More questions than answers: Kim Cole, with her daughter Fallon Finch, who died in a Durban hospital in January last year after taking an overdose
Western Cape mother Kim Cole, whose daughter died of a drug overdose after allegedly not receiving lifesaving treatment at Durban’s Busamed Hillcrest Private Hospital, apparently because of the cost of blood tests, is still seeking answers regarding the circumstances a year after her loss.
Cole has appealed the Health Professions Council of South Africa’s (HPCSA) decision after a preliminary inquiry into the matter found the doctor who examined her 34-year-old daughter Fallon Finch was not guilty of professional misconduct.
Cole, and Finch’s sister Kirsty Davies, said this week there were many unanswered questions about the circumstances surrounding her overdose before she was admitted to the KwaZulu-Natal hospital’s emergency unit on 15 January last year.
Hillcrest police are investigating the matter.
State forensic pathologist Dr Steven Naidoo said in his autopsy report, released to the family on Monday, that his findings were consistent with the clinical findings documented in the hospital medical records. He noted allegations of foul play could be neither confirmed nor refuted by the autopsy findings.
He also found that although the levels of substances, including cocaine, alprazolam, diazepam, midazolam and acetaminophen, found in Finch’s body were non-fatal, the “interpretation and significance … must be contextualised to the length of the survival period and related medical intervention”.
“Notably, the clinical summary from King Edward VIII Hospital documented elevated paracetamol levels … plus-minus eight hours post ingestion, which would be consistent with the reported history of possible Stilpain [sic] overdose,” Naidoo said.
“The allegations of suspected foul play regarding the exact circumstances of the reported overdose and/or ensuing events can neither be confirmed nor refuted by the autopsy findings and correlation with police investigation is therefore essential.
“In addition, the concerns regarding the medical management should be referred to an independent panel of appropriate medical experts for independent review.”
KZN South African Police Service (SAPS) spokesperson Lieutenant Colonel Nqobile Gwala confirmed that Hillcrest police are investigating an inquest docket. “We are awaiting the toxicology report. Unfortunately, we cannot divulge further information because our investigation is at a sensitive stage.”
Dr Thobile Masilela, who was contracted to third-party service provider ER Consulting at the time, was the casualty/emergency unit doctor on duty at Busamed Hospital on the night Finch’s boyfriend brought her to the hospital.
Cole said he discovered her daughter collapsed at home and took her to the emergency room after it appeared she had ingested 100 Xanax (alprazolam) tablets and Stilpane (containing paracetamol and codeine).
She alleged that apart from giving Finch 1mg of Anexate, the staff had left her in the unit for 2.5 hours — citing the hospital’s medical notes, which the Mail & Guardian has seen — without administering lifesaving treatment for the overdose.
However Masilela, speaking via her attorney Karin Zybrands, said this week she had prescribed and immediately administered life-saving emergency treatment, including giving the patient activated charcoal, to which she had responded. Finch’s boyfriend had declined blood tests and for her to be admitted to ICU for further treatment due to the cost.
The hospital notes indicate that Masilela prescribed continued activated charcoal treatment. But Masilela, whose shift ended at 7pm, said it appeared the nursing staff had failed to continue giving Finch the treatment.
Zybrands alleged Finch’s boyfriend demanded that she be transferred to a public hospital in his vehicle but Masilela arranged for a Meditech ambulance at the hospital’s cost.
“Dr Masilela and the nursing staff counselled [the boyfriend] extensively regarding the importance of performing blood tests whilst waiting for the patient’s transfer to a state hospital and on the importance of monitoring the patient in an ICU but he nevertheless refused to consent … and opted to delay all further investigations and treatment until the patient was transferred to the public facility,” Zybrands said.
Finch’s boyfriend, whose name is being withheld, declined to comment, saying only that “these are not friendly people” and that a police investigation was underway.
“Fallon tried desperately to live after realising her mistake,” Cole said.
“She was fighting to live. Imagine that — your child lying in a hospital, trying desperately to live, and left to slowly die.”
Cole said Finch, a South African citizen who had been living abroad, had only been in the country for 10 weeks and was not yet on medical aid.
Davies said Finch’s boyfriend only informed the family at around 3am that her sister was in hospital, adding that, if they had known sooner, they would have provided funds for her treatment in a private hospital.
According to Busamed’s patient records, Finch arrived at the hospital at 5.15pm after allegedly taking the overdose at about 4.40pm and was transferred to the public RK Khan Hospital in a “stable” condition at 9.41pm. She arrived at 11.15pm “unresponsive” and 100% dependent on an oxygen mask, RK Khan’s records say.
However, ambulance provider Meditech’s notes indicate that Finch’s triage early-warning score was a 5-6 code orange, meaning she needed urgent care within 10 minutes.
“They also recorded that she was “snoring”, an indication that she was battling to breathe but scored 14/15 on the Glasgow Coma Scale. This dropped to 3/15, a code red, by the time Finch arrived at RK Khan.”
Davies said the ambulance team should never have transferred her sister to the public hospital.
“She should have been taken back into the ER for treatment,” Davies said. “Fallon was completely unresponsive and was intubated in the triage room … she simply could not have crashed so quickly. The ambulance records cannot be correct.”
Meditech declined to comment, saying the matter had been referred to its attorney.
Davies said she believed if Finch had been administered the activated charcoal within the first four hours of overdosing, she might still be alive.
Cole praised the nursing and medical staff at King Edward VIII and RK Khan for “doing everything they possibly could” to save her daughter.
However, at 2am she slipped into a coma. She was transferred to King Edward VIII, where she died at 9am on 19 January last year.
Finch is just one of many South Africans who fall through the cracks of the country’s highly unequal health system every year. According to a Wits University report, Healthcare in South Africa: How Inequity is Contributing to Inefficiency, which focuses on lessons from the Covid-19 pandemic, the underfunded public sector caters to 71% of the population, while most South Africans can’t afford the exorbitant cost of private healthcare that serves around 27% of the population.
Masilela told the HPCSA at a preliminary inquiry meeting in October that she had offered Finch testing, which was refused.
According to the HPCSA’s finding, highlighted in a letter to Cole, the committee accepted Masilela’s explanation and resolved the matter.
“Appropriate testing was offered but refused by the individual who was present at the time and appeared to be able to make a decision,” the HPCSA said.
Cole filed an appeal against the decision, which she said did not answer her questions about why her daughter had not been given activated charcoal. She said her daughter was in no mental state to make the decision to refuse blood tests.
“No one that took that amount of medication would be of sound mind, nor would they be sober. Someone who is suicidal is not of sound mind.
“I cannot believe that I even have to point this out to an institution that exists to protect the public against malpractice,” Cole said.
Cole said ER Consulting chief specialist Peter Anderson had sent her Masilela’s notes on 14 February.
“ER Consulting, on our request, furnished us with unsigned, not dated, doctor’s notes which contradict Busamed, as well as the doctor’s own statement to the HPCSA, that my daughter refused treatment,” Cole said.
Asked to comment on Cole’s concerns this week, ER Consulting chief executive Steve Holt said the matter had been “addressed through the HPCSA … and the doctor was found not guilty. Given that the matter is on appeal with the HPCSA, and the family is taking this to the ombudsman, I am unable to comment on any questions relating to the case.”
“ER Consulting Inc remains supportive of any investigations into the conduct of its doctors or the practice (through legal or regulatory bodies) and has complied with requests from the family to meet. ER Consulting Inc is a long-established, ethical practice that conducts itself in a professional manner at all times,” Holt added.
Busamed CEO Dumani Kula said ER Consulting and Busamed had spent time with the family, answering their questions. “I was involved in the last family meeting, and spent several hours dealing with exactly the questions below,” Kula said.
“We are not in a position to answer the patient-specific questions you raise without breaching patient confidentiality … We encourage the family to pursue that route of the appeal, Health Ombudsman and SAPS.”
According to Cole, the family is preparing to file a complaint with the Health Ombudsman and the National Consumer Commission.