By Dr Volker Hitzeroth, Medicolegal Consultant, Medical Protection
Dr L was an intern at a large state hospital. She consulted with Ms N regarding abdominal pain, nausea and vomiting in the emergency unit. Ms N’s symptoms started a few days earlier, were slowly increasing in severity and fluctuating in nature.
Dr L requested several special investigations and, as she suspected that the patient suffered from either gallbladder pathology or appendicitis, referred Ms N to the surgery department. Dr M was a community service doctor who was on duty for all the surgery referrals. Dr M assessed Ms N and diagnosed her with acute appendicitis. A decision to operate was made and the patient was admitted for surgery under another surgical team. Unfortunately, the surgery was delayed due to the large number of other emergencies that took precedence.
Ms N continued to complain of significant pain while on the ward. This was managed by the nursing staff with the pain relief medication prescribed by the team’s community service doctor, Dr K. Ms N reported feeling worse and despite alerting the nursing staff to her concerns, and requesting to speak to a doctor, nothing happened. Ms N texted her husband to share her concerns and he contacted the hospital’s CEO, who was a friend of his employer. When the husband’s complaints were referred to the surgical team Ms N was assessed by Dr K again.
Unfortunately, by this time Ms N was very unwell with suspected peritonitis. Her vital signs indicated a severe illness, and it was decided to proceed with surgery as a matter of urgency. During surgery, the registrar, Dr D, confirmed a ruptured appendix with significant intra-abdominal sepsis. Ms N’s postoperative course was complicated by renal failure, ventilation, a longer ICU admission and three further operations. Unfortunately, she did not recover and died shortly after the final operation.
A complaint, inquest and HPCSA investigation
Ms N’s husband immediately sent a formal complaint to the hospital’s CEO in which he complained about his wife’s care and threatened to escalate the matter. The CEO responded to the complaint without requesting the doctors to contribute. She did not invite the doctors to brief her and only informed them afterwards that she had already responded to Mr N’s complaint and the doctors had nothing to worry about. Ms N’s husband was dissatisfied with the CEO’s response as it did not address the doctor’s roles and only explained how the service was severely stretched, how overworked the nursing staff were and how nothing could have been done to prevent the tragic outcome.
Mr N proceeded to complain to the HPCSA about the conduct of all the doctors involved. Medical Protection was able to assist our three members Dr L, Dr D and Dr M by instructing our panel attorneys to assist them in responding to Mr N’s complaint. Dr K was not indemnified at all and ignored the HPCSA complaint notification.
The explanation for Dr L was accepted while both Dr D and Dr M were referred to the Professional Conduct Committee. Again, Medical Protection was able to assist both doctors with our panel attorneys instructing an advocate to lead their defence. Fortunately, after a two-day hearing both doctors were found to have conducted themselves professionally and no further action was taken against them. The whole HPCSA process took three years. Dr K was ultimately tracked down by the HPCSA, fined for contempt of council and found guilty of unprofessional conduct for neglecting to treat Ms N promptly. Dr K received a significant fine and was suspended for one year.
Four years after the death of Ms N the SAPS approached all the doctors for a statement as the matter had escalated into an inquest. Fortunately, Medical Protection instructed panel attorneys who were able to advise and assist Drs L, D and M in drafting their police statements. The inquest magistrate decided to hold a formal inquest and our members were again ably assisted by the instructed attorneys and advocates, who were able to defend them successfully throughout the inquest proceedings and specifically during the gruelling cross examinations. The magistrate determined that none of the Medical Protection members acted in a manner that could be criticised.
At the same time Mr N lodged another complaint at the Office for Health Care Standards (OHSC) against Dr K. Medical Protection was informed that Dr K’s conduct was severely criticised by the inquest magistrate and that the National Prosecuting Authority were considering charging Dr K with culpable homicide. At this stage, five years after the clinical event, Dr K was unemployed, had no further financial resources, was recently divorced from his spouse, was refused access to their two children and was living in another province with his elderly parents.