One of Johannesburg’s oldest hospitals, Helen Joseph, is in disarray. Lack of security, non-payment of food service providers, dirty linen piling up in the corridors, decaying infrastructure and poor governance and leadership are just some of the challenges highlighted in two reports released by the Health Ombud and Office of Health Standard Compliance (OHSC) during a media briefing on 10 March.
The reports share the findings of an investigation prompted by a Facebook Live video by former broadcaster Thomas Holmes, also known as Tom London. In the video, which went viral on social media, London complained about disrespectful hospital staff, ill-treatment from doctors who lacked urgency and courtesy and the general decay of the hospital’s infrastructure.
Health Minister Dr Aaron Motsoaledi, who requested the health ombudsman to investigate London’s allegation, says it’s important for his department to know what is happening in healthcare institutions.
Helen Joseph Academic Hospital is affiliated with Wits University’s medical school. The institution has a range of specialist clinical units including a stoma unit, a chronic pain unit and a breast clinic. The 639-bed hospital serves a catchment population of more than 1.5 million people. It receives referrals from regional hospitals and 22 feeder clinics and community health centres.
The Investigation
The investigation, which ran between September and November last year, found that seven of London’s 10 complaints were unsubstantiated. Here’s a breakdown:
Complaint: Doctors and student doctors disrespect patients by treating them like ‘cockroaches’.
Finding: The allegation was not based on fact, and was expressly disputed by all the patients interviewed by the investigators. The patients indicated that they were happy with the care provided by the doctors at the hospital.
Complaint: The hospital changed his doctor without alerting him and his CT scan was cancelled because the staff forgot to administer contrast medium (dye) – a substance used to make certain areas of the body more visible during a scan.
Finding: A radiographer told the investigation team that the CT scans were taken and sent to the radiologist for reporting, a radiologist then identified the need for a contrast CT scan and this was done the same day.
Complaint: London was not seen by a doctor for 48 hours.
Finding: The investigation revealed that he was seen and examined 23 times during his 11-day stay at the hospital.
Complaint: London received poor clinical care.
Finding: London was generally satisfied with the clinical care provided while in the hospital. During the investigation, he said: “I have no criticism of the clinical care I received at Helen Joseph Hospital.”
Complaint: A patient died and was left for hours before the body was removed from the cubicle.
Finding: The patient died at 6:30 am and the time logged in the mortuary register was 9 am, two hours and 30 minutes after his death. [In the viral video London indicated that the patient died 20 minutes ago, but when interviewed by investigators he said the body was in the ward for 4 hours.]
A picture taken by OHSC during their investigations at Helen Joseph Hospital.
Findings Of OHSC Report: Dilapidated Infrastructure
In addition to the Health Ombuds’ investigation of London’s complaints, the OHSC investigated the hospital’s infrastructure, management and human resources. The OHSC inspection report identified critical areas that require immediate attention, including infrastructure repairs, cleanliness improvements, and enhanced training for hospital staff on professional conduct.
The OHSC conducted inspections at the hospital to focus on the problem areas that require immediate attention which include infrastructure repairs, cleanliness and enhanced training for hospital staff on professional conduct.
OHSC CEO Dr Siphiwe Mndaweni says the initial inspection confirmed three of London’s complaints: the hospital’s infrastructure is decaying, toilets and basins are broken, and electrical plugs in ward 8 are not functioning.
“The inspections revealed serious contraventions of the prescribed norms and standards regulations for quality and safety and various other applicable laws aimed at ensuring safe and quality healthcare services,” she says.
She says the hospital’s infrastructure was in poor condition, with leaking water from steam pipes, and a sagging ceiling, which posed safety risks to patients and staff. Several toilets were out of order, forcing some staff members to travel to a nearby shopping mall to relieve themselves.
“Electrical plugs in the wards showed signs of poor maintenance. Some plugs were mounted on the walls with tape due to a lack of support from the maintenance unit,” she says.
She adds that the door hinges of the staff toilets were broken, and toilet seats and covers were also damaged.
“The ward manager stated that requesting repairs from the maintenance department is always delayed due to a lack of material from the maintenance department,” she says.
Additional Findings
The investigation found serious issues within the hospital’s human resources unit. The HR manager and some subordinates did not have a good working relationship. Health Ombudsman Professor Taole Mokoena says ‘the human resources department is completely dysfunctional.’
“The hospital staff members and the Gauteng Department of Health functions in silo. There are no policies or standard operating procedures at the hospital,” he says.
Leadership – or the lack thereof – is another problem. Since 2019, the hospital has gone through four acting CEOs. The posts of senior managers are also occupied by acting personnel. At the time of the investigation, in mid-September 2024, the acting CEO was Dr Arthur Manning, who was appointed on 1 August 2024 and remains in the position.
“The chronically unstable leadership has compounded the poor governance at the hospital. There is also no clear separation of duties within the finance department and that makes it risky as payments may be sent to the wrong suppliers. Anyway, this is a polite way of saying there might be corruption,” Mokoena says.
He adds that there is a lack of governance at the hospital, as a result, staff did not follow protocols when performing functions.
The investigation further found poor linen management in the hospital and no linen control systems in place. Service providers refused to deliver food items as they had not been paid their previous invoices. Only 36 out of 166 cameras were functioning, as a result there was a challenge with vandalism and theft of infrastructure.
Other findings include overcrowding in the emergency department, lack of admission beds and unavailability of porter services.
Recommendations
Mokoena says the Gauteng health department must prioritise the employment of leadership, and other vacancies must be filled to meet the requirements of a tertiary hospital.
“All potential candidates for the CEO post must undergo reference checks and vetting before being appointed. The department should advertise all funded vacant posts and get staff appointed within three months after the release of the report by the Ombud,” he says.
He says the department must appoint an independent forensic audit firm within two months.
Other recommendations:
- Gauteng Premier to ensure that the hospital is prioritised for refurbishment within six months.
- The hospital is to have its resident artisan within one month.
- The hospital must address the governance matters, and develop written policies.
Response by Health Department
Motsoaledi says both reports show management gaps especially when it comes to infrastructure and human resources.
“The lack of delegation is an issue. You can’t manage a hospital from an office in town. That’s why the NHI Act says, especially academic hospitals, must be autonomous. The CEO and the board must be able to do anything, including procurement,” he says. The Gauteng Department of Infrastructure is the implementing agency of the department’s infrastructure developments. At the moment the hospital CEO’s do not have powers to fix anything in their facilities. They have to consult the Department of Infrastructure.
Motsoaledi says even without being autonomous, they don’t have to wait for the permission of the provincial government to paint the wall.
“I know in Gauteng they do so. There is a department called DID (Department of Infrastructure) , I don’t even want to hear that name. It causes me problems. I once exploded when I was visiting Chris Hani Baragwanath Hospital and I found that globes were not working. I asked the CEO how on earth can this happen and he said no minister, I don’t have delegations, anything to do with infrastructure is delegated to DID,” Motsoaledi says.
“I hope the Gauteng health HOD is listening carefully and DID. You need delegations, you can’t run these institutions from afar and the CEO must be able to wake up and fix problems at the hospital. The issue of delegation is very important within the government and we will be looking at it very carefully,” he says.
Motsoaledi adds that the report was an eye opener and he doesn’t regret asking the health ombudsman to investigate the allegations at Helen Joseph Hospital.
“After the video by London, Gauteng Health announced that they were going to rush to the hospital but I said the appropriate structure to investigate the allegations is the ombudsman and OHSC. Because when you investigate yourself you will leave the ugly parts aside. And I said Gauteng Health can’t investigate itself, somebody else must come who will unveil the whole truth and I am happy it happened that way,” he says.-Health-e News
