Instead of surgery, orthopaedic patients at Livingstone Hospital in Gqeberha, Eastern Cape, are being given a letter explaining that they cannot be helped because there are no metal implants available, with the recommendation that they call the Presidential Hotline. The phone number is included.
Livingstone is one of three tertiary hospitals in the Eastern Cape and one of the largest and busiest casualty units in the province, serving about 2.5m patients, many of whom live in surrounding rural areas, reports Daily Maverick.
The letter (see below) lists three telephone numbers: one for the hospital’s complaint service, the other for the Eastern Cape Department of Health’s complaint line, and the third for the Presidential Hotline.
Desperate patients with broken arms and legs are begging for help, but the doctors say there is nothing they can do.
“The sad truth is that most of our patients think it is acceptable for them to wait,” a hospital source said. Patients also worry that complaining will jeopardise their chances to get surgery.
“Resources do not exist to treat trauma emergencies to a medico-legal standard,” clinicians warned in a letter to the department’s managers in 2021. Yet the crisis continues.
Department actions
In a written answer to the Eastern Cape Legislature a month ago, Dr Rolene Wagner, head of the provincial Health Department, said the department was providing patients – whose jobs depended on successful surgeries – with sick notes and additional medical reports.
She said the procurement of implants and medical and surgical supplies was under way. The hospital was also working with district hospitals to see which surgeries could be done there, she said.
The department, however, was unable to provide a timeframe for when the surgery backlog would be addressed.
Failure of governance and oversight
Livingstone Hospital last had a permanent CEO in 2018 when a violent protest by four unions organised by Nehawu forced then CEO Thulane Madonsela and his management team out of the hospital.
Madonsela eventually resigned after being suspended by the former head of the department, Dr Thobile Mbengashe.
Madonsela and his management team were recently paid millions after the Labour Court ordered they each be compensated with six months’ salaries and legal costs. The court confirmed an arbitration ruling that their suspension had been wrong.
In December 2022, Dr Mtandeki Xamlashe, the hospital’s then acting CEO, admitted to the Health Portfolio Committee doing oversight at Livingstone Hospital that there was a shortage of orthopaedic implants and more than 100 trauma patients on the waiting list. Xamlashe has since been promoted to top management in the provincial department.
Failed legislature intervention
In June 2022, the Eastern Cape Legislature passed a unanimous motion, brought by the DA’s Jane Cowley, that the suppliers of orthopaedic implants to state hospitals must be paid. Yet payment did not happen.
The shortage of implants was again raised in a letter from a number of senior doctors in the metro.
Health MEC Nomakhosazana Meth blamed Covid-19 and possible duplication of invoices.
In August 2022, the department admitted that it owed the suppliers of orthopaedic implants R52m.
Meth highlighted in her answer to the Eastern Cape Legislature that there had been “unprecedented demand” for trauma and mental health services in the Nelson Mandela Bay metro, which she said was also due to the city’s increased population.
Meth indicated the invoices would be paid by August 2022 – which did not happen and, in November, replying to oral questions in the legislature, she again promised suppliers would be paid.
Delivering his budget speech this month, Mlungisi Mvoko, the Eastern Cape MEC for Finance, said medico-legal claims were still draining provincial coffers, resulting in serious cash flow challenges.
There had been a 96% reduction for in-year irregular expenditure to less than R3.4m in 2022/23 from R104m in 2021/22, due to improvements in systems and controls.
“The provincial Health Department has reprioritised its budget and made available R544m over the (medium term) towards maintenance and acquiring much-needed health machinery and equipment,” he said.
Cowley said the operational budgets of all hospitals in the province were dramatically reduced to enable the Eastern Cape Health Department to settle medico-legal claims against them.
“It’s outrageous,” she said. “How can the situation at Livingstone be so dire if all of the steps mentioned above have been taken? And why will the department not refer patients, whose lives are in danger, even if this means referring them to another province?”
The letter by Livingstone Hospital doctors
Dear Patient,
You have been admitted to Livingstone Hospital because you require emergency/urgent treatment for an orthopaedic condition.
Unfortunately, the implants (metal devices used to fix broken/deformed bones) needed to best treat you are not currently available in the hospital. Depending on your injury and the delay the implant unavailability causes, you might not be able to be treated surgically and have a poor result/outcome. Your doctors have not been informed when implants will be available or given any alternative hospitals to transfer you to.
See more from MedicalBrief archives:
EC Health Department ordered to pay overdue bills for orthopaedic implants
DA: Dramatically reduced budget leaves Livingstone Hospital hamstrung
Nehawu criticises conditions at PE’s Livingstone Hospital