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A National Hospital Network Magazine


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Issue 3 | July 2019

Network Health | Issue 3 | July 2019

Hospital Networks DAY HOSPITALS Advanced De La Vie Day Hospital Advanced Durbanville Surgical Centre Advanced East Rand Day Hospital Advanced Emalahleni Day Hospital Advanced Groenkloof Day Hospital Advanced Knysna Surgical Centre Advanced Medgate Day Clinic Advanced Panorama Surgical Centre Advanced Soweto Day Hospital Advanced Vergelegen Surgical Centre Advanced Worcester Surgical Centre Alchimia Clinic Bethlehem Medical Centre Day Theatre Bioart Fertility Clinic Birchmed Surgical Centre Cape Dental Clinic Capital Surgical Westridge (Pty) Ltd Centre for Gynaecological Endoscopy Centre of Advanced Medicine (Dexenet) Centurion Day Hospital Citymed Day Theatre Cure Day Clinics - Bellville Cure Day Clinics - Bloemfontein Cure Day Clinics - Erasmuskloof Cure Day Clinics - Fourways Cure Day Clinics - Medkin Cure Day Clinics - Midstream Cure Day Clinics - Somerset West Cure Day Clinics - St Stephens Paarl Driftwood Clinic Edenvale Day Clinic Ekurhuleni Surgiklin Day Clinic Fauchard Clinic Fordsburg Day Clinic George Surgical Centre (Pty) Ltd Hermanus Day Hospital Hibiscus Surgical Day Hospital Howick Day Clinic Kango Clinic Kilnerpark Anaesthestic Clinic KZN Day Clinic Lorne Street Anaesthetic Clinic Mayo Clinic Medi-Harts Day Clinic Panorama Plastic Surgery Clinic Shelly Beach Day Hospital Somerset Aesthetic Clinic The Ear and Eye Clinic The Surgical Institute Thembani Thetres Vidamed Day Hospital (Pty) Ltd Waterkloof Surgical Centre Wesfleur Private Clinic Wijnland Fertility Clinic OPTHALMOLOGY HOSPITALS Cape Eye Hospital Centurion Eye Hospital Durban Eye Hospital East London Eye Hospital Highveld Eye Hospital Johannesburg Eye Hospital Khangella Eye Theatre Lakefield Surgical Centre (PTY) Ltd Ocumed Eye And Laser Institute Optimed (Pty) Ltd - Alberton Optimed Eye And Laser Clinic Pasteur Eye Hospital (prev Horizon Eye) Pietermaritzburg Eye Hospital Port Elizabeth Eye & Laser Institute Pretoria East Eye Institute Pretoria Eye Institute Rustenburg Private Eye Clinic Sandhurst Eye Clinic The Healthy Eye Twenty Twenty Eye Surgery Centre Visiclin Eye Clinic Visiomed Eye And Laser Centre



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ACUTE HOSPITALS Africa Healthcare Fochville Hospital Africa Healthcare The Fountains Hosp. African Healthcare St Helena Hospital Ahmed Al-Kadi Private Hospital Arwyp Medical Centre Botshilu Private Hospital Busamed Bram Fischer Intern. Hos. Busamed Gateway Private Hospital Busamed Harrismith Hospital Busamed Hillcrest Private Hospital Busamed Lowveld Hospital Busamed Modderfontein Pvt Hospital Busamed Paardevlei Private Hospital Cairnhall Hospital Capital Oncology (Pty) Ltd Care Cure Queenstown Hospital Cormed Clinic Crossmed Mthatha Private Hospital Daymed Private Hospital Eden Gardens Private Hospital Emalahleni Private Hospital Hibiscus Private Hospital Jane Keyser Clinic Kiaat Private Hosptial Kim-Med Private Hospital Kwadukuzu Private Hospital Lenmed Ethekwini Hosp & Heart Centre Lenmed Health Ahmed Kathrada PH Lenmed Health Daxina PH Lenmed Health Kathu PH Lenmed Health La Verna PH Lenmed Health Randfontein PH Lenmed Health Royal PH & Heart Cntr Lenmed Health Shifa PH Lenmed Health Zamokuhle PH Louis Pasteur PH Maseru Private Hospital Matatiele Private Hospital Medicure24 – Maternity Unit Melomed Bellville Melomed Gatesville Melomed Mitchell’s Plain Melomed Richards Bay Hospital Melomed Tokai Metro Maternity Home Midlands Medical Centre Midvaal Private Hospital MMHS Sunningdale Hospital MMHS Wilmed Park Private Hospital MooiMed Hospital Nelspruit Surgiclinic Hospital Nurture Aurora Private Hospital Quality Care Private Hospital RH Abaqulusi Private Hospital RH Matjhabeng Private Hospital RH Medleb RH Phodiclinic RH Vryburg Private Hospital Riemland Clinic Riverview Manor Rondebosch Medical Centre Rustenburg Medi Care Hospital Shelly Beach Private Hospital St Vincent Hospital Sunshine Hospital Urolocare Hospital Willies Hospital Zoutpansberg Private Hospital Zuid Afrikaans Hospital




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Network Health | Issue 3 | July 2019

Hospital Networks Continued PSYCHIATRIC HOSPITALS Beethoven Recovery Centre Bloemcare (Pty) Ltd Cape Gate Neuro Clinic Care Victoria Gardens Quick step Careline Clinic Crescent Clinic - Cape Town Denmar Specialist Psychiatric Hospital Fisha Wellness Hospital Kgatelopele Wellness Centre Kim-Med Mental Health Institute Life Path Group - Claro Clinic Life Path Group - Helderberg Clinic Life Path Group - Pines Clinic Life Path Group - Sereno Clinic Life Path Group - Tijger Clinic Life Path Group - Tyger Valley Clinic Life Path Group - West Beach Clinic M-Care Durbanville Wellness M-Care Optima (Bloempsych) M-Care Optima @ Rustenvrede Melomed Private Clinic (Pty) Ltd. MMHS Parkmed Neuro Clinic Nurture Harmony Substance Abuse Clinic Nurture Sunnyside Nurture Woodlands (Prev Hillandale Sub-Acute) Palm Tree Trading No. 8 (PTY) LTD Summit Clinic Rondebosch Vista Clinic ZwavelStream Clinic SUB-ACUTE AND PHYSICAL REHABILITATION HOSPITALS Alliance Care Andalusia Clinic Bryanston Sub-Acute Care at Midstream Care Cure Rynmed Care Cure Vereeniging Care Cure Victoria Gardens Carewell Stilbaai Sub-Acute Hospital Circle Healthcare Gauteng Clayton House Corona Mediese Sorg Pty (Ltd) Faircape Health Tokai Groenkloof George Care Unit Humana Healthcare Kim-Med Acute Rehabilitation Ladysmith Sub-Acute Hospital (Essen) Lynnmed Clinic M-Care Highveld M-Care Nelspruit M-Care Potchefstroom Morehill Clinic (Pty) Ltd Mothwa Med-Step Clinic Mthatha Sub Acute Hospital Northcliff Medwedge Sub-Acute Nurture Aurora Physical Rehabilitation Centre Nurture Cape View Nurture Hillandale Health Care Centre (Acute Rehabilitation) Nurture Newlands Nurture Umhlanga Hospital (Inmind) Oasis Care Centre Oatlands Care Centre Palm Garden Retreat Helen Zille Wing Robin Trust Royal Rehabilitation Hospital Spescare George Spescare Helderberg Sub-Acute Spescare Hermanus Spescare Paarl Spescare Stellenbosch St Mary’s Step-Down Vidamed Sub-Acute Hospital



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Network Health | Issue 3 | July 2019

About Us National Hospital Network (NHN) was founded in 1996 with the prime objective of bringing together leading independently owned private hospitals and medical facilities under one umbrella; to gain synergy and cost effectiveness, and to collaborate on best practice patient care. NHN’s role is to coordinate and provide resources to its members so as to assist them, particularly in achieving efficient and effectively managed patient servicing and input costs that are competitive in the marketplace. NHN has a total of 215 Hospitals, consisting of 69 Hospitals, 54 Day Hospitals, 21 Ophthalmology, 28 Psychiatric, 40 Sub-Acute, 3 Rehabilitation. Our demographic footprint includes the major urban areas of Johannesburg, Pretoria, Bloemfontein, Cape Town, Port Elizabeth and Durban, as well as in smaller centres including Louis Trichardt, Bela-Bela, Lebowakgomo, eMahlahleni and Nelspruit, which means that NHN facilities and quality care are within easy reach of as many patients as possible. A substantial number of NHN hospitals are BEEE compliant, underscoring NHN’s value as a significant support structure for driving transformation in the private hospital industry.

265 Von Willich Street, Centuria Park office, Building 16, Centurion Email: I Tel (+27 11) 268 6063 I Website: Registration No: 2007/005053/08 I Association Not for Profit: Ref No 073-559 Directors: O.F.A.K. Wypkema, I Bhorat, B Khan, Y Harneker, B Goss-Ross, J.S. Nel, D van Wyk, F Louw, G.S. du Toit. 215 total Hospitals, 54 Day Clinic, 69 Hospital, 21 Ophthalmology, 28 Psychiatric, 40 Sub-Acute, 3 Rehabilitation


Network Health | Issue 3 | July 2019

Contents Board of Directors


NHN Roadmap




New CEO at the helm


New Operations Assistant for NHN


NHN appoints a Communications Specialist


Medical Malpractice Judgments of 2018


Hibiscus Hospital Cato Ridge Development Progress


Urology Hospital update


Tokai Estate Hospital update


Pietermaritzburg Eye Hospital NewsBites


Care at Midstream update


Melomed Hospital NewsBites


RH Matjabeng NewsBites


National Health Awareness Calendar


Lenmed launches aeromedical service


Lenmed represented at Medical Tourism and wellness conference


Midland Medical Centre NewsBites


Ahmed Al-Khadi NewsBites


Busamed PPH update


Facelift for Zoutpansberg Private



Network Health | Issue 3 | July 2019

Board of Directors Chairman: Otto Wypkema Otto Wypkema is the Managing Director of Arwyp Medical Centre, one of the largest independently owned private hospitals in South Africa, and the first private hospital in Africa to be ISO 9001:2000 certificated and now COSASA accredited. He is currently the Chairman of the Board of the National Hospital Network. He started his career in the healthcare industry in 1985. Otto has five daughters and a son and enjoys flying in his spare time.

Vice-Chairman: Ismail Bhorat Ismail Bhorat is currently an Executive Director of Melomed Hospital Holdings. After completing his schooling career at Diocesan College (Bishops) in 2001, Ismail pursued a Business Science Degree majoring in Finance and Accounting at the University of Cape Town which he finished with honours in 2005. Ismail then joined the Melomed Group where he has occupied various positions and remains till today. Ismail has served on the NHN Board for the past six years and is currently also the Vice-Chairman.

Francois Louw Francois Louw, CEO of Vista Clinic and the Crazy-for-Walking Initiative, has served as a director for NHN since 2016. He holds a BTh degree from Andrews University (Michigan, USA) with business- and theology majors. He is Trustee of and the chair of the SEDMED Board of Trustees, a registered closed medical insurance scheme. After his graduate studies, he was conscripted to the South African National Defence Force and served as the SO2 officer in the Directorate Chaplains’ Services. He thereafter, amongst others, accepted a position as project manager at Protocon and Metica Development Corporations, overseeing national security- and advanced property development at these companies. In 2000 he became an elected regional president for the SDA Church and later for the Southern African territories. During this period, he was assigned to the development of Hope Channel International on the African Continent, served as chair for ADRA SA, MOWCS, SEDCOM and became the Chancellor of Helderberg College. As a member of the GC Executive Committee, Washington DC, he was assigned various key leadership positions and continues to serve on a 24 country Southern African region Health Systems Board of governance since 2005. Apart from chairing institutional- and hospital boards he has served on international health audit committees in East Central Africa. He is an appointed director of APHHS (Adventist Professional Health and Humanitarian Services) and its Property Company since 2010. His hobbies and interests include nature and the outdoors, reading, music, art, vintage vehicles and family life.

Riel du Toit Riel du Toit is the sub-acute and rehabilitation respresentative on the NHN board. He is the chair of the Nurture Group in South Africa and of the Erongo Medical Group in Namibia and I Care Africa in Swaziland. Riel is a founder member of the NHN and this is his third stint as a director. He is also a founder member of the Hospital Association of South Africa (HASA) and previous chair. He holds degrees in psychology and political science from the NMU and an MBL from UNISA. He lives in Port Elizabeth.

Bibi Goss-Ross Bibi Goss-Ross obtained her BA degree from the Nelson Mandela University in 1988. Further qualifications include a Diploma in Business Management (1993) as well as a Diploma in Risk Management in Healthcare (2007). Bibi started her career in healthcare with Maddocs group at Akasia Hospital in 1994 and formed part of the commissioning team to Bahrain in 2002. She joined Community Hospital group for 10 years and Netcare in 2008 as Funder Risk Manager. Thereafter joined MedCeptional as Operational Manager (Subsidiary of SpesNet’s specialising in day hospitals) focussing on operational facilities specifically day hospitals and DOH engagement. Currently, Bibi is the Chief Operational Officer at Advanced Health group of day hospitals, a listed company on the Altx division of the JSE managing and owning 11 day hospitals in and around South Africa. Bibi is passionate about the healthcare industry and the challenges and competition we face in the day hospital industry. As representative for the day hospital sub-group within NHN and a director of the DHASA (Day Hospital Association of South Africa), she is working together with her colleagues to promote appropriate same-day surgery for day hospitals.


Network Health | Issue 3 | July 2019

Board of Directors Continued Bilal Khan Bilal Khan C.A (S.A) is a resident of Pietermaritzburg, KZN. Graduated from the University of Natal – Pietermaritzburg with a Bachelor of Commerce (Accounting) Degree (B.Com) and thereafter graduated with a Bachelor of Commerce Honours (Accounting) Degree (B.Com (Hons)) from the University of KwaZulu Natal. Completed his SAICA Articles at PricewaterhouseCoopers – Pietermaritzburg and qualified as a Chartered Accountant. After 10 years of auditing, he then decided to venture out into the unknown commerce world. At the age of 36, Bilal is now the Group CFO of the Mid-Medic Holdings Group of Companies which includes amongst others, Midlands Medical Centre Private Hospital (Acute) (283 beds), Royal Rehabilitation Hospital (Sub Acute and Rehab) (104 beds) and Midlands Medical Centre Pharmacy. He was appointed as a Director of NHN in March 2019. Bilal is also a part time (well actually more social than anything else) road cyclist and runner.

Yaseen Harneker Yaseen commenced his career in healthcare administration and management while still a student almost 25 years ago. He started as a telephonist on Saturday mornings and steadily worked his way through many posts including receptionist, reception and allied services manager, case manager and medical coder, before making his way into hospital management. In addition to managing established health facilities (including oncology treatment centres), he has also commissioned and managed green fields projects through construction, commissioning and post-commissioning. He currently works as a Funder Relations Manager for Busamed Hospital Holdings.

Johan Nel Johan qualified as a Chartered Accountant (SA) in 2009. Currently he is the Group Financial Manager of the Cure Day Hospitals Group. Johan was the Financial Manager at Intercare until May 2016 and joined the Cure Group in June of 2016. Prior to Intercare, Johan held a manager position at KPMG. He gained international experience at KPMG as a Manager with an 18-month secondment to KPMG Singapore. He worked with major companies in Singapore’s healthcare industry, Raffles Medical Group (listed on Singapore Stock Exchange, Ministry of Health (Singapore’s Public Sector Health). In South Africa his major clients were G4S and the Efficient Group.

Deon van Wyk As Chief Executive Officer of Visiomed, Deon van Wyk presides over a group of companies and their respective divisions. He was previously sales and marketing director of Rolab pharmaceuticals SA, which merged with two multinational pharmaceutical companies to form Novartis the largest Pharmaceutical company world-wide at the time. Deon is passionate and dedicated to the total healthcare value chain and quality assurance in the Ophthalmological surgical field. He has gained vast experience in coordinating with all levels of hospital staff, administration and the healthcare professional. Deon is acutely aware of the challenges that private healthcare are facing in South Africa today and is a strong believer that any leader in healthcare today should have strong core attributes. He was elected to the NHN board in 2018 and are proud to serve Ophthalmology at large as discipline that can change patients’ lives.


Network Health | Issue 3 | July 2019

NHN Roadmap* to Improvement Optimising our collective strength Member Relations

Organisational Restructuring


Stakeholder Relations


Network Health | Issue 3 | July 2019

Foreword The period under review has been filled with exciting change. From a macro perspective the healthcare landscape will witness fundamental change – it is critical that the NHN is able to adapt to these changes by ensuring a commensurate change management approach.

place at a hospital. Whilst it may sound bizarre, a lesson which we can all take from this occurrence is that the strength of intent can overcome any obstacle. This is another good news story to emanate from our hospitals, who consistently adapt to any scenario presented to them. The appointment of a new CEO and We congratulate the team involved key personnel is a step in the right and wish the newlyweds all the direction – however these are just health in the world. the operational framework. Real Another feel good story is one of change will come in an appreciation our hospitals is achieving a door that the NHN will indeed operate to needle time of 17 minutes for a under a very different set of rules stroke patient. The ‘door to needle’ – and in order to succeed in these (DTN) time is to minimise damage waters member unity is a crucial and improve clinical outcome for ingredient. We must be able to stroke patients. This is from the time ensure that notwithstanding the that the patient enters the hospital competitiveness between us – that to the time take to administer the we use the vehicle of the NHN to clot-busting medication. Read more pursue common goals – goals that on page 16. This issue also features would otherwise bypass us. a round-up of medical malpractices We also bid farewell to Morne of 2018. Although medico litigation Myburgh, and wish him all the is rare in private practice, there are very best in his future endeavours. lessons to be learnt from the state. We welcome a brand new Read up on this on page 7. Communications & PR Specialist, Adele Hansen – watch this space for a fresh look NHN with super improved member communication platforms. We will also be rolling out a medical scheme engagement platform to ensure that these important stakeholders are kept abreast of activities at NHN. Our cover story is somewhat an unexpected one - a wedding taking


Many of our member facilities are also expanding and increasing their service offerings, as such, this edition features many launches, appointments and first birthdays.

Neil Nair CEO

Network Health | Issue 3 | July 2019

NEW LEADER AT THE HELM OF NHN: NEIL NAIR The NHN is proud to announce the appointment of its new CEO, Mr Neil Nair. Mr Neil Nair served as the Principal Officer from an early age and served as the SRC of SAMWUMED from its inception in 2001 chairperson and activist in the heady days until January 2019. of the student uprisings in the 1980’s – He has pioneered the scheme growth to within the student and civic movement. approximately to 80 000 lives, with a nett Neil joined the progressive trade union claims ratio of 80% and reserves of over movement in 1993, where he was primarily 80% and assets in excess of R1.5 billion. focused on employee benefits. In this capacity he championed the launch of A singular challenge and employee benefit options for workers achievement was taking previously denied access to social benefits.

an unknown entity and growing it into a brand, in an otherwise conservative and highly competitive industry.

The Scheme has been in the Alexander Forbes top 3 most sustainable medical schemes in South Africa from 2015 to 2017 – and was vot- ed as the BHF Scheme of the Year in 2015.

He also served as a founding delegate to the SALGBC’s Employee Benefits Working Group. This working group was instrumental in drafting the framework for the rationalisation of medical schemes in the local government sector – including the equalisation of employee benefits. Neil was a founding labour delegate to the National Information Technology Forum (NITF) – under the then Minister of Telecommunications, Jay Naidoo.

Neil was engaged in student activism He also served as a Director of the Board


Network Health | Issue 3 | July 2019

of Healthcare Funders of Southern Africa (BHF) where he sat on the Constitutional Review Panel and also served as Deputy Chairperson. Prior to Joining SAMWUMED as the Principal Officer in 2001, Neil was a technical advisor to the Scheme’s board from 1998.

He played a leading role in the Scheme’s transformation from a regional bargaining council benefit to a selfadministered, national medical scheme. Neil was selected by Health Minister Aaron Motsoaledi to serve as a Technical Advisor to the NHI Ministerial Advisory SubCommittee: Work stream 2: Design and Implementation of NHI Health Care Service Benefits and Work Stream 4: The role of medical schemes in an NHI environment. In addition to this, he had been appointed as one of four medical scheme representatives to serve on a Council for Medical Schemes’ Task Team. This team has been set up to review sections of the Medical Schemes Act with specific reference to Prescribed Minimum Benefits. Neil takes up the post as CEO of the NHN at a critical juncture and looks forward to the challenges that lie ahead.

“NHN is built upon diversity – our strength comes from unity, notwithstanding the competitive relations of our members – our anthem in pursuit of our common goal therefore must be Stand by Me. Each of us needs each other – let us build the NHN together”, Neil Nair


"If the sky that we look upon Should tumble and fall Or the mountains should crumble to the sea I won't cry, I won't cry, no I won't shed a tear Just as long as you stand, stand by me." John Lennon (Stand by me)

Network Health | Issue 3 | July 2019

THERESA NAIDOO JOINS NHN’S OPERATIONS TEAM Ms Theresa Naidoo joins the NHN as Operations Assistant. Theresa has vast experience in the managed care sphere and is an award winning case manager. Theresa Naidoo is a qualified professional experience and expertise in the healthcare nursing sister who graduated with a sector, of which her last 19 years have been diploma in 1991 and is registered with the devoted to health risk management. South African Nursing Council (SANC). Theresa has been privileged to work in She is also a practicing award-winning both sectors of the managed health care case manager and a member of the Case arena. She spent seven years at Healthshare Management Association of South Africa Health Solutions, a managed health care (CMASA). She has accumulated 28 years of administrator, where she held the position of a senior project manager and care coordinator, for the SADAC countries. In addition, she spent 12 years at Louis Pasteur Private Hospital, an NHN hospital, as HOD. This is where she gained her vast experience in the value chain of private hospitals from admissions, pre-booking, pre-authorization, case management, billing/auditing to credit control. She played an integral role in the set up and implementation of standard operational procedures. Theresa is also a certified coder, and has completed the intermediate ICD10 & CPT4/ CCSA coding courses in 2011. Training and empowering people has always been her passion and thus she has been facilitating training in case management and coding for both sectors of the managed health care industry.


Network Health | Issue 3 | July 2019

COMMUNICATIONS & PR SPECIALIST, ADELE HANSEN Adele Hansen joins the team at NHN as Executive PA/Communications Specialist on 1 July 2019. Adele has gained experience in the medical industry as PRO & Media Liaison at the South-African Medical Association (SAMA) as well as at a medical scheme, first as Communications & Marketing Specialist, where she was soon promoted and excelled as Sales & Marketing Manager.

sphere, is evident from her career which spans over 15 years. A self-taught website developer and digital designer, she has both a flair with copy as well as creative artwork.

Adele holds a degree in BCom Marketing Management from the University of Pretoria as well as several certifications and accreditations in digital marketing tools. She recently completed a certificate in Her strength and passion for marketing and Project Management from the University of communications, particularly in the digital Cape Town.






21 June 2019

Mossel Bay

Co-Mind: Shop 15, Prince Vintcent Building c/o Church and Bland Street

3 July 2019


Eden Gardens: 100 Archie Gumede Drive, Mason Mill

4 July 2019


Ahmed Al-Kadi: 490 King Cetswayo Highway, Mayville

8 July 2019


Pasteur Eye Hospital: 54 Pasteur Avenue, Hospital Park

11 July 2019


Vista Clinic: 135 Gerhard Street

12 July 2019


Vista Clinic: 135 Gerhard Street


Network Health | Issue 3 | July 2019


JUDGMENTS OF 2018 By Donald Dinnie, Chief Executive Officer with Aneesa Bodiat, Head of Legal - National Medical Financial Service

Is there a medico-legal litigation “crisis” in South Africa? The Natmed review of the medico-legal handed down in 2018 paints a more nuanced picture. Natmed’s annual review of medical malpractice judgments of 2018 is a comprehensive review of all of the South African judgments of 2018 with a summary of facts, findings and commentary.

Undoubtedly, there is a large amount of litigation in various forms both in the public and private sector which is ongoing and in different stages of progress. Many cases are resolved in one way or another and for different reasons, before being argued in court or before a final judgment.

the fact that just because a patient suffers an adverse health event, that does not automatically mean that the medical practitioners are at fault. There was an alarmingly high prevalence of lost and incomplete medical records and, sadly, most of the cases related to injuries to minor children (babies in fact), due to injuries that occurred during labour and birth. The majority of the cases related to the public healthcare sector. The Natmed review uncovered another four judgments relating to medical negligence issues in an ancillary way (for example, dealing with legal costs recoverable in a medical malpractice case, and another discussing expert evidence in personal injury cases in general).

Notwithstanding that, and despite ongoing re- ports of the medico-legal litigation melee in South Africa, there were only 22 judgments delivered by the South African courts in 2018 nationally deal- ing with medical malpractice cases. A number of trends appear from those cases, including

Limited Private Healthcare Sector Judgments Of those 22 medical malpractice cases only three were brought against private hospitals or private practitioners. One related to the duties and negligence of a covering doctor (a dispute between a hospital and a doctor),


Network Health | Issue 3 | July 2019

where it was found that a covering doctor does not have a lesser duty towards the patient as compared to a patient’s primary or usual doctor. Another was a dispute about whether the window of opportunity was still open for therapeutic treatment of the patient’s stroke when he arrived at the hospital.

The judgment did not deal with the merits of the claim (they are still to be determined) but addressed the question of whether the case should be separated to answer the question of causation (just one aspect of liability) before addressing the remaining issues.

those cases, the baby had passed away. These cases are usually launched by mothers, in their personal capacity, and on behalf of the minor child. Most of the birth injury cases are based on allegations of failure to deliver the child timeously, resulting in cerebral palsy as a result of lack of oxygen during labour or prolonged labour. Often the allegations relate to the need to have carried out a caesarean section, which was not done at all or not done quickly enough. There was one claim for failing to diagnosis jaundice, which allegedly led to cerebral palsy. In these matters, the mother/patient succeeded in eight of the 14 cases.

The court decided that all the issues of the claim must be dealt with together to avoid piecemeal litigation. The third was a case related to sciatica, with a claim against the doctor for alleged lack of informed consent and a rush into spinal surgery. The patient argued that the doctor had not allowed for a sufficiently meaningful period of conservative treatment before advising the patient to undergo further surgery. The court noted that all surgery is risky and “spinal surgery carries with it its own set of risks, no matter how routine the procedure and no matter how skilled the surgeon.” The doctor had acted reasonably, and the patient’s claim failed.

Birth Injuries Of the 22 medical malpractice cases, 14 were cases related to birth injuries, that is, claims relating to various injuries to newborn babies that allegedly occurred during labour or delivery or shortly after birth. Of those 14, at least 10 related to claims regarding cerebral palsy. In two of

Some of those cases failed not on the merits but on the interlocutory issues (that is, technical issues unrelated to the merits of the main claim). For example, two of those judgments related to applications related solely to compelling the production of documents – which did not exist. Both failed. In that regard, the court held that the defendants could only be compelled to discover or produce documents over which they had control and which they could find. The merits of those claims still need to be determined. Where the birth injury claims failed, the issue was often the inability of the claimant to prove causation (it could not be established when the brain injury occurred). If it occurred immediately before birth, it was


Network Health | Issue 3 | July 2019

too late to do anything. If it had occurred days or weeks before birth, nothing could be done by the birthing team. If it occurred during prolonged labour, the patient was generally successful in her claim.

provided for the absence of the records. In all of the cases, the courts found that medical records are crucial and indispensable. Hospital employees have both a Constitutional and statutory obligation to keep appropriate clinical notes. Medical practitioners are further obliged to do so by the various ethical rules and guidelines of their relevant professions. While in some judgments the court did not draw any adverse inference against the hospital because of the absence of the records, it did find that the absence of records played a role in determining whether the evidence of the patient was acceptable and satisfactory in establishing the alleged negligence on the part of the medical staff.

Often the absence of records, or incomplete records, means that the patient’s version of events goes largely uncontested. In one of the cerebral palsy case judgments, the defendant MEC argued that the court conflated the failure to keep records with causal negligence and that was incorrect. The court did say that the question whether missing records should bear on a finding of causation and negligence is an important one to be considered and clarified by the Supreme Court of Appeal. The court was careful not to say that it had drawn a negative inference against the MEC due to the missing records, but the court did imply that the missing records bore weight in the judgment. Because of the increasing A lot of the judgments had to deal with number of medical negligence cases missing or inadequate medical records involving the absence of or incomplete in some way or the other. In dealing with records, the court allowed leave to appeal this, the courts sometimes draw an adverse to the Supreme Court of Appeal. inference but that is not always the case. It will be interesting to see what that SCA Eleven of the judgments dealt with records does with the question. It is likely that the or documents in some way or another. All impact of absent or incomplete medical of those judgments were cases against records will always be dependent on the a Provincial Health authority. In many facts of the particular case and evidence instances, no acceptable explanation was presented. What is clear is that the absence

Lost Medical Records


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of or incomplete medical records constitutes a significant ongoing problem for public health facilities – in particular in the defence of medical malpractice claims.

To the contrary, the courts often refer to earlier judgments – cautioning against the natural human tendency when an innocent patient is injured, such as:

“… we should be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong…We must insist on due care for the patient at every point, but we must not condemn as negligence that which is only a misadventure”.

Harm Does Not Always Lie Where It Falls A number of the judgments also considered whether the mere fact that the injury had occurred should lead to an inference of negligence. The judgments dealt with the principle of res ipsa loquitor (which holds that the mere occurrence of the kind of injury is sufficient to imply negligence), and reiterated that this principle is nothing more than a convenient latin phrase used to describe proof of facts sufficient to support an inference that the defendant was negligent. The courts con- sistently held that the principle was not a magic formula nor presumption of law. It is merely a permissible inference the court may employ if upon all the facts it appears justified. All of the judgments emphasised that the onus of proof in medical negligence cases is no different than in any other civil case. The onus is on the plaintiff to prove all the elements of the claim on the balance of probabilities. The judgments con- sistently held that the courts will not likely assume negligence just because an injury occurred.

The courts have also consistently held that if a doctor acts reasonably, they cannot be found negligent merely because another doctor also acting reasonably would have done something different. Of the 19 judgments against the State, the plaintiff was successful in nine. This indicates a less than 50% success rate despite what one might have intuitively thought would have been a poor record of success by Public Health Facilities in defending claims (although of course not all of those judgments dealt with the merits of the case). Also indicating that provincial health authorities are rel- atively discerning about the matters, which they choose


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to take to court to defend and when defended to trial, generally a good job is done. Of course, that does not take into account the other thousands of cases that are in various stages of process against the provinces and matters that the provinces are compelled to settle because they are indefensible.

The Gauteng, KwaZuluNatal, Eastern Cape and Western Cape provinces feature more prominently in the reports. Furthermore, in choosing to litigate, there is no quick result. Most of the cases took about seven to eight years to conclude from the date of harm to the date of the judgment. An outlier was one cerebral palsy case that took 15 years to conclude. Another judgment took 18 years to conclude but that was a claim that had actually prescribed (expired due to the running of time). The patient had been treated for a gunshot wound by the relevant Hospital in August 1999 but only launched his claim seven years after the injury, which was an unreasonably long time period based on the facts of this case. The court found that the patient had knowledge of his treatment and the quality or lack thereof from the first day in hospital and had suffered pain

continuously after that. That was exactly the same information which had caused him to ultimately and belatedly seek advice in 2011. There was no reason to deviate from the normal three-year prescription period. A few judgments were given about four years after the harm occurred, but were interlocutory judgments – for example, dealing with access to documents. It is clear that litigation did not provide a speedy resolution of the claims and, pending judgment, the successful patient was without funds for ongoing treatment and would also have had (absent any contingency arrangement) to fund the ongoing litigation. In those circumstances, alternative medical dispute resolution of medical malpractice claims – currently much favoured by many of the private practitioner professional bodies, and the National and Provincial Health authorities, including mediation – is to be recommended in appropriate cases. A tabulated review of these medical malpractice judgments from 2018 which details the type of case, whether a public or private practitioner was involved, the outcome, period to conclusion and the case names (copies of the judgments are also available by contacting admin@natmed. mobi).



Network Health | Issue 3 | July 2019

OPTOMETRISTS UPDATED ON GLAUCOMA MANAGEMENT AND DIAGNOSIS Pietermaritzburg Eye Hospital, hosted their first CPD accredited optometry meeting sponsored by Allergan, on 13 March. In support of World Glaucoma Week, Dr Ed Anderson, specialist ophthalmologist, presented to over 35 optometrists from across the KZN Midlands. He updated them on the latest techniques and tools in diagnosis, monitoring and management of glaucoma including the three surgical procedures available.

Although elevated intraocular pressure is an important risk factor, 30-80% of glaucoma patients have normal pressures. Thus, to diagnose glaucoma, you need to look beyond intraocular pressure.

The early signs of glaucoma occur on the optic nerve, and in the retina. Viewing the optic nerve with an ophthalmoscope or with photographs is a good starting point. Optometrists are able to evaluate optic nerve head Glaucoma is the second most common and take retinal photographs, as well cause of preventable blindness in the as monitor intra-ocular pressure. If world. Despite all the progress that has there is any suspicion, a referral to an been made, more than 50% of cases Opthalmologist is recommended. are never diagnosed. One of the advances in early diagnosis The current definition of the open angle is the development of the OCT (Ocular glaucomas according to the European Coherence Tomography). With an OCT Glaucoma Society is: thinning of the optic nerve rim, loss of retinal nerve fibres and ganglion cell can be detected which are all “Chronic, progressive optic layers early signs of glaucoma.

neuropathies, that have in common characteristic morphological changes at the optic nerve head and retinal nerve fibre layer in the absence of other ocular disease or congenital abnormalities. Progressive retinal ganglion cell death and visual field loss are associated with these changes.�


Repeat and follow up scans identify and disease progression and the need for escalation of treatment. Monitoring of disease progression is important across all fields of healthcare, and is essential in the management of Glaucoma. Identifying a healthcare practitioner who can assist you in the years to come is quite beneficial. The initial treatment for glaucoma is a variety of the single or combined topical medication (eye drops). If this fails, and disease progression continues, surgery may be considered. The most common glaucoma operation is the

Network Health | Issue 3 | July 2019

Pictured: Tanya Coetzee and Kerry Robertson from Allergan, Dr Ed Anderson and Allison Deysel from Pietermaritzburg Eye Hospital

traditional trabeculectomy and laser trabeculectomy. However, there are now several new less invasive options which fall under the title of MIGS (Minimally Invasive Glaucoma Surgery). The two most commonly performed procedures are the iStent and the Xen Gel Implant. Glaucoma is a rapidly evolving field. The focus is early diagnosis and treatment, to prevent this common and silent cause of blindness. The Pietermaritzburg Eye Hospital is a specialist facility committed to eye health. Their patient-centric approach combines exceptional care and specialist treatment. Examine, diagnosis and extensive treatment is provided through a team of doctors, each with their own area of expertise, who are supported by the experienced nursing team. Visit the Pietermaritzburg Eye Hospital website to find out more:


Network Health | Issue 3 | July 2019

PIETERMARITZBURG EYE HOSPITAL TURNS ONE YEAR OLD A year ago, the Pietermaritzburg Eye Hospital opened its doors aiming to become a leading provider of eye health services in KwaZulu-Natal. Backed by five of Pietermaritzburg’s top ophthal- mologists, the 72 people hospital team have since touched 1445 lives and have performed 2261 procedures creating a dedicated centre of excellence for ophthalmic care. The Pietermaritzburg Eye Hospital marked this mo- mentous occasion with a team celebratory high tea at the beginning of March. Dressed to match the theme, the team was full of jubilation as the high- lights of the past 12 months were presented by hospital manager, Allison Deysel. She recognised in her presentation the contribution each team member has made in creating the success the hospital is enjoying with their attention to the patients

and their dedication to providing the highest quality of medical and surgical care. She went onto remark “We also recognise the importance of the community around us and how improving and maintaining vision changes live. Through the ‘Right to Sight” initiative we have been able to operate on 24 patients free of charge.” Dr Uys, one of the ophthalmologists operating and practicing from the hospital, remarked:

"The future is bright as we remain at the cutting edge of ophthalmic developments and we look forward to another exciting year ahead.”

Pictured: Dr E. Uys, Allison Deysel & Dr S. Lalloo all from the Pietermaritzburg Eye Hospital.



Network Health | Issue 3 | July 2019


One evening in March, a patient was brought into Melomed Gatesville trauma unit after being allegedly attacked by robbers. Our first and main priority of the medical team was to ensure the medical stabilisation of the patient and good clinical outcomes. We then learnt of his wedding to take place the following day. The management and staff of Melomed tried their best to accommodate for this special event to continue as planned and arranged for the ceremony to take place at the hospital for the couple and their families. We are truly delighted that the we were able to provide a successful wedding ceremony without disrupting any hospital operations. This


was an example of providing holistic nursing care to patients health and well-being. It was the first wedding ceremony held at the hospital and something very special that we will remember. The medical team, nursing and staff all played an integral part of this morning event.

Network Health | Issue 3 | July 2019

RECORD DOOR TO NEEDLE TIME FOR MELOMED GATESVILLE Melomed Gatesville Hospital offered lifesaving treatment to a stroke-patient by achieving a door to needle time of 17mins. The Angels Initiative is committed to increasing the number of stroke ready hospitals and optimising the quality of all existing stroke centres. It also strives towards Excellence in Stroke Care and for giving Life a Chance. Melomed hospitals namely, Melomed Gatesville, Melomed Bellville, Melomed Tokai and Melomed Richards Bay are part of the Angels Initiative. With dedication and commitment of Melomed hospitals facilities and the medical professional team, this is now a reality.

The international standard guideline from the International Institute of Health (NIH), USA recommends a ‘door to needle time’ which is also referred to as the ‘door to treatment time’ of under 60 minutes. The ‘door to needle’ (DTN) time is to minimise damage and improve clinical outcome. This is from the time that the patient enters the hospital to the time taken to administer the clot-busting medication. The Melomed Gatesville hospital stroke team under the guidance of Dr O Ameen in-house Neurologist achieved a door to needle time of only 17 minutes. In recognition of this Melomed Gatesville hospital achievement, the Angels Initiative will be awarding Melomed Gatesville hospital with the certificate of acknowledgement.



Network Health | Issue 3 | July 2019

MELOMED HOSPITAL LETTING CHILDREN DRIVE CARS TO HELP THEM FEEL BETTER Melomed Gatesville Hospital have found another way to make their stay of the young patients at the hospital a little less scary. The hospital will allow children to drive batteryoperated cars from one ward to another to help them feel better while they are admitted to the hospital.

"Our little patients will be able to drive themselves from the ward to their place of treatment - from making a pit stop at Pathology or to theatre.

"The battery operated cars might not be new "Internationally, hospitals have intro-duced to the medical field, but at Melomed we are battery-operated cars to help ease the anxiety confident that the Melocares cars will bring children may face when being hospitalised. At excitement to our young patients and ensure their Melomed, we look forward to the excitement stay will be a memorable one," the hospital said. of making these cars available within our wards under strict supervision," the hospital said in a statement.


Network Health | Issue 3 | July 2019

RH MATJHABENG APPOINTS NEW PHARMACY MANAGER Thabiso Motaung, BPharm, is the manager of RH Matjhabeng Private Hospital pharmacy. Thabiso received his Bachelor of Pharmacy from the University of KwaZulu Natal in 2010. Before then, Thabiso was studying medicine, in his 4th year he decided to pursue his first love, studying to be a pharmacist. He worked at Harrismith Busamed private hospital from 2016, until January 2019. In February 2019, Thabiso Motaung joined RH Matjhabeng Private Hospital. He joined the Hospital to be a manager in pharmacy. Thabiso believes in making things happen, no matter the circumstances. He describes himself as a caring person and bighearted. Big hearted both at work and at home, he says this as he bursts into laughter. Thabiso believes he and his team will take RH Matjhabeng pharmacy to greater heights, as he has ‘Big Plans’ for it.


Network Health | Issue 3 | July 2019



2-6 Corporate Wellness Week

1-7 • World Breatfeeding Week • CANSA Care Week

11 World Population Day

5 - 11 Polio Awareness Week

18 Nelson Mandela International Day

6 - 12 Rheumatic Fever and Rheumatic Heart Disease

28 World Hepatitis Day

7 - 14 HPV vaccination second round 9 National Women's Day 12 International Youth Day 26 - 31 African Tradional Medicine Week 31 African Traditional Medicine Day




Network Health | Issue 3 | July 2019


Young families and their newborns will be in good hands in the KZN Midlands. This follows the announcement by Midlands Medical Centre (MMC) Private Hospital of the appointment of an experienced and highly-qualified professional to manage the Hospital’s Maternity, Nursery and Neonatal ICU centres of excellence. Sister Lungi Mbobo (pictured - left) is MMC’s new Unit Manager in this important area of the hospital. Mbobo is a Registered Nurse who qualified almost two decades ago and boasts a diploma in neonatal nursing science. She comes with a wealth of experience, having worked and managed NICU centres for the past decade. Pictured welcoming Mbobo is Nursing Services Manager Sister Raksha Govender (pictured - right). 36

“My passion has always been in the field of mother and child care. I look forward to enhancing MMC’s already excellent baby and mother-friendly environment, where families feel welcome to celebrate and enjoy their special occasions, being looked after by highlyskilled and compassionate professionals,” noted Mbobo.

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HONOURING AND CELEBRATING NURSES ON NURSES DAY Midlands Medical Centre (MMC) Private Hospital recently held a function to celebrate International Nurses Day and the work done by this critical category of healthcare worker.

right) Registered Nurse Praveen Prabhakara Kurup, Staff Nurse Janine Everton, Nursing Services Manager Sister Raksha Govender, Enrolled Nursing Assistant Ashlynne Lubbe The Hospital focused on honouring nurses, and Sister Christine Chetty. which constitute the largest group of health The nurses were rewarded for their dedication professionals in this sector. and commitment in rendering high-quality Several nurses were acknowledged for their care to pa- tients. The theme for International outstanding work, during a Recognition Nurses Day was “A voice to lead – health for Awards ceremony. Pictured were (from left to all.”



Emergency services personnel from across the KZN Midlands recently re-iterated their support of the services offered by Midlands Medical Centre (MMC) Private Hospital, at the launch of the Trauma Specialist-led Doctor practice group Midlands Trauma Group (MTG) to paramedics and emergency services. MTG is based at MMC’s Emergency and Trauma Department. Emergency services employ- ees engaged with MMC and the Hospital thanked them for the sterling work they do in saving lives.

Midlands Medical Centre (MMC) Private Hospital was recently awash with colour and creativity following an Easter Basket décor competition which ran across the institution. The Administration and Finance department (pictured) fought off stiff competition to take the winner’s accolade, thanks to their originality and imagination. Staff members in the ICU (Level 5) were placed second in the competition.


Network Health | Issue 3 | July 2019


Midlands Medical Centre (MMC) Private Hospital recently held a function to celebrate International Nurses Day and the work done by this critical category of healthcare worker. The Hospital focused on honouring nurses, which constitute the largest group of health professionals in this sector.

right) Registered Nurse Praveen Prabhakara Kurup, Staff Nurse Janine Everton, Nursing Services Manager Sister Raksha Govender, Enrolled Nursing Assistant Ashlynne Lubbe and Sister Christine Chetty.

The nurses were rewarded for their dedication and commitment in rendering Several nurses were acknowledged for their high-quality care to pa- tients. The theme outstanding work, during a Recognition for International Nurses Day was “A voice to Awards ceremony. Pictured were (from left to lead – health for all.”

MMC’S EMERGENCY AND DISASTER MANAGEMENT TEAM ALWAYS READY Residents, businesses and the public at large in and around KwaZulu-Natal can be rest assured that they can rely on Midlands Medical Centre (MMC) Private Hospital in the case of an emergency.

Communications and Ambulance Services.

External auditors were present and participated in assessing the drill. The exercise confirmed that MMC’s emergency and disaster management team are onThe recently-conducted a mass mock drill hand to deal immediately and effectively involved the key professional services offered with challenges under these circumstances by the hospi- tal, including the Emergency – while also providing areas where the Department, Doctors, Nurses, Operating services could be further enhanced. Theatres, Administration, Health and Safety,


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The staff members at Medical D-Ward at Midlands Medical Centre (MMC) Private Hospital were recently treated to a hightea in honour of their high-quality care. This followed a heartfelt letter from a patient, who commended their commitment to the ethos of the hospital.

commendable level humane disposition, dedication, good cheer and professionalism. That lifted my spirits every day and that I believe, was a major factor that helped the team of doctors to make some headway,” noted the patient in a heartfelt letter to the hospital. Pictured are the Medical Ward team “I came in fairly despondent. Your nurses, ward members with senior management at the sisters and even the cleaners and catering high-tea. staff, in my view, naturally demonstrated a


KZN residents with cancer and blood-related conditions have strengthened hope with the newlylaunched Midlands Haematology and Oncology Centre of Excellence. The nine-bedded centre was opened recently by Midlands Medical Centre (MMC) Private Hospital.

at Hopelands), Dr Robbie Dent (Oncologist at Hopelands), Dr Yagalen L. Naidoo (Clinical Haematologist), Dr Maresce Bizaare (Clinical Haematologist), Dr Douglas Ross (MMC Hospital Manager), Dr Pelham Piek (Oncologist at Hopelands) and Dr Nirven Maharaj (Oncologist – Dorchester Pictured at the official ribbon cutting ceremony were Cancer Centre). (from left to right) Dr Jeethen Sithlu (Oncologist 39

Profile for National Hospital Network (NHN)

NHN Network Health | Issue 3 | July 2019  

A National Hospital Network Magazine

NHN Network Health | Issue 3 | July 2019  

A National Hospital Network Magazine