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Pietersburg Provincial Hospital: In the heart of the beast

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Pietersburg Provincial Hospital might soon lose half of its component of health care practitioners to other provinces due to the fact that some doctors are reportedly unhappy with the way things are done at the institution and have started looking for employment in other provinces.
It is alleged that theatre conditions at the hospital are not improving while emergency operations have been delayed because only one theatre is working during the night and nurses refuse to open a second one. During the day several elective operations apparently have to be postponed or delayed to accommodate emergencies. It was also learned that three doctors in top management positions are harassing doctors and interfering with their clinical decisions, hence forcing some doctors to look for posts elsewhere. The names of the managers are being withheld.
These allegations prompted Polokwane Observer to conduct investigations which revealed that there is a shortage of doctors on call in the surgical department, a situation necessitating the three managers in charge to force medical officers from other departments to assist in operations. One of the managers allegedly threatens to stop overtime pay if medical officers refuse to abide with their instructions, according to a source.
Two of the managers are allegedly the ones who decide which patients are admitted to the Intensive Care Unit (ICU) and are not doing it professionally, with consequent harm to patient management. The source indicated that patients with medical conditions needing high quality care receive lesser priority, based on the decisions of these two managers. It was revealed that in April one of the man­agers gave unlawful and unreasonable instructions to a surgeon, a Cuban doctor who has been working in the province for more than 20 years. The surgeon refused the instruction, but little did he know that the managers would stop the commuted overtime part of his salary and forbade him to be on call. The instructions were to operate on a patient who did not need the procedure. The patient in question was cured without operation and discharged five days later.
In another incident, the surgeon was instructed to discharge a patient from ICU in an early post-operative period after cancer resection. The patient was intubated that same night and died a month later without leaving the ICU. The findings show that the surgeon’s choice of treatment was right and the manager was wrong, stressed the source. The source emphasised that the surgeon has appealed to all instances in the Department of Health but his efforts were fruitless.
Response from Health Department: operating theatres  
The Department of Health was contacted to comment on the allegations and departmental spokesperson Derrick Kganyago stated that there is one maternity theatre and six operating theatres and agreed that only one theatre is operational after hours, due to the fact that fewer operations are done because only emergencies are operated on. There are clinical protocols that dictate which emergency should get priority over others. A pregnant woman is top of the list of priorities. A number of theatres opened after hours, depending on the need and the number of emergencies admitted after hours requiring surgical operations. The number of nurses available is a limiting factor as well as the availability of anaesthetic doctors. There are times when the hospital opened two theatres and the extra theatre was not utilised. This amounts to fruitless expenditure as the hospital pays staff to be on duty, however no work is done. As from September, the hospital opened two theatres after hours and the department is monitoring utilisation of the theatres.
Overtime incentives
Kganyago indicated that overtime is based on need and not on doctors’ preference. According to the policy of the department, hospital management has a responsibility to review the number of patients seen after hours and approve overtime for those departments. “Departments that do not see a lot of patients should have their overtime reviewed and adjusted. Overtime is not an entitlement as some doctors seem to think. The overtime policy of the department requires that twice a year approval of overtime gets reviewed.”
Shortage of doctors
He conceded that there is a huge shortage of doctors and nurses in the hospital and the department is unable to appoint more because of the moratorium on appointment of staff as per Treasury Instruction Note 7.
The allocation of doctors to departments varies because different departments have different workloads and it will also vary from hospital to hospital, he explained. There is no standard across departments and hospitals. Management has the responsibility to allocate resources where the need is greatest, according to him. Workload will be defined by the number of beds allocated to each department, the number of patients they see in that department and the procedures done, Kganyago indicated.
Three managers
One of the three managers is the clinical director of the hospital, meaning he is in charge of all the doctors. His responsibilities are to ensure that the standard of care given by the doctors to patients is of acceptable level and beyond reproach. He said it is within the doctor’s job description to ensure that when doctors do not perform according to acceptable standards he intervenes and corrects what needs to be corrected. When the hospital gets complaints from the community, it is the clinical executive director who intervenes. If there are doctors who are not happy about the intervention the department would like to believe that it is the same doctors who provide the community with poor quality care. All the doctors who are being complained about are tasked with managing the hospital and have to intervene when doctors are not giving patients appropriate quality of care, he stated.
Hospital policies
Kganyago indicated that the hospital does not formulate its policies and the hospital management is applying the same policies all other hospitals in the province are applying. Doctors who do not like the rules should challenge them through relevant channels, he emphasised. The majority of doctors in the hospital are hard-working individuals and do not have problems with their managers, Kganyago said. “Unfortunately a number of doctors want to deviate from the policies. Some doctors do not want to see patients when they are called at night. The hospital management receives numerous complaints from community members about the poor quality of care. The hospital also receives complaints from other hospitals about the doctors at Pietersburg Provincial Hospital refusing to accept patients and in other cases some doctors work less hours than they are being paid. It is the same few individuals who commit these transgressions that taint the image of the profession.” He concluded by saying the department will not allow any doctor to put a patient’s life at risk.

Story: ENDY SENYATSI
>>endy@observer.co.za