Surgeries delayed at Charlotte Maxeke as key machine decommissioned before replacements are ready • Spotlight

Staff say patients at Charlotte Maxeke Johannesburg Academic Hospital in need of vascular surgery face a three-month wait for life-saving surgery because of what some staff are calling “fishy” operational management and bad planning. PHOTO: Gauteng Health

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17th August 2023 | Ufrieda Ho

What appears to be a poorly planned decommissioning process of a specialised angiogram machine has led to a three-month delay before patients will be able to access potentially life-saving vascular imaging and surgery at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Concerned staff tell Spotlight they were given short notice that the old angio suite system was being retired at the beginning of August and weren’t given adequate contingency support. They say there has also not been a satisfactory explanation for the haste to decommission and remove the old machine as the two newly acquired replacement angio suite systems can only be brought on stream in three months’ time.

The procedure is critical to save lives or to prevent the loss of limbs in patients with vascular disease.

The angio suite is a multi-million rand piece of equipment used for cardiovascular imaging of blocked arteries and is necessary for guided vascular surgery. The procedure is critical to save lives or to prevent the loss of limbs in patients with vascular disease.

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Short notice

At the beginning of August, staff from the radiology and surgical departments at the hospital were informed that the machine would be decommissioned within a week. “We were expected to just inform patients who were expecting their procedure in the upcoming weeks that they would not be getting their surgeries, which means they could die. It’s not easy to tell this to patients, we are talking about a serious threat to life, but management never takes responsibility – they don’t have to speak to patients,” one staff member tells Spotlight.

“It makes no logical sense to decommission the machine at this point because there’s no proper contingency in place. You can’t help but think that there is something fishy going on or that this is just irrational planning,” another staff member says.

It’s not easy to tell this to patients, we are talking about a serious threat to life, but management never takes responsibility – they don’t have to speak to patients. – A staff member

By “fishy”, she means there are questions about who has benefitted from the sale of the old machine and why the buyer was allowed to take possession at a point in time when the old machine was still in use and the new machines have not yet been installed.

She says the angio suite, which had reached its 10-year lifespan in 2018 already, had long been flagged for replacement. But without timely procurement, staff made do. The machine limped along but was working till it was decommissioned. Another three months of working with an old machine rather than having no machine at all would have been the obvious way forward, under the circumstances, she says.

You can’t help but think that there is something fishy going on or that this is just irrational planning. – a staff member

There are also concerns about how the acquisition and installation process of the two new machines has been carried out. Together the machines cost just under R44.5 million. But the hospital tells Spotlight the machines cannot be brought on stream immediately because the hospital first needed to find an additional R2.8 million for room alterations and renovations at the two sites where the two new angio suites will be used. This work is now being carried out.

It’s left staff flummoxed, with one staffer asking, “Why would you spend R44.5 million on the machines and then not have R2.8 million to have the theatres ready?”

‘Patients diverted’

According to communications officer for CMJAH, Tabudi Madisha, the three-month delay to complete the renovations so the machines can be brought onstream is being managed. He says patients are being diverted to Chris Hani Baragwanath and Steve Biko academic hospitals. According to him, A CEO to CEO agreement is in place between CMJAH and Baragwanath. A memo from CMJAH (seen by Spotlight) states that operational details are still to be finalised between clinical heads of surgery and the head of clinical units and that emergency cases will be discussed case by case between doctors from the two hospitals.

Why would you spend R44.5 million on the machines and then not have R2.8 million to have the theatres ready?

Some doctors at CMJAH are sceptical that this will work in practice. One doctor says in his informal discussions with his counterparts at another hospital he’s been told “it will be impossible and impractical” to take on CMJAH’s patients.

“Management may be saying that everything will be up and running within three months, which we know from experience this will probably be closer to six months. But even at three months, it means at least 80 patients will be affected,” the doctor adds.

Sold for scrap

Madisha says maintenance of the old machine was done “according to the tender specification and the manufacturer’s maintenance plan”. He, however, did not disclose who the buyer of the old machine is, responding with, “As far as we know, the machine is not sold for use, but it is sold for scrap. The machine will be removed by the successful bidder who has bought it as scrap.”

But this leaves one staff member asking, “If the angio suite is indeed being sold for scrap, then surely it can wait – why the rush?”

As far as we know, the machine is not sold for use, but it is sold for scrap. – Tabudi Madisha

Madisha says replacement of the old machine took place as part of the hospital’s annual procurement plan. He confirms the successful bidder for the two new machines is a Midrand-based company Tecmed who have provided the two new angio suites at a price of R44.43 million.

“The registration of need is done by the hospital but the tender process is the function of head office (the Gauteng Department of Health),” he explains.

The Gauteng Department of Health did not respond to questions from Spotlight, including one about the value of the old machine and who it was sold to.

Second-hand market

A representative of a Joburg-based medical equipment refurbisher and reseller not involved in the case says currently the market in second-hand imaging machinery is “over-flooded” with the likes of CT scanning machines and X-ray equipment. But he says there would likely still be a market for specialised second-hand equipment if the machines remain widely in use internationally and are supported by manufacturers.

If the angio suite is indeed being sold for scrap, then surely it can wait – why the rush?

He adds that proper management and maintenance of medical equipment is essential as part of managing costs and extending the life of equipment. “Nobody wants to just scrap a machine. But it can also be dangerous if a hospital hasn’t planned a decommissioning process properly. If a machine is over its lifespan, then it can harm patients and there is also an issue of potential legal action if something goes wrong,” he says.

He says the notice of sale of second-hand medical equipment from public health facilities is usually gazetted and companies like his can then make bids. Equipment is also auctioned off and he says some facilities make their own deals with buyers.

*CMJAH staff quoted in this article have not been named because of the risk that they will be victimised if identified. The Spotlight editors are satisfied that the factual claims made by these sources have been verified.