Authored by Amber Lawlor.
In April 2026, the High Court found a provincial MEC for Health liable for damages arising from the negligent care and management rendered to the claimant by the medical and nursing staff at various public clinics and hospitals between March and May 2015.
The claimant, who was pregnant at the time, repeatedly presented to public healthcare facilities with severe abdominal pain and vaginal bleeding over a period of several weeks. Although she underwent ultrasounds and was treated symptomatically, the cause of her recurring symptoms was never properly investigated. She was ultimately diagnosed with a ruptured cornual ectopic pregnancy only after her condition significantly deteriorated and she required emergency surgery.
Following the initial surgery, the claimant developed further complications, including bowel perforation, wound sepsis and intra-abdominal abscesses, requiring additional surgeries, including a hysterectomy. She was also transferred between hospitals on several occasions despite ongoing concerns regarding her condition.
The claimant alleged that the medical and nursing staff were negligent in failing to properly investigate and diagnose the cause of her abdominal pain and vaginal bleeding, failing to appreciate the seriousness of her deteriorating condition, delaying necessary surgical intervention, and transferring her prematurely to a lower-level facility following major surgery.
The defendant denied negligence and argued that the claimant’s pregnancy had initially appeared to be a normal intrauterine pregnancy, that a cornual ectopic pregnancy is difficult to diagnose, and that the treatment rendered throughout was appropriate. The defendant further argued that the claimant’s post-operative complications were influenced by other factors, including haemorrhagic shock and her HIV status.
The court accepted that a cornual ectopic pregnancy is rare and difficult to diagnose. However, it found that the medical staff repeatedly failed to investigate the source of the claimant’s persistent abdominal pain and vaginal bleeding over an extended period. The court held that the issue was not merely whether an incorrect diagnosis had been made, but whether the claimant’s symptoms were properly investigated and managed at all.
The court further found that there had been delays in recognising the deterioration of the claimant’s condition following the first operation and that the decision to transfer her back to a lower-level hospital shortly after major surgery was premature. The court held that these failures contributed to the claimant’s subsequent complications and additional surgery.
Importantly, the court rejected the defendant’s reliance on the claimant’s HIV status and alleged tuberculosis diagnosis as explanations for the post-operative complications, finding no rational connection between those later developments and the events giving rise to the claim.
This judgment serves as a reminder that healthcare providers are required to not only treat presenting symptoms, but also to adequately investigate their underlying cause.
Mooketsi v MEC for Health and Social Development, North West Province (Case No 16/2018)