The Supreme Court of Appeal (SCA) has ordered the Gauteng Health MEC to pay damages a mother whose womb was removed following complications during childbirth.
The ruling comes after the MEC sought to overturn an earlier Gauteng High Court decision, which found that medical staff were possibly negligent in their handling of the patient’s care.
While the SCA set aside parts of the original ruling, it upheld the finding that the mother is entitled to damages linked to the hysterectomy (removal of the uterus).
C-section complications lead to a hysterectomy
The case centres on events that unfolded on 23 April 2016 when a pregnant woman, identified as C.B.M. sought medical assistance at a clinic in Soshanguve after her water broke.
She was referred to Dr George Mukhari Academic Hospital in Ga-Rankuwa and arrived in the late afternoon.
According to her testimony, she was only attended to several hours later.
An ultrasound performed late that evening showed a normal foetal heart rate.
However, by the following morning, medical staff detected complications, prompting an urgent caesarean section (C-section).
C.B.M. later told the court that she regained consciousness three days later in the intensive care unit (ICU).
Although her baby was delivered healthy and without complications or cerebral palsy, she experienced severe postpartum haemorrhage (PPH) during the surgical procedure.
The life-threatening bleeding led to doctors performing an emergency hysterectomy to save her life.
The woman testified that she was informed of the removal of her womb, but was not given a full explanation.
Aftermath and legal challenge
On 29 April 2016, the patient chose to leave the hospital after declining further treatment, stating that she felt sufficiently recovered and wanted to go home to her family.
She subsequently revisited the hospital twice to have her stitches taken out.
Following her discharge, C.B.M. initiated legal proceedings against the Gauteng Health MEC, arguing that substandard medical care led to the loss of her uterus.
She also claimed she did not receive adequate counselling after the procedure.
The mother presented the testimony of Dr Mpho Stella Pooe in support of her case, while the MEC relied on the evidence of Dr Anne Manthata-Cruywagen, a specialist obstetrician and gynaecologist, and the head of department (HOD) at 1 Military Hospital in Pretoria.
SCA judgment
In delivering judgment, SCA Judge Piet Koen highlighted critical issues with the evidence presented, particularly the absence of key medical records from the initial trial.
He acknowledged that the MEC’s legal team “demonstrated good faith” in explaining the missing documents and ruled that the High Court had erred in drawing negative conclusions from their absence.
The court examined several possible causes of the PPH, including delayed treatment, infection, surgical error, and natural uterine failure.
Infection was ultimately ruled out following laboratory testing.
Koen was sharply critical of Pooe’s testimony as an expert witness, describing her conclusions as “notoriously unreliable”.
The judge also noted that the medical practitioner had been suspended by the Health Professions Council of South Africa (HPCSA) at the time of her testimony and had failed to disclose this fact to both C.B.M and the High Court.
“When she testified, she was engaged in mining. Her suspension, whatever the reasons may be, disqualified her from practising as a medical practitioner.
“Another cause for concern was her stubborn refusal to concede that she never qualified as a specialist obstetrician and gynaecologist,” the recent judgment reads.
In contrast, Manthata-Cruywagen’s testimony was found to be well-reasoned.
“The opinion of Dr Manthata-Cruywagen, in contrast to that of Dr Pooe, was based on cogent reasoning, followed the terms of the guidelines, was clear, supported by facts and studies, and presented in a fair manner without favour to either side.”
‘Some culpable mistake’
The SCA further noted that Manthata-Cruywagen had indicated it was “difficult to say” whether the haemorrhage was caused by a surgical error during the C-section or by a spontaneous uterine failure.
Therefore, the court found that if there was a surgical error, it pointed to a strong likelihood of medical negligence, and the hospital staff was responsible.
“Statistically, there is a very high probability against a hysterectomy becoming necessary in the ordinary course of a caesarean, unless there was some culpable mistake.”
Koen also criticised the MEC’s legal team for failing to call the two doctors who performed the operation to testify.
“It was also not placed on record that they were not available to give evidence. It must therefore be accepted that they were available and could give evidence.”
While the SCA rejected some of C.B.M.’s claims – including her allegation that she did not receive adequate post-operative care – the Gauteng Health MEC was ordered to pay damages related to the loss of her uterus, as well as the legal costs of the appeal.
