Settlers surgery shock

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As of 1 April, patients in Grahamstown who are seriously injured or ill and require urgent emergency surgery must travel to Port Alfred or further to receive treatment, if the situation occurs after-hours. This is because of a labour dispute between theatre staff and the Department of Health. However, public service watchdog PSAM warns that there is a statutory obligation to provide essential services at a hospital such as Settlers.

Nolene Ferreira, Clinical Services Manager at Settlers Hospital this week confirmed that while the emergency department is fully operational to assist with emergencies, emergency after-hours surgery i!s being diverted to Port Alfred. Settlers Hospital is part of a public-private partnership under Nalithemba Hospitals, ,which is in turn managed by Netcare. Port Alfred Hospital was also a Netcare public private partnership, Ferreira said in reply to questions from Grocott’s Mail.

“Emergency response units have been made aware of this, in line with the relevant protocols,” Ferreira said.

Asked whether an assertion by the Department of Health this week that the dispute had been resolved meant the service would resume, Ferreira said the situation was unchanged from their perspective.

Indefinitely

Local doctors received a letter from Nalithemba Hospitals dated 29 March and marked urgent, informing them that after-hour emergency theatre services at Settlers Hospital would be suspended indefinitely with effect from 1 April 2018.

The letter, which Grocott’s Mail has seen, is signed by Ferreira, who wrote: “We have been informed by the consortium of Department of Health on-call theatre staff that they will not be available for after hour and weekend services until further notice, due to an unresolved dispute with the Department of Health.
“Nalithemba is not in a position to provide this service independently of the Department of Health staff allocated to theatre.” Port Alfred Hospital theatre was available as a divert hospital for any private emergency theatre cases, Ferreira said.

However the Public Service Accountability Monitor says the facility could be odds with its statutory obligations in withholding this service.

Health researcher at PSAM Nicola Sulter said in terms of the Regulations Relating to Categories of Hospitals passed in 2012, Settlers Hospital was a medium sized District Hospital.

“These same regulations state that a District Hospital must, inter alia, ‘provide a district hospital package of care on a 24 hour bases’ and ‘must provide services that include in-patient, ambulatory health services as well as emergency health services’,” Sulter said.

“Obviously, in terms of s27(3) of the Constitution ‘no one may be refused emergency medical treatment’ and in terms of section 5 of the National Health Act ‘a health care provider, health worker or health establishment may not refuse a person emergency medical treatment’.

Not disclosed

“Furthermore, in terms of s12 of the National Health Act, a district health council and municipality have are obligated to share certain information including ‘the types and availability of health services… and other aspects of health services which may be of use to the public.”

Sulter said the latter would be particularly relevant if the halt to after-hours emergency surgery had not been disclosed to the public.

Regarding the industrial action undertaken by theatre staff, Sulter affirmed that Section 23(2)(c) of the Constitution allowed every worker the right to strike.

“However, this right is subject to the limitation clause in section 36 of the Constitution. The Constitution states that that limitation must be reasonable and justifiably taking into account, inter alia, ‘the nature of the right, the importance of the purpose of the limitation, the nature and extent of the limitation, the relation between the limitation and its purpose, and less restrictive means to achieve the purpose’,” Sulter said.

“Section 64 of the Labour Relations Act confers upon employees the right to strike as long as certain procedures set out in that section have been followed. However, section 65(1)(d)(i) denies this right to people who are ‘engaged in an essential services’. Section 213 of the Labour Relations Act defines essential services as, inter alia, ‘a service the interruption of which endangers the life, personal safety or health of the whole or any part of the population’.

Sulter said services performed by theatre staff are classified essential services. She also said the fact that Settlers is a public-private partnership was unlikely to make any difference to its statutory obligations.*

Resolved

A source told Grocott’s Mail that theatre nurses at Settlers Hospital were on strike because the Department had not paid them overtime for seven months. Put to Eastern Cape Department of Health spokesperson Sizwe Kupelo, he said on Wednesday the dispute between theatre staff and the Department had been resolved.

“We have resolved the issue,” Kupelo told Grocott’s Mail. “The overtime payments fall under accruals which would be paid this month. The delay was due to the fact that we were ending the financial year.”

Ferreira said it would not be accurate to use the word “strike” in this context. However, she said, “From our perspective the situation is unchanged and, while the emergency department is fully operational to assist with emergencies, the hospital remains on divert for after-hours emergency surgery.”

Ferreira said, “Thank you for your further questions and for highlighting the Regulations Relating to Categories of Hospitals passed in 2012 and The Constitution. We wish to reiterate once again that emergency care is, as always, being provided within the emergency department, but that after-hours emergency surgery, in theatre, will for now be provided by Port Alfred Hospital.”

Provincial Chairperson of the Democratic Nurses Association (Denosa), Zanele Mdliva*, said while she was not up to speed with the specific situation with Settlers theatre nurses, they had the right to industrial action.

“If the staff is not receiving overtime and if management is not willing to listen to workers they have no option but to take action. This will not be a strike, however, Mdliva said. “It will either be a go slow (skeleton staff with emergency services still available) or a total shutdown.

“There must always be someone to help because we are not dealing with objects, but lives,” Mdliva told Grocott’s Mail in a telephone interview. “We still having that heart that someone needs to assist the community. But we also want management to give an ear to our complaints.”

*  PSAM comment about essential services status of theatre services as well as statutory obligation of public-private partnership updated.
* “Mkiva” corrected to Mdliva.

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