This blog is co-authored by Danita Mungaroo, candidate attorney.
The High Court recently dealt with a complex medical negligence case involving allegations of substandard care at Themba Hospital. The matter concerned a child born with severe mixed-type cerebral palsy due to hypoxic-ischemic encephalopathy (HIE), a brain injury caused by oxygen deprivation during birth. The claimant, representing the minor child, sought to hold the defendant, the Mpumalanga Provincial Government, liable for the injuries sustained due to alleged negligence of hospital staff. The court held the defendant liable for 100% of the proven or agreed damages related to the child’s injuries. It emphasised that the hospital staff’s actions fell below the expected standard of care, resulting in a preventable birth injury.
The events leading to the child’s birth spanned four days in December 2010. The claimant was admitted to the hospital multiple times, eventually giving birth via caesarean section. The court examined several key issues, including the alleged ingestion of herbal substances by the claimant, the standard of care provided by the hospital staff, and resource constraints within the hospital. Ultimately, the court determined that the injury was not caused by the claimant’s actions but by the failure of the hospital staff to adhere to the expected standards of care.
One pivotal aspect of the case was the delayed caesarean section. Despite indications of obstructed labour and prolonged use of oxytocin, which increases the risk of foetal distress, the baby was delivered over five hours after the procedure was deemed necessary. The Guidelines for Maternity Care in South Africa recommend that a Category 1 caesarean section—required in emergencies where there is immediate risk to the mother or baby—should be performed within an hour. The extended delay and lack of continuous foetal monitoring during this period were critical factors leading to the adverse outcome.
The Health Department argued that resource constraints, including limited theatre availability and staffing, made it impossible to provide better care. However, the court noted the absence of corroborative evidence, such as duty rosters or theatre schedules, to substantiate these claims. The failure to monitor the foetus continuously during the critical period before delivery was particularly damning. This lapse in care, combined with the failure to perform intra-uterine resuscitation to mitigate oxygen deprivation, underscored the hospital’s negligence.
The court addressed the claimant’s use of herbal substances, alleged to have been consumed to expedite labour. While these substances were noted in the hospital records, medical evidence showed no direct link between their use and the child’s condition. Instead, the records highlighted that the claimant was appropriately monitored after disclosing this information, and her labour progressed without complications until the critical period of delay.
The case highlights the critical need to adhere to medical guidelines and exercise vigilant care during emergencies. Additionally, it reinforces that systemic failures do not absolve healthcare providers of their duty to prioritise patient safety and prevent avoidable harm.