One of the country’s biggest public hospitals has been operating with just one back-up CT scanner, resulting in patients having treatment delayed, receiving inadequate care, and even dying, says a whistle-blower doctor, who blames management for failing to renew maintenance contracts.
In fact, he told Daily Maverick, for nearly three weeks, Dr George Mukhari Academic Hospital in Ga-Rankuwa, north of Pretoria, had no functioning CT scanners at all.
A doctor at the hospital, who asked not to be named, told Daily Maverick the problems with the scanners began last year, and the situation was “horrifying”.
“I know of at least one patient who has died because of this, and I can only assume that a significantly larger number of patients have also died,” he added.
“Instead of lying in casualty for one day, they are there for four to six days with illnesses that cause enormous suffering, yet no one can intervene because they can’t get the information from the CT scanner that is needed.”
Failure to renew warranties
The doctor said two of the CT scanners were between eight and 10-years-old and that a new machine was installed in 2023: however, it has lower specifications.
“It can’t handle significant patient load. It’s more just to supplement what we can do on the other two scanners,” he said.
Those two had stopped working last year: the first in June or July and the second in about November.
The new low-spec scanner stopped working early this month – leaving the hospital with no CT scanners at all.
“The way it works with our suppliers is that when the machine is bought, they give you a five- or eight-year warranty. Once that expires, you need to pay for an additional warranty,” he said.
But, according to the doctor, these warranties were not renewed by hospital management.
Typically, when a hospital cannot manage emergency patients, it is placed on divert, meaning patients are sent to other hospitals nearby.
“Our management team has been very reluctant and resisted putting our hospital on divert. But they are fully aware of this problem. They are fully aware it is causing deaths and suffering.”
The CT scanners were supplied by two manufacturers, one of them being Philips. The expiry date for the Philips contract was June 2023.
“Towards the end of 2022, our head of department issued a purchase order to… management knowing we would be needing to renew these contracts,” he said. But the paperwork lay stagnant until April 2023.
“A meeting was then held with our supply chain (management), who at that point said: ‘Why have we not issued these documents earlier?’ But they had been issued … they were just sitting on someone’s desk,” he said.
Suppliers renew maintenance and warranty contracts for three to five years as an industry standard.
“Our hospital felt the cost was not something they could budget for, so they asked us to go back to Philips to negotiate,” he said.
Philips offered a six-month contract in the middle of 2023.
“That six-month renewal contract was delayed again at supply chain and management until about November/December,” the doctor said.
A meeting was held at the beginning of this year, when it was revealed that the hospital could not afford a six-month contract. It would need to renegotiate with Philips for a three-month contract, as the 2024 budget for the hospital only takes effect in April.
“The fact of the matter is, this is a problem everyone has been aware of for longer than a year and a half. And they keep throwing in a new excuse or new forms or new stipulations.”
Other technology affected
The hospital’s picture archiving and communication system also relies on Philips.
“When we do a scan, that allows – whether it’s a CT scan, MRI, X-ray – those images to go on to the local network, so the radiologists can report on them, and the clinicians can view the images on their computers in whichever department they are, as well as the reports,” the doctor said.
But the system has had limited functionality for almost two years.
“It is a running joke that it pretty much stops working for a week every month, and you revert to writing stuff by hand, and the clinicians can’t see the images.
“We’ve been instructed by management to ‘make do’.”
The doctor said Philips had been providing good service, compromising and going out of its way to help the hospital.
“Yet at some point, if you aren’t being paid for a couple of years, you need to draw a line somewhere.”
Siemens was due to install a new system towards at the end of January or beginning of February this year, but there have also been constant delays with that, he said.
Patients bearing the brunt
Worryingly, the hospital has lost 18 months’ worth of patients’ studies and CT scans. They had been stored on the archiving system on two hard drives, but one of the drives failed and could not be repaired, while the other was stolen.
“With a patient on chemotherapy, usually they’ll have a scan before they start treatment, then follow-up scans after that to see if they are responding to treatment,” the doctor said.
“But because we can’t access these old studies, there’s nothing for us to compare.”
Although doctors were doing their best, he added, patients were being harmed, with some falling through the cracks or having to be rescanned and subjected to more radiation than they needed to be.
The situation was now “horrifying, and people are dying”.
A head of department and another doctor had been engaging with the hospital management, to no avail.
“They’ve been banging on that door for months,” he said.
On 16 January, one of the scanners had started working again, but the machine was overloaded and could break down at any time.
“It is the back-up machine, so we can only do a fraction of the cases we need to do… but at least we can do most of our emergencies now,” he said.
Daily Maverick asked the Health Department for comment on 17 January and again on 22 January, but there was no response by the time of publication.
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