In May 2025, the High Court examined whether the hospital staff’s actions were negligent and if this negligence caused the brain injury of her child during childbirth. The claimant argued that the staff did not monitor the foetus properly, ignored warning signs, and delayed intervention and delivery, breaching medical guidelines. The hospital claimed that causation was not proved and that various risk factors meant the outcome could not be solely blamed on the hospital.
Expert evidence was crucial. The claimant’s experts highlighted the link between prolonged foetal distress, lack of timely intervention, and the resulting brain injury. They pointed out the failure to act on foetal distress and the absence of essential resuscitation equipment at birth. The hospital’s experts argued that cerebral palsy is complex and has multiple causes.
A key dispute was the timing and management of labour. All experts agreed that signs of foetal distress were present from the evening before delivery, but it took almost fifteen hours before an emergency caesarean section was performed. The court found that this delay, along with inadequate monitoring and lack of intrauterine resuscitation, was substandard care and amounted to negligence by the hospital.
The court applied both the traditional “but for” test and a more flexible approach, recognising that in cases with multiple risk factors and systemic omissions, it is sufficient for the claimant to show that the negligent conduct significantly contributed to the harm, even if it is not the sole cause. The court found the hospital’s alternative explanations speculative and unsupported by evidence, emphasising that the negligent management during labour and delivery was the most probable cause of the injury.
The court held that it was enough to establish causation by showing that the negligent conduct materially contributed to the harm.The hospital’s substandard care, prolonged labour, failure to recommend and perform an emergency caesarean section in time, and lack of appropriate measures to avoid harm to the baby directly contributed to the child’s brain injury and cerebral palsy.
This judgment underscores the importance of following medical guidelines, the standard of care owed by hospitals, and the need for timely intervention when warning signs are present. It shows the courts’ willingness to adopt a practical approach to causation, especially in complex medical cases with multiple risk factors.
YM obo LM v Member of Executive Council, Health, Gauteng Province [2025] ZAGPJHC 500