11 December 2009

Toddler's amputation 'unavoidable'

The amputation of the legs of a toddler being treated for burns to her hands was not avoidable, according to a preliminary report released on Thursday.


The amputation of the legs of a toddler being treated for burns to her hands was not avoidable, according to a preliminary report released on Thursday.

Gauteng health and social development department spokesman Simon Zwane said the report of a team set up to probe the circumstances leading to the amputation was received by MEC Qedani Mahlangu. 

Thembisa Nikelo (2) was admitted to the Far East Rand hospital in Springs with burns on her hands and face in September. However, her legs later became gangrenous. She was transferred to the Charlotte Maxeke Johannesburg Academic Hospital where her legs were amputated. 

Zwane said the six-member team of investigators, led by Professor Joe Veriava, dismissed allegations that the gangrene was caused by intravenous drips inserted in Nikelo's feet. However, it did express concern at the standard of care she received at the hospital, he said. 

'Inadequate communication and interaction'

"Our primary concern relates to a failure by doctors to recognise the severity of the child's clinical condition, the degree of senior supervision, oversight and involvement," the team said in its report.  
It found there was inadequate communication and interaction between surgeons and the paediatricians on the management of Nikelo. There was also no consideration given to treating the child in a high care or an intensive care unit where paediatricians could play a major role in her care.

The team found Nikelo should have been transferred much sooner as the gangrene was well established by the time she arrived at the second hospital. This meant "amputation was unavoidable", the team said after its week-long probe.
It could not find any problem with the care the toddler received at the Charlotte Maxeke Johannesburg Academic Hospital. The team is expected to conduct as in-depth investigation into the incident in January.
In a letter to the media on Tuesday, University of the Witwatersrand paediatric surgery head Professor Peter Beale said he gave the instruction for the amputations. 

'Amputation inevitable'

"The misrepresentation has been given that amputations were carried out on normal legs of a child who had burnt hands as a callous act of negligence," he wrote.

He said Nikelo developed a severe diarrhoeal illness with dehydration shortly after she was admitted to the Far East Rand hospital for treatment of the burns. 

"She rapidly became severely ill with a septicaemia. An organism had entered and spread in the blood, either from an invasive burn infection or gut related to her enteritis."

The child developed septic shock as a consequence of which arterial blood flow to her lower legs was hampered.  
"Doctors at Far East Rand Hospital instituted treatment and saved her life, but tragically not her limbs." 

After her transfer to Charlotte Maxeke Johannesburg Academic, her parents were counselled and given time to consult with their ancestors and elders before consenting to the amputations, Beale wrote. 
"These were carried out, adhering to principles of retaining growth plates and as much length as possible in a growing child." (Sapa, December 2009)


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