Authored by Deniro Pillay and Amber Lawlor.
In March 2026, the High Court dismissed a claim arising from the amputation of a claimant’s leg at a public hospital following a gunshot injury. The court confirmed that the claimant failed to prove that the hospital staff were negligent and that the amputation arose from any alleged negligence.
The claimant was admitted to a level 2 public hospital during the early morning of 27 December 2018 with gunshot wounds to her right knee and left leg. The nursing records reflected that, for approximately 48 hours after admission, her neurovascular status remained stable. Regular assessments recorded good circulation, movement and sensation in the affected limbs.
On 29 December 2018, at 05h38, the claimant verbalised that she was unable to move her right toes, with intact sensation. However, at 16h00, she could move her toes, with good sensation and good capillary refill.
On 30 December 2018, her condition deteriorated. The nursing staff noted that at 04h00 she was unable to feel her right foot, it was not moveable and was cold to the touch. A doctor was informed at 05h20 and attended to her at 06h00. She was later transferred to a level 3 public hospital for specialist care, where her leg eventually had to be amputated.
The claimant alleged that the level 2 hospital staff were negligent in failing to detect and act on earlier signs of vascular compromise. Her expert witnesses, including a surgeon, a vascular surgeon and a registered nurse, argued that earlier intervention, particularly when loss of sensation first emerged on 29 December 2018, would likely have prevented the amputation.
The defendant MEC for Health disputed this, maintaining that the complication was rare and uncommon, and that appropriate monitoring, including regular neurovascular assessments, had been conducted throughout the relevant period.
The defendant led the evidence of an expert vascular surgeon who testified that there were no abnormalities on the neurovascular checks conducted on 27, 28 or 29 December 2018, despite the claimant’s complaints of pain. The expert disagreed with the claimant’s experts that the claimant should have been transferred to the level 3 facility on 29 December 2018 as there was no diagnosis of popliteal artery injury on that day. The expert argued that the claimant was evaluated by treating physicians and was found to have adequate limb perfusion. The diagnosis of acute limb ischemia was made on 30 December 2018, and the correct management steps were taken.
The court considered whether the conduct of the level 2 hospital staff was negligent and whether the harm suffered was reasonably foreseeable in the circumstances. The court decided that the claimant had been appropriately monitored according to the accepted guidelines during the critical period following her admission and that no clear signs of vascular injury were present during that time. The deterioration occurred later as a result of what was accepted to be an uncommon complication. When the change in her condition was identified, the nursing staff advised a doctor within a reasonable timeframe. The court was not persuaded by the claimant’s expert evidence that earlier intervention would probably have prevented the amputation. It rejected and labelled aspects of the claimant’s expert evidence on this issue as speculative. The court found that the harm was not reasonably foreseeable and that the hospital staff could not be faulted. The claim was accordingly dismissed with costs.
This judgment reinforces that in medical negligence claims, adverse outcomes alone do not establish liability. Just because there is a complication or an adverse outcome for a patient does not mean there is blameworthy conduct on the part of medical staff.