A private hospital’s bid to wash its hands of a troubled labour that caused the foetus to suffer debilitating brain injuries – and to pin the blame entirely on the delivering doctor – has been dismissed with costs, writes Matthew Hattingh for MedicalBrief.
The Supreme Court of Appeal on 16 October 2025 upheld a judgment of the North West High Court (Mahikeng) that found that the Victoria Private Hospital, also in Mahikeng, and Dr Kofi Ofori Amanfo (Ofori) had been negligent and were jointly and severally liable.
Ofori, a specialist obstetrician and gynaecologist, was not contesting the finding by the High Court that he had been negligent; he was not party to the appeal.
The matter dates back to 11pm on 29 January 2007 when the baby’s mother, a patient of Ofori, was admitted to the hospital with labour pains. She was at full term.
At 8am the next day, Ofori examined her, diagnosing a prolonged latent phase of labour and that she had an unfavourable cervix; it was 2cm dilated.
Ofori administered Prostin to induce labour before leaving the hospital to attend a medical service outreach programme, arranging for colleague, Dr Mmutle, to stand in for him. Ofori requested the midwives call him when the cervix was 8cm dilated.
At 2pm Mmutle instructed the dose of Prostin be repeated.
The mother, who was by then 4cm dilated, had mild contractions and there was a spontaneous rupture of the membranes.
Between 8pm and 8.30pm, Ofori received a call from the hospital. He arrived and after examining the patient, who he said was 8cm dilated, prescribed Syntocinon to speed the labour.
When Ofori delivered Baby D with a suction device around 9.10pm, her heart rate was zero, and she was not breathing.
With the help of a paediatrician who arrived and took over the process, D was resuscitated and began breathing on her own after about 20 minutes.
Based on the minutes of expert witnesses and hospital and nursing records, the High Court found that inadequate monitoring during labour and delays in intervening resulted in the foetus suffering a permanent hypoxic ischaemic brain injury, causing a debilitating quadriplegic cerebral palsy.
Ofori testified personally and as an expert in his field. He did not call other witnesses.
The hospital called expert witnesses but none of its midwives, including Sister Ojeng.
Ojeng’s evidence was vital given her crucial role in the saga, managing the birth process, including taking notes (which on some points differed from Ofori’s). The hospital said it had not called her because she had relocated to Saudi Arabia.
The High Court preferred the evidence of Professor Johan Smith, a neonatologist, who in joint minutes with the other experts, said that the injury developed gradually from hypoxic events that went undetected, rather than from a single acute episode.
It found that the onset of the injury likely began “from the active phase of labour after the administration of the repeat Prostin tablets at 2pm”. The contractions were probably more frequent and lasted longer which did not give the foetus sufficient time to recover.
The administration of Syntocinon at 8.45pm was the “last straw that broke the camel’s back”, as explained by Smith, and not the cause of D’s injury as the hospital had argued.
The appeal court said the High Court could not be faulted for accepting this view.
SCA judge Phillip Coppin said: “The hospital’s argument that the reliance by the High Court on Smith’s opinion was not justified is clearly incorrect. The argument is not based on sound reason, and is purely geared to accommodate the hospital’s main contention, namely, that the brain injury only occurred when Ofori was present and in control of the birth process.”
Coppin noted that another of the experts, Dr Peter Koll, a specialist obstetrician and gynaecologist, contended that the oxygen deprivation followed the Syntocinon.
But the judge found Smith’s reasoning, backed by citations from the literature, more persuasive and consistent with the hospital’s witnesses.
He said that Koll aside, the hospital had put up nothing of substance to support its attack on the High Court findings.
“The experts seem to have been in agreement that if there was proper monitoring, the midwives would have become aware as early as possible of foetal distress, and that this could have been conveyed to Dr Ofori, and that steps could have been taken to prevent irreversible injury to the foetus.
“Instead, the lack of proper monitoring here seems not only to have been the cause of not becoming aware of any foetal distress and uterine hyperstimulation, which must have been present, but also of the inappropriate further augmentation with Prostin and Syntocinon, thereby making the birth riskier and increasing the likelihood of injury to the foetal brain, before birth.”
Coppin said every minute between 8.45pm and 9.10pm had been crucial. Had the foetus' abnormally slow heart rate been detected promptly, the syntocinon might have been discontinued timeously and forceps used to speed the delivery, avoiding the brain injury.
He said Ofori's presence did not reduce the midwives’ responsibility to properly monitor the foetus and keep the doctor informed.
“It was also proved that the midwives ought to have foreseen the debilitating consequences of not monitoring, or properly monitoring, the foetus… before and after Dr Ofori returned.”
Coppin, with four other appeal judges concurring, agreed with the High Court that the midwives had been negligent and that the hospital was jointly and severally liable with Ofori for the full amount of damages agreed to, or proven to have resulted from D’s brain injury.
The court also confirmed that the hospital acted unreasonably in rejecting a settlement offer from the mother before the High Court trial, leading to an order for the hospital to pay higher legal costs.
See more from MedicalBrief archives:
Judge slams hospital nurses over cerebral palsy negligence
Department to pay after lawyers' blunder in cerebral palsy appeal case
Lifetime cost of care in cerebral palsy medical negligence claims