An investigation by the SA Society of Psychiatry (Sasop) into complaints against the management of Tower Hospital in Fort Beaufort has uncovered alleged human rights violations at the 400-bed facility, reports The Herald.
A report released by the South African Society of Psychiatry (Sasop), following a visit to the facility on 6 March, details seclusion rooms that pose a risk to patients. Other findings showed widespread systemic issues in the hospital’s record-keeping practices and staff shortages that create a “perfect storm” of problems.
The report says the visit included representatives of the Treatment Action Campaign and the South African Federation of Mental Health, following complaints submitted to Sasop last month by former Tower psychiatrist Dr Kiran Sukeri.
Sasop president Professor Bernard Janse van Rensburg said the most urgent issue related to four high-risk seclusion rooms, meant to be used only when patients were aggressive. According to the report, these rooms do not have basic amenities like toilets or sources of water. “These rooms are unsafe, in a courtyard nowhere near a nurses’ station (or medical supervision),” Janse van Rensburg said.
The report details a case in February where one patient, a habitual self-harmer, set himself on fire and sustained burns on both legs before medical staff intervened. “(Sasop Eastern Cape chair) Professor Zuki Zingela immediately phoned the surgeon-general from the premises to say the hospital should stop using those rooms with immediate effect.”
Another major concern is the discrepancies in the hospital’s records of patient deaths. “Significant inaccuracies exist about the hospital’s available information on the number and nature of the deaths of inpatients that have occurred over the last five to eight years,” according to the report. “This has led to important records not being recorded or stored properly and reported instances where (the) recording of information has been done retrospectively instead of at the point of occurrence. It is unclear whether this was done as an attempt to give an impression of lower death rates or better care.”
Janse van Rensburg said this left the hospital vulnerable to legal action. “Their records (which are written by hand) contain contradictory information.”
The report says in their meeting with management, Sasop was told 63 deaths were recorded between January 2013 and December 2017, instead of the 25 deaths previously reported to MEC Phumza Dyantyi’s office. Certain pages of the death registers were missing, however, with none of the personnel in attendance able to provide an explanation.
Sukeri’s complaints also referred to the poor quality of food and clothes given to the hospital’s 323 patients, though Janse van Rensburg said this was not what they had found. But, the report says, during a subsequent visit to the facility, National Education and Allied Workers Union (Nehawu) branch chair Lawrence Mtsila said brand new supplies, including new patient uniforms and fresh food, had been hurriedly brought out before an inspection by Dyantyi on 5 March.
Hospital CEO Ntombizandile Ngcume denied these claims. “There was no way (we could have known),” Ngcume said. “It was a surprise. We didn’t even tell the day staff.”
The report says Ngcume further denied Sukeri’s claims of patients being treated poorly and death registers being forged. Sukeri, who worked as a part-time psychiatrist, is due to conclude his duties at the end of this month. Ngcume said they had advertised a full-time position at the beginning of 2018 and found a candidate from Limpopo. Sukeri welcomed this news. “It would be amazing for the hospital to have a full-time psychiatrist, because the patients need specialised care.”
According to the report, he said he had chosen to reach out to Sasop for the sake of the patients. “We need to respect our patients’ rights and have an obligation to report it if those rights are infringed.”
In its report, which has been given to the Eastern Cape Health Department, Sasop recommended an investigation around irregularities in the death registration process, as well as the hospital’s information management systems. “The severe shortage of medical, psychiatric and other personnel (also) needs to be addressed urgently.”
Health department spokesperson Sizwe Kupelo said another independent investigation was being carried out. “Anyone with allegations must present themselves to this investigation team,” Kupelo said. “If anything is exposed we will accept those findings and act.”
He said Sasop was doing a parallel investigation, which was not necessary at this stage.
“Sasop and anyone else with information must present their allegations to the investigation team. The investigation will give recommendations and we will adhere to their findings and recommendations,” he said.
Sasop said certain limitations of the one-day visit led to only evidence presented on the day being considered. The Times reports that the findings were of such a nature that Sasop has urged the Department of Health to urgently investigate the situation at Tower Hospital.
Janse van Rensburg said there was little doubt that significant problems existed for some time in terms of the running of the hospital. “Although management identified difficulties in the smooth running of the institution‚ no effective strategies have ever been employed to address or solve the challenges and on at least two occasions the problems were of such nature that it required the intervention of the Eastern Cape Department of Health. “Patient and death records‚ death notification‚ as well as the manner and capacity of secluding patients at this facility has been infringing on patients’ human rights‚” Janse van Rensburg said.
He added that although hospital personnel of all categories‚ including senior management‚ largely seemed to have goodwill towards patients and patient-care‚ there seemed to be a limited understanding (especially at senior management level) of how long-standing systemic failures and inadequacy of actions taken to address these failures had exacerbated the situation and affected patient rights.
“Such systemic failures seem to have aligned with individual factors within the senior management team of the hospital (communication challenges‚ flouting of standing protocol and procedure with minimal consequences‚ poor conflict resolution‚ lack of proactive management etc) to create a perfect storm. This seems to have resulted in the crisis that has manifested in Tower Hospital currently.”
Janse van Rensburg said Tower Hospital‚ which is a 400–bed long-term psychiatric hospital in the central part of the Eastern Cape‚ had been utilised for many years as a non-voluntary‚ in-patient facility for patients with serious mental conditions requiring long-term care from across the province.
“However, to date‚ there has been no development in the province that could have facilitated the implementation of the appropriate deinstitutionalisation of patients to be treated in a least restrictive community-based environment close to their homes. To make matters worse the staff shortages of only two medical officers on the floor at Tower Hospital is further infringing on the physical health of patients‚” he is quoted in the report as saying.
[link url="http://www.heraldlive.co.za/news/2018/03/25/damning-risk-report-hospital/"]The Herald report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-03-22-serious-problems-found-at-tower-psychiatric-hospital-sasop/"]The Times report[/link]