Life Esidimeni: it can occur in the Western Cape too

Western Cape Premier Helen Zille recently wrote in her Daily Maverick column of her administration’s efforts to prevent a Life Esidimeni-type situation in the province. But she also tweeted, provoking accusations of insensitivity, “What did [Esidimeni families] do before these tragic deaths to raise the alarm about their loved ones starving + living in profound neglect?"  But Section 27, representing the families, said testimony at the inquiry answered her question.

But raise the alarm to whom – disinterested health department officials and premier?

Her tweet especially, suggests there are functioning complaint processes and mechanisms within the public health service and if patients and families only used them, it would have prevented or mitigated the tragedy.  Or at the very least, families should have brought to the various health institutions’, MECs and premiers’ attention problems before it reached crisis. If she is to be believed, the Western Cape has systems in place to prevent these occurrences.  But Zille is disingenuous and forgetful of recent health problems in the province including the Eerste River Hospital I wrote about before.  

The National Health Act, 2003, chapter 2 section 18 states, “any person may lay a complaint about the manner he/she was treated and have the complaint investigated” (emphasis added).  It also speaks of “protecting, respecting, promoting and fulfilling the [constitutional] rights”. These rights are also mentioned in the National Patients’ Rights Charter.  Both the act and charter further patients’ constitutionally protected “physical and psychological integrity”.

In my mother’s case I wrote about previously (and here) there was stonewalling all the way to the head of the health department Dr Beth Engelbrecht and Zille.  In September 2017, a month and half after she promised to refer our complaint to the Western Cape's Independent Health Complaints Committee (IHCC) – a couple of days after confirming the inquiry will proceed – Engelbrecht informed me the IHCC, formed under the provincial act of 2014, was not functioning for “logistical reasons”.  She didn’t say what these were, when the IHCC would resume business and if complaints submitted before it ceased functioning would be investigated once it resumed.

In terms of the IHCC Act, the head of the Western Cape Health Department provides all resources and personnel to the IHCC, except the three-person inquiry board who are “independent” outsiders.  This leads to the question: if the IHCC is dysfunctional, is the department’s complaints process dysfunctional too?

Engelbrecht said we had the option to instead submit complaints to the SA Human Rights Commission, public protector or national health ombudsman. But this is misleading and passing the buck because these agencies are not the first in line to submit health-related complaints to. Under the National Health Act, healthcare providers – public or private – are obliged to investigate patient complaints.  I believe the sudden cancellation was to prevent the investigation of the hospital’s questionable patient care, that it had not obtained (patient) informed consent and of officials’ conduct including Engelbrecht’s preemptive exoneration of the hospital without the full facts or applying her mind to them.

In November, after promising to investigate our complaints, Zille cancelled.  She used the fact there’s an open police docket – routine where “unnatural causes” deaths are recorded – and our related criminal complaint, of which she was already aware, as a reason. But the Inquests and National Health acts do not state healthcare providers should not conduct their own internal investigations.  In fact, Cape Town’s Director of Public Prosecutions requested the IHCC’s non-existent inquiry report.  This suggests the two processes – health department and other official – are not mutually exclusive or incompatible. 

These examples prove what Zille said about preventing Esidimeni and other healthcare failures in the province are untrue. Life Esidimeni too shows the patient complaints process countrywide is dysfunctional and problematic and biased against them and their families.  Too often complaints of poor service throughout the public service fall on deaf ears.  Problems are ignored until it’s too late and victims and complainants are shunted from pillar to post, and in the end investigations, sometimes after being promised, are denied for made-up reasons.

In another context Zille wrote of the “inevitable tendency in bureaucracies for officials either to actively protect one another or at least to give each other the benefit of the doubt”, and often for political reasons and to prevent exposure and culpability.  This attitude was confirmed by former Life Esidimeni MD Dr Morgan Mkhatshwa’s testimony that “it was sad to see how clinicians could succumb to what I’d call political pressure. I said it’s bad if you forget the [medical] oath you took.”This is the solipsistic, arrogant and unsympathetic attitude that contributed to Esidimeni, pit latrine deaths and all the other cases the media doesn’t report on.

In my mother's case, I reported our concerns to the Western Cape health department and Zille. But not only did they do nothing, they refused to listen. I ask again - to whom should one raise the alarm?  In her case, unless it's the "Gospels according to Helen", the truth is not worth knowing.

The motto of the National Prosecutions Authority is “justice in our society, so that people can live in freedom and security”.  The political and administrative failures and denial of justice poor people especially face daily, removed from the sanctimonious and dishonest alternate reality politicians operate in, should not give us hope Justice Dikgang Moseneke’s findings will make a difference to the overall quality of healthcare in the country, as it is weighed down by usual official indifference and lies about real change.

Revised, adding links to previous posts and a paragraph 14/04/2018.