When Nicole Cunningham was a baby, she remembers her moustached father dancing with her in the living room. The avid golfer and former South African Airways employee, had fallen on hard times financially but he loved his sport.

Van der Nest (51) left the Houtkapper Street home he shared with his elderly parents for the Prime Time Sports Bar on Elgin Road, to watch the rugby on 28 February with a friend.

He never came home.

In the early hours of 1 March, van der Nest was likely bludgeoned with a metal pipe while walking home from the bar. Thieves took his cell phone, but left behind his Capitec bank card with his name on it and a Swiss luxury Raymond Weil watch.

When paramedics responded to an emergency call regarding Van der Nest they found him conscious, confused and scared. He continued to plead with them to “take anything you want, just don’t hurt me,” according to Nicole, who interviewed bystanders as part of months of investigation into her father’s death.

The paramedics have signed affidavits stating that her father’s watch and bank card with his full name were on him when they admitted him into Tembisa Hospital at 4:48am.

At the time of admission he had a Glasgow Coma Scale (GCS) score of 14/15. The GCS is a 15-point scale used to assess brain injury severity. The higher the score, the better the prognosis.

A litany of delays

But it took 90 minutes before Tembisa Hospital staff opened a patient file and the hospital and Gauteng’s Department of Health maintain they do not have the signed ER24 documents – in Nicole’s possession – that indicate he arrived much earlier.

It took another four hours before a CT scan of his brain was ordered, according to the patient file obtained by police. The scan showed massive brain injury and Van der Nest was admitted to Tembisa’s intensive care unit (ICU).

It took almost 12 hours before staff attempted to refer him to the Steve Biko Academic Hospital that has the neurosurgery department needed to deal with the severe head injury Van der Nest’s CT scan reveals.

No bed was available and, according to a note in Van der Nest’s patient file, the doctor said that his file must be reviewed by a neurosurgeon on the Monday – two days later.

Ominously, Van der Nest’s file goes quiet for two days. No notes are made until 7pm on Monday 4 March when a doctor records his time of death.

• Read a timeline of Van der Nest’s last moments in Tembisa Hospital

Critical outreach services had not been running for weeks

[quote float=”left”]“Why go into nursing as a profession if you don’t want to help people – if you don’t have that kind of sympathy?”

There is no record of Van der Nest’s heart stopping and subsequent adrenaline shots as is alleged to have happened by one doctor interviewed by Nicole – and this is despite the hourly observation that should accompany ICU admission.

According to Gauteng Department of Health Spokesperson Simon Zwane, ICU patients are seen daily by doctors and hourly by nurses. Every procedure is supposed to be noted and Zwane says that this applied for Van der Nest.

Zwane added that Steve Biko Academic runs a weekly neurosurgery outreach programme to Tembisa. If no beds are available at Steve Biko Academic, the two hospitals jointly manage the case and this can include surgery at Tembisa Hospital.

According to Susan Cunningham, Van der Nest’s ex-wife, ICU staff said this outreach service had not been running for weeks.

“We found out from the ICU staff when we went in on a Saturday that they generally have people coming from Steve Biko from the neurosurgical department every week to look at patients,” Susan said. “There had been no one coming for the last three weeks.”

Van der Nest’s file also shows no attempt to operate on or move Van der Nest to another facility like Charlotte Maxeke Hospital that might have had better capacity to deal with severe head traumas. Charlotte Maxeke is roughly the same distance from Tembisa Hospital as Steve Biko Academic.

A family’s quest for the truth

[quote float=”right”]“That’s how we saw him – duct tape around his neck, duct tape around his feet and they had to cut (the sheeting) open.”

A lecturer at the University of Johannesburg, Nicole took three weeks off work to piece together her father’s last days. This has included multiple trips to Tembisa Hospital and more than three hours of conversations between herself and hospital staff that Nicole videotaped on her cell phone.

During these meetings, hospital staff claim that they never received the signed ER24 handover in Nicole’s procession that shows her father was admitted much earlier than hospital records.

The videos also show hospital staff giving very different accounts of why they did not try to alert social workers or police sooner of an unidentified patient in the ward.

Van der Nest’s ex-wife Susan Cunningham describes the family’s first attempt to find out more about his death at the hospital from the matron in charge of the ICU.

“We went to see her and she said she was busy having a cup of tea and that she’d deal with this when she’d finished her tea,” said Susan. “Why go into nursing as a profession if you don’t want to help people – if you don’t have that kind of sympathy?”

Hospital management had to be persuaded to open the morgue so that Van der Nest’s 75-year-old mother could see her son’s body.

Susan said the morgue “looked like a storeroom with all the bodies lying on this shelving…in a row with plastic sheeting and duct tape.”

“That’s how we saw him – duct tape around his neck, duct tape around his feet and they had to cut (the sheeting) open.”

According to Nicole, the morgue smelled so badly that the family sprayed deodorant on tissues and held them to their faces while viewing the body.

From pillar to post

In the more than two months since her father’s death, Nicole has recorded conversations, amassed whatever paper work related to the death she could and pursued various avenues of complaints after her aunt laid an initial complaint on 9 March with the hospital itself.

Nicole called everyone from lawyers to the Health Professionals Council of South Africa to the Hospital Ombudsman to try to get justice for her father.

On 28 March, she filed a complaint with the Gauteng Premier’s Hotline and on 2 April Democratic Alliance Caucus Leader Jack Bloom forwarded her email about the matter to Health MEC Hope Papo.

She received no response until 21 March when a hotline staff member phoned her to say the matter had been referred to a Department of Health’s group looking at serious adverse events (SAEs) at public facilities.

When she asked what had prompted feedback after almost nine weeks, the staff member said it was due to media involvement, Nicole says.

As of yesterday,  Nicole said she was still awaiting a follow-up phone call from the hotline.

According to the Gauteng Department of Health spokesperson Simon Zwane, the hospital CEO never received Nicole’s hotline complaint but has now tracked it using her reference number.

A quality assurance manager has started working on the case and the response should be completed in two weeks’ time when one of the consulting doctors returns from overseas, Zwane added. He said the department encourages patients to report problems with the heads of facilities and the hotline at 0860 428 8364.

Tembisa Hospital may be the worse in the province 

[quote float=”right”]“For Tembisa Hospital to have more serious adverse events than the largest hospital in South Africa, Baragwaneth, is shocking”

Just weeks after van der Nest died, Bloom released a list of what he dubbed Gauteng’s “killer hospitals,” including Tembisa Hospital, based on the number of reported SAEs at facilities.

“(SAEs) are basically negligence, or things that shouldn’t have happened,” Bloom said. “In this case, it didn’t even get that far – they just ignored him.”

Between January 2012 and September 2013, Tembisa Hospital had 71 SAEs – more than any other Gauteng hospital monitored during the same period. Chris Hani Baragwanath – with more than double the beds as Tembisa – had 64 SAEs during the same period.

“For Tembisa Hospital to have more SAEs than the largest hospital in South Africa, Baragwaneth, is shocking,” said Bloom who added he has been hearing increasing reports of poor care and conditions at Tembisa Hospital. “I think these are warning bells.”

“What’s hard to bear is, because he had no ID, that nobody was there fighting for him,” said Susan. “We just don’t know if anyone really did anything for him and because there was no one fighting for him, he just became another statistic.”

Nicole will never get her father back. She also knows she may never know what really happened to him as he lay alone dying in Tembisa Hospital but she hopes that her fight will spare another family from having to go through the same thing.

“While I will never really know if he could have survived should he have received the proper medical care, I feel the care provide by Tembisa Hospital was grossly inadequate,” she said. “I just don’t want anyone else to have to go through this.” – Health-e News Service.

An edited version of this story was originally published in The Star newspaper.