A child’s severe brain injury and subsequent cerebral palsy were unrelated to the birth procedure and resulted from an infection developed before labour, the Supreme Court of Appeal found, rejecting a mother’s claim for R28.2m in damages but slamming missing records and a failure to call critical witnesses, reports IOL.
The court also criticised and highlighted the wider problem of substandard care in some Eastern Cape public hospitals.
The woman’s legal battle with the Eastern Cape Department of Health revolved around the birth of her son in 2019, who suffered a serious brain injury at Dora Nginza Provincial Hospital in Gqeberha. His mother said negligence by hospital staff during her prolonged labour caused or contributed to the injury.
At the time, she had endured excruciating abdominal cramps and underwent repeated medication administrations to induce labour, with multiple vaginal examinations.
Despite her deteriorating state and prolonged induction spanning 96 hours, staff failed to properly monitor her or perform a timely Caesarean section. When delivery reached its final stages, she was left largely unassisted, crying for help and pushing until she collapsed from exhaustion.
Nurses attempted fundal pressure – pushing on her abdomen – and tried repeatedly to use a vacuum extractor before a doctor arrived to deliver the child.
The baby was born non-responsive and required resuscitation. Doctors told her that he had suffered permanent brain damage from prolonged oxygen deprivation. Today, the boy has severe cerebral palsy, intellectual disability, and epilepsy, and is unable to speak or walk.
Injury occurred before labour
Writing for the majority, Judge Kathree-Setiloane found that the objective medical evidence supported the conclusion that his brain injury had occurred before the onset of labour.
The majority found the evidence of Drs Reddy and Janowski to be logically reasoned and supported by the available medical records and academic research.
By contrast, they found shortcomings in the evidence of the experts relied upon by the mother, particularly their failure to adequately address the significance of the placental findings.
On a balance of probabilities, they concluded the cerebral palsy was caused by an injury before labour.
However, the judgment was not unanimous. Judge Mocumie, supported by Acting Judge Chili, said they would have allowed the appeal and held the Eastern Cape MEC for Health liable for the negligence of hospital employees. Mocumie said she would also have sent the matter back to the High Court for a determination of the damages payable.
The minority noted that the mother had suffered unmanaged, agonising pain for five days, was subjected to 96 hours of prolonged induction, and had no doctor supervision during an arduous eight-hour second stage of labour.
They also criticised the failure to call the medical staff who had treated her to testify, and expressed serious concern about the loss of her medical records, which was another troubling aspect of the case.
The judgment noted that the missing records could have provided the courts with a clearer picture of what happened. The medical staff who had treated her were also not called to give evidence.
Mocumie warned that the loss of records can prejudice both patients bringing medical-negligence claims and the department itself, because complete records could potentially exonerate the department in appropriate cases.
She also highlighted the wider problem of substandard care in some Eastern Cape public hospitals, referring to earlier criticism by the SCA of what it described as persistent negligence and inadequate standards in hospitals under the provincial department.
Despite the minority’s dissent, the majority dismissed the appeal. The SCA therefore upheld the outcome that left the mother without damages for her son’s brain injury, finding that she had not proved that negligent conduct by hospital staff was the probable cause of the injury.
The majority accepted that there were deficiencies in the hospital’s care but that those had not been shown to be the cause of the cerebral palsy.
The appeal was dismissed with costs.
See more from MedicalBrief archives:
Another negligence claim – R6.4m – pummels Eastern Cape Health
Eastern Cape Health to fork out R12m in negligence case
Eastern Cape Health slammed over negligence claims
Lifetime cost of care in cerebral palsy medical negligence claims
SCA displeasure over ‘pervasively substandard’ care in state hospitals