The healthcare workers at Tembisa Tertiary Hospital were described as the biggest elephants in the healthcare system after the findings by the Office of the Health Ombud revealed that Shonisani Lethole’s body was found in rigor-mortis stage, days after he tweeted Health Minister Dr Zweli Mkhize about conditions at the hospital.
On Wednesday, Health Ombud, Professor Malegapuru Makgoba, said during a virtual media briefing that Lethole did not receive food for more than 100 hours while at the hospital.
The investigation was undertaken after a complaint was lodged by Mkhize with the Office of the Health Ombud to investigate the circumstances surrounding the care and death of Lethole.
@DrZweliMkhize mkhize can I respond to your tweets if the problems I have at one of your facilities continues its becoming unbearable and the don’t seem to care. Didn’t eat for 48 hours.
— shonisani lethole (@Shonilethole) June 25, 2020
The Tweet went viral and triggered an online #JusticeforShoni movement which saw Twitter users demanding answers and justice.
Makgoba said to his knowledge 25,936 people signed a petition that was handed over.
During the briefing, Makgoba confirmed Lethole was not given food for 43 hours and 24 minutes in the first incident and later, 57 hours and 30 minutes until he passed away on 29 June 2020.
It is also unclear exactly when Lethole passed away because of the lack of medical records and contradictory reports from staff and patients.
Makgoba touched on the quality of the healthcare system’s components.
“Our policies are very good. Our infrastructure I would categorise as medium. Our biggest elephant in the room is, however, the people. We need to create a new culture of training medical staff.”
It was also found Lethole was placed in ward 23, where positive and negative patients were mixed, posing a serious health risk to him.
Lethole was also nursed in an area where he was in proximity with corpses in Covid-19 isolation for hours, before the bodies could be moved to the hospital mortuary.
Lethole was certified dead, in rigor-mortis stage, on 20 June after he was last attended to by a doctor two days prior.
“This for a patient sedated, intubated, and not being fed who needed intensive monitoring, evaluation and interventions, was grossly negligent,” Makgoba said.
The investigation further found that there were missing doctor’s notes for the dates of the 23, 24, 25, 28, 29, and 30 June 2020.
Makgoba recommended that Gauteng MEC for health, Nomathemba Mokgethi, urgently appoint an independent forensic and audit firm to conduct a competency, “fit-for-purpose” assessment of the leadership and management staff at the hospital, and to review and revise the hospital’s admission policy and processes.
He further recommended disciplinary inquiry against various doctors and healthcare workers.