AN on behalf of EN v Member of the Executive Council for Health, Eastern Cape

The appellant, a mother acting on behalf of her minor child, sued the MEC for Health, Eastern Cape, for damages arising from severe brain damage suffered by the child at birth at All Saints Hospital, Engcobo. It was common cause that hospital staff negligently failed to properly monitor the mother and foetus during labour, particularly during the second stage of active labour between 06h00 and 06h45. The child was born with hypoxic-ischaemic encephalopathy resulting in cerebral palsy. Expert evidence established that the injury was caused by an acute, profound hypoxic-ischaemic insult due to a sudden, total interruption of blood supply to the brain, most likely caused by umbilical cord compression (a sentinel event). The appellant alleged that proper monitoring would have detected warning signs, allowed expedited delivery, and prevented the injury.

The appeal was dismissed.

The case reaffirms the strict requirement in South African delict law that factual causation must be proven, even in the face of clear medical negligence. It clarifies the limited application of Lee v Minister for Correctional Services and confirms that it did not replace the traditional but-for test. The judgment is significant in medical negligence litigation, particularly obstetric injury cases, by emphasising the evidentiary burden on plaintiffs to prove that negligence probably caused the harm.