Abuse of patients’ rights and failure to execute duty of care are some of the findings of the professional body that investigated allegations about Tower Psychiatric Hospital. Meanwhile, the Fort Beaufort facility’s CEO strongly denies claims of a cover-up and says the whistleblower was motivated by resentment. Kathryn Cleary reports
The South African Society of Psychiatry (SASOP) has presented the Department of Health with recommendations for improved care at Tower Psychiatric Hospital in Fort Beaufort, after the professional body’s investigations confirmed human rights violations. The 15 recommendations concern policy and procedure, food and clothing, physical health of patients, death registration and notification, and advocacy.
SASOP’s investigation follows claims made by whistleblower and former Tower psychiatrist, Dr Kiran Sukeri. An exposé in City Press and Rapport on 4 March 2018 presented shocking images of an isolation room at Tower Psychiatric Hospital in Fort Beaufort. Sukeri spoke out about the alleged degrading and inhumane treatment of patients and claimed death registers had been altered, meaning an alarming number of patient deaths at the hospital in recent years had gone unrecorded.
Sukeri’s claims were refuted by the Department of Health in the Eastern Cape.
The Society issued a statement on their findings on 22 March 2018. The report is set to be released on 29 March and the findings have been shared with the Eastern Cape Department of Health.
The Society’s president, Professor Bernard Janse van Rensburg, said, “Patient and death records, death notification, as well as the manner and capacity of secluding patients at this facility has been infringing on patients’ human rights.”
Grocott’s Mail visits Tower Hospital
Following Sukeri’s allegations, Grocott’s Mail approached the Eastern Cape Department of Health to request permission to visit the facility. Spokesperson Sizwe Kupelo arranged permission, encouraging our journalists to “see everything”. This followed claims of a clean-up as part of an alleged cover-up ahead of Health MEC Phumza Dyantyi’s inspection of the facility on 5 March. Two journalists visited the premises on Friday, 16 March.
Isolation cells in the Ward 6B complex. The depiction of one of these in the 4 March Rapport article was among the concerns that has triggered a series of investigations into the facility in the past three weeks. Photo: Sue Maclennan.
Grocott’s Mail was escorted through the gate to the main administration building, where we conducted an interview with hospital CEO, Ntombizandile Ngcume. A tour of the hospital followed, hosted by Ngcume and accompanied by Deputy Nursing Manager, Lawrence Baart. The tour included the laundry and kitchen facilities, as well as admission ward 6B and long-term ward E (LTE). Ngcume expressed that touring all 14 wards would take “all day”, hence the journalists would visit only two.
The CEO rubbished claims by the National Health and allied Workers Union (Nehawu) that the hospital had been specially cleaned up the night before the MEC’s visit. The interview with the CEO seemed to support Dyantyi’s view that nothing was amiss; however, Grocott’s Mail found contradictory information about the use of the isolation cells. One of these was depicted in a filthy state in the 4 March Rapport article.
Grocott’s Mail confidentially spoke to several staff members after the visit who remain adamant that a concerted clean-up was undertaken the night before the MEC’s visit. One source said they had seen them “cleaning until midnight”.
That night, flood lights had been turned on at the facility as staff and management cleaned up and moved things around.
Nehawu branch chairperson Lawrence Mtsila told Grocott’s Mail, “Lights were really on, seen by me. Doing what is called preparation or cleaning up dirty things.
“They did that until midnight, even seen by night staff. Some staff members were supposed to go [home]as early as 6pm but due to this cleaning went home at 9pm.”
Grocott’s Mail’s visit to Tower was four hours in total.
Whistleblower had a grudge, says CEO
Commenting on Sukeri’s claims, Ngcume said, “It has been very hard for all of us, because the things that are said are not true.” Sukeri’s allegations against Tower include the ill-treatment of patients, forged death registers and unsatisfactory food, as well as the taxation of patients’ money.
Ngcume said Sukeri had not informed her of his grievances before the publication of the Rapport article on 4 March.
Ngcume said she believed his resignation was sparked by plans to open a 60-bed acute unit at the hospital.
Tower is currently a referral hospital, meaning patients are sent there from other institutions – mostly with long-term chronic conditions. An acute unit would mean patients could be admitted there directly. “I think [it]was this problem, we were going to open an acute unit,” said Ngcume, who asserted that Sukeri did not want to work in such a unit.
She later added that he had resigned to pursue his private practice, and claimed he had been a part-time psychiatrist at the hospital.
Grocott’s Mail approached Dr Sukeri for a response to Ngcume’s claims about his motivation. Sukeri stated that he had been advised by SASOP to refrain from public comment at this stage.
Ngcume said they had advertised a position for a full-time psychiatrist the beginning of 2018 and found a candidate from Limpopo. Ngcume said with so few psychiatrists in the Eastern Cape, this was a challenge.
Ngcume claimed Sukeri was angry about news of this appointment.
‘There was no cover-up’
Ngcume refuted claims of a cover-up the night before the MEC’s visit. “That story is totally untrue,” she said. Ngcume also denied that staff knew of the visit. “There was no way [we could have known]. It was a surprise – we didn’t even tell the day staff,” she said.
Mtsila told both Rapport and Grocott’s Mail that staff had worked alongside Ngcume until midnight, cleaning and fixing the night before the visit.
“Who worked until midnight?” Ngcume said to Grocott’s Mail. “No such thing happened.”
“Maybe there are things that we do not know happening in the institution”, she said. “We did [ward]rounds.” She said the rounds had finished before seven that evening.
However, when Grocott’s Mail put this new version of events to Mtsila, he said, “Doing rounds is something totally different. As I said before, they worked up until midnight.”
Ngcume said the union members had fabricated the cover-up as a way to express their own grievances. “They wanted to make the story of Dr Sukeri strong. It’s because they’ve got their grievances – they see it as an opportunity,” Ngcume said.
Ngcume emphasised that there cannot be a management that allows each person to do what they want. “What is wrong is wrong, what is right is right, you cannot manage an institution that is ‘laissez-faire’,” she stated. “You have to make controls, you have to make stability in your institution.”
The single rooms
Last week, Grocott’s Mail reported that the single rooms (as depicted in Rapport) had been used up until the MEC’s visit. This was confirmed by Nehawu Chairperson, Mtsila.
A subsequent photo released by the DA showcased the same room as the Rapport photo but completely empty. A delegation from the DA had visited Tower on 12 March. The delegation was told by Ngcume that the rooms were not used because they failed to meet the required standards.
Grocott’s Mail journalists on Friday 16 March found the single room in the photo to be empty, but other single rooms had mattresses stored inside, while at least one other was complete with a made-up bed, with linen and a pillow. Ngcume earlier told Grocott’s Mail, “The patients that are there in the single rooms wanted to be there.”
“Some patients are there voluntarily.” Patients could otherwise be placed in single rooms only on doctor’s orders, she said.
SASOP, in its recommendations, urged that the use of these rooms being stopped immediately.
“The seclusion rooms are positioned in the court yard of the hospital, far away from the nurses’ station or other point of observation by staff, with no amenities available, and seem to have already been precipitating incidents of harm to and human rights abuses of patients,” said Van Rensburg.
The kitchen and laundry
Mtsila told Grocott’s Mail last week that the night before the MEC’s visit, brand-new supplies were brought out. This included new patient uniforms, ward beds and fresh food.
However, Ngcume said that it would not have been possible for the hospital to acquire new patient clothing or food stock before the MEC’s visit. She said food was ordered at the beginning of each month, and patient clothing was delivered from a manufacturer in KwaZulu-Natal.
Grocott’s Mail journalists were shown a linen store room filled with patient clothing and bedding, as well as various fridges and pantries in the kitchen fully stocked. Both areas were clean and organised.
Since the visit on 16 March, Grocott’s Mail spoke to Abongile Sipondo, Area Manager of the South African Human Rights Commission (SAHRC). Sipondo confirmed that the SAHRC was aware of the allegations against the hospital.
“The Monday after the City Press article (ie 5 March) we drafted an allegations letter and sent it to the MEC.”
“We gave them seven days to respond to the allegations. In addition, we decided to go and visit ourselves. We spoke to the CEO as well as two hospital senior managers – asked about the allegations. We did a tour – the wards, the laundry, the kitchen – all the places mentioned in the story.”
SAHRC received the MEC’s response within seven days, Sipondo said, and was told that she had not found anything suspicious during her visit. However, she decided to set up an investigative team.
Sipondo informed that the MEC’s task team was at the hospital for two weeks, 12 through 24 March.
“When the Department of Health has finished their investigation, we will do our report. It will be a compilation of what we saw, and what the Department reports.”
Sipondo said that during a visit to the hospital with two other staff members everything had seemed in order and hospital management had provided responses to each allegation made by Sukeri. SAHRC had also been told that only two out of the eight single rooms in ward 6B were not used. The others were used if a patient was restless, they had been told.
The final status of the SAHRC’s report will depend on the outcome of the MEC’s investigation. “Most reports published on our website – investigative reports – make a directive, i.e. the ‘respondent must do this and that’,” stated Sipondo.
However, a source within Tower has questioned the integrity of the MEC’s investigation.
“Since last week the investigation team from the Province has been here,” the source told Grocott’s Mail on Monday.
“They have been calling staff in one by one and on the basis of confidentiality asking them to speak out about any problems in the institution.”
“This week, the CEO called in all the managers and shouted at them. She said, ‘Why are you telling them [the inquiry people]lies?’”
“Who told the CEO what the staff said, when the inquiry was confidential?” the source asked.
“The MEC is from the Province and this inquiry is from the Province – which means this is a flawed process.”
Grocott’s Mail will continue to report on further developments of this story.
-Additional reporting by Sue Maclennan
*This story has been re-edited as of 3 June 2018, the original story was published online on 24 March 2018.