First-time mom wins damages case against health department

The Bhisho high court has ordered the Eastern Cape health department to pay damages to a mother whose child was born with cerebral palsy after suffering injuries during labour and/or delivery.

In a recent judgment, judge Rob Griffiths ordered the department to pay still-to-beagreed or proven damages to the mother in her personal capacity and on behalf of her child.

The Dispatch reported on Monday that the Eastern Cape government’s integrated medicolegal strategy had resulted in a significant reduction in new medical negligence claims but the province still faces claims or contingent liabilities of more than R22bn.

In his ruling, the judge said the damages flowed from neurological injuries suffered by the infant during labour and/or delivery in August 2017, and his resulting cerebral palsy.

The department was ordered to pay the mother’s legal costs.

The mother was referred from Canzibe District Hospital to Nelson Mandela Academic Hospital, about an hour away, for a caesarean-section birth.

Griffiths said according to the woman and to the case records, she was a first-time mother with no medical risks.

She arrived at Canzibe Hospital at 1.40pm on August 24 and was assessed as being 36 weeks’ pregnant. Foetal movement was detected.

At 4.34pm, the cardiotocography (measurement of a baby’s heart rate) was recorded as being “non-reassuring” and the baby was judged to be in distress.

The mother was told that, because there were no doctors at the hospital, she would be transferred by ambulance to Nelson Mandela Academic Hospital.

She arrived in Mthatha at 9pm and was taken for the operation at 11pm.

Griffiths said the baby was born at 11.29pm and no one said anything about resuscitation. The baby had a weak cry.

The mother testified that the infant did not cry at birth and had seizures.

When she saw him the next morning, he had tubes inserted and she had to express milk to tube-feed him.

“The mother further testified that [the baby] remained in hospital for about two weeks, after which he was transferred to Canzibe, from where he was discharged.”

Prof Savvas Andronikou, a radiologist who testified on the mother’s behalf, confirmed that an MRI scan of the baby’s brain showed “hypoxic-ischemic brain injury”, or a shortage of oxygen to the brain, “in keeping with a prolonged insult occurring in the perinatal period”.

The radiologist said there were no chromosomal abnormalities, and that the cause of the baby’s condition was hypoxia, not infection.

“He stated clearly that the brain pattern was not representative of a growth restriction pattern as growth-restricted brains shrink globally, causing the entire brain to shrink, not a portion thereof,” Griffiths said.

It was clear from the evidence there had been substandard care amounting to negligence, because there had been poor monitoring of the foetal heart rate.

Because Canzibe was a district hospital, it should have been able to perform a caesarean section. Because Canzibe could not perform the caesar, the medical staff should have done more, including “regular monitoring, to prevent foetal stress over the many ensuing hours until 11.29pm, when the baby was born at Nelson Mandela Academic”.

Griffiths said the mother and doctors’ evidence had made a strong case that the injury to the baby’s brain occurred because of the extended labour due to the delay in getting her on to the operating table.

“The [department] called none of the medical staff, or indeed any staff, who were involved in the treatment of the mother during her confinement at both Canzibe and Nelson Mandela.

“I accordingly find the mother has established on a preponderance of probabilities that [the baby’s] hypoxia and consequent cerebral palsy was caused by the negligent conduct of the department’s employees.”