After a year-long investigation, the Health Ombudsman has made damning findings against the CEO of the Rahima Moosa Mother & Child Hospital, saying the award-winning institution has plummeted to one showing a callous and chilling disregard for human safety with CEO Dr Nozuko Precious Mkabayi at its helm.
Health Ombud Professor Malegapuru Makgoba called for Mkabayi to be replaced urgently following the release this week of the findings against the leadership and staff of the hospital.
The investigation came after a complaint in April 2022, centred on the treatment of expectant mothers at the hospital, which sparked widespread outrage, reports News24.
The complaints followed reports and a video that went viral of pregnant women sleeping on the floor and allegations of the CEO not being at work as expected, and of senior managers showing a significant lack of discipline and being manipulative.
Then in May, the head of the children’s ward, Tim De Maayer, penned an open letter to the Gauteng Health Department about the dire conditions at the facility. This was supported by numerous other healthcare professionals.
“The disregard for human safety is chilling, evident in the dire lack of resources for a hospital providing critical tertiary level specialist services in the 21st century,” Makgoba said.
The investigative report, which involved 34 in-depth interviews with patients and staff at the hospital, recommended that a suitable and permanent CEO be identified and appointed as a matter of priority within three months.
Makgoba said three words were mentioned in almost every interview: “dirty”, “filthy” and “unsafe”, reports Bhekisisa.
In August and September 2022, one of the nurses couldn’t find stock of the antiseptics health workers normally use to clean patients’ skin before abdominal surgery, so she made her own concoction and diluted a type of hand sanitiser with water.
During those two months 11 patients who were operated on developed sepsis. They had to be taken back to theatre for “relook” operations. There was no such cases in the prior months.
The nurse didn’t consult anyone before making the solution. But the senior clinical manager at the hospital also didn’t condemn her actions when he found out about it.
This was included in the report, which found that it was “unprofessional, unethical and inexplicable” for the nurse to concoct a “self-made solution”, for which there was no scientific evidence that it was either safe or effective.
Her only explanation was: “I ensured there was not much foam.”
Makgoba said there were some 14 other unsettling findings about the specialist facility, including that there had been little upkeep in the 80 years since the facility was built in 1943.
This has resulted in sewage flowing freely through the hospital campus and “filthy” treatment conditions, among other issues. His report recommends that the Health Department should immediately prioritise maintenance projects at the hospital.
Also uncovered were several lapses in the employment processes followed by the Gauteng Health Department in appointing Mkabayi as CEO in 2020.
The team in charge of appointing her paid no regard to the tests and skills requirements that were in place to make sure she was equipped for the job, Makgoba found.
The advertised requirements were deficient for a senior position in comparison to several other equivalent advertised CEO posts in different provinces, and additionally, two important documents were missing from the hospital’s human resources department regarding her appointment.
There was no copy of her post-graduate HIV management diploma, which was noted to be an advantage in the job advertisement, and there was also no copy of her driving licence, a requirement in the advertisement.
Mkabayi also made no mention in her application of her chronic mental illness and did not disclose her condition during the interview.
Furthermore, written employment referees indicated that Mkabayi did not work well under stress and either “retreats into blocking out” or “breaks down due to illness”.
Notably, one reference indicated that she was “not clinically competent and …required to be referred to HPCSA (Health Professions Council of South Africa) for serious deficiencies”.
The reports added that throughout 2021, the HPCSA health committee recommended Mkabayi undergo a proper psychiatric assessment to assist her in stabilising her condition.
The report reads: “This simple advice failed because Dr NP Mkabayi failed to honour appointments made with the HPCSA. Hence, on 7 December 2022, the HPCSA health committee issued an intention to suspend her from practising in the profession in South Africa on the basis of health impairment.”
The report of allegations that Mkabayi was not full-time at the hospital to ensure everything ran smoothly was substantiated. The investigation found that 27 working days were unaccounted for in 2021 and 71 in 2022, and substantive irregularities regarding her leave.
The report recommended that the Gauteng Health Department institute disciplinary action against Mkabayi for failing to ensure the hospital had functional systems in place.
It found that the hospital, which was built in 1943, had never received substantial upgrades, and the ageing infrastructure and sewage reticulation system are failing, leading to numerous pipe spillages and toilet blockages.
The report said there appeared to be no ongoing maintenance of infrastructure, despite the allocation of budget, personnel and the apparent need.
The hospital’s laboratory and blood services also did not operate 24 hours a day, which affected its provision of high-risk specialist obstetrics, gynaecology, neonatology, paediatric and surgical services.
It was further recommended that Gauteng Health MEC Nomantu Nkomo-Ralehoko urgently appoint an independent forensic and audit firm within two months to conduct a competency, “fit for purpose” assessment of the leadership and management staff at the hospital.
The investigation further found that the Health Department failed to promote and implement relevant human resource policies in a standardised and transparent manner.
“This led to so-called ‘trust agreements’ between supervisors and supervisees where each party ‘trusted’ that the other party was fulfilling their professional responsibilities.
“It has been demonstrated that this manner of working is not only fraught with pitfalls (once the trust relationship has broken down), but it (is also) open to abuse as there is no accountability.”
The department was also asked to fast-track the establishment of a fully functional adult ICU at the hospital within six months.
Gauteng Premier Panyaza Lesufi was instructed to ensure the hospital was one of the first to be refurbished within six months.
The report also recommends that:
• Rahima Moosa be upgraded to a tertiary hospital, so that it qualifies for tertiary grants, enabling the facility to procure commodities, equipment and supplies;
• The Gauteng Health Department should review its processes for the appointment of hospital CEOs;
• Within two months, the Gauteng Health Department should implement short-term interventions, such as certain provisions in the Financial Management Act that could result in the facility receiving extra funds;
• Within two months, the Gauteng Health MEC has to appoint an independent forensic and audit firm to conduct a competency, “fit for purpose” assessment of the leadership and management staff at Rahima Moosa;
• Within six months, the Gauteng Health Department has to establish a “fully functional adult intensive care unit” at Rahima Moosa;
• Within one month, the Gauteng Health Department and Rahima Moosa hospital should institute disciplinary inquiries against the nurse who used a “self-made” solution for surgeries and former CEO, Nozuko Mkabayi for her failure to ensure the hospital was functional and to manage her leave in accordance with hospital regulations.
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News24 article – The once proud Rahima Moosa hospital – now filthy and unsafe – needs a new CEO fast, ombud says (Restricted access)News24 article – Pregnant women forced to sleep on Joburg hospital floor, health ombud finds (Open access)
See more from MedicalBrief archives:
Viral video leads to investigations at Rahima Moosa Hospital
Floundering Rahima Moosa Hospital ‘needs to admit it has a crisis’
Doctors back paediatrician’s account of Rahima Moosa collapse
HRC to monitor Rahima Moosa, calls for reclassification of hospital