Judge Reinstates Medical Negligence Claim Related to Childbirth

Eish, one of the most shocking facts in the healthcare system is that medical negligence during childbirth can result in severe medical conditions for the child. In a landmark ruling, a PIETERMARITZBURG High Court judge has overturned a previous dismissal of a medical negligence claim related to childbirth, following an appeal brought by the curator ad litem for a minor child.

Advocate Chamelle Jaipal, the curator ad litem for the minor child referred to as 'E,' brought the appeal following the mother's death. According to the judgment, the appeal was against the ruling handed down by a Durban High Court judge. The respondent in the matter is the KwaZulu-Natal MEC for Health.

The case highlights serious allegations of negligent management during the mother's labour, resulting in severe medical conditions for the child. According to the court papers, the mother experienced a series of complications during a prolonged labour, culminating in the child being born with severe medical conditions, including cerebral palsy and hypoxic-ischaemic encephalopathy (HIE).

In the papers, it read that evidence established that at approximately 9pm on July 18, 2011, the mother experienced the onset of labour pains. During the early hours of July 19, 2011, she went to the clinic for assessment. The clinical records reflected moderate uterine contractions and cervical dilation of 2cm.

The foetal condition was assessed as satisfactory, and continuous cardiotocograph (CTG) monitoring commenced. However, a reassessment conducted at approximately 11:30am revealed no progress in cervical dilation, and the attending clinicians recorded a diagnosis of 'poor progress'.

The clinical records further reflect that the mother's condition was discussed with a doctor, however, neither the substance of that consultation nor the clinical advice given was recorded. The mother was informed that she should be transferred to the hospital because 'she did not have (sic) sufficient opening for (her) to be able to give birth'.

According to the court papers, the mother arrived at the hospital at approximately 2pm and was admitted for continued observation and CTG monitoring. Subsequent examinations demonstrated gradual labour progress. By midnight, cervical dilation was recorded at 8 cm, the foetal head had descended to 3/5 above the pelvic brim, and CTG remained reactive.

However, the hospital records disclosed material irregularities in the maintenance of the partogram. An earlier entry reflecting cervical dilation of 6 cm at midnight had been erased, and a further entry at 2am reflecting cervical dilation at 8 cm was also subsequently erased.

According to the court papers, at approximately 3am, cervical dilation remained at 8 cm with the foetal head engaged at 2/5 above the pelvic brim. The mother was noted to be restless and experiencing strong contractions. Although the CTG was recorded as reassuring, medical review was requested and the antenatal note bore an illegible signature.

At approximately 3:30am, cervical dilation had advanced to between 9 and 10 cm. The clinical records recorded foetal head moulding and documented that the CTG machine was no longer functioning.

Importantly, the foetal heart rate exceeded 155 beats per minute and decelerations were observed during contractions. Delivery within the following hour was anticipated.

According to the court papers, the records relating to the subsequent examination at 4:30am revealed notable inconsistencies. Although cervical dilation was recorded at 9 cm, the notes simultaneously recorded a reactive CTG, absence of caput and moulding, and an intention to reassess after a further two hours.

However, the child was delivered at approximately 5:30am by vacuum extraction. The delivery records note poor maternal effort, repair of the episiotomy, and that the paediatric team had been alerted. E was born in a depressed condition, with Apgar scores of 3 out of 10 at both one and five minutes.

A subsequent record made at approximately 5:45am confirmed the live birth of a female infant by vacuum extraction, although the recorded Apgar scores are illegible. E was later diagnosed with spastic cerebral palsy and HIE.

Judge Bruce Bedderson, in handing down judgment, said the appeal turns on whether the birth was caused by a 'breach of duty' on the part of the respondents.