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Surgeon charged for unprofessional conduct

2018-10-29  Alvine Kapitako

Surgeon charged for unprofessional conduct
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WINDHOEK – A Windhoek-based specialist surgeon last week appeared before an inquiry of the Health Professions Council Conduct Committee on charges of unprofessional conduct regarding the death of a patient that was under his care. 

Dr Jeremy Nel is charged with failing to immediately attend to Charmaine Bernadette Morkel at the Roman Catholic Hospital, after being informed of the patient’s condition and despite his knowledge of the patient’s recent abdominal surgery of total gastrectomy (removal of the stomach) which was performed on 26 February 2013. 

He is further charged with telephonically prescribing medication (Stemetil 12.5 mg) to the patient without examining her. 
Nel is additionally charged with failing to ensure that Morkel who was admitted on the night of 7 May 2013, was properly investigated by immediately ordering a scan or abdominal and chest x-rays, alternatively ordering the scans in the morning of 8 May 2013, after receiving the patient’s blood results and examining the patient to establish with certainty the cause of her complaints. 

The doctor is also charged with discontinuing or ignoring the possibility that the symptoms Morkel suffered could be associated with or be the result of the gastrectomy that he had performed on 26 February 2013. 
Further, Nel is charged with referring Morkel to a surgeon on call, Dr Manoj Kamble on 8 May 2013 without properly handing Morkel or by discussing in detail with Kamble the patient’s surgical history, post-operative care, diagnosis of 8 May 2013 and future management. 

Nel is further charged with failing to avoid Morkel’s death when through the exercise of reasonable care and diligence, he could have done so. 

On 7 May 2013, the late Morkel went to the emergency department of the Roman Catholic Hospital with complaints of severe epigastric pain. She was admitted in the ward of the hospital at around 23h30 as Nel’s patient under his care after his accepting responsibility of the patient. 

The emergency unit senior medical officer, Dr Munyaradzi Majangara allegedly called and described the condition of the patient and said she was suffering from severe epigastric pain and vomiting. 

Nel was allegedly also told Majangara had put a drip on the patient and given her painkillers and took blood samples. 
On 8 May 2013, Nel telephically referred the patient to Kamble who was the specialist on call on that day (8 May 2013) and over the weekend of 10-12 May 2013. Kamble took over the patient and continued the treatment that Nel had prescribed and increased the spasmolytic medication and pain treatment. 
Morkel died in the early hours of the morning on 9 May 2013 at the hospital. 

The post-mortem conducted on the patient established that the patient most likely died from a bowel perforation and secondary to bowel obstruction or strangulation. 

The post-mortem report established that the likely cause of the strangulation was adhesions from recent abdominal surgery of the patient.  Testifying before the Health Professions Council Conduct Committee on Wednesday and Thursday, Dr David Stein a specialised surgeon from Cape Town in his capacity as expert witness, said Nel was not responsible for the patient after the morning of 8 May because he had handed over the patient to Kamble who was the surgeon on duty. Therefore, Kamble had the obligation of seeing the patient and attending to her based on the findings of his examination and diagnosis of the patient. 

 “If somebody hands over a patient to me, I’m responsible,” explained Stein. Stein further explained that informing Kamble about the gastrectomy was “not all that important because he would have taken his own history on the patient“.
“There is no proof that the obstructed bowel was a result of the gastrectomy. Not even the post-mortem shows that,” Stein maintained. 

In retrospect, it was discovered that Nel’s working diagnosis was not correct all along and had he seen the patient a different diagnosis would have been possible.

“Dr Nel made a firm diagnosis. In retrospect, now that we know the cause of death we know that it was a wrong diagnosis but all for the right reasons,” argued Stein. 

“Dr Kamble was supposed to do his own investigations on the patient,” said Stein.  
Also testifying in favour of Nel on Thursday and Friday, another specialist surgeon from South Africa, Professor Brian Warren, said “the extent of the gastrectomy had no factor on what happened. She enjoyed a good quality of life (due to gastrectomy) which she hadn’t in many years.” 

He admitted that if Morkel was seen earlier by a doctor, her life would have been saved. 
“By the time she (Morkel) had died her bowel had been dead for at least six hours. Within that period survival was still possible depending on what extent of the bowel had died,” said Warren. He added that if Morkel had been seen by a doctor by 11 o clock in the morning of 8 May she would have had a good chance of survival. The case was postponed to 18 February 2019 for arguments.  

The Health Professions Council Conduct Committee consisted Dr Matti Kimberg, gynaecologist (chairperson), Dr Jack Vries (retired), Dr Theresia Aochamus (dentist), Ngamane Karuiahe-Upi (member of the public) and Chris Mouton (lawyer). The committee by Advocate Nixon Marcus of Nixon Marcus Public Law office. Nel was represented by Gerhard van der Merwe. 

2018-10-29  Alvine Kapitako

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