Authored by Deniro Pillay
In May 2026, the Supreme Court of Appeal found a provincial MEC for Health liable for the claimant’s damages caused by an emergency total abdominal hysterectomy performed during a caesarean section as a result of a post-partum haemorrhage (PPH). PPH is the leading cause of maternal mortality.
According to the claimant, at 09h00 on 23 April 2016, shortly before she was expected to give birth, her membranes ruptured. She went to public clinic at 15h00 and was referred to and admitted to a state hospital at 16h30. She was only attended to at 23h00. At 02h00 on 24 April 2016, she was taken to theatre for a caesarean section, but there were no doctors to attend to her, so she was returned to the ward. At 07h00, she had an ultrasound and she was informed that her baby’s heartbeat was suppressed. She was taken to theatre. A caesarean section was performed at 09h00. While undergoing the caesarean section, the claimant suffered a severe PPH. This required her to undergo a total abdominal hysterectomy. The baby was delivered without complications. Her next recollection is waking up in the intensive care unit three days later when she was informed by a doctor that her uterus had been removed.
The claimant’s main argument, with the support of expert evidence, was that the removal of her uterus was caused by the prolonged labour, with foetal distress, due to the negligence of the hospital’s medical staff.
The Court considered the evidence of the MEC, with supporting expert evidence, and found that the claimant was monitored after her admission to the hospital and managed in accordance with the applicable Guidelines for Maternity Care in South Africa (2015). It was not established by the claimant on a balance of probabilities that there was a culpable, inordinate delay by the hospital’s medical staff, which resulted in the PPH, hysterectomy and removal of the uterus.
The possible causes of the PPH, as identified by the MEC’s expert, were a mistake during the operation or the uterus failing naturally. On the evidence, the Court decided that the more probable cause of the PPH and consequent hysterectomy was a mistake by the hospital’s medical staff that occurred during the operation. As a result, the Court found the MEC liable for the claimant’s damages suffered as a result of the hysterectomy.
The Court reaffirmed that the res ipsa loquitur maxim (the circumstances speak for themselves) should rarely, if ever, be used in cases of alleged medical negligence, especially when the facts are not proven and expert opinions are based on speculation, leading to multiple equally plausible explanations for how an injury occurred. In medical malpractice, negligence does not automatically result from something having gone ‘wrong’.