MBOMBELA – A High Court ruling that was made last Friday now paves the way for hundreds of state orthopaedic patients in Mpumalanga who have been waiting for surgery for months.
The provincial Department of Health was ordered by the High Court in Pretoria to provide Mr Dingaan Mngomezulu (34) immediately with the necessary treatment to repair his broken leg. He had already sustained the fracture in April. A report by a private orthopaedic surgeon, stating that surgery is Mngomezulu’s only hope, formed part of the application. Not only has he been left permanently disabled because of the department’s failure to provide him with adequate care, but every day that he is denied surgery, places him at risk of even more health complications.
Still, it seems as if the department doesn’t realise the urgency of this operation as its plan of action simply entails having him readmitted to a district hospital where such surgery cannot be performed.
Mngomezulu’s case is testimony to the problems hampering the department’s ability to provide orthopaedic patients with the necessary care. The first is a dire shortage of surgeons, an issue which has been haunting health for several years.
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Another challenge is the shortage of material necessary to perform surgeries which Lowvelder reported on three weeks ago. The department had advertised an open bid for the supply and delivery of the material, but it couldn’t be finalised due to technical problems and had to be re-advertised. Companies that supply this in the interim do not have all the required material in stock. This was reiterated by Mngomezulu’s affidavits as he relayed a lack of orthopaedic material as the reason why planned surgeries on him had been countlessly postponed.
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What makes his case even more infuriating is that there is no reason why patients who suffer a fracture like his, shouldn’t have the same level of functioning they had before sustaining it.
A hopeless situation
To fully comprehend the extent of the issue, one needs to understand the department’s referral policy to treat patients. There are 33 state hospitals in Mpumalanga. They are classified as district, regional and provincial. There are only five which can conduct major orthopaedic surgeries, namely Rob Ferreira, Mapulaneng, Themba, Witbank and Ermelo.
A patient must first be admitted to a district hospital. If it proves unable to treat the patient properly, he/she will be transferred to a regional and only then to a provincial hospital if necessary.
Mngomezulu was admitted to Matikwane near Hazyview which is a district hospital. He was never referred to a regional one as the department felt his condition had been properly managed. Rob Ferreira’s orthopaedic ward has only 37 beds, but currently accommodates 42 patients. Sixteen more patients are treated in other wards.
The start of Mngomezulu’s nightmare
He had been running on uneven terrain on April 2 when he fell and broke his upper right leg. He was admitted to Matikwane where he was examined by Dr Badicel. He found that Mngomezulu had suffered a so-called closed fracture and recommended skin traction as the course of treatment.
Mngomezulu would lie here for three months, with nothing more than a few bricks attached to his leg in an attempt to keep it in traction.
A builder by profession, he worked for Ms Isdora Vorster on a contract basis. She heard that he had been in Matikwane for months without any signs of improvement and contacted Dr Corné Ackermann, a private orthopaedic surgeon, for help.
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Ackermann examined him and found he required urgent surgery. Mngomezulu didn’t have the money for the operation and the doctor suggested they seek legal help. They turned to Ms Lesley Anne Breytenbach, an attorney at Breytenbach & Van der Merwe Attorneys in Mbombela. She specialises in personal injury and medical negligence.
Ackermann supplied her with a report, stating that surgery was Mngomezulu’s only hope and Breytenbach consequently instructed an advocate to bring an urgent application before the High Court which would force the department to provide him with the necessary care.
Administering inferior care
Ackermann explained in her report that the traction should have taken place with proper balanced skeletal traction, “by means of a Steinman pin as described by Thomas”. After 12 weeks of having lain in Matikwane with no signs of improvement, Vorster assisted Mngomezulu to discharge himself on June 26 and brought him to Ackermann. They then turned to Breytenbach for help and she instructed an advocate to file an application which would force the department to take a more aggressive approach towards treatment.
In its defence, the department argued that the application wasn’t urgent. The court agreed and the case was postponed to September 30. Meanwhile, Breytenbach took Mngomezulu to Rob.
Being sent from pillar to post
There he was turned away and supplied with a letter confirming that there were no beds available. Mngomezulu was told to return on July 15, but was again refused because he didn’t have a referral. However, Dr Oduah consulted with him that day and and told him that the hospital had run out of the pins and screws required to perform the surgery.
Mngomezulu was given a prescription and told to return to Rob on August 5. That day, he was first told that his file had gone missing and then informed that it was with the CEO as legal proceedings were pending.
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He was again seen by a physician that day who said the pins were still not available. Mngomezulu was told to return on September 2, only to be turned away again because there was still a shortage. He was told to return on October 8.
Victory
Mngomezulu’s application was finally heard on September 30. The department requested another postponement, but the judge, Mr Justice Fabricius wouldn’t grant it. He stood the matter down to October 2 to allow health the time to respond why the court shouldn’t grant the order. The department consequently filed an answering affidavit on Thursday, citing the traction as adequate medical care. Fabricius didn’t agree and granted the order.
He even assigned himself as case manager, which meant that the department had to report to him specifically. Breytenbach said this showed how concerned Fabricius must have been, having taken the matter into his own hands.
He further ordered the department to submit a report today in which it states the steps taken to comply with the court order.
Back to square one
Spokesman for the department, Mr Dumisani Malamule, said, in order to comply with the court order, Mngomezulu was to present himself to Matikwane where he had been initially admitted and “continuously assessed by an orthopaedic surgeon”.
“It should be noted that the patient discharged himself from the medical facility and he was never refused medical treatment by the department. In terms of the referral policy, before a patient can be admitted to a provincial hospital, he must first be admitted to a district facility. If the district hospital is unable to manage the condition, the patient will be referred to a tertiary one. The patient must present himself at Matikwane. An arrangement has already been made for his admission. In conclusion the department has complied with the court order.”
Mngomezulu’s response
“I am very sad,” he responded when Lowvelder asked him how he felt about having to return to Matikwane. “They couldn’t help me in the first place. Why should this time be different?”
Unable to work, he has a wife and three children to support. They currently live off a disability grant. “I lie around at home all day and have to use a walking frame to get to the toilet,” he sighed.
Permanently disabled
Mngomezulu has shortening of the upper leg by at least five centimetres. It will be impossible to regain the original length and he will always walk with a limp. It can be improved with a heel raise of the shoe. For every pair of shoes Mngomezulu buys, he will have to have the right one modified to have the length discrepancy corrected.
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The muscles at the back of his leg have weakened severely because of inactivity and being immobile causes further harm on a daily basis. The wasting of muscle can become so profound that it might not be able to restore the strength adequately if surgery is further delayed.
