonically was not listed as a contact or next of kin in my mother's hospital record, neither was that member's number.
Manipulating a medical record is common fraud and violates health laws. Because there was to be an official inquiry, my mom's hospital file ought to have been sealed. But it wasn't, and this was Patel's, Engelbrecht's and Nicol's responsibility. Alleged tampering would have been done with their knowledge and consent and even collusion.
I reported it to the NPA who did nothing. But since the NPA and police had failed to undertake basic steps in the "inquiry", like taking statements from those involved in the case and themselves were accused of a cover up and corruption, it's understandable they would ignore alleged official fraud.
Late 2019 a Woodstock detective advised us to hire a lawyer, in other words, to initiate a private lawsuit or prosecution. Bizarrely, he did this while lying about their interest in the case - the police and NPA had been indifferent from the start, protecting their principal, government. But it would be hard to start legal action when the hospital, WCHD and organs of justice - police, prosecutor, pathologist and even Inquest Court - had stitched up the case, ignored and manipulated evidence and just failed to do their jobs.
The NPA and Cape Town Magistrate Inquests Court has ignored our annual requests for status reports and copies of the file. A letter to then deputy justice minister John Jeffery was unanswered.
This post contains previously posted information and the edited contents of affidavits to the NPA and Cape Town Magistrate Court.
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