Government regulations require an accident victim to be taken to the nearest provincial hospital but the staff there are not always willing to help
Laura Matthews and Sharon Gill
When 13-year-old Mba-lenhle Zondi was hit by a car on a busy Verulam road, near Durban, the paramedics stabilised her at the scene of the accident and then took her to the nearest provincial hospital. But instead of receiving the immediate medical attention she needed, the child was blatantly avoided by the very people who are entrusted to dispense care and compassion to the ill and injured. The first person the paramedics saw at Mahatma Gandhi hospital was a doctor or, more accurately, they say they saw the back of his white coat as he scuttled away, muttering, “Don’t talk to me, talk to them!” “Them” were three indifferent women sitting behind a desk, the paramedics say. “We are a level one hospital,” said a woman with a stethoscope round her neck. “[The paramedics] didn’t phone,” said a nurse, “so they can’t insist we take this patient. If she stays here, we can’t treat her.” “This happens all the time,” sighs Kerry Staples, the attending Netcare paramedic, who says the medical superintendent said the hospital was not equipped to handle the patient, despite the fact that casualty departments are legally obliged at least to assess patients brought to them.
This is the stark reality faced by many paramedics as they respond to hundreds of emergency calls throughout the country. Common sense would have it that they rush a patient to the nearest hospital, but the protocol that governs the jurisdiction of provincial hospitals often has the opposite effect. The current arrangement regarding hospital jurisdiction arose out of the dismantling of all apartheid-oriented services. In Pietermaritz-burg, for example, there were three hospitals for different population groups Greys, Edendale and Northdale. With the amalgamation of the three, Greys hospital was literally overrun with patients. It got so bad one night that the hospital actually locked its doors in the early hours of the morning and refused to admit any more patients. The rationale behind the zoning of hospitals was also informed by the need to spread the workload evenly among different institutions. How- ever reasonable the motive behind the move may be, it proves unworkable in practice. According to government regulations, an accident victim must be taken to the nearest provincial hospital. The logic behind this protocol is that paramedics can hand over the patient to the nearest hospital and get back on the road. The hospital will evaluate and stabilise the patient, and then arrange a transfer to a bigger or better equipped hospital if required.
But because the paramedics’ main concern is for the patient, they often go the extra mile and negotiate with another hospital to accept a patient if the nearest one proves to be uncooperative. It appears bureaucracy, ethics and priorities are all in conflict. Ambulances are not duty-bound to provide a taxi service, but protocol and their code of ethics compel the paramedics to ferry patients from an unreceptive hospital to one which may be able to offer help. “We’re often asked, ‘What took you so long?’ when we arrive at an accident scene,” says Staples. “But while we’re tied up in red tape with one patient, there could be another one literally bleeding to death on the road somewhere. It happens so often that we can actually sense we are to be confronted with a negative response before we’ve even wheeled a patient through the hospital doors.”
A conspicuous poster pinned on the notice board of Mahatma Gandhi hospital strikes a contradictory note, despite its reassuring message: “We believe that initial care is of the utmost importance since we are the focus of the institution. We believe that every human being should be held in high esteem and treated with dignity at all times.”
Refusing to be beaten by obstructive officialdom, Staples managed to arrange a bed for Zondi at Addington hospital, and the child’s father is taking legal action against the Mahatma Gandhi hospital. The Mahatma Gandhi hospital referred all press enquiries to the Department of Health. Professor Ronnie Green-Thompson, secretary for the KwaZulu-Natal Department of Health, says he will be investi- gating the matter. “A level one hospital is a modern facility which should be able to deal with any sort of emergency. Prompt attention is of the utmost importance and we all need to work together. A patient should be taken to the nearest hospital where appropriate emergency care must be given before he or she is transferred to a bigger hospital.” “I love what I do,” says Staples, who operates out of St Augustine’s hospital. “While a patient is in our hands we will do our best. We will go out to any life-threatening situation and we treat everyone the same; whether he can pay or not, whether he’s Thabo Mbeki or a vagrant, a suspected gunman or a victim of that gunman.” Staples says there is a general perception that paramedics just arrive at the scene of an accident with an ambulance, chuck the patient in the back and dump him at the hospital; and that people in service jobs like paramedics are “second rate.”
Hans Hartmann, regional manager of Netcare 911 in KwaZulu- Natal, explains that when a hospital refuses to admit a patient, paramedics “can’t simply leave him at the hospital entrance”. As a private organisation, Netcare 911 is under no obligation to transport government patients from one hospital to another. “But we do it because our priority is always the patient.” The delay isn’t always caused by the recalcitrance of the nearest hospital to treat patients the paramedics bring to them. Often the paramedics are at fault, and they admit it openly. “I once picked up a patient with a gunshot wound to the neck who should have been taken to Addington,” says Hartman, “but it defied logic to drive past the gates of King Edward VIII hospital. The patient’s condition was critical and the extra few kilometres could have cost him his life. Fortunately, we won the argument that night.” Hartmann explains that paramedics know the capabilities of hospitals and the treatment they are able to provide. He wouldn’t bother taking a patient with a gunshot wound to Mahatma Gandhi hospital, for example. “I would drive straight to Addington or King Edward VIII hospital, and prepare myself for an argument with the administrators. Any delay could be fatal.” He argues for flexibility in applying the rules regarding the zoning of hospitals.