- The High Court in Mbombela found the Mpumalanga Health Department fully responsible for all the damages suffered by a child.
- The court determined that nurses did not properly monitor the baby’s heart rate during a long and difficult labour.
- Judge TV Ratshibvumo found that the lack of monitoring led to the brain injury that caused cerebral palsy.
The High Court in Mbombela found the Mpumalanga Health Department responsible for the brain injury and cerebral palsy suffered by a child after hospital staff did not properly monitor both the mother and her baby during a long labour.
In a judgment delivered by Acting Judge President TV Ratshibvumo, the court found that nurses at Piet Retief Hospital gave substandard care, failing to record and carry out the monitoring required by the 2007 Maternity Guidelines during both the active and second stages of labour.
The child, now 14 years old, lives with spastic quadriparesis cerebral palsy, profound intellectual disability and epilepsy, and relies completely on his mother for all daily needs.
Hospital records went silent during the final hours of labour
The mother told the court she was admitted to Piet Retief Hospital on 17 November 2009 with labour pains. After a check at 8pm on 18 November, she was not examined again until she was taken to the labour room at around 4am the next day. She gave birth with forceps assistance at about 4.15am.
She testified that her baby did not cry right after birth and that nurses had to stimulate him by slapping his feet. The first cry she heard was only around 5.30am, and it was more like a squeaking sound than a normal loud baby’s cry.
She also said her baby could not suckle, was placed in an incubator and was fed through a tube for about a week. The court accepted her account as reliable and consistent with a developing neurological injury.
Experts agreed monitoring was seriously lacking
A key feature of the case was that both sides ultimately agreed the hospital’s monitoring and record-keeping were below standard.
The court found that neither the mother nor the baby were monitored or had their observations recorded from 8.30pm on 17 November until 6am on 18 November. During the active phase of labour, the baby’s heart rate was only checked every two hours, instead of every 30 minutes as the guidelines require.
Crucially, there was no record of any monitoring of the baby during the vital period between full dilatation at 2am and delivery at 4.10am.
The plaintiff’s obstetric expert, Dr Constant Ndjapa-Ndamkou, described this as “a significant dereliction of the standard of care” and said that an evolving lack of oxygen would probably have gone unnoticed during the unmonitored second stage of labour.
The plaintiff’s neurological and neonatal experts, Professor Regan Solomons and Professor Victor Davies, said MRI scans showed a partial, prolonged brain injury from lack of oxygen during labour. They added that other causes, such as infection, metabolic disease and congenital abnormalities, had been effectively ruled out.
Department relied on Apgar scores
The department’s experts argued that the child could not have suffered brain damage from lack of oxygen during labour because the recorded Apgar scores were 9/10 and 10/10, no resuscitation was noted, and the baby seemed well at first.
Professor Daynia Ballot testified that brain injury from lack of oxygen during labour would usually show up in the first six to 12 hours after birth, and that the child’s decline about 50 hours later suggested another cause.
Dr Peter Koll agreed the record-keeping was poor, but argued that monitoring might have been done even if it was not written down.
Judge rejects reliance on incomplete records
Judge Ratshibvumo pointed out a contradiction in the department’s argument. “It is contradictory,” the judge said, “to insist the hospital’s Apgar scores and post-natal assessments are completely reliable, while also admitting that the same staff failed badly in their required monitoring and record-keeping during labour.”
The court noted that the records did not show how the Apgar scores were worked out. The mother’s evidence that her baby did not cry and was not breathing normally directly contradicted a perfect score. The judge found the Apgar scores unreliable in these circumstances and said they could not be used alone to rule out birth asphyxia.
The court was also critical of attempts to dismiss the mother’s observations. Judge Ratshibvumo said blaming the baby’s twitching, rolling eyes and inability to suckle on the mother’s inexperience was speculative and not supported by the evidence.
Failure to monitor caused the injury
On causation, the court used the “but-for” test and found that proper monitoring would probably have detected distress in time for intervention. “The hospital staff had a legal duty to check the baby’s heart rate every 30 minutes during active labour, and even more often during the second stage,” the judge said.
By not monitoring the baby during the delayed second stage from 2am to 4.10am, the staff had “closed their eyes to the baby’s condition.”
The court rejected the idea that one normal CTG reading just before delivery could show the baby had been fine during the two hours before.
Judge Ratshibvumo accepted the plaintiff experts’ timeline: failure to monitor, missed signs of distress, prolonged lack of oxygen, brain injury, neonatal encephalopathy and eventually cerebral palsy.
“I am satisfied the plaintiff’s expert witnesses gave a logical, coherent and medically sound account of what happened,” the judge said.
Department held fully liable
The court concluded that the plaintiff had proved, on a balance of probabilities, that hospital staff were negligent and that their negligence caused the child’s brain injury and cerebral palsy.
The MEC for Health was ordered to pay all of the plaintiff’s proven damages from the injury, as well as the costs of the trial, including the plaintiff’s expert witnesses. The amount of compensation will be decided in future proceedings.
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