Daniella Lalezari v North Metropolitan Health Service [2026] WADC 68 (Link to JADE).
This claim arose from the birth of the plaintiff in 2020 at King Edward Memorial Hospital. At birth, she was in a critically compromised condition, described as pale, floppy and shallow breathing. By five minutes post‑delivery she was not breathing at all, and her heart rate had fallen to less than 100 beats per minute. After a prolonged period of resuscitation, her vital signs improved and she survived. Nevertheless, it subsequently became apparent that she had sustained a hypoxic‑ischaemic brain injury. That injury has resulted in significant and ongoing functional impairment likely to persist into adulthood.
The claim alleged that the defendant acted unreasonably in delaying a decision to expedite delivery in the face of clinical indicators of developing injury.
The medical issues were complex and the judgment is a long one which requires careful reading.
In relation to breach of duty, the court held at [367]:
I am satisfied that had Dr Marcano, or any other clinician acting on the defendant’s behalf, reviewed the CTG trace at 6.43 pm in accordance with the defendant’s obligation to appropriately monitor and assess CTG surveillance, it would have been open to that clinician to regard the trace as raising a potential risk of acidosis and, at the least, as necessitating further evaluation. The failure at that point was therefore not a failure to correctly interpret the CTG, but a failure to undertake any interpretation at all. In that respect, and when regard is had to the factors provided for in s 5B(2) of the Act, the defendant failed to take a level of precaution that I am satisfied the reasonable person in the defendant’s position would have taken.
In relation to causation the trial judge commented at [371] that a negligent act or omission need not be the sole cause of the harm. Where more than one condition is necessary for the occurrence of a particular harm, an act or omission that forms part of a set of conditions which, in their totality, were jointly necessary for the harm will constitute a ‘necessary condition’. The trial judge ultimately held at [518] – [520]:
Put at its highest, and adopting the formulation most favourable to the plaintiff, the evidence supports no more than a possibility that earlier delivery might have avoided the pre‑terminal bradycardia which Professor Hyett considered likely to have occurred in the period prior to delivery. It likewise permits the possibility that Daniella may have been born in a less compromised condition, may have required less extensive resuscitation, and may have sustained a less severe injury. However, the evidence does not rise beyond possibility. Those matters cannot be established as matters of probability, nor can it be concluded that earlier delivery from 7.46 pm onwards would have been a necessary condition of the avoidance of the injury or of any reduction in its severity. To reason otherwise would move beyond permissible inference and into speculation.
At its highest, the evidence establishes that Daniella’s injury was capable of resulting from a series of persistent hypoxic insults associated with recurrent uterine contractions over a period of approximately 33 minutes, just as it was capable of resulting from a similar process operating over a longer period of approximately 53 minutes. Given the additional uncertainty introduced by the role of post‑delivery resuscitation, it is not possible on the evidence to determine whether that difference would have had any material effect on the development or severity of Daniella’s injury.
Accordingly, on the evidence available, it is not possible to determine that the injury sustained would have been materially different depending upon the duration of that period. In those circumstances, the plaintiff has not established that earlier delivery would, on the balance of probabilities, have avoided the injury or reduced its severity, with the consequence that the injury must be regarded as inevitable for the purposes of the causation analysis.
Having failed on causation, the plaintiff’s claim was dismissed.
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