The newborn did not live long enough to be given a name by his teenage mother‚ and had been responding well to treatment for low blood sugar.
However‚ his short life ended in an overcrowded neonatal ICU ward at the well-regarded teaching hospital in January‚ when a nurse mistakenly administered medication that was never ordered by his doctor.
The shocking medical bungling that lead to the demise of newborn “baby of Phumzile Ndlovu” is contained in a detailed patient safety incident report‚ obtained by The Times.
It outlines how a professional nurse had sent a fatal drug‚ potassium chloride‚ surging into his tiny body‚ instead of the potassium free ordered by the doctor.
The report states that the parents were informed that the cause of death was unknown and that a “busy unit” was found to have contributed to the accident.
The recommended action to remedy the problem was enforcement of the medication policy. There was mention of action against the nurse and hospital management failed to report the matter to the Health Professions Council of South Africa.
HPCSA spokesperson Daphney Chuma said that their investigators would probe what had led to the baby’s death.
“Now that the matter has been brought to our attention‚ we will conduct a preliminary investigation to determine whether there is a prima facie case against any practitioner registered with the Council. If there is any‚ then disciplinary steps will be taken in accordance with our Professional Conduct regulations‚” she said.
The Department of Health in KZN refused to be drawn on specifics surrounding the death‚ saying only that the death of any child was a tragedy‚ irrespective of the circumstances.
“Parents informed that cause of death is unknown and that a post mortem has been requested to ascertain cause‚” reads the patient safety incident report‚ which was leaked to the Sunday Times.
But three months after Baby Ndlovu’s death‚ no post-mortem has been conducted‚ according to a source at the provincial mortuary.
It is unclear what happened to the baby’s body after he died.
In an affidavit nurse Neliswa Yaka — who has moved to a new clinic in Inanda after the death — reveals that fatal error that cost the newborn his life.
“Sister asked me to administer 6ml of potassium free neonatalyte to the patient. At the time the doctor was still writing down the order. I then withdrew 3ml of potassium chloride…and administered [it] to the patient.”
She told of how the colour had immediately drained from the boy‚ who turned blue.
Other nurses and the doctor rushed to her aid and tried to revive the child‚ and in the panic that followed another dose of the wrong medication was given.
The following day‚ when asked by a colleague to produce the medication she had given to baby Ndlovu‚ the cause of death emerged.
Yaka didn’t respond to queries.
Efforts to trace Phumzile Ndlovu‚ the baby’s mother‚ were unsuccessful. KZN Department of Health spokesman Sam Mkhwanazi expressed their condolences to the family of the baby.
“To lose a child‚ irrespective of the circumstances thereof‚ is a very painful and traumatic experience.”
“On the specific issues raised by the newspaper‚ the department requires more time to collect and interrogate information so that it (the department) can provide the public with accurate information.”