In SN obo ON v MEC for Health, Eastern Cape[1], the Supreme Court of Appeal (SCA) considered whether hospital staff were negligent in failing to adequately manage and monitor a patient and her foetus during labour, and if so, whether this negligence caused the child's brain damage.
The appellant, acting on behalf of the minor child, ON, brought a claim against the MEC for Health, Eastern Cape (the respondent), alleging that hospital staff failed to properly monitor both the mother and the foetus during labour. This failure allegedly led to ON being born with hypoxic ischemic encephalopathy (HIE)—a condition resulting from sustained oxygen deprivation to the brain during labour.
The appellant argued before the High Court that the hospital staff failed to: perform accurate and appropriate monitoring of the foetal heart rate, maintain an accurate partogram, monitor the foetal heart rate with sufficient frequency, and detect signs of foetal distress.
ON's heart rate was monitored at 07h30 (142 bpm), 10:00 (138 bpm), and 12h00 (136 bpm), with no monitoring between 10h00 and 12h00. A labour summary indicated that the umbilical cord was wrapped around ON's neck at birth. Although the respondent admitted to negligent monitoring, it contended that the brain injury was caused by an unknown event.
In its reasoning, the SCA referenced MEC for Health, Eastern Cape v DL obo AL[2] where the court emphasised that circumstantial evidence and expert opinions are critical when assessing alleged negligence. In determining liability, the courts must ask: " Whether the brain damage sustained by the [child] would have been averted if the hospital staff had properly monitored the mother and foetus and had acted appropriately on the results?"[3]. This is a fact-specific enquiry that requires consideration of all the circumstances of the case.
The High Court accepted staff testimony that ON's heart rate was normal and that the cord around ON's neck was not tightly wrapped. On this basis, the High Court ruled that monitoring had been adequate and that the cord was not the cause of the injury. On appeal, the SCA disagreed. It accepted expert evidence that the cord was likely the cause of the HIE and that foetal distress would have likely been detected with proper monitoring between 10:00 and 12:00. The SCA found the staff testimony unreliable, especially as the clinical notes lacked any indication whether the cord was loose or tight.
The SCA held that hospital staff were negligent in failing to monitor the foetal heart rate during this critical period. This failure led to missed opportunity for timely intervention, which could have prevented the injury. The appeal was upheld with costs.
It is clear that courts will strictly analyse and rely on the evidence, in the form of medical records and expert opinions in medical negligence claims.
This judgement underscores that courts will closely scrutinise medical records and expert testimony in medical negligence claims. It further highlights the vital importance of consistent foetal monitoring and accurate clinical note-keeping to mitigate risks during childbirth.
