The Eastern Cape Health Department has been ordered to pay damages to the mother of a child who suffers cerebral palsy due to medical negligence at the Madzikane KaZulu Memorial Hospital.

The mother had appealed the decision of the Eastern Cape Division of the High Court in Mthatha, in which the health MEC’s plea amounted to a bare denial, denying every aspect of negligence, to the Supreme Court of Appeal (SCA).

The minor child, born in 2013, suffered a brain injury during the birth process and, according to the court record, this was due to the medical staff's negligence in not properly conducting observations and could have prevented the injury that caused cerebral palsy.

There was uncontested evidence that there was a cord around the foetus's neck during the birth process. The cord was wrapped thrice around the baby’s neck and this was recorded as a complication.

The baby suffered an ischaemic hypoxic injury, and the SCA had to find out whether the medical staff attended timeously.

SCA Judge Fikile Mokgohloa differed with the findings of the high court’s decision, which held that the medical staff assessment and evaluations were done accordingly and at the correct intervals.

“It is clear on the probabilities in this matter that the injury was caused by the cord around the neck of (the baby). Such injury, according to (expert witness) Dr Ebrahim, could have been prevented by proper monitoring by the nursing staff to determine whether there was foetal heart rate (FHR) decelerations. There was, however, no monitoring at 10.30am up to 11am. There was also no monitoring at 11.15am when (the mother) was fully dilated, and none at 11.30am when the mother started bearing down and the cord probably tightened.

“This was a serious and critical period to determine any deceleration in the FHR, yet it is clear from (the nursing sister who attended to the mother) evidence that the nursing staff did not take reasonable and necessary steps to monitor the FHR of the baby. The nursing sister’s evidence points to clear substandard monitoring that did not accord with the standards set out in the guidelines.

“According to her evidence, the FHR was 138 bpm at around 10am and 136 bpm somewhere around 11.30am and 12pm. On the probabilities, that reading cannot be correct because shortly thereafter, the baby was born floppy and lethargic,” said Mokgohloa.

Mokgohloa also averred that the nursing sister was “not an honest and trustworthy witness” and that her “evidence should have been rejected as being unreliable and not credible”.

“Of much concern in the evidence of the nursing sister is that she recorded in the maternity case record (MCR) that the cord around the neck was a complication yet she did not indicate whether the cord was tight or loose. She did not indicate whether the meconium, which is indicative of foetal stress, was thin or thick.

“She had no recollection of what happened to the patient except for what she recorded in the MCR and what she would normally do in the circumstance. Curiously, she could recall that she got her finger under the cord and cut it yet this was never recorded in any of the hospital records. How she remembered this remains a mystery,” the judge said.

Eastern Cape Health Department spokesperson, Siyanda Manana, said the department is "still studying the judgement and will decide on a way forward".

chevon.booysen@inl.co.za