ATC170524: Report of the Select Committee on Petitions and Executive Undertakings on the Hearings of the Fuzane Petition, held on 6 May 2015, 13 May 2015 and 3 June 2015, at Parliament
NCOP Petitions and Executive Undertakings
REPORT OF THE SELECT COMMITTEE ON PETITIONS AND EXECUTIVE UNDERTAKINGS ON THE HEARINGS OF THE FUZANE PETITION, HELD ON 6 MAY 2015, 13 MAY 2015 AND 3 JUNE 2015, AT PARLIAMENT
1. BACKGROUND
The Fuzane Petition (petition) was referred to the Select Committee on Petitions and Executive Undertakings (Committee), by the Chairperson of the National Council of Provinces (NCOP), for its consideration and resolution on 25 November 2014.
The petition is submitted to NCOP by Ms Nobuntu Fuzane (Ms Fuzane) on behalf of her late daughter, Tamara Fuzane (Tamara). In the petition, Ms Fuzane directs complaints against two medical facilities located within the City of Cape Town, namely, Groote Schuur Hospital (GSH) and Khayelistha District Hospital (KDH). In this respect, Ms Fuzane contends that Tamara was negligently discharged from GSH, in or around July 2011, after undergoing an invasive brain operation. She further contends that three years later, in or around, February 2014, Tamara was physically assaulted whilst admitted at KDH.
2. HEARINGS ON THE PETITION
The Committee, together with the Portfolio Committee on Health (PC on Health), held a total of three hearings on the petition at Parliament. A primary purpose of these hearings was to afford the petitioner as well as the relevant stakeholders the opportunity to make first hand oral submissions on the petition.
3. FIRST HEARING ON THE FUZANE PETITION
The first hearing on the petition was held on 6 May 2015 at Parliament.
3.1 Committee Members and Officials
The following Committee Members attended the hearing on the petition:
3.1.1 Hon S G Thobejane, ANC, Limpopo;
3.1.2 Hon M J Mohapi, ANC, Free State;
3.1.3 Hon LPM Nzimande, ANC, Kwa-Zulu Natal;
3.1.4 Hon M T Mhlanga, ANC, Mpumalanga;
3.1.5 Hon G M Manopole, ANC, Northern Cape;
3.1.6 Hon D L Ximbi, ANC, Western Cape;
3.1.7 Hon T Wana, ANC, Eastern Cape’
3.1.8 Hon Michalakis, DA, Free State;
3.1.9 Hon J W W Julius, DA, Gauteng; and
3.1.10 Hon M Chetty, DA, Kwa-Zulu Natal.
The Committee Members attending the hearing were supported by the following Committee officials:
3.1.11 Mr N Mkhize, Committee Secretary;
3.1.12 Dr M Gondwe, Committee Content Advisor;
3.1.13 Adv. T Sterris, Committee Researcher,
3.1.14 Ms A Zindlani, Committee Assistant; and
3.1.15 Ms N Fakier, Executive Secretary to the Committee Chairperson.
The following Members of the PC on Health attended the hearing on the petition:
3.1.16 Hon ML Dunjwa (Chairperson), ANC, Eastern Cape;
3.1.17 Hon Dr P Maesela, ANC, Gauteng;
3.1.18 Hon AF Mahlalela, ANC, Mpumalanga;
3.1.19 Hon SM Jafta, AIC, Eastern Cape;
3.1.20 Hon I Mosala, ANC, North West;
3.1.21 Hon MA Scheepers, ANC, Free State;
3.1.22 Hon Dr WG James, DA, Western Cape;
3.1.23 Hon HC Volmink, DA, Gauteng;
3.1.24 Hon LV James, DA, Western Cape;
3.1.25 Hon MO Mokause, EFF, Northern Cape;
3.1.26 Hon SJ Nkomo, IFP, Kwa-Zulu Natal; and
3.1.27 Hon AM Shaik, NFP, Kwa-Zulu Natal.
The PC on Health was supported by the following officials:
3.1.28 Ms L Ngomane, Content Advisor;
3.1.29 Ms V Majalamba, Committee Secretary;
3.1.30 Ms N Magubane, Committee Assistant; and
3.1.31 Mr Z Rahim, Committee Researcher.
3.2 Stakeholders
The following stakeholders attended the hearing on the petition:
3.2.1 Ms N Fuzane, the Petitioner;
3.2.2 Dr T Carter, Deputy Director General, National Department of Health;
3.2.3 Dr D Bass, Medical Advisor, Western Cape Department of Health;
3.2.4 Dr B Engelbrecht, Head of Department, Western Cape Department of Health;
3.2.5 Dr Patel, Chief Executive Officer, Groote Schuur Hospital; and
3.2.6 Dr A Kharwa, Chief Executive Officer, Khayelitsha District Hospital.
3.3 Submissions by the Petitioner
The petitioner introduced herself as Ms Fuzane from Khayelitsha and further stated that she is currently employed as a cleaner at a local police station.
Ms Fuzane then proceeded to explain that she submitted the petition on behalf of her daughter, Tamara Fuzane (Tamara), who passed away on 12 April 2015 in Groote Schuur Hospital (GSH) and was subsequently buried on 18 April 2015, at the age of 32 years. Ms Fuzane explained that because Tamara had been diagnosed with a brain-related condition from childhood she was compelled to, time and again, receive medical treatment at various medical facilities within the Western Cape Province including at GSH and Khayelitsha District Hospital (KDH).
Ms Fuzane informed the Committee that, in or around July 2011, her daughter’s took a turn for the worst and she was forced to take her daughter to GSH for medical treatment. During her daughter’s admission at GSH she was informed that the drain pipes inserted into her brain were blocked and she would need an operation to replace them. And she signed the necessary consent papers for her daughter’s operation however when she arrived to visit her daughter, following the operation, she was shocked to discover that her daughter had been admitted in a normal ward and not in the Intensive Care Unit (ICU) ward of the Hospital given the seriousness of the operation she had undergone. She further informed the Committee that she was later refused a medical report on her daughter’s condition and was told that she should take her daughter home since there was nothing more the Hospital could do for her.
Ms Fuzane further informed the Committee that she informed the media of the incident and it was published in a local publication called City Vision (Khayelitsha) on 25 August 2011. Following the publication of the article she received a call from the management of GSH, requesting a meeting with her. After her meeting with the management of GSH, her daughter was re-admitted her to the GSH, and later referred her to Conradie Care Centre (Centre) for her rehabilitation.
Ms Fuzane also informed the Committee that after three months, Tamara was discharged from the Centre and the Centre made an appointment for Tamara to go to GSH for a checkup towards the middle of November 2011. And when she took Tamara to GSH for her checkup, the attending doctor informed her that her daughter would be discharged and referred back to KDH. However, because no referral letter was issued by the attending doctor she had great difficulty in accessing treatment for her daughter at KDH.
[Due to time constraints, Ms Fuzane was unable to complete her submissions and the hearing was subsequently postponed to 13 May 2015.]
4. SECOND HEARING ON THE FUZANE PETITION
The second hearing on the petition was held on 13 May 2015 at Parliament.
4.1 Committee Members and Officials
The following Committee Members attended the second hearing on the petition:
4.1.1 Hon S G Thobejane, ANC, Limpopo (Chairperson of the Committee);
4.1.2 Hon M J Mohapi, ANC, Free State;
4.1.3 Hon L P Nzimande, ANC, Kwa-Zulu Natal;
4.1.4 Hon G M Manopole, ANC, Northern Cape;
4.1.5 Hon D L Ximbi, ANC, Western Cape;
4.1.6 Hon T Wana, ANC, Eastern Cape;
4.1.7 Hon M Chetty, DA, Kwa-Zulu Natal
4.1.8 Hon J W Julius, DA, Gauteng; and
4.1.9 Hon G Michalakis, DA, Free State;
The Committee Members attending the hearing were supported by the following Committee officials:
4.1.10 Mr. N Mkhize, Committee Secretary;
4.1.11 Dr M Gondwe, Committee Content Advisor;
4.1.12 Adv T Sterris, Committee Researcher;
4.1.13 Ms A Zindlani, Committee Assistant, and
4.1.14 Ms N Fakier, Executive Secretary to the Committee Chairperson.
The following Members of the PC on Health attended the hearing on the petition:
4.1.15 Hon ML Dunjwa (Chairperson), ANC, Eastern Cape;
4.1.16 Hon Dr P Maesela, ANC, Gauteng;
4.1.17 Hon AF Mahlalela, ANC, Mpumalanga;
4.1.18 Hon SM Jafta, AIC, Eastern Cape;
4.1.19 Hon I Mosala, ANC, North West;
4.1.20 Hon MA Scheepers, ANC, Free State;
4.1.21 Hon Dr WG James, DA, Western Cape;
4.1.22 Hon HC Volmink, DA, Gauteng;
4.1.23 Hon LV James, DA, Western Cape;
4.1.24 Hon MO Mokause, EFF, Northern Cape;
4.1.25 Hon SJ Nkomo, IFP, Kwa-Zulu Natal; and
4.1.26 Hon AM Shaik, NFP, Kwa-Zulu Natal.
The PC on Health was supported by the following officials:
4.1.27 Ms L Ngomane (Content Advisor);
4.1.28 Ms V Majalamba (Committee Secretary);
4.1.29 Ms N Magubane (Committee Assistant); and
5.1.30 Mr Z Rahim (Committee Research).
4.2 Stakeholders
The hearing on the petition was attended by the following stakeholders:
4.2.1 Ms N Fuzane, the Petitioner;
4.2.2 Dr T Carter, Deputy Director General, National Department of Health;
4.2.3 Dr D Bass, Medical Advisor, Western Cape Department of Health;
4.2.4 Dr B Engelbrecht, Head of Department, Western Cape Department of Health;
4.2.5 Dr Patel, Chief Executive Officer, Groote Schuur Hospital; and
4.2.6 Dr A Kharwa, Chief Executive Officer, Khayelitshe District Hospital.
5. Continuation of Submissions by the Petitioner
At the second hearing on the petition, Ms Fuzane resumed with her oral submissions and outlined at great length and detail the events that led her to submit the petition on behalf of her late daughter, Tamara whom she contends was neglected and maltreated during her admissions at GSH and KDH.
5.1 Complaints against Groote Schuur Hospital
In her submissions, Ms Fuzane informed the Committee she initially took Tamara to GSH, in or around May 2011, and the attending doctor at the time, Dr Thompson, told her to take Tamara back home because GSH had no medical history on Tamara. She further informed the Committee that, two weeks later, Tamara’s health deteriorated and she was forced to return to GSH on 28 July 2011. Dr Thompson was, once again, the attending doctor on 28 July 2011 and he informed her that Tamara had to be operated on because the drain pipes or surgical shunts inserted into her brain were blocked and needed to be replaced.
Ms Fuzane also submitted that after she visited Tamara, at GSH after her operation, she was shocked to find that Tamara had been admitted in a general ward rather than in the Intensive Care Unit (ICU) ward of the Hospital. She visited Tamara, again, on 1 July 2011 and the nursing sister in charge told her that Tamara had been discharged despite her still being in a critical condition. On being told that Tamara had been discharged, Ms Fuzane pleaded with the nursing sister in charge, Sister Peterson, to let Tamara remain at the Hospital until the following day as she had come straight to the hospital from her place of work and had not brought a change of clothing for Tamara nor had she made transport arrangements for taking Tamara back home. Sister Peterson informed her this was not possible as Tamara’s bed had already been allocated to another patient.
Ms Fuzane then sought the assistance of Ms Belinda Bailey (Ms Bailey), a medical social worker, and Ms Bailey attempted to convince Sister Peterson to let Tamara stay another night however Sister Peterson gave her the same reason she had given Ms Fuzane. Sister Peterson then provided Ms Fuzane with a bed sheet to wrap around Tamara and also advised her to hire a car in order to take Tamara home. Ms Fuzane, instead, called her place of work for assistance in taking Tamara home because she had no money to hire a car. And the human resources unit, at her place of work, was able to assist her by sending a driver to fetch her and Tamara.
Ms Fuzane further submitted that she had also requested Sister Peterson to provide Tamara with a wheel chair as Tamara was unable to walk and Sister Peterson had informed her that there was a long process involved in getting a wheelchair and a waiting list for persons requiring wheelchairs. Sister Peterson did however agree to lend Ms Fuzane a wheel chair in getting Tamara to the car on condition that a security guard accompany the wheel chair to the car.
Ms Fuzane further that she was so aggrieved by this particular incident at GSH that she decided to report the incident to the media and the incident was reported in City Vision (Khayelitsha), a local community newspaper. After she reported the incident to the media, GSH kept calling her and requesting that she withdraw the story from the media. Further according to Ms Fuzane, following the publication of her experience at GSH in the media, GSH called her and arranged for her to meet with the superintendent of the hospital, Dr Belinda Jacobs (Dr Jacobs). At the meeting Dr Jacobs stated that because Tamara’s operation had been improperly done, she needed to be readmitted at GSH and the following day GSH sent an ambulance, escorted by two police vehicles, to fetch Tamara. Tamara’s attending doctors at the time, Dr Fagan and Dr Mjoli, subsequently informed her that Tamara would need another operation.
Dr Mjoli performed the operation and Tamara was admitted in ICU at the Hospital. Whilst Tamara was admitted at GSH, a medical social worker informed her that the attending doctors had recommended that Tamara be placed in a care centre. She was given the option of placing Tamara at the Conradie Hospital Care Centre or the Booth Memorial Hospital Care Centre. She opted to have Tamara placed at the Conradie Hospital Care Centre as it was much cheaper than the Booth Memorial Hospital Care Centre. After Tamara was placed at the Conradie Hospital Care Centre, GSH undertook to attend to her. Ms Fuzane also submitted that at some point she enquired, from the medical social worker at the care centre, if the medical doctors from GSH had attended to Tamara. The medical social worker informed her that no medical doctors had attended to Tamara as she was not on their list of patients. On 4 November 2011, Tamara was discharged from the Conradie Hospital Care Centre and she was informed by the attending doctor to take Tamara to KDH for medical attention. The reason given for the discharge by the attending doctor was that Ms Fuzane and Tamara were from the Khayelitsha area and the Conradie Hospital Care Centre did not admit patients for a period of more than 6 weeks. Lastly, Ms Fuzane added that for the remainder of 2011, Tamara was not seen by any doctor.
5.2 Complaints against Khayelitsha District Hospital
With respect to the complaints against KDH, Ms Fuzane submitted to the Committee that after Tamara’s health took a turn for the worst, on 4 February 2014, she was forced to call an ambulance. The ambulance came and took Tamara to KDH. Tamara was later referred to GSH as her medical records were at GSH and not at KDH. On 7 February 2014, Tamara was referred back to KDH by GSH. On 13 February 2014, KDH phoned Ms Fuzane and requested her to come and fetch Tamara because she had been discharged from the hospital.
When Ms Fuzane arrived at the hospital and, as she was preparing to take Tamara home, she noticed that Tamara had been beaten up. She then approached the nursing sister in charge and asked her who had beaten Tamara up. The nursing sister in charge responded that she did not know who had beaten Tamara up and proceeded to question other nurses in an effort to establish what had happened to Tamara and they indicated that they knew nothing. The nursing sister in charge then advised Ms Fuzane to complete a J88 form and consult a private doctor. Ms Fuzane completed the form and consulted a private doctor by the name of Dr Mawisa. Dr Mawisa examined Tamara and confirmed that Tamara had sustained lesions or abrasions on her back and also established that Tamara had a fractured hip. After consulting the private doctor, Ms Fuzane reported the incident to the police and the police took pictures of her injuries and promised to investigate the matter.
Ms Fuzane also submitted that she had informed the Reverend of her church about the incident and the Reverend phoned Mr Kupelo who referred her to Ms Mashego in Pretoria. She related the incident and the circumstances surrounding the incident to Ms Mashego and Ms Mashego requested her to send photos of Tamara pre and post the operation and she did just that. However, Ms Mashego later informed her that there was nothing she could do because she did not work for the relevant government department and she advised her to engage a lawyer.
Ms Fuzane further stated that, on 18 February 2014, she also opened a case against KDH at Harare Police Station, in Khayelitsha, and she met with a senior prosecutor by the name of Ms Haramse and a constable regarding her case and Ms Haramse told her she would take the matter to the High Court. At the end of October 2014, Ms Haramse informed her she had closed the case as she had not been able to establish what had happened to Tamara. She further advised her to find a place where Tamara can be looked after and also advised her to find a lawyer to assist her to sue the hospital. In her closing submissions, Ms Fuzane informed the Committee that a non-governmental organization known as the Treatment Action Campaign was currently trying to provide her with legal assistance in relation to her complaints.
In relation to the relief sought, Ms Fuzane told the Committee that she had been affected by the manner in which she and Tamara were treated at GSH and KDH and as such she sought to hold the concerned health facilities accountable in this regard, particularly in their treatment of Tamara. She added that by the time Tamara passed on she was unable to walk and had pressure sores as a result of not being able to walk. She also added that the nursing sister, Sister Mdekaze that KDH had sent to her house to provide home based care for Tamara cried when she saw the deplorable state that Tamara was in.
Ms Fuzane also informed the Committee, during the course of her submissions, that she had not been informed of the consequences of the operation on Tamara even though she signed consent forms for the operation. She further indicated that she only signed the consent forms because she was told Tamara would recover after the operation.
Lastly, Ms Fuzane maintained that after Tamara’s operation at GSH, she had had no interactions with officials from the offices of the MEC for Health and Director General for Health and had only interacted with Sister Mdekaze from the Provincial Department of Social Development as she had come to assess Tamara and provide home based care for her before she died.
5.2 Submissions by the Khayelitsha District Hospital
In his submissions, Dr Kharwa, the Chief Executive Officer (CEO) of KDH submitted that in his capacity as the CEO of KDH, he had had a number of interactions with Ms Fuzane and Tamara Dr Kharwa further explained that Tamara was diagnosed as having a cyst in the brain which resulted in her experiencing recurring epileptic seizures. And as a result of her condition she received surgical intervention and a shunt was inserted in her brain, at GSH, to relieve pressure on the brain. Dr Kharwa further submitted that subsequent to this operation at GSH, she was admitted to KDH on 7 February 2014. On admission, KDH personnel noted she had pressure sores and blisters on her right foot and she had received the necessary care to minimise the discomfort associated with the blistering and pressure sores. However, concerns later arose around the shunt inserted into her brain and a decision was taken to transfer her to GSH for further medical examination. GSH accordingly examined her and she was transferred back to KDH on the same day.
Dr Kharwa also informed the Committee that due to Tamara’s condition, she could not move and as such was susceptible to getting pressure sore and blisters. He added that Ms Fuzane’s allegations of assault were investigated by KDH and the key findings of the investigation, into these allegations, pointed to the fact that no assault had taken place. The findings also determined that there had been no malicious intent on the part of the attending nurses. Further according to Dr Kharwa, what appeared on Tamara’s body as assault wounds was pressure ulcerations that mimicked assault wounds in their appearance. In his submissions, Dr Kharwa
further submitted that the hospital also sought legal guidance and was advised to support Ms Fuzane by looking after Tamara and home based care services were arranged for Tamara and care givers were sent to Ms Fuzane’s home two or three times a week. He added that from the KDH’s perspective, the necessary support was extended to Ms Fuzane and her daughter was given the best care possible. Dr Kharwa also stressed that under no circumstances was Tamara assaulted and the marks on her body were as a result of the pressure ulcers she exhibited. Dr Kharwa further acknowledged the fact that the attending nurses should have picked up on the marks on her body and noted this as an oversight on the part of the attending nurses. Dr Kharwa further submitted that Tamara was already wheelchair bound when she came to the KDH and further denied that her hip was broken whilst she was in the care of KDH.
[Due to time constraints, Dr Kharwa was unable to finish his submissions and the hearing was, accordingly, postponed to 3 June 2015.]
6. THIRD HEARING ON THE FUZANE PETITION
The third and final hearing on the petition was held, by the Committee and the PC on Health, on 3 June 2015.
6.1 Committee Members and Officials
The following Committee Members attended the third hearing on the petition:
6.1.1 Hon S G Thobejane, ANC, Limpopo (Chairperson of the Committee);
6.1.2 Hon M J Mohapi, ANC, Free State;
6.1.3 Hon L P Nzimande, ANC, Kwa-Zulu Natal;
6.1.4 Hon G M Manopole, ANC, Northern Cape;
6.1.5 Hon D L Ximbi, ANC, Western Cape;
6.1.6 Hon T Wana, ANC, Eastern Cape;
6.1.7 Hon M Chetty, DA, Kwa-Zulu Natal
6.1.8 Hon J W Juluis, DA, Gauteng; and
6.1.9 Hon G Michalakis, DA, Free State.
The Committee Members attending the hearing were supported by the following Committee officials:
6.1.10 Mr. N Mkhize, Committee Secretary;
6.1.11 Dr M Gondwe, Committee Content Advisor;
6.1.12 Adv T Sterris, Committee Researcher;
6.1.13 Ms A Zindlani, Committee Assistant, and
6.1.14 Ms N Fakier, Executive Secretary to the Committee Chairperson.
The following Members of the PC on Health attended the hearing on the petition:
6.1.15 Hon ML Dunjwa (Chairperson), ANC, Eastern Cape;
6.1.16 Hon Dr P Maesela, ANC, Gauteng;
6.1.17 Hon I Mosala, ANC, North West;
6.1.18 Hon MA Scheepers, ANC, Free State;
6.1.19 Hon Dr WG James, DA, Western Cape;
6.1.20 Hon HC Volmink, DA, Gauteng;
6.1.21 Hon MO Mokause, EFF, Northern Cape;
6.1.22 Hon SJ Nkomo, IFP, Kwa-Zulu Natal; and
6.1.23 Hon AM Shaik, NFP, Kwa-Zulu Natal.
The PC on Health was supported by the following officials:
6.1.24 Ms L Ngomane (Content Advisor);
6.1.25 Ms V Majalamba (Committee Secretary); and
6.1.26 Ms N Magubane (Committee Assistant).
6.2 Stakeholders
The hearing on the petition was attended by the following stakeholders:
6.2.1 Ms N Fuzane, the Petitioner;
6.2.2 Dr T Carter, Deputy Director General, National Department of Health;
6.2.3 Dr D Bass, Medical Advisor, Western Cape Department of Health;
6.2.4 Dr B Engelbrecht, Head of Department, Western Cape Department of Health;
6.2.5 Dr Patel, Chief Executive Officer, Groote Schuur Hospital; and
6.2.6 Dr A Kharwa, Chief Executive Officer, Khayelitsha District Hospital.
6.3 Continuation of Submissions by Khayelitsha District Hospital
In making his closing submissions to the Committee, Dr Kharwa chose to read out paragraph 9 of the memorandum, which was prepared by Dr Beth Engelbrecht (Dr Engelbrecht), the Head of Department for the Western Cape Department of Health.
The stated paragraph in the memorandum, in essence, summarises the details around Tamara’s admission at KDH and the actions taken by KDH upon Ms Fuzane discovering that Tamara had sustained injuries to her upper body.
Dr Kharwa further submitted that it was regrettable that no one at KDH noticed the injuries until such a time Ms Fuzane brought them to the KDH’s attention. He also reiterated the he commissioned an investigation aimed at determining the cause of Tamara’s injuries and whether these injuries could have been inflicted on Tamara whilst she was admitted at KDH. However, the investigation he commissioned did not attribute the injuries to an assault on Tamara whilst admitted at KDH.
Also his submissions to the Committee, Dr Kharwa mentioned that, in his capacity as the CEO of KDH, he had had a number of interactions with Ms Fuzane and Tamara. Dr Kharwa further explained that because Tamara was diagnosed as having a cyst in the brain which resulted in her experiencing recurring epileptic seizures, she received surgical intervention and a shunt was inserted in her brain, at GSH, to relieve the pressure on the brain. And subsequent to this operation at GSH, she was admitted to KDH on 7 February 2014. On admission, KDH personnel noted she had pressure sores and blisters on her right foot and she received the necessary care to minimise the discomfort associated with the pressure sores and blisters.
Also according to Dr Kharwa, Tamara was discharged on 13 February 2014 whereupon the petitioner enquired about the injuries on her back. On 14 February 2014, Ms Fuzane took Tamara to a private doctor who concluded that she had suffered soft tissue injuries and a fractured hip. Thereafter she lodged a formal complaint with KDH and the complaint was handled by the quality assurance manager (manager) of KDH. The manager arranged for Tamara to be assessed by a doctor and the assessing doctor discovered she had lesions in the area of her right buttock and pressure sores on parts of her back. On 21 February 2014 a follow up appointment was arranged for Tamara and her wounds were reviewed by a clinician who determined that the blistering and pressure sores were in the process of healing and she should continue with the treatment given to her. Her psychological condition and recurring seizures were also reviewed. On 14 March 2014, Tamara was also examined by Dr Lowrie, an emergency physician specialist and Dr Lowrie reported that Tamara did not have a fractured hip.
Dr Kharwa further submitted that a constable from the South African Police Service informed KDH that Ms Fuzane had opened an assault case against the hospital and he met with Ms Fuzane and other hospital officials in an effort to deal with the matter. The hospital then took a decision to appoint an external investigator to look into the matter and Dr Viljoen, a general specialist and clinical manager at Heldeberg Hospital was appointed as an external investigator. Dr Viljoen’s findings were that there was no malicious intent on the part of KDH and its personnel to inflict harm on Tamara. Dr Viljoen also found that Tamara had, between her various admissions, developed the noted lesions and pressure sores. Dr Viljoen found that the lesions and pressure sores could not be attributed to injuries inflicted on her by the medical personnel caring for her. Dr Kharwa also submitted that a similar determination was made by a magistrate after the matter was brought before a magistrate with Treatment Action Campaign representing Ms Fuzane. The magistrate made the determination that Tamara had not been assaulted.
In concluding his submissions, Dr Kharwa informed the Committee that, in or around December 2014, attempts were made by KDH to arrange a placement for Tamara for 6 weeks in order to relieve Ms Fuzane form caring for her. Ms Fuzane, however, refused to give her consent for the placement to be made. Eventually Ms Mdekaze, a nursing sister, was sent by KDH to visit Ms Fuzane and Tamara in order to determine the type of intervention they required and home based care services (including wound dressing and the provision of supplies such as adult nappies) were provided to Tamara on a weekly basis. Tamara was later re-admitted on 4 April 2015 for severe septic wounds, pressure sores and seizures. She was initially referred to Tygerberg Hospital but ended up at GSH (because GSH had the file on her medical history) until she passed on, on 8 April 2015. In concluding his submissions to the Committee, Dr Kharwa concluded that during her admission at KDH, Tamara received the best care as evidenced from the clinical and medical notes made in relation to her admissions and on no occasion was she assaulted by personnel at KDH.
6.4 Submissions by the National Department of Health
After Dr Kharwa concluded her submissions to the Committee, the Committee heard submissions from Dr Carter, a Deputy Director General in the National Department of Health.
In his submissions, Dr Carter informed the Committee that he had consulted Professor Saayman, Head of Forensic Medicine, at the University of Pretoria with regards to the petition and had requested him to draw conclusions as to the most likely cause of the injuries sustained by Tamara. Professor Saayman then concluded, in a written report, that the injuries sustained by Tamara could be attributed to an assault, with an object resembling a cane or stick. In his report, Professor Saayman, also indicated that the injuries were inflicted in a repetitive manner and as such were not consistent with accidental injuries. Professor Saayman further concluded that the injuries were likely inflicted on Tamara on the day before she was discharged from KDH.
Dr Carter also informed the Committee he undertook a visit to KDH in an effort to investigate the complaints against KDH and no one had any knowledge of what might have happened to Tamara during her admission at KDH in July 2011. Dr Carter further indicated that he requested the names and contact details of the nurses and patients who might have useful information around the alleged assault on Tamara. According to Dr Carter, it was highly unlikely that no one witnessed anything related to the alleged assault. As part of his investigations, Dr Carter also undertook a visit to Khayelitsha Police Station and perused the docket pertaining to the alleged assault on Tamara and found that it had been closed and later reopened on 15 May 2015. He added that he spoke to the Senior Prosecutor assigned to the case and informed him he had new information relating to the case and further recommended to him that the case be reinvestigated.
6.5 Submissions by the Provincial Department of Health
Dr Engelbrecht gave submissions on behalf of the Provincial Department of Health. Prior to making her submissions, Dr Engelbrecht informed the Committee that as part of her submissions she would read out in full the memorandum she had prepared for the hearing in an effort to summaries the facts surrounding Tamara’s admission at the relevant hospitals. (See the memorandum submitted by Dr Englebrecht, attached as Annexure A hereto). Dr Engelbrecht also emphasised that as Head of Department, she took full responsibility for the actions, of all the personnel placed under her supervision.
In the course of responding to questions from the Committee on her submissions, Dr Engelbrecht indicated she only became aware of the complaints set out in the petition when the petition was submitted to Parliament and not when the complaints were initially levelled against the concerned medical facilities. She further clarified that the investigation carried out by Dr Viljoen under the direction of KDH was intended to determine, solely, the cause of the injuries sustained by Tamara despite the injuries being a few days old. She further stated that she accepted Tamara had sustained injuries but it was not clear who should be held accountable for the injuries because there is no record of the injuries or when they occurred.
In her submissions, Dr Engelbrecht also requested the Committee to allow Dr Patel, the Chief Executive Officer of GSH, to briefly expand on the complaints procedure at GSH.
In her brief submissions, Dr Patel submitted that the GSH took every complaint it received from its patients in a serious light and it had looked into the complaint from Ms Fuzane, namely that Tamara had been improperly and neglectfully discharged from GSH in July 2011. Dr Patel further stated that after looking into the complaint they established that Tamara’s discharge had not been patient-centred and for that reason, GSH apologised to Ms Fuzane for the discharging nurse’s behaviour and assured her that GSH would talk to the relevant discharging nurse regarding her behaviour in this instance.
7. OBSERVATIONS AND FINDINGS
The Committee made the following observations and findings in relation to the submissions made during the hearings on the petition:
7.1 Groote Schuur Hospital investigated the complaints into the improper and negligent discharge of Tamara from the medical facility and determined that Tamara’s discharge from the medical facility had not been patient centred. And thereafter, the medical facility tendered an apology to Ms Fuzane and assured her that it will address the complaint with the discharging nurse.
7.2 The external investigation conducted by Khayelitsha District Hospital, into the alleged assault on Tamara, is not conclusive or extensive enough as no statements were taken from the relevant patients or attending medical personnel.
7.3 Nothing in the submissions, made by Khayelitsha District Hospital, points to the fact that Tamara was thoroughly examined pre and during her admission at the medical facility. In fact, the attending medical personnel at Khayelitsha District Hospital failed to notice the lesions and abrasions on Tamara, during her admission, and as such Ms Fuzane was the first person to notice the lesions and abrasions on Tamara ’s body.
7.4 Record keeping by the attending nurses, at Khayelitsha District Hospital, appears to have been poor and incomplete and this is evidenced by the fact that in the course of its oral submissions, the medical facility, could not, for instance, reliably confirm how many times Tamara was turned in a day or that she was thoroughly examined before she was admitted.
7.5 The poor and incomplete record keeping, at Khayelitsha District Hospital, referred to in 7.4 above, is not only contrary to the principles of Batho Pele (which are aligned to the Constitution) but also regrettable given the sensitive and confidential nature of the information involved (i.e. medical information).
7.6 The submission, by Dr Kharwa and the Head of the Provincial Department of Health, that it is regrettable that no one at Khayelitsha District Hospital noticed the lesions and abrasions on Tamara’s body is tantamount to a prima facie admission that Tamara sustained the lesions and abrasions whilst admitted at Khayelitsha District Hospital.
- A request by the Committee for the relevant attending nurses, from Khayelitsha District Hospital, to appear before the Committee and make oral submissions on the petition was not acceded to by the Head of the Provincial Department of Health. This reluctance, on the part of Head of the Provincial Department of Health, to permit the relevant attending nurses to appear before the Committee is contrary to the spirit and the letter of the principles of co-operative governance articulated in the Constitution.
7.8 The memorandum prepared by the Head of the Provincial Department of Health, in response to the petition, is not detailed enough and lacks information on, amongst others, the extent of the internal investigation conducted, by Khayelitsha District Hospital, to determine if Tamara had been indeed assaulted.
7.9 Dr Carter, from the National Department of Health, conducted an investigation into the complaints against Khayelitsha District Hospital and came to the conclusion, together with Professor Saayman, that Tamara was likely assaulted given the nature and appearance of the lesions and abrasions on Tamara’s body.
8. RECOMMENDATIONS
Following extensive deliberations on the submissions made during the hearing on the petition, the Committee recommends as follows:
- That the National Department of Health (NDH) conduct a thorough investigation into the complaints raised by Ms Fuzane in the petition, against Khayelitsha District Hospital and Groote Schuur Hospital. The investigation by the NDH is to take into account the following:
- The fact that no statements were taken from the relevant medical personnel, at both Khayelitsha District Hospital and Groote Schuur Hospital, during internal investigations into the complaints by Ms Fuzane;
- The reluctance, on the part of the Provincial Department of Health, to allow the relevant medical personnel, from Khayelitsha District Hospital, to make oral submissions to the Committee on the issues raised in the petition;
- The poor and incomplete record keeping at Khayelitsha District Hospital;
- The outcomes of the investigation conducted by Dr Carter concluding that Tamara Fuzane was likely assaulted whilst admitted at Khayelitsha District Hospital; and
- The medical report by Professor Saayman which concluded that the injuries which Tamara Fuzane sustained, whilst admitted at Khayelitsha District Hospital, could be attributed to an assault, with an object resembling a cane or stick.
- That the House refer the investigation, by the NDH referred to in 8.1 above, to the Select Committee on Social Services for oversight and further require the Select Committee on Social Services to request a progress report on the investigation, within 90 days of the tabling of this report in the House.
- That the National Prosecuting Authority and the Independent Police Investigative Directorate investigate the assault allegations raised by Ms Fuzane in the petition as well as whether appropriate action was taken by the South African Police Services in investigating the allegations.
- That the House refer the investigations by IPID and the NPA to the Select Committee on Security for oversight and require the Select Committee on Security to request a progress report on the investigations, within 90 days of the tabling of this report in the House.
- That the House assist Ms Fuzane to refer the complaints, against both Khayelitsha District Hospital and Groote Schuur Hospital, to the Office of the Health Ombud for further investigation.
Report to be tabled for consideration.
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