A woman whose miscarried twins were removed from her body 30 days apart has lost her R1.8m negligence lawsuit, with a North West High Court (Mahikeng) judge rejecting a report from the “expert witness” and concluding she did not present any evidence to demonstrate hospital staff were responsible for causing her miscarriage.
The then 29-year-old woman had initially had one foetus removed at Zeerust Hospital, but a month later, sought medical attention at a local clinic for abdominal pain, where doctors discovered the second deceased twin was still in her womb.
‘Incomplete’
The patient had started having abdominal pain and vaginal bleeding on 4 April 2018, and went to Gopane Clinic, which referred her to Lehurutshe Hospital.
The Citizen reports that after assessment, she was transferred by ambulance to Zeerust Hospital, where she was again examined, and where she told medical staff she was pregnant.
She was subsequently discharged the next morning with a diagnosis of “incomplete miscarriage”. Her condition was considered stable at the time.
A month later, she experienced the same symptoms again. She returned to Gopane Clinic for help and was referred to Dinokana Community Health Centre, where the medical records stated she “delivered a foetus spontaneously” at 12.15pm on 5 May.
Medical records presented in court revealed that a doctor noted on 7 May that, although she had miscarried when discharged from Zeerust Hospital, she had “subsequently carried the remaining unevaluated twin”.
Testifying in court, the woman said she was pregnant and “close and/or ready to deliver” when admitted to Zeerust Hospital. She alleged that staff failed in their duty of care by incorrectly concluding she had suffered a miscarriage.
Additionally, she argued that after one foetus was removed from her uterus, staff failed to conduct a thorough examination, leaving the second dead foetus unnoticed in her uterus for more than 30 days.
Expert report
An expert report by specialist obstetrician and gynaecologist Dr Donald Amoko was submitted as evidence in court.
Amoko stated that “in a district hospital under normal conditions, when a patient is referred with a nursing diagnosis of incomplete miscarriage, the doctor must conduct a thorough examination including ultrasound before instituting a definitive treatment”.
He found that this crucial evaluation had not been conducted in the plaintiff’s case.
“If this were done, a twin pregnancy would not have been missed. It is also strange that during an evacuation a twin pregnancy was missed.
“Furthermore it is mandatory that a patient who has been to theatre for evacuation must have post-evacuation ultrasound before discharge,” the report reads.
The gynaecologist concluded that the hospital had been “grossly negligent”, and the woman was entitled to compensation for her “pain, suffering, and stress”.
Lawyers representing the Minister of Health, named as a defendant, did not present any evidence, due, apparently, to the court’s refusal to grant the Minister additional time to submit an expert report.
In her judgment delivered on Friday, Acting Judge Okgabile Dibetso-Bodibe determined that Amoko’s report was largely based on the woman’s “say-so”.
“No research had been done to assist the court on the medico-legal understanding of the concepts of twin pregnancy, miscarriage vis-à-vis stillbirth, given the period of gestation, missed miscarriage, incomplete miscarriage, retained products of conception (clots, membranes and placenta), etc.
“The expert also referred to some sources of information that he received without including same in the report,” the judgment reads.
Dibetso-Bodibe noted that it was “strikingly odd” that Amoko’s report did not include his personal qualifications or specialised experience, rendering the document insufficient as an expert report.
The judge said Amoko’s failure to provide oral testimony left “all the grey areas” in his report unanswered.
This, therefore, placed an undue burden on the court to evaluate the factual evidence from a single witness without the support of relevant medical expertise.
“In the premises, the court is inclined to reject the unsubstantiated opinion of Dr Amoko more so that he also failed to give oral evidence of his opinion, technically leaving the court with no opinion at all,” Dibetso-Bodibe said.
She also found that the woman did not present any evidence to demonstrate that the staff at Zeerust Hospital were responsible for causing her miscarriage.
Dismissed
Dibetso-Bodibe pointed out the contradiction in the woman’s testimony that she was “close to or ready to” give birth.
“During cross-examination she told the court she was the one who told Zeerust hospital staff that she was pregnant and that she was two months and three weeks. According to Dr Amoko, the plaintiff’s gestation was of three months.”
The judge further noted the lack of crucial evidence.
“The plaintiff’s cause of action is dependent on what transpired at Zeerust Hospital yet no attempts were made on both sides of the litigants to assist … with the medical records from Zeerust Hospital and/or witnesses who offered the plaintiff the medical treatment during the said period.”
Dibetso-Bodibe dismissed the woman’s case for damages due to medical negligence, but did not impose a costs order because she was unemployed.
“The evidence … is insufficient to attract delictual liability in general. The lack of medical records and a well-reasoned expert opinion left the court with general assumptions as to the cause of negligence and this mitigates against the plaintiff’s case.”
She also noted the absence of evidence from the Minister, highlighting that the defendant missed three deadlines, including the deadline to file the expert report by 15 December 2023.
See more from MedicalBrief archives:
North West crisis a ‘silent killer’ say doctors
Doctors plead for resolution of North West Health crisis