James Swart was found cold and stiff on a hospital bed with a wound in his stomach gaping open without stitches. His family is seeking justice for his untimely death after surgery to remove a tumour at Steve Biko Hospital went wrong.
Swart was 63 years old in February 2014 when he underwent surgery to a tumour on his left adrenal gland, a procedure that he was told would help control his high blood pressure. But a post-mortem examination report and a medical report indicated that there was no tumour on Swart’s adrenal gland.
The two doctors who performed the surgery, Professor Letlhogela Ntlhe and Dr Mpho Sandamela, are accused of negligence and have been charged with culpable homicide.
On a cold Wednesday morning, Swart’s son, Kenneth, and his wife, Lilian, are at home in Eersterust, Pretoria. Lilian, with grey track pants and a hoodie, sits on a two-seater couch and recalls how her husband ended up at Steve Biko Hospital.
Swart was first diagnosed with high blood pressure in 2011 at Eersterust Clinic. Later, his health worsened, and he was compelled to visit the clinic every month. But these monthly clinic visits were not helpful, Lilian said. The nurses added a tablet each time he mentioned that he was not getting better. Eventually, Lilian told her husband to ask the nurse to refer him to a doctor. “He was a ticking time bomb,” she said.
In 2012, Swart went to Steve Biko Hospital where he did a CT scan to see what was causing his high blood pressure. The doctor who examined him said the scan showed a tumour on his left adrenal gland. “The doctor said they had to remove that gland so it won’t be necessary for him to be on medication again. His blood pressure will be normal because that was the cause of the high blood pressure,” she said. “In the meantime, the medication that the hospital gave him stabilised him. There was a difference compared to when he went to the clinic, in fact, he was well and fit.”
As life-changing as the surgery could be, Lilian was sceptical when the doctor said they would operate on Swart from the front. “I am not a doctor, but I was worried. All the people I know of who have had a kidney operation were cut on the side, not the front,” she said, touching her right rib area.
She said her husband booked to undergo the surgery many times, but each time it was cancelled because there were insufficient beds at the hospital. Eventually, on 18 February 2014, Swart was scheduled for the surgery.
The first surgery
On the morning of the surgery, Lilian received a call from her husband. “He called me at 7am telling me that they are taking him in.”
Twelve hours later, Lilian, along with her son, her daughter Janelle, and friends went to see Swart. She said the nurses were unable to tell her where her husband was. Finally, she asked a nurse who told her that doctors were running around trying to save her husband. “She said there was a person who was taken into theatre and the doctors were running around in all the ICUs looking for adrenaline.”
After an hour of waiting, Lilian said Sandamela came to let them know that they had experienced difficulties in the theater. “Your husband’s veins were fragile. Every time we touch a vein it just [burst], and there was blood everywhere,” she recalled the doctor saying.
Sandamela asked whether her husband consumed alcohol or smoked cigarettes. “I said [he used to drink], but it’s about 20 years now that he didn’t drink anymore. It’s been six months since he quit smoking.” At this, Sandamela apparently threw his hands in the air and said the damage was already done.
When she went to the ICU to see her husband, she found him lying on the bed unconscious, his eyes wide open and unblinking. “I was standing by his feet. I touched his feet, and they were cold. Then I said to myself, maybe is because he was in the theater for the whole day. His hands were stiff. He was in a coma. [The doctors] induced him,” Lilian explained. “He had a pipe in his mouth. This pipe had a hole. There was nothing connected to it.”
A nurse present in the theatre showed Lilian and her family the readings on the monitor placed on the other side of the room. “The monitor showed that everything was fine, including his blood pressure. Not like that of a person who is very ill,” she said.
The next morning, the hospital asked for consent to reopen Swart and check whether everything was okay. Lilian gave verbal consent over the phone.
The second surgery
At 9am, Swart’s family went to see him. Lilian said he was in the same position that they had left him in the night before. His stomach was bigger. When they asked the nurse the reason for the abnormally large stomach, she said: “They haven’t closed him up yet. [The operated section was covered with] a transparent plaster. She even opened and showed us,” explained Lilian.
Swart was then taken to the theatre for his second surgery. When he was brought back, he was lying in the same position he was in when they took him into the theatre, Lilian said.
When she asked the doctor whether her husband was alive or not, she was told that Swart had 15 minutes to live, and they had 15 minutes to say their goodbyes.
“He was not connected to any machine. He was cold and stiff, and you could feel the cold coming from his body.“
After 15 minutes, they were told that he had died, and they have to leave. “But we have never seen him exhale [or] take his last breath. It was just as it was the previous night,” she said.
James was declared dead on 19 February 2014, but his family believe he was dead on the morning of the first surgery.
The family seeks answers
Kenneth said they were told that there was no need for an autopsy because his father died of kidney failure. But he tirelessly asked for one to be done.
In an email exchange between Lilian and Dr Mathabo Mathebula, the CEO of Steve Biko Hospital, Lilian asked why she was not called when the doctors encountered problems in the theatre. Mathebula wrote, “You were not called because the staff members were busy resuscitating Mr Swart and had to put their time and concentration on that.” Mathebula added that Swart’s veins burst because of uncontrolled hypertension, and that his liver was scarred by alcohol and that he must have been a smoker.
Dr Ryan Blumenthal, a senior specialist at the Forensic Pathology Service in Pretoria, provided Swart’s post-mortem examination report to the Pretoria Magistrate’s court. The examination found that there were no obvious signs of a tumour on the adrenal gland.
Dr Dean Lutrin from the Association of Surgeons of South Africa provided a medicolegal opinion. Lutrin concluded that there was negligence involved and that Swart died as a result of his operation. According to the notes he observed in the file, urine and blood tests were not done, and that the surgery was performed based on a CT. “It is a major breach of standard of care if urine or [hormones produced by your adrenal glands] are not measured prior to consideration of surgery for [a tumour on the adrenal gland]. Had this patient had these tests done, they would have been normal and the patient would not have been treated as if he had a [tumour],“ Lutrin explained.
He added that Swart was not completely fit for surgery and was a high risk considering that he had multiple conditions at the same time.
Lutrin pointed out the possibility that Swart was inappropriately managed during the second operation. “The surgeon who did the initial operation [Ntlhe] should have been present at the relook laparotomy and not left the operation for a registrar [Sandamela] to perform. There might have been an error in judgement at the time of reoperation,” he said.
Doctors still working
The Health Professions Council of South Africa (HPCSA) communications officer Priscilla Sekhonya said the two doctors still have active status on the HPCSA register. Sekhonyana said Swart’s family has lodged a complaint with the organisation, but there has not been a disciplinary inquiry as yet. “The HPCSA is waiting for the confirmation of the new dates from the legal representatives of Professor Letlhogela Ntlhe and Dr Mpho Sandamela.”
In 2016 and 2017, the doctors appeared at the Pretoria Magistrates Court. However, the case was postponed for further particulars, explained Phindi Louw, the National Prosecuting Authority’s Gauteng spokesperson.
Trial has been set to run from 20 to 24 April 2020.
Attempts to get comment from Gauteng health spokesperson Lesemang Matuka, including by phone calls, emails and WhatsApp messages, were unsuccessful.
“We want justice,” Lilian said. Kenneth added: “The problem is that justice is delayed since 2016. The doctors are still working, and they are being supported.”