Johannesburg - It took the Cunningham family 10 days to find their relative’s body, wrapped in black plastic and ringed with duct tape. Now the family of Johannes van der Nest say that Tembisa’s “killer hospital” left their father to die.
As a baby, Nicole Cunningham remembers her moustached father dancing with her in their living room. The avid golfer and former SAA staffer had fallen on hard times financially but he loved sport.
On February 28, Van der Nest, 51, left the Houtkapper Street home he shared with his elderly parents for the Prime Time Sports Bar on Elgin Road to watch rugby with a friend.
He never returned home.
Early on March 1, Van der Nest was probably bludgeoned with a metal pipe while walking home from the bar.
Thieves took his cellphone but left his Capitec bank card and a luxury Swiss Raymond Weil watch.
When paramedics responded to a call regarding Van der Nest they found him conscious, confused and scared.
He pleaded with them to “take anything you want, just don’t hurt me”, said Cunningham, who interviewed bystanders as part of an investigation into her father’s death.
At the time of admission to Tembisa Hospital at 4.48am that day, he had a Glasgow coma scale (GCS) score of 14/15.
The GCS is a 15-point scale used to assess brain injury severity. The higher the score, the better the prognosis.
But it took 90 minutes before Tembisa Hospital staff opened a patient file. The hospital and health department maintain they do not have the signed ER24 documents, in Cunningham’s possession, that indicate he arrived much earlier.
It took another four hours before a CT scan of his brain was ordered, according to the patient file obtained by police.
The scan showed massive brain injury and Van der Nest was admitted to Tembisa’s intensive care unit (ICU).
It took 12 hours before staff attempted to refer him to the Steve Biko Academic Hospital. It has a neurosurgery department, which was needed to deal with the severe head injury Van der Nest’s CT scan revealed.
No bed was available and, according to a note in Van der Nest’s patient file, the doctor said that his file had to be reviewed by a neurosurgeon on Monday - two days later.
Van der Nest’s file has no entries for two days. No notes were made until 7pm on Monday, March 4, when a doctor recorded his time of death.
There is no record of Van der Nest’s heart stopping and subsequent adrenaline shots, as is alleged to have happened by one doctor interviewed by Cunningham - despite the hourly observation that should accompany an ICU admission.
Gauteng Department of Health spokesman Simon Zwane said ICU patients were seen daily by doctors and hourly by nurses. Every procedure was supposed to be noted and this applied to Van der Nest as well.
According to Zwane, Steve Biko Academic runs a weekly neurosurgery outreach programme to Tembisa. If no beds are available at Steve Biko Academic, the hospitals jointly manage cases and this can include surgery at Tembisa Hospital.
According to Susan Cunningham, Van der Nest’s former wife, ICU staff said this service had not been running for weeks.
“We found out from the ICU staff when we went in on a Saturday that they generally have people coming from Steve Biko from the neurosurgical department every week to look at patients,” Susan said.
“There had been no one coming for the last three weeks.”
Van der Nest’s file shows no attempt to operate or to move him to another facility, such as Charlotte Maxeke Johannesburg Academic Hospital, that might have had more capacity to deal with serious head trauma. Charlotte Maxeke is roughly the same distance from Tembisa Hospital as is Steve Biko Academic.
Nicole, a University of Johannesburg lecturer, took three weeks off work to piece together her father’s last days. This has included many trips to Tembisa Hospital and three hours of conversations between her and hospital staff that Nicole videoed on her cellphone.
During these meetings, hospital staff claimed that they never received the signed ER24 handover in Nicole’s procession, which shows her father was admitted much earlier than hospital records show.
The videos show staff giving very different accounts of why they did not alert social workers or police sooner of an unidentified patient in the ward.
Susan describes the family’s first attempt to find out about his death at the hospital from the matron in charge of the ICU.
“We went to see her and she said she was (drinking) tea and that she’d deal with this when she’d finished,” said Susan.
“Why go into nursing as a profession if you don’t want to help people - if you don’t have that kind of sympathy?”
Hospital management had to be persuaded to open the morgue so that Van der Nest’s 75-year-old mother could see her son’s body.
Susan said the morgue “looked like a storeroom with all the bodies lying on this shelving… in a row with plastic sheeting and duct tape.
“That’s how we saw him - duct tape around his neck, duct tape around his feet and they had to cut (the sheeting) open.”
Nicole said the morgue smelled so bad that the family sprayed deodourant on tissues and held them to their faces while viewing the body.
In the two months since her father’s death, Nicole has recorded conversations, amassed paperwork related to the death and pursued various avenues of complaints after her aunt laid an initial complaint on March 9 with the hospital.
She has called lawyers, the Health Professions Council of South Africa and the Hospital Ombudsman.
On March 28, she filed a complaint with the Gauteng Premier’s Hotline and on April 2, DA caucus leader Jack Bloom forwarded her e-mail on the matter to Hope Papo, who was then the health MEC.
She received no response until last Wednesday, when a hotline staff member called her to say the matter had been referred to a Department of Health group looking at “serious adverse events” at public facilities. When she asked what had prompted feedback after almost nine weeks, the staff member said it was due to media involvement, Nicole said.
As of Tuesday afternoon, Nicole was still waiting for a follow-up call from the hotline.
Zwane said the hospital’s chief executive had not received Nicole’s hotline complaint but had now tracked it down using her reference number.
Zwane said a quality assurance manager had started working on the case and the response should be completed in two weeks’ time when one of the consulting doctors returned from overseas.
He added that the department encouraged patients to report problems with the heads of facilities and the hotline on 0860 428 8364.
Just weeks after Van der Nest died, Bloom released a list of Gauteng’s “killer hospitals”, including Tembisa Hospital, based on the number of reported serious adverse events at facilities.
These events “are basically negligence, or things that shouldn’t have happened. In this case, it didn’t even get that far - they just ignored him,” Bloom said.
Between January 2012 and September 2013, Tembisa Hospital had 71 serious adverse events - more than any other Gauteng hospital monitored during the same period.
Chris Hani Baragwanath - with more than twice the number of beds as Tembisa – had 64 serious adverse events during the same period.
“For Tembisa Hospital to have more serious adverse events than the largest hospital in South Africa, Baragwanath, is shocking,” said Bloom, who said he had been hearing increasing reports of poor care and conditions at Tembisa Hospital.
Susan said: “I think these are warning bells. What’s hard to bear is, because he had no ID, nobody was there fighting for him. We just don’t know if anyone really did anything for him and because there was no one fighting for him, he just became another statistic.”
Nicole will never get her father back. She also knows she may never know what really happened to him as he lay dying and alone in hospital.
But she hopes her fight will spare other families from going through the same thing.
“While I will never really know if he could have survived should he have received the proper medical care, I feel the care provided by Tembisa Hospital was grossly inadequate. I just don’t want anyone else to have to go through this,” she said.
On March 1, Kempton Park father of three Johannes van der Nest is attacked while walking home from watching rugby at a nearby pub. He is found conscious, confused and frightened by local neighbourhood watch guards and taken by ER24 ambulance to Tembisa Hospital.
Three days later he is dead.
Now his family want to know what happened.
* 3.50am: Neighbourhood watch guards discover Van der Nest in the street and call paramedics. Van der Nest appears to have been bludgeoned from behind with a metal object while walking home from a local pub where he had watched rugby.
Guards later report that Van der Nest’s watch and bank card are still on his body when they hand him over to ER24 paramedics.
* 4.08am: An ER24 ambulance arrives. Van der Nest is conscious but afraid. He reportedly pleads with paramedics to “take anything you want, just don’t hurt me”. He is in an unstable condition when he arrives at Tembisa Hospital, with a Glasgow coma scale (GCS) score of 14/15. The higher the score, the better the prognosis.
* 4.48am: Van der Nest is handed over to Tembisa Hospital casualty staff, who sign for him on the ER24 patient report under the name “John”.
6.30am: The first entry appears on the patient file that Norcom Park police have obtained through colleagues in Tembisa. The name on the file reads “Johan unknown surname”.
* 8.20am: A doctor orders chest, skull and pelvic X-rays for Van der Nest. Drugs are administered. About 30 minutes later, Van der Nest has a seizure.
* 9.30am: a CT scan is ordered. CT scans combine X-rays and computer imaging to create cross-sectional images of the brain. The scan is carried out about two hours later.
* 1.15pm: Doctors receive the CT scan results and the file notes that he is in critical condition. About an hour later he is still an 8/15 on the GCS.
* 3pm: Doctors admit him to the intensive care unit (ICU). But without a bed, Van der Nest waits at least another hour and a half for admission to ICU. When he is admitted, his GCS score has fallen to 6/15 but he is still opening his eyes and responding to stimulus, notes the file.
* 6pm: Unequipped to handle severe brain trauma, Tembisa Hospital refers cases to the Steve Biko Academic Hospital, about 30 minutes away by car. There is no bed available at Steve Biko. Doctors prescribe pain medication and note that Van der Nest must be reviewed by a neurosurgeon on Monday, March 4.
Charlotte Maxeke Johannesburg Academic Hospital, which is also equipped to deal with head trauma, is about 10km further from Tembisa Hospital than Steve Biko Academic Hospital but is never contacted.
* 7pm: An entry notes Van der Nest’s death in his patient file. Staff note calling 10111 to try to trace his next of kin.
Health-e News Service