- A North West woman made multiple trips back to a provincial hospital as pain from a finger injury worsened, but doctors failed to recognise that she had developed a serious chronic condition as a result of the fracture.
- The hospital’s own expert admitted the condition was not recognised by any of the treating healthcare professionals, a failure the court said fell below the standard expected of medical professionals.
- The High Court held the provincial health department 100 percent liable for the woman’s damages after finding that the missed diagnosis caused lasting impairment.
For months, Msego Beauty Pheko kept returning to Joe Morolong Hospital with a painful finger that refused to heal.
What began as a simple injury when a brick fell on her hand eventually developed into a debilitating chronic pain condition that doctors at the hospital never recognised. Instead of healing, her pain and symptoms only got worse with time.
The High Court in Mahikeng has now found that the failure by hospital staff to identify the developing complication amounted to negligence. Judge FMM Reid ruled that the MEC for Health in the North West is liable for the harm suffered by Pheko after repeated opportunities to diagnose and treat her condition were missed.
The case stems from the care Pheko received at Joe Morolong Hospital in February 2016, after a brick struck her right index finger, causing a deep cut and a fractured bone.
At the hospital’s emergency department, her wound was cleaned, stitched and bandaged. X-rays confirmed the fracture, and she was sent home with pain medication and a follow-up appointment. But the healing never came.
A problem that kept getting worse
Over the following months, Pheko kept returning to the hospital as her finger remained painfully swollen and the fracture still wouldn’t heal. Court records show that she attended the hospital on multiple occasions during 2016, including follow-up visits in March, April, May and June.
Despite her ongoing symptoms, doctors never identified the underlying complication developing in her hand. Pheko eventually sought help from private doctors in Vryburg. One doctor administered an injection and advised her to return to the hospital. Another doctor confirmed through further x-rays that the fracture had still not healed and sent a referral letter back to the hospital requesting further treatment.
But when Pheko returned to the hospital with that referral, a doctor refused to act on it and scolded her for going to a private doctor.
Judge Reid noted that this response denied Pheko an opportunity to receive appropriate treatment and reflected a dismissive attitude toward her ongoing medical complaints.
Experts reveal the missed diagnosis
Both sides called orthopaedic surgeons to testify about the medical issues at the centre of the case. Dr LF Oelofse testified for Pheko and explained that the nature of the injury required careful management and monitoring because of the risk of complications.
Dr WE Williams, who testified for the health department, initially defended the early treatment provided at the hospital. However, his own medical findings ultimately proved critical to the court’s decision.
The experts agreed that Pheko developed complex regional pain syndrome, a severe chronic pain condition that can arise after injuries.
The judgment records that Williams acknowledged the condition had gone undetected by the treating staff. In the joint expert minutes, he stated that the condition was not recognised by any of the treating healthcare professionals.
He further wrote that it is regrettable that no healthcare professional who attended to the plaintiff could recognise the presence of CRPS and refer her to the appropriate services or professionals for appropriate treatment.
Dr Williams also explained that the failure of treatment appeared to stem from the fact that medical staff were unfamiliar with the features of the condition.
During cross-examination, he conceded that his use of the word regrettable effectively described negligence, even though he avoided using the legal term directly as an expert witness.
Court finds hospital failed its duty of care
Judge Reid said the evidence showed that the plaintiff repeatedly presented to the hospital with ongoing symptoms while the fracture failed to heal. Despite these warning signs, none of the healthcare professionals recognised the developing complication.
The judge emphasised that the defendant’s own expert confirmed that the condition was not recognised by any of the treating healthcare professionals.
The judgment states that the failure to identify a known complication of a common injury, especially when symptoms persist over time, falls below the standard expected of reasonable medical professionals.
Judge Reid concluded that the missed diagnosis prevented the plaintiff from receiving treatment that could have prevented or reduced the severity of her condition.
As a result, Pheko now lives with a chronic pain syndrome that makes it difficult to use her hand for everyday tasks and has a major impact on her daily life.
Health Department held fully liable
The court ultimately ruled that the health department is responsible for the harm suffered by Pheko. Judge Reid found that the defendant, through its employees at Joe Morolong Hospital, breached the duty of care owed to the patient. The judgment states that the defendant is liable for 100 percent of the plaintiff’s proven or agreed damages.
The determination of the amount of damages will be decided later, as the court postponed the question of compensation. The department was also ordered to pay the plaintiff’s legal costs, including counsel’s fees on Scale C.
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