Article #2194

The tragedies that recently befell two young children at private hospitals owned by Life Healthcare Group have unleashed further negligence accusations against doctors and nurses in the group’s hospitals. With one multi-million rand claim filed and others pending, serious questions are being raised about the future of South Africa’s third largest health care group.

As you read this, corporate advisers are preparing strategic options for Life Healthcare, in the wake of 22% shareholder Mvelaphanda announcing last September that it was realising and unbundling its assets. One option, say market sources, is a listing on the JSE, as early as May. Another is that 21.9% shareholder Brimstone Investment might snap up Mvela’s stake, valued at around R1.6bn.

But who will rush to buy Life Healthcare Group shares after reading this?

Life Healthcare Group, with its 60 acute care facilities and 7,600 beds across the country, is currently valued at around R7.4bn. Brimstone and Tokyo Sexwale’s Mvela were the leaders in a BEE consortium that acquired the group, then called Afrox Healthcare, in 2005, paying R3.4bn for Afrox’s 69%, as well as snapping up the minorities for a billion or so more.

The hospital group has been a crucial cog in the Mvela machine, making up 44% of its net asset value. But profits are dependent on performance, and at Life Healthcare everything appears to be geared to boosting the bottom line, with medical ethics apparently coming a poor second best.

As a private company, revenue and profits are kept secret, but Mvela’s annual report to June 2009 reveals a 14.4% growth in businesses at the healthcare group, with the key measure of “paid patient days” up 4.3% and bed occupancies running at “a more than acceptable” 67%. Mvela took R178m last year from Life Healthcare in dividends and loan repayment.

But has South Africa’s first BEE health care group, with its unquenchable lust for big bucks, become just one enormous rip-off? Certainly, the death of four-year-old Zenande Mdwaba, and the severe disablement of six-month-old baby Laila Subramoney, have opened the floodgates to more shocking revelations about goings-on in Life Healthcare hospitals.

Baby Zenande

Last November The Star reported how Laila went into Life Wilgeheuwel hospital to be treated for an ear infection, only to be discharged a month later mentally disabled, almost blind, and deaf in one ear.

Nose123 told how another little girl, Zenande, never awoke after anaesthetist Dr Marius Gouws put her to sleep for a routine – and unnecessary – procedure at Life Fourways hospital last May. The child was suffering from occasional constipation and a biopsy was performed after paediatrician Dr Ashraf Ahmed said he suspected Hirschsprung’s, a serious disease of the bowel – a diagnosis that did not match the child's profile of otherwise radiant good health. Ahmed had also ordered a battery of expensive blood tests, X-rays and an MRI scan.

These simply showed that Zenande was suffering from nothing more serious than constipation. But by then she had died from the allegedly seriously mismanaged biopsy and/or hospital after-care.

A detective inspector at Brixton police station has now completed an initial investigation into the circumstances of Zenande’s death, after her parents, Zuko and Ursula Mdwaba, opened a docket alleging death by negligence. An inquest is still pending.

The Mdwabas have also filed a complaint with the Health Professions Council against four doctors attached to the Life Fourways hospital: anaesthetist Marius Gouws, paediatricians Ashraf Ahmed and Dewald Buitendag and paediatric surgeon Bob Banieghbal. Last October, four months after Zenande’s death, the council told the Mdwabas’ attorneys that they had received “outstanding explanations” from Dr Buitendag and Dr Ahmed, but were awaiting records from Life Fourways and Garden City Clinic.

Baby Laila

Life Healthcare Group’s general manager (marketing) Adam Pyle comments: “The inquest and HPCSA have got to work out: was this an appropriate procedure to do, and did the doctors have justifiable clinical reasons for doing it? Also, what anaesthetic did Dr Gouws give? Was he around afterwards? Should he have been around?” 

Since The Star’s report about baby Laila, her parents – human resources manager Kogie and banker Rajentheran Subramoney – have issued summons against Wilgeheuwel hospital and Life Healthcare Group, claiming R20m in damages.

The particulars of claim outline the horror. Laila was admitted to Life Wilgeheuwel last September with an ear infection. The following day she was examined by an ear, nose and throat specialist who recommended insertion of grommets. This was duly done two days later and Laila was discharged with a short drip attached to her arm (for the administration of an antibiotic at the hospital the following day).

The next day, nurse Gladness Dlamini proceeded to administer the antibiotic. Laila’s mother Kogie pointed out that there was a lot of blood in the drip cord. But Dlamini proceeded anyway and Laila began to cry
hysterically, gasping for breath.

Laila then stopped breathing. Kogie screamed for a doctor and the baby was taken to the intensive care unit and placed on life support. Her parents claim that Laila, now 10 months, has sustained significant brain damage, is partially blind, deaf in one ear, unable to roll or sit and will never be totally independent. The parents’ lives have been “devastated”; they require treatment for depression and psychological assistance in dealing with the difficulties and challenges of raising a disabled child.

Their bill from Life Wilgeheuwel hospital: R82,086.

Life Healthcare’s spokesperson Marietjie Shelley commented to The Star: “In baby Laila’s case we can say with confidence that there was no negligence or wrongfulness.” The nurse who treated her “fully adhered to nursing procedures”.

Both stories have brought shocked reaction from readers. The name of Dr Ashraf Ahmed, the paediatrician who suspected Zenande Mdwaba might have Hirschsprung’s, struck a grim chord with Johannesburg IT consultant Anthony Poltera. Of Zenande’s death, Poltera says: “Those poor parents. I can tell you, if it had happened to us, I would spend the rest of my life fighting them. The disgusting thing is that those extravagant tests weren’t necessary.”

Back in July 2008 Poltera and his wife Nicole took their then three-month-old son Kaden to Dr Ahmed’s rooms at Life Fourways. Both parents had been down with the flu and they thought that Kaden had picked it up. Says Poltera: “Dr Ahmed said our son had severe pneumonia and immediately administered a drip in his room. He was adamant that Kaden be immediately admitted to hospital with his mother as he required intensive hospital care.

“He also insisted on some expensive blood tests as he thought our son may have leukaemia. That raised an alarm bell in my head. You can’t just say ‘he might have leukaemia’!

“My wife was beside herself; as new parents we did not question his diagnosis. I was told to pay R11,000 upfront and my wife and son were admitted to a private room. It was after two days of lying in hospital that my wife suspected the possibility of a scam by Dr Ahmed and Life Fourways hospital. During that time Dr Ahmed did not attend to our son once, and apart from receiving antibiotic drops orally from the nursing staff, nothing else seemed to be done.

“When my wife said she could administer the drops at home, they promptly released her and Kaden. We left Life Fourways feeling we had been conned into an unnecessary expensive hospital stay that ultimately our medical aid, Discovery Health, would bear the brunt of. I wonder if Dr Ahmed and Co have some sort of shareholding in Life Fourways hospital?”

(Dr Ahmed holds 15,000 shares in Docvest Investments which owns around 7% of Life Healthcare Group, giving the paediatrician an approximate 0.01% shareholding).

A previous health minister has condemned the practice of doctors owning shares in private hospitals as a perverse incentive. The more tests, procedures and admittances they can drum up, say critics, the bigger the profit to the hospital group – and the bigger the dividend to its shareholders.

Life Healthcare’s Adam Pyle comments: “There are quite a few hundred doctors who own shares in Life Healthcare. But a doctor will get much more money from medical aids paying for his services than he will from the dividend at the end of the year.”

Life Healthcare’s Wilgeheuwel hospital, where baby Laila became so terribly disabled, is singled out by readers for some harsh criticism. Dianne Farrell writes about the 16 March 2007 death of her 17-year-old son there. “My son died as a result of a doctor in the casualty department refusing to treat him because it was 18h50 – and she was going off at 19h00. She told me she was not a doctor, when she was the ‘doctor on duty’.

“Our son bled to death in their hospital. They did not have the equipment that the surgeon needed, who took him to theatre three hours after arriving. We were harassed for payment for their account of over R40,000 – for seven hours in their hospital, two hours of which our child lay in casualty not being treated. His total bills amounted to R92,000.

“Wilgeheuwel hospital needs to be closed down and the staff should be jailed for their actions.”

A parent of a healthy five-year-old girl writes: “Our daughter went in to Wilgeheuwel for a routine ear operation and came out with a ‘theatre acquired infection’ which left one ear deformed.”

Another parent, Tasneem, writes: “My daughter had a bad experience at Life Wilgeheuwel. She had needles inserted into the bones in her knees without being given pain medication. The nurses should be fired and not allowed to practise. Their attitude makes me sick to my stomach – and what makes it worse is they get away with it. My prayers are with Laila and her family.”

Meanwhile, Zenande’s parents are determined to bring the doctors and nurses at Life Fourways hospital to account. “Are these so-called investigative procedures a money-making scheme or what?” asks Zuko Mdwaba. “I will not rest until these people account for what they did. They put us through hell.

“My view on the Life Healthcare Group of hospitals is that they are out there to make money at all costs. The hospital cost us the life of our child and they didn’t even contact us – no flowers, message of condolence, nothing. It was as if our child was nothing but another number.

“To add insult to injury, we are still getting invoices for shortfalls – measly amounts – to payments made by medical aid. It feels like we are constantly reminded that we have to pay for the hospital taking our child’s life.” 

Why hospitals are bad for your health

Noseweek’s medical expert, Inside Tract, writes: “Up to 15 years ago specialists referred their patients without any specific loyalty to a particular clinic. They worked from consulting rooms some distance from and completely independent of the clinics.

“The clinics then began to offer them rooms attached to the hospitals at very favourable (like nil) rentals. They also underwrote running costs like uniforms, staff and telephones.

“In order to feed these specialists they had to have a conduit. So, one after the other, they opened casualty sections. Initially they persuaded local GPs that this was in their best interest, because they would now have a place to send their patients after hours. These casualty sections were run by group practices comprising the local GPs. It didn’t take long, however, for these group practices to be disbanded and for hospital managements to strike deals with a new breed of doctors specialising in ‘trauma management’.

“The net result of all this was that the GP was now bypassed. The patient attended the casualty, was referred to an in-house specialist, and treated at the hospital. This of course involved cross-referral between specialists, use of the in-house pathology lab and of the radiologists, who now had rooms in the hospital.

“A patient of mine, a young newly-wed, developed a bladder infection over a weekend, and attended the local clinic. Had I seen her I would have examined her urine and prescribed an antibiotic, after explaining that cystitis is common in someone recently sexually active.

“She, however, was referred to the in-house gynaecologist, who sent her to the urologist attached to the clinic, who scoped her in theatre, under general anaesthetic. She was then referred for a CT scan of her abdomen. Needless to say, all this bombed out her medical aid benefits for the rest of the year. Eventually, she was given an antibiotic and sent on her way.

“A young woman, a single mother, attended a clinic when her toddler fell at the play centre and lacerated his ear. The doctor on duty said that the cartilage was exposed and she needed a plastic surgeon. They wanted a R30,000 deposit, which she didn’t have.

“A friend of hers, a patient of mine, phoned me and I met them. A bit of local anaesthetic and two stitches later she was on her way. A week later there was hardly a mark.

“The bottom-line is very much in evidence in private health care. There is a symbiotic relationship between the specialists and clinics, which is a phenomenon of the last two decades. A busy surgeon can make the difference between profit or otherwise to a clinic.

“To maximise profits, corners are being cut. But the real time-bomb is in nursing care. Years ago there was a hierarchy in the hospitals. Matron was in charge and under her were the ward sisters who supervised the senior and junior nurses and nursing aides. Everyone worked under supervision, and never took on what they were not qualified or trained to do.

“In the new PC world we live in there is no chain of command. If a doctor finds that his instructions were not carried out, there is no one accountable. The buck bounces about. Should he be ill-advised enough to reprimand a nurse, you may be sure that the next day the union will be there in full strength.

“The elementary principles of hydraulics, for example, such as the fact that a fluid runs downhill, has to be taught. Otherwise they put a drip bottle below the patient when they transport them on a trolley. They have to be taught to consult the electronic gadgets they see in a ward. A monitor is useless if no one looks at it or listens to the alarms.

“As a GP, I consider it one of my prime functions to keep my patients out of hospital.”