The High Court has held the North West Health MEC liable for medical negligence after hospital treatment delays left a local teacher with permanent brain damage.
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The North West health department will have to fork out damages to a school teacher who suffered permanent brain damage after urgent treatment he needed was delayed at the health facilities in the province.
The North West High Court, dealing with an appeal, overturned a 2024 earlier ruling that dismissed a medical negligence claim brought by Tebogo Joseph Koboyatau. The court declared the Health MEC liable for 100% of Koboyatau's proven or agreed damages. The quantum of damages will be decided at a later date.
Judge Andre Reddy, Acting Judge J.T. Maodi and Acting Judge G. Maree found that Koboyatau had proved that negligent treatment at Gelukspan District Hospital and Mafikeng Provincial Hospital caused the catastrophic injuries that left him permanently disabled.
In the judgment, the court said Koboyatau was a 29-year-old teacher at Ikopanyeng Secondary School when he was stabbed in the left side of his chest and upper arm in June 2014. He was initially treated at Setlagole Clinic before being transferred to Gelukspan District Hospital later that evening.
The referral letter accompanying him described him as seriously ill, suffering from shortness of breath, weakness and bleeding, and warned that internal bleeding was suspected.
Despite these warning signs, the court found that crucial emergency interventions were delayed. Although doctors recorded that Koboyatau was suffering from dangerously low blood pressure, no chest X-ray was performed that evening and no intercostal chest drain was inserted until approximately 12 hours after his admission.
The judges found that this delay allowed blood to accumulate and clot inside his chest, significantly worsening his condition.
The court also found that, by July 1, 2014, medical records showed that the chest drain was no longer functioning and X-rays revealed that part of Koboyatau's left lung had failed to expand. Despite these findings, no doctor took corrective action or referred him to a higher-level facility during the following four days.
When he was eventually transferred to Mafikeng Provincial Hospital in early July 2014, doctors discovered pus in the chest drain and diagnosed him with a retained, infected haemothorax and a mediastinal shift, indicating severe complications.
However, instead of receiving immediate surgery, Koboyatau waited another 16 days before undergoing a thoracotomy in July 2014. Shortly after the operation, he suffered a cardiorespiratory arrest, resulting in hypoxic ischaemic brain damage.
The judgment records that Koboyatau has been left with permanent cognitive and executive dysfunction, neuropsychological and behavioural disorders, visual impairment and partial incontinence, with medical experts agreeing that there is no prospect of meaningful recovery.
The appeal court sharply criticised the conduct of medical staff at both hospitals and rejected the trial court's conclusion that the failures amounted merely to errors of judgement rather than negligence.
The judges held that the evidence overwhelmingly demonstrated negligent treatment, pointing to the failure to perform an immediate chest X-ray, delays in inserting the chest drain, the failure to address the blocked drain, the failure to refer Koboyatau sooner to a specialist facility, and the prolonged delay before performing life-saving surgery.
The court found that the treating doctor's later explanation that Koboyatau had been too restless for emergency treatment was inconsistent with the contemporaneous medical records, which instead recorded that he was sleeping while awaiting an X-ray and was to be examined "when awake". The judges described the explanation as an afterthought designed to justify the failure to provide urgent treatment.
In reaching its decision, the court placed considerable weight on expert medical evidence. Five of the six expert witnesses concluded that the treatment fell below acceptable medical standards and directly caused Koboyatau's injuries. The judges noted that even experts engaged by the MEC largely supported the conclusion that earlier intervention would have prevented the devastating outcome.
The court was also critical of the MEC's litigation strategy after the department elected not to call two of its own expert witnesses despite having filed their reports. Those reports concluded that Gelukspan District Hospital had failed to provide care consistent with accepted medical standards and that the delays at Mafikeng Provincial Hospital ultimately led to Koboyatau's current condition.
The judges drew an adverse inference from the MEC's decision not to call those witnesses, finding that their oral evidence would probably have been unfavourable to the department's case.