OUTCOME OF INQUIRY INTO KLIPTOWN CLINIC

Issued by: Gauteng Health Department, Sowejoca and the ANC

11 June 1998

BACKGROUND

Kliptown Clinic in Southern Johannesburg was in the news some weeks ago, when baby Raygene Dixon (aged six weeks) died on April 24 after being turned away from the clinic and outraged members of Sowejoca subsequently kept clinic staff captive in the building.

These events led to the establishment of a joint investigating committee charged not only with probing the circumstances of Raygene Dixon's death but a number of other complaints about the functioning of Kliptown Clinic.

The Committee, chaired by the Gauteng Health Department's director for Medico-Legal Services, Dr Frew Benson, comprised representatives of the Department, Sowejoca and the ANC. It completed its report on May 18 after which the parties concerned received an opportunity to study the findings. The Department, in particular, had to decide on appropriate action to take in the light of the findings.

Yesterday the Department, the ANc and Sowejoca met to ratify the report and discuss the proposed course of action by the Department.

MAIN FINDINGS

• Kliptown Clinic was closed during working hours on April 24, when Raygene Dixon required emergency care - apparently for bronchopneumonia. A public function to celebrate the expansion of clinic facilities was taking place at the clinic that day.
• A sign on the gate, produced by the dentist at the clinic, announced the temporary closure of the clinic. There was no indication that emergencies would be attended to and no emergencies were, in fact, seen on that day. This was in contradiction to a directive by the Superintendent of Coronation Hospital that emergency cases should be seen despite the celebrations.
• After Raygene's mother had gone twice to the clinic and found it closed, a neighbour called an ambulance. The baby was rushed to Chris Hani Bargwanath Hospital approximately two hours and 45 minutes after the mother's first fruitless visit to the clinic. She was certified dead soon after arrival.
• Raygene was also seen at Kliptown Clinic nine days prior to her death. She was treated for a cough by a relatively inexperienced primary health care nurse, who had no training in treating neonates. The nurse did not follow protocols which require that she should have referred Raygene to an experienced nurse or doctor. However, the committee pointed out that, in the absence of a post-mortem, they could not be sure that this early ailment was in fact the same infection which caused the baby's death.
• The committee concluded that the dentist, who had played a key role in upgrading the clinic and in the opening ceremony, had acted "over-enthusiastically", often exceeded his formal authority. This contributed to confusion around the functioning of the clinic on that day. Evidence pointed to him being responsible for the strong (and incorrect) perception that President Mandela would be attending the ceremony.

ACTION BY THE DEPARTMENT

A Departmental circular has been issued underscoring the fact that health institutions may under no circumstances close down for public functions. On all such occasions steps must be taken to ensure that emergencies are properly attended to.

Disciplinary procedures will be instituted in relation to the dentist, who has been transferred to a different clinic. Further action will depend on the outcome of the disciplinary process.

The training curriculum for primary health care nurses is being revised to ensure that treatment of young babies is included. Steps will also be taken to ensure that PHC nurses who have already qualified get an opportunity to make good this gap in their training.

A number of measures have been taken to improve the overall quality of care at Kliptown Clinic.

• Firstly, it will no longer operate as an extension of Coronation Hospital but as part of the district health system, where the development of primary health care is a priority.
• Within this system, steps will be taken to increase staffing levels and particularly to ensure the full-time attendance of a medical practitioner.
• The feasibility of extending clinic hours will also be investigated. And, since there were persistent (if unproven) allegations of staff not being in attendance throughout existing working hours, management has been instructed to pay particular attention to this aspect of service.
• Further action relating to the formation of a new clinic committee, the renaming of the clinic and a provincial complaints mechanism is to be taken.

CONCLUDING COMMENTS

Our organisations concur that the investigating committee approached its task with a real commitment to consider the evidence and uncover the factors that contributed to Raygene's death.

The findings have been extremely useful in pointing to corrective action which should prevent any recurrence of the unprofessional and irretrievable lapse in care which was experienced by the Dixon family.

The steps taken by the Department are concrete and appropriate - but all of us recognise that there is still much more work to be done (by community groups as well as government) to build an accountable and responsive health centre in Eldorado Park and Kliptown.

Jointly released by the Gauteng Department of Health, Sowejoca and the ANC (Gauteng)

Contact persons:

Jo-Anne Collinge (For the Department): 082 574 5510 Dr RAM Salojee (For the ANC) 854 4398 Basil Douglas (For Sowejoca) 834 7434 (w) 935 6630 (h)