A previous ruling that dismissed a medical negligence claim – brought by a teacher who suffered permanent brain damage after delays in emergency treatment for stab wounds at two provincial hospitals – has been dismissed by the North West High Court, which slammed the staff at both facilities for their failures to provide timely and adequate treatment, reports The Star.
A full Bench comprising Judge Andre Reddy, Acting Judge JT Maodi and Acting Judge G Maree, found that Tebogo Joseph Koboyatau had proved that negligent treatment at Gelukspan District Hospital and Mafikeng Provincial Hospital caused the catastrophic injuries that left him permanently disabled, and upheld his appeal against a 2024 High Court decision dismissing his claim.
Koboyatau, who was a 29-year-old teacher at the time, was stabbed in the left side of his chest and upper arm in June 2014. He was initially treated at Setlagole Clinic before being transferred to Gelukspan District Hospital later that evening.
The referral letter accompanying him described him as seriously ill, suffering from shortness of breath, weakness and bleeding, and warned that internal bleeding was suspected.
However, the court found that crucial emergency interventions were delayed. Although doctors recorded that Koboyatau was suffering from dangerously low blood pressure, no chest X-ray was performed that evening and no intercostal chest drain was inserted until 12 hours after admission – the delay allowing blood to accumulate and clot inside his chest, significantly worsening his condition.
By 1 July 2014, show medical records, the chest drain was no longer functioning and X-rays revealed that part of Koboyatau’s left lung had failed to expand. Despite these findings, no doctor took corrective action or referred him to a higher-level facility over the next four days.
When he was eventually transferred to Mafikeng Provincial Hospital, doctors discovered pus in the chest drain and diagnosed him with a retained, infected haemothorax and a mediastinal shift, indicating severe complications.
However, instead of receiving immediate surgery, he was forced to wait another 16 days before undergoing a thoracotomy. Shortly after the operation, he suffered a cardiorespiratory arrest, resulting in hypoxic ischaemic brain damage.
The judgment records that Koboyatau has been left with permanent cognitive and executive dysfunction, neuropsychological and behavioural disorders, visual impairment and partial incontinence, with medical experts agreeing that there is no prospect of meaningful recovery.
The appeal court sharply criticised the conduct of medical staff at both hospitals and rejected the trial court’s conclusion that the failures amounted merely to errors of judgment rather than negligence.
The judges held that the evidence overwhelmingly demonstrated negligent treatment, pointing to the failure to perform an immediate chest X-ray, delays in inserting the chest drain, the failure to address the blocked drain, the failure to refer Koboyatau sooner to a specialist facility, and the prolonged delay before performing life-saving surgery.
The court found that the treating doctor’s later explanation that Koboyatau had been too restless for emergency treatment was inconsistent with the contemporaneous medical records, which instead recorded that he was sleeping while awaiting an X-ray and was to be examined “when awake”.
The judges described the explanation as an afterthought designed to justify the failure to provide urgent treatment.
Five of the six expert witnesses concluded that the treatment fell below acceptable medical standards and directly caused Koboyatau’s injuries. The judges noted that even experts engaged by the MEC largely supported the conclusion that earlier intervention would have prevented the devastating outcome.
The court was also critical of the MEC’s litigation strategy after the department elected not to call two of its own expert witnesses, despite having filed their reports. Those reports concluded that Gelukspan District Hospital had failed to provide care consistent with accepted medical standards and that the delays at Mafikeng Provincial Hospital ultimately led to Koboyatau’s current condition.
The judges drew an adverse inference from the MEC’s decision not to call those witnesses, finding that their oral evidence would probably have been unfavourable to the department’s case. A similar adverse inference was drawn from the failure to call the medical and nursing staff who treated Koboyatau during several critical periods of his hospitalisation.
The appeal court concluded that the trial judge had materially misdirected himself by treating the failures as mere errors of judgment, despite overwhelming expert evidence demonstrating negligence. It further found that the lower court had improperly relied, at least by implication, on evidence from the MEC’s only expert, whose opinions it had itself criticised and largely rejected.
The judges held that the chain of causation had been established on a balance of probabilities – that had Koboyatau received immediate treatment when he first arrived at hospital, his blood would probably have drained before clotting, and the severe infection could have been prevented.
They consequently upheld the appeal, set aside the earlier judgment and declared the MEC liable for 100% of Koboyatau’s proven or agreed damages.
The MEC was also ordered to pay the costs of the trial, the application for leave to appeal and the appeal itself, including the costs of senior counsel and Koboyatau’s expert witnesses.
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