- The High Court found that hospital staff failed to adequately monitor a baby during labour at Schweizer Reneke Hospital.
- Judge Petersen ruled that negligent management of labour probably caused a child’s cerebral palsy and brain injury.
- • The North West Department of Health was ordered to pay 100 percent of the child’s proven damages and legal costs.
The High Court in the North West has ruled that negligent management of labour at Schweizer Reneke Hospital probably caused a child to suffer hypoxic ischaemic brain injury and cerebral palsy during birth in December 2006.
Acting Judge President AH Petersen found that medical and nursing staff failed to properly monitor foetal wellbeing during labour, even though the mother arrived at the hospital with a prolonged rupture of membranes, a condition that increased obstetric risks.
The matter was brought by the child’s mother in her representative capacity as parent and guardian. The court dealt only with the issue of liability, with the determination of damages to follow separately.
Background to the labour and delivery
The court heard that the mother arrived at Schweizer Reneke Hospital on 27 December 2006 after experiencing clear fluid drainage for about 48 hours. Medical staff diagnosed a prolonged rupture of membranes and decided to induce labour.
According to the judgment, labour progressed over several hours before oxytocin was administered during the early hours of 28 December 2006 to augment labour. The child was delivered vaginally shortly before 3 a.m.
After birth, the baby required tracheal suctioning, oxygen and further medical intervention. The child was later transferred to Klerksdorp Hospital with respiratory distress.
Years later, the child developed significant neurological impairment and cerebral palsy. Magnetic resonance imaging scans performed in 2013 showed what experts described as a watershed hypoxic ischaemic brain injury pattern.
Judge Petersen wrote that a watershed injury is consistent with a prolonged evolving hypoxic process rather than an instantaneous catastrophic event. The court accepted expert evidence that the injury pattern pointed to progressive intrapartum hypoxia developing during labour.
Failures in foetal monitoring
A central issue in the case was whether hospital staff adequately monitored the baby’s condition during labour. Expert witnesses for the plaintiff told the court that prolonged rupture of membranes required enhanced vigilance and closer foetal surveillance during labour.
The court found that no cardiotocography monitoring was performed and that foetal monitoring during active labour fell materially below accepted obstetric standards.
Judge Petersen wrote that the evidence established that foetal monitoring during active labour was materially below accepted standards. The judgment found that intermittent recordings showing apparently normal foetal observations were insufficient to prove that the baby remained well throughout labour.
"Sparse intermittent reassuring observations do not establish continuous foetal wellbeing throughout the entire active phase of labour," the judge said.
The court also found that oxytocin was administered despite inadequate foetal surveillance, which formed part of what the judgment described as broader inadequate clinical management.
Arguments over causation
The North West Department of Health argued that other possible explanations, including meconium aspiration syndrome or developmental causes, could have contributed to the child’s condition.
However, the court found that those alternative explanations were not supported strongly enough to displace the evidence showing intrapartum hypoxia.
Judge Petersen said that the alternative explanations advanced by the defendant do not materially displace the plaintiff’s causation case. The court accepted evidence that proper monitoring would probably have detected signs of foetal compromise in time for medical intervention.
Judge Petersen wrote that a prolonged evolving hypoxic insult inherently presents a window during which detection and intervention may prevent irreversible injury.
The judgment concluded that the child’s injuries were probably avoidable had reasonable obstetric care been provided.
Liability and costs order
The High Court declared the department liable for 100 percent of the child’s proven or agreed damages arising from the negligent management of labour and delivery.
The department was also ordered to pay the plaintiff’s legal costs, including the costs of counsel, expert witnesses, medico-legal reports, magnetic resonance imaging investigations and related consultations.
Judge Petersen concluded that the plaintiff had proved, on a balance of probabilities, that the defendant’s employees were negligent in their management of her labour and delivery and that such negligence probably caused the child to sustain the hypoxic ischaemic brain injury reflected on magnetic resonance imaging and manifested clinically thereafter.
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