In this Supreme Court of Appeal judgment 21.pdf (saflii.org) in a claim for medical negligence damages, the court again cautioned against commencing with an unfavourable outcome and working backwards in search of a cause. 

South African and other courts have cautioned that a doctor should not be held negligent simply because something went wrong.  That would be to impermissibly reason backwards from effect to cause. 

In this case, the claimant’s child sustained a brain injury at birth. The question was whether the medical staff at the defendant’s hospital were negligent in the care and the treatment of the mother of the child and whether that negligence caused the consequent medical condition from which the child suffers. 

The child had experienced an intrapartum acute profound hypoxic-ischaemic event.  That is a sudden not progressive event and is to be distinguished from a partial prolonged hypoxic-ischaemic event.  There was no evidence of a sentinel event.  The court said that the contention that a sentinel event could have been detected and avoided if reasonable care had been taken is based on the reverse reasoning that, because the child suffered the injury (in this case with resultant cerebral palsy), there must have been a detectable unavoidable sentinel event during his birth. 

The court warned :

“Hornbuckle J [the author of an academic article] warned that with the benefit of the knowledge that there has been a neurologically unfavourable birth outcome, a plaintiff’s attorney ‘can take any foetal monitor strip and make a malpractice case out of it’”

The evidence overwhelmingly pointed to the child having an acute profound hypoxic-ischaemic event intrapartum. Based on the evidence of the claimant’s own experts the injury sustained was not one that might have been reasonably foreseeable. 

The court also found on the evidence, and previous authority, that cardiotocography (“CTG”) tracings or monitoring would not have made a difference.  

There was no evidence that the hospital staff were negligent.