As if the psychological strain that comes with the death of a loved one wasn’t enough, after her death, Mrs Lombaard’s family has had to deal with a drawn out and apparently interminable dispute over what is to happen to her mortal remains.
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“After so many days of not knowing what is going to happen to her body, we, as a family, feel rattled and emotionally drained,” says Mrs Lombaard’s daughter Daleen Engelbrecht.
A 'natural' or 'unnatural' death?
On Wednesday 17 February this year, Marie Lombaard, aged 78, had arrived at Netcare Montana Hospital in the north of Pretoria complaining of chest pains. She was diagnosed as having suffered a heart attack that left one side of her heart deprived of oxygen for a period of time, and was admitted to the hospital’s ICU.
In preparation for an angiogram, which the hospital scheduled for the following day, Lombaard was given blood thinning medication.
When her family arrived at the hospital the following morning, they were told that Mrs Lombaard had been taken into an operating theatre at 10am.
At around 12:30pm, the attending cardiologist, Dr Zeelie, informed them that when he had inserted a stent into one of Mrs Lombaard’s veins during the angiogram procedure, the vein had burst and that Mrs Lombaard was currently undergoing a double bypass heart operation conducted by his colleague Dr Roos, a cardio thoracic surgeon.
At about 4pm, Dr Roos told the family that the situation was problematic as Mrs Lombaard’s heart had stopped and partially filled with blood, leaving her brain without oxygen for a period of time. This happened after the vein burst earlier that morning.
An artificial pacemaker
On Friday the 19th of February, Mrs Lombaard’s family was told repeatedly that she was in a critical condition and at about 12 o’clock, they were informed that she had passed away. When they were shown into her room, they were told that the heartbeat signal evident on the machines was merely emanating from an artificial pacemaker and that the machines would be switched off.
A sister told the family that because Mrs Lombaard had died in hospital within 24 hours of undergoing a medical procedure, the death would have to be declared as “unnatural”, that the body would have to go to the state mortuary where an autopsy would have to be performed, and that the police would open a case.
When the Engelbrechts (Mrs Lombaard's family) met Dr Roos on the following Tuesday, he informed them that after consulting with Professor Saayman, a forensic pathologist at the state mortuary, they had jointly decided that no negligence had been involved in Mrs Lombaard’s death and that it had, in fact, been “natural”. As a result, the police closed the case that had been opened initially.
The family asked Dr Roos about the pacemaker that was mentioned on the day of Mrs Lombaard’s death. He replied that he couldn’t remember if he had fitted Mrs Lombaard with a pacemaker or not, and that if he had fitted a pacemaker, he couldn’t recall whether or not he had actually activated it.
A body in limbo
After some administrative hassles in having the mortuary release the deceased’s body, Mrs Lombaard’s funeral was held on Saturday the 27th of February 2016. The body was then transferred to a crematorium in Johannesburg for cremation and that’s when the family’s problems really started.
Having discovered that Mrs Lombaard died in hospital within 24 hours of an operation, Dr Schwartz at the crematorium declined to give permission for the cremation to proceed, insisting that according to law, a post mortem needed to be done before he could give the go-ahead. Mrs Lombaard’s family also continued to be puzzled by the matter of the pacemaker which may or may not have been fitted, wondering if something had gone wrong: “Why do they not want to do an autopsy?”
Given the impasse, Mrs Lombard’s body was returned to a mortuary in Pretoria, where it remains to this day, more than two months after her death.
Her family has received very little in the way of assistance in getting the matter resolved. “Emotionally, I’m tired of fighting over this every day for such a long time,” says Mrs Engelbrecht. “Is it fair that the hospital and the doctors involved have already claimed their fees, but when it comes to after-service they don’t seem to feel anything for what we are going through? We just want the autopsy to be done so that the cremation can go ahead and we can lay my mother to rest and bring this chapter of our lives to a peaceful conclusion.”
A month after Mrs Lombaard’s death, her family registered a complaint with the Health Professions Council of South Africa (HPCSA), but were told that the “investigation of a complaint is a lengthy process”. At this point, no progress appears to have been made in the HPCSA investigation.
Who is correct?
So who is in the right in this case? Is it Dr Roos and Prof Saayman in Pretoria who insist that the cremation should go ahead because they declared the death to have been “natural”, or is it Dr Schwartz at the crematorium who disagrees, believing the “24-hour rule” to require a post mortem before the cremation can be authorised.
According to a document entitled “Death on the table”, published in 2012 by Dr Sandhya Jithoo of the University of KwaZulu-Natal’s Department of Anaesthetics, it would appear that while it is correct that “unnatural” deaths following a medical procedure are subject to a formal inquest and autopsy under the Inquests Act 58 of 1959, it is also true that the medical practitioner in charge has the discretionary power to decide whether to declare the death as “natural” or “unnatural”.
If there is any doubt about how to classify the cause of death, it is common practice for the doctor to discuss the matter with the local forensic pathologist and for them to come to a joint decision. This is, in fact, the course of action followed by Dr Roos and Professor Saayman in coming to the conclusion that Mrs Lombaard’s death was “natural”.
Jithoo notes that “many clinicians previously used a so-called ‘24-hour’ rule – a misconception that if a death occurred within 24 hours of the anaesthetic, it should be reported as unnatural”, adding that “according to the legislation, no such time frames exist”. All of this puts in question Dr Schwartz’s decision not to authorise the cremation of Mrs Lombaard’s body.
In consultation with Mrs Engelbrecht, Dr Roos has suggested two potential remedies the deceased’s family could pursue:
- They could pay for a private autopsy in order to clear up the matter and allow the cremation to be carried out. Unfortunately, the family cannot afford the costs involved.
- They could forgo cremation and opt for a conventional burial, but they have already paid for the cremation and don’t want to go against Mrs Lombaard’s wishes to be cremated after her death.
Jithoo suggests a third alternative:
- An “autopsy may be requested by the deceased’s family even if categorised as a natural death by the doctor. The autopsy may either be conducted by a private pathologist enlisted by the family, or the family may open a case with the South African Police Services and have the autopsy done by the state pathologist”. As yet, the police have refused to reopen the case.
At the time of publication, Mrs Lombaard’s case has still not been resolved. Her body remains in a Pretoria mortuary as her family grows increasingly exhausted, frustrated and disillusioned by a system that continues to deny them the dignity to lay their loved one to rest.
Much of the information presented in this article reflects the perspective of Mrs Lombaard and her family. Drs Roos and Schwartz as well as Professor Saayman were repeatedly approached via telephone and email, but declined to comment to the matter.
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