Patients suffer and R4.8 million is lost as computers break down at George Mukhari Hospital

Patient care has been badly affected at the George Mukhari Hospital in north-west Gauteng due to the breakdown of their computer system, which has also resulted in a revenue loss of R4.8 million.

This is revealed by Gauteng Health MEC Nomathemba Mokgethi in a written reply to my questions in the Gauteng Legislature.

According to Mokgethi, the Medicom system at the hospital has not been functional since 23 January this year. The infrastructure equipment for Medicom was acquired between 2011 and 2012, but it was no longer under warranty or supported by the original manufacturer.

Mokgethi says that “as a result of continuous exposure to occasional power outages and the age of the equipment, the equipment was compromised and failed.”

The result for patients is “a huge negative impact on service delivery” as old patient files cannot be retrieved and new paper files have to be opened. Furthermore, there is “inability to retrieve files for medico-legal cases, Road Accident Fund claims, follow-up of information for SA National Blood Services, follow-up of complaints lodged.”

Manual registers are being used instead, which require “intense monitoring” as they have drawbacks that include:

  1. High risk of fraud
  2. It can be stolen or misplaced
  3. There is no backup

The estimated revenue loss because patients cannot be properly billed and debts followed up is estimated at R4.8 million.

The Department concedes that this outdated system cannot be fixed and says that the hospital has been prioritised for the new health information system which they envisage will start on 11 July 2022.

The reason that patients are still suffering from an outdated system is because of massive corruption under former Health MEC Brian Hlongwa who is currently on bail facing charges of fraud, corruption, money laundering and racketeering along with former senior Gauteng Health officials.

One of the charges is the award of a R1.2 billion tender to the Baoki consortium in 2008 to set up a health information system and electronic health record. They were paid more than R400 million before their contract was cancelled a year later with no system installed.

I have long advocated a new health information system and I hope they finally get this right as it is crucial to improve efficiency and to cut queues for patients.

 

Adverse events rise in Gauteng’s worst hospitals

Serious Adverse Events (SAEs) in Gauteng public hospitals have risen from 4170 in 2019 to 4701 last year, an increase of 13%, with Tembisa Hospital by far the worst with 1226 SAEs during this period.

This is revealed by Gauteng Health MEC Nomathemba Mokgethi in a written reply to my questions in the Gauteng Legislature.

A SAE is defined as an event that results in an unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.

Hospitals with high numbers of SAEs for 2019 and 2020 include the following:

George Mukhari  – 1022

Chris Hani Baragwanath  – 883

Kalafong  – 850

Weskoppies  – 74

Charlotte Maxeke Johannesburg  – 632

Thelle Mogoerane  – 380

Mamelodi  – 362

Sebokeng  – 324

Helen Joseph  – 319

Leratong  – 258

Jubilee  – 204

The Rahima Moosa Mother and Child Hospital has the best record, with not a single SAE in 2019, and only 2 SAEs last year.

Steve Biko had the fewest SAEs of the four academic hospitals (the others are Bara, Charlotte Maxeke and George Mukhari), with 55 SAEs in 2019 and 200 SAEs last year.

Some hospitals saw sharp increases from 2019 to 2020. Edenvale hospital went up from 13 to 129, Leratong from 61 to 197, Helen Joseph from 102 to 217, and Sebokeng from 107 to 217.

The 747 SAEs at Weskoppies mental hospital are of concern as there is no surgery at this hospital.

Tembisa’s very number of adverse events highlights the poor judgement in choosing it as a Covid-19 treatment centre. This was a finding of the Medical Ombudsman when he investigated Shonisani Lethole’s death at this hospital.

Our health sector has been battered by the Covid-19 pandemic, and effective measures need to be taken to ensure medical negligence is minimised as much as possible. Proper staffing and resources is critical, as well as good training, and disciplinary measures for non-performance.

Dr George Mukhari Hospital falling apart because of poor maintenance by Infrastructure Department

An oversight visit by the Gauteng’s Health Portfolio Committee to Dr George Mukhari Hospital saw the result of years of mismanagement of the maintenance function by the Department of Infrastructure Development.

Despite the presence of officials from both the Department of Infrastructure Development who are responsible for maintenance, as well as officials from the Health Department who oversee infrastructure, the hospital is falling apart and is deteriorating at an increasing rate.

This is as a result of a management vacuum within both the Infrastructure Development and Health departments. Up until now, there has been no policy that defines the maintenance dynamics nor are there operating procedures that indicate how the two sets of officials who are responsible for maintenance are to work together. The result has been a total lack of integration between the departments and a downward spiral in terms of getting ahead of maintenance problems.

Broken doors, broken windows, unsanitary toilets, broken paving, leaking water pipes, building rubble and litter on the hospital site are some of the issues that confronted the committee. In response, all the officials could do was shrug their shoulders and say that the hospital is old. No accountability, no responsibility.

Pictures of the hospital can be found hereherehere and here.

It was also shocking to discover that despite construction work taking place in the kitchen, that the cooking of food continued unabated. While the kitchen staff valiantly tried to manage the situation, this unprofessional approach from the Infrastructure Department was accompanied by disinformation when the department indicated that construction only took place after hours.

It is not surprising that it has been estimated that in order for 32 hospitals in Gauteng to become safety compliant, the administration needs to find R6 billion. A shrinking economy and incompetence within the public infrastructure sector are likely to make NHI a pipedream.

Slow progress in investigation into deaths at George Mukhari hospital Burns Unit

Gauteng Premier David Makhura has ordered a forensic investigation into the deaths of 9 patients at the Burns Unit of the George Mukhari Hospital three years ago.

This is revealed by Gauteng Health MEC Bandile Masuku in a written reply to my questions in the Gauteng Legislature.

The Burns Unit was built with a R3 million donation from the Smile Foundation and another R3 million from the Department of Infrastructure Development. It opened on 21 November 2016 and was closed in January 2017 because of the deaths of patients.

Medical experts allegedly warned that patients would die because of inadequate ventilation in the unit, but certain officials insisted that the opening go ahead.

Another allegation is that the Hospital CEO Dr Freddy Kgongwane failed to inform the then Health MEC Gwen Ramokgopa that 9 patients had died and claimed that clinicians had only raised concerns about the ventilation system after the opening rather than before the opening. Dr Kgongwane is currently suspended facing a range of charges on this and other issues.

I am concerned that three years after the deaths forced the closure of this Burns Unit, we have still not seen effective action against at least three allegedly implicated people.

Patients have suffered as the Burns Unit has only recently been re-opened.

There needs to be accountability as soon as possible for any deaths that could have been avoided at this Burns Unit.

4097 patients wait for surgery at George Mukhari Hospital

4097 patients are on the waiting lists for surgery at the George Mukhari Hospital in north west Gauteng, some of whom will wait as long as 5 years for their operation.

This information is disclosed by Gauteng Health MEC Bandile Masuku in a written reply to my questions in the Gauteng Legislature.

The worst waiting time is for hip and knee surgery – 558 patients will wait from 4 weeks if it is urgent, otherwise up to five years. This means that a newly diagnosed patient could be given a date in 2024 for his or her surgery!

Other long waiting lists and waiting times are as follows:

  • General surgery: 1386 patients waiting from 2 weeks to 1 year;
  • Opthalmology: 984 patients waiting from 2 weeks to 2 years;
  • Hand and Micro: 240 patients waiting from 3 weeks to 2 years;
  • Paediatric surgery: 233 patients waiting from 2 weeks to 36 weeks;
  • Neurosurgery: 141 patients waiting from 1 week to 2 years

According to Masuku, reasons for the long waiting times include the following:

  • Theatre time: Insufficient theatre time;
  • Personnel: Shortage of anaesthetists and nurses;
  • Infrastructure challenges – very old hospital, roof leakage, electricity outages, abnormal temperatures;
  • Shortage of linen;
  • Shortage of consumables;
  • Shortage of ICU beds;
  • Population explosion, many referrals from other provinces and many foreign nationals;
  • Increasing trauma and violence (trauma unit extremely busy).

This large academic hospital has been sadly neglected even though it serves a large rural population.

It is unconscionable that people can wait in pain for years before they have an operation. Orthopaedics is a particular problem, particularly for elderly women who suffer more than men from osteoporosis.

A dedicated orthopaedic theatre is needed urgently as well as other measures to cut the huge surgery backlog.

Poor facilities for mental health patients in Gauteng

I am concerned by the report of the SA Human Rights Commission which visited George Mukhari Hospital in north west Gauteng this week and found overcrowding and poor facilities for mental health patients.

There were 37 patients in a mental health ward equipped for only 14 patients, and they were disturbed by noise and intrusive contractors working to refurbish the facility.

Patients used one bath tub in an isolation room meant for uncontrolled patients, and there was a hole in the wall where animals could enter.

There is a general problem of long delays in the refurbishment of mental health wards in Gauteng hospitals because of incompetent contractors. The mental health wards at the Charlotte Maxeke Johannesburg Hospital were supposed to have been completed 10 years ago, and renovations at the Helen Joseph Hospital wards were recently completed nearly three years after the planned date.

I commend the SAHRC for their inspections into mental health facilities and I hope the Gauteng Health Department takes their recommendations seriously.

It is enormously distressing that mental health patients are still treated badly in Gauteng hospitals even after the Esidimeni tragedy where 144 patients died from gross neglect.

R1.6 Billion Overspend Projected For Gauteng Health

Gauteng Legislature’s Health Committee

The Gauteng Health Department is projected to overspend by R1.6 billion by the end of the 31 March financial year.

This was revealed in a presentation by the department at a meeting of the Gauteng Legislature’s Health Committee earlier this week.

According to the presentation, the biggest overspend will be R1.162 billion by the four academic hospitals (Chris Hani Baragwanath, Charlotte Maxeke Johannesburg, Steve Biko and George Mukhari).

Provincial hospitals will also overspend by R199 million and district health services by R50 million.

Court-ordered payments for medical negligence are a major reason for the overspend.

Health Science and Training Programme

Other reasons include the improvement of conditions of service funding gap on the Occupational Specific Dispensation (OSD), and the payment of accruals on medicine, medical supplies and agency and support services.

The Health Science and Training Programme is projected to overspend by R137 million mainly because of the cost of training students to become doctors in Cuba.

The department’s funding crisis is leading to delayed payments of suppliers, pushing many small companies into financial ruin.

The funding deficit is also likely to rise because of the extra costs in relocating psychiatric patients from unsuitable NGOs where they were placed after the closure of Life Healthcare Esidimeni.

New Health MEC Gwen Ramokgopa faces a daunting task in fully funding services for patients.

I suspect that the provincial government will have to bail out the health department, diverting money from other departments as has happened previously.

 

 

Media enquiries:

Jack Bloom MPL

DA Gauteng Shadow MEC for Health

082 333 4222

[Image source]

Workmen’s Comp Owes R38m To Gauteng Hospitals

Gauteng public hospitals are owed R38.2 million by the Workmen’s Compensation Fund, with some claims dating back to 2001.

This shock information is revealed by Gauteng Health MEC Qedani Mahlangu in a written reply to my questions in the Gauteng Legislature.

In the last three years, 9061 claims were lodged by the Gauteng Health Department for a total value of R17.4 million, but only R3.34 million was paid out by the Fund.

Workers whose employers are registered with the Fund can claim if they are involved in an accident at work or develop an illness caused by working conditions.

According to Mahlangu, the under-recovery is due to insufficient information provided by the patient with regard to employers’ details, and employers not completing the relevant Employers report (WCL 2).

There is also a lack of response by the Fund to the claims submitted.

The largest amount (R7.5 million) is owed to the Steve Biko Hospital.

Other hospitals with more than R1 million outstanding include the following:

  • Charlotte Maxeke Johannesburg – R4.9 million;
  • Tembisa – R4.416 million;
  • George Mukhari – R4.399 million;
  • Thelle Mogoerane (Natalspruit) – R2.47 million;
  • Helen Joseph – R2.19 million;
  • Kalafong – R1.95 million;
  • Chris Hani Baragwanath – R1.78 million; and
  • Leratong – R1.37 million.

The hospital with least owing to it is Rahima Moosa Hospital, where only R5186 is outstanding.

The department appointed a service provider in November last year to assist in recovery of outstanding claims from the Fund, but this measure has clearly failed

It is outrageous that so much is owed from the Fund, as the money is desperately needed to improve treatment in our hospitals.

Effective measures should be taken to ensure that outstanding money is recovered as soon as possible.

 

Media enquiries:

Jack Bloom MPL

DA Gauteng Shadow MEC for Health

082 333 4222

[Image source]

20 Die And 1 533 Suffer From Hospital-Acquired Infections in Gauteng

Nosocomial

A total of 1533 patients got infections from Gauteng public hospitals in the last three years, and 20 died from these infections that are largely caused by poor hygiene.

These shock figures are revealed by Gauteng Health MEC Qedani Mahlangu in a written reply to my questions in the Gauteng Legislature.

The technical name for hospital-acquired infections is nosocomial, which refers to infections that are caught in hospitals, often caused by organisms that are resistant to antibiotics.

The number of nosocomial infections has increased alarmingly, rising from 236 in 2012, to 322 in 2013 and 975 patients in 2014.

Most Common Nosocomial Infections

Chris Hani Baragwanath Hospital is the worst hospital for infecting patients. Last year, 376 patients got nosocomial infections and 13 died, mostly babies from Klebsiella pneumonia.

Other hospitals with high infection rates in 2014 were as follows:

  • George Mukhari Hospital – 146 patients;
  • Steve Biko Hospital – 138 infections;
  • Leratong Hospital – 79 infections;
  • Helen Joseph Hospital – 77 infections;
  • Sebokeng Hospital – 26 infections; and
  • Natalspruit Hospital – 21 infections.

The most common nosocomial infections last year were as follows:

  • Klebsiella Pneumoniae – 294 infections;
  • Acinetobacter Baumanli – 226 infections;
  • Methicillin Resistant Staphylococcus Aureus (MRSA) – 145 infections;
  • Escheria Coli – 99 infections;
  • Pseudomonas Aeruginosa – 91 infections; and
  • Candida Albican – 51 infections.

According to Mahlangu, predisposing factors for nosocomial infections are:

  • Population growth which leads to overcrowding of patients;
  • Premature babies are vulnerable to acquiring micro-organisms in hospital because their immune system is not well-developed; and
  • The recommended standard for space between incubators is 91 cm apart.

She says that steps to bring down these infections include continuous monitoring and adherence to World Health Organization protocols, and involving the community in hand hygiene practices when they visit relatives in hospital.

Hygiene Must Improve Radically

I am disturbed by the increasing rate of nosocomial infections in Gauteng hospitals, and special attention needs to be paid to Chris Hani Baragwanath Hospital.

It is encouraging that there were only 8 nosocomial infections at the Charlotte Maxeke Johannesburg Hospital last year, which shows that infection rates can be kept down with proper care.

It is terrible that so many patients suffer from infections they get in hospitals, often because of poor hygiene, which needs to improve radically.

 

Media enquiries:

Jack Bloom MPL

DA Gauteng Shadow MEC for Health

082 333 4222

[Image source]