SCA baby neglect ruling urges health minister to address negligence at hospitals

The Supreme Court of Appeal (SCA) on Thursday highlighted how often it was confronted with cases of serious and serial negligence at state hospitals in the Eastern Cape, saying that substandard care was pervasive.

In a ruling on Thursday, it dismissed an appeal against the provincial health department but ordered that the judgment be forward to National Health Minister Zweli Mkhize and provincial health MEC Sindiswa Gomba “in the hope that this situation will be urgently addressed”.

“The situation is to be deprecated,” the court stated.

The SCA had in May heard an appeal from the Eastern Cape High Court in Mthatha, brought by a mother against the department.

She was admitted to All Saints hospital for her first birth in Engcobo on October 2, 2013.

Hospital staff

The delivery appeared uncomplicated until staff were alerted to the possibility of damage due to low Apgar scores.

It emerged that during the second stage of active labour, the baby sustained a sudden, total and persistent lack of oxygen to the brain for a sustained period due to compression of the umbilical cord.

The baby developed cerebral palsy.

The SCA said it was common cause that the hospital staff did not properly monitor the labour.

Staff monitored the foetal heart rate via stethoscope as the hospital was not equipped with the appropriate machine.

“The last recorded foetal heart rate was taken at 06h00. The damage took place during a 45 minute period. The appellant’s claim is that the failure to monitor during this period caused the damage,” the justices said.

The mother’s case was that damage resulted because no warning signs were detected through regular monitoring of the heart rate.

“If there was in all probability no warning, the issue is whether, when the sentinel event occurred, there would have been sufficient time to avoid the damage by expediting the delivery,” the majority judgment read.

“The obvious first factor in this enquiry is that counsel for the appellant candidly admitted that it could not be proved when the sentinel event occurred. Without being able to do so, it could not be said at what time monitoring would have alerted the staff to this event.”

Dire situation

Justices Trevor Gorven – with Justices Azhar Cachalia, Zukisa Tshiqi and Sharise Weiner concurring – found that it was not proved that there would have been sufficient time in which to deliver the baby so as to avoid damage.

It upheld the findings of the high court in that the interruption of blood supply happened without warning and happened at a time when intervention through an emergency delivery could not have been performed in time to avert the damage.

A minority judgment by Justice Mahube Molemela differed and would have upheld the appeal because of a view that causation had been proved.

The SCA indicated that during the hearing, it had put the dire situation at provincial hospitals to the legal team for the health department.

“The response was that this sad state of affairs and the need for urgent remedial intervention had pertinently been brought to the attention of the relevant authorities. Despite this, such conduct does not appear to have abated significantly, if at all.”

The court did not make a costs award as a mark of its displeasure over the situation.

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