- A Gauteng woman will receive compensation after losing her uterus during childbirth at a public hospital.
- The Supreme Court of Appeal said the most likely cause was a mistake during surgery.
- The woman’s claim for counselling and support after the operation was dismissed.
A Gauteng woman who lost her uterus after complications during a caesarean section has won a medical negligence case against the Gauteng Department of Health in the Supreme Court of Appeal.
The case arose after the woman gave birth to her first child at Dr George Mukhari Academic Hospital in April 2016. During the procedure, she suffered severe bleeding, and doctors performed an emergency hysterectomy to save her life.
The woman later sued the Department of Health, claiming that negligent medical treatment caused the loss of her uterus and that she did not receive proper counselling afterwards.
The High Court ruled in her favour and ordered the department to compensate her. The department then took the matter to the Supreme Court of Appeal.
What happened at the hospital
The woman arrived at a clinic in Soshanguve on 23 April 2016 after her waters broke. She was referred to Dr George Mukhari Academic Hospital, where she arrived later that afternoon.
She testified that she was not attended to for several hours. During the early hours of the following morning, she was taken to the theatre for a caesarean section but was returned to the ward because no doctor was available. At about 9am on 24 April 2016, she underwent the operation under general anaesthetic.
The woman’s next memory was waking up in intensive care three days later. A doctor informed her that her uterus had been removed after severe postpartum haemorrhage during the operation.
She was discharged from the hospital on 29 April 2016 after signing a form refusing further treatment. She later returned twice to have stitches removed.
Court rejects delay argument
One of the central issues before the appeal court was whether delays in treatment caused the complications that resulted in the hysterectomy.
The woman relied on expert evidence that she had already been in labour when her membranes ruptured and that an unreasonable delay in performing the caesarean section caused the bleeding. However, the Supreme Court of Appeal found that this theory was not supported by the evidence.
Judge PA Koen found that the woman had been managed in accordance with national maternity care guidelines and that it had not been proven that delays caused the haemorrhage. Judge Koen said, “The respondent was monitored after her admission to the hospital and managed in accordance with the Guidelines.”
The court accepted evidence that the woman was not yet in active labour when she arrived at the hospital and that the timing of the caesarean section was consistent with accepted medical practice.
Missing records and unanswered questions
A major challenge in the case was that most of the woman’s hospital records could not be found despite efforts to locate them. Only limited records, including maternity, theatre and intensive care registers, were available. Judge Koen said, “The absence of the documents should have been treated as a neutral factor.”
The court rejected the High Court’s finding that an adverse inference should be drawn against the Department simply because records were missing. However, the missing records meant there was no direct explanation for what caused the severe bleeding during surgery.
Medical evidence identified three possible causes. These were infection, a natural failure of the uterus to contract, or a mistake during the operation. Infection was later ruled out after laboratory testing.
The department failed to explain the surgery
The doctors who operated did not testify during the trial. The court found that whether a surgical mistake had occurred was a matter that fell within the knowledge of those doctors.
Judge Koen said, “Whether either of these two eventualities arose would only be known to the doctors who performed the operation.”
The court found that the most likely explanation for the haemorrhage and hysterectomy was a mistake during surgery. Judge Koen said, “The remaining and most likely prima facie cause of the PPH and hysterectomy was a mistake that occurred during the operation.”
Because the department failed to present evidence from the doctors involved, it failed to rebut the inference of negligence. Judge Koen concluded, “The appellant failed to do so.”
The court therefore upheld the finding that the Department must compensate the woman for damages arising from the hysterectomy.
Counselling claim fails
The woman also claimed damages because she allegedly did not receive counselling and support after the operation.
The court found that arrangements had been made for her to meet a psychologist, social worker and gynaecologist, but that she discharged herself from hospital before those consultations could take place. Judge Koen said, “She lost that opportunity because she discharged herself.”
The court noted that she later returned to the hospital on two occasions but did not request counselling. As a result, the Supreme Court of Appeal dismissed that part of her claim while confirming that she was entitled to compensation for damages resulting from the hysterectomy.
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