MEC for Health and Social Development of Gauteng Provincial Government v Machete (A70/2021; 69859/2017) [2023] ZAGPPHC 21 (20 January 2023)
- Citation
- [2023] ZAGPPHC 21
- Status
- Judgment
- Jurisdiction
- South Africa
- Court
- North Gauteng High Court, Pretoria
- Panel
- MA Lukhaimane, AJ Motha, CJ van der Westhuizen
- Case number
- A70/2021; 69859/2017
More details
- Court
- North Gauteng High Court, Pretoria
- Panel
- MA Lukhaimane, AJ Motha, CJ van der Westhuizen
- Case number
- A70/2021; 69859/2017
On this page
Professional case brief
Research organized from the available case record
01
Holding and result
The court found that although there was a failure by the hospital staff to monitor the foetal heart rate every 30 minutes as prescribed by the guidelines, the monitoring at 08h00 and 10h00 showed no abnormalities requiring intervention. The injury suffered by the minor was of an acute profound type, occurring immediately before delivery, and not a partial prolonged injury that could have been prevented by earlier monitoring or intervention. Expert evidence and joint minutes confirmed that the acute event was sudden and not foreseeable or preventable by the staff's conduct prior to delivery. Therefore, the respondent failed to prove on a balance of probabilities that the breach of duty caused the harm. The appeal was upheld, and the plaintiff's claim was dismissed.
Court disposition
Appeal upheld; order of the High Court set aside; plaintiff's claim dismissed with costs.
Orders
- The appeal is upheld.
- The order of the High Court is set aside and replaced with: The plaintiff's claim is dismissed with costs.
02
Material facts
Parties
MEC for Health & Social Development of Gauteng Provincial Government
Appellant Counsel: SS Maakane, SCTebogo Evah Machete
Respondent Counsel: AN Tshabalala03
Procedural history
Posture
Civil Appeal / Appeal From High Court Judgment on Liability in Medical Negligence; Appeal Heard by Full Court
04
Questions and positions
Legal issues
- 01
Whether the hospital staff were negligent in monitoring the respondent during labour.
- 02
Whether any negligence caused the minor's hypoxic ischemic injury and resultant cerebral palsy.
- 03
Whether the failure to monitor and expedite delivery constituted a breach of duty resulting in liability.
Party arguments
- Applicant
- The appellant argued that the hospital staff acted with the necessary skill, care, and diligence expected of professionals in similar circumstances. They contended that there was no negligence in the treatment of the respondent and denied any causal link between the alleged omissions and the brain injury suffered by the minor. The appellant relied on expert evidence and joint minutes to assert that the monitoring and management were adequate, and that the injury was of an acute profound type, not preventable by earlier intervention.
- Respondent
- The respondent claimed that the hospital staff failed to adequately monitor her labour in accordance with the National Maternal Guidelines of 2007, resulting in a negligent omission. She argued that this failure led to the minor suffering cerebral palsy due to hypoxic ischemic encephalopathy. The respondent maintained that proper monitoring would have detected foetal distress in time, allowing for expedited delivery and prevention of the injury. She relied on expert testimony and joint minutes to support her case.
05
Court’s reasoning
Legal principles
- 01
Kruger v Coetzee 1966 (2) SA 428 (A)
Negligence arises if a reasonable person in the defendant's position would foresee the possibility of harm and take reasonable steps to prevent it, and the defendant failed to take such steps.
- 02
ZA v Smith 2015 (4) SA 574 (SCA)
Factual causation is determined by the 'but-for' test: whether, but for the defendant's wrongful and negligent conduct, the harm would not have ensued. The plaintiff must establish this on a balance of probabilities, not with certainty.
- 03
National Health Act 16 of 2003, sections 13 and 17
Hospital and clinic records must be created, maintained, and protected from unauthorized access.
- 04
Coopers (South Africa) (Pty) Ltd v Deutsche Gesellschaft für Schädlingsbekämpfung MBH 1976 (3) SA 352 (A)
Expert opinion must be reasoned and based on disclosed facts or data; mere assertion is insufficient.
- 05
McGregor and Another v MEC Health Western Cape [2020] ZASCA 89
The functions of an expert witness include providing evidence of fact, general knowledge, and their own inferences and opinions, with grounds for those conclusions.
06
Ratio, limits and disposition
Ratio decidendi
The court found that although there was a failure by the hospital staff to monitor the foetal heart rate every 30 minutes as prescribed by the guidelines, the monitoring at 08h00 and 10h00 showed no abnormalities requiring intervention. The injury suffered by the minor was of an acute profound type, occurring immediately before delivery, and not a partial prolonged injury that could have been prevented by earlier monitoring or intervention. Expert evidence and joint minutes confirmed that the acute event was sudden and not foreseeable or preventable by the staff's conduct prior to delivery. Therefore, the respondent failed to prove on a balance of probabilities that the breach of duty caused the harm. The appeal was upheld, and the plaintiff's claim was dismissed.
Obiter and limits
- The absence of neonatal records was noted, but the lack of documentation did not alter the outcome as the causal link was not established.
- Conflicting evidence regarding the exact time of delivery was deemed irrelevant to the determination of causation, given the nature of the injury.
- The court emphasized that adherence to guidelines is important, but liability requires proof of causation, not merely breach of protocol.
Court disposition
Appeal upheld; order of the High Court set aside; plaintiff's claim dismissed with costs.
- The appeal is upheld.
- The order of the High Court is set aside and replaced with: The plaintiff's claim is dismissed with costs.
Source and reliance status
North Gauteng High Court, Pretoria
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