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[2011] ZASCA 6
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Premier of the Province of KwaZulu-Natal v Sonny and Another (047/10) [2011] ZASCA 6; 2011 (3) SA 424 (SCA) (4 March 2011)

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THE
SUPREME COURT OF APPEAL OF SOUTH AFRICA
JUDGMENT
Case no: 047/10
PREMIER OF THE PROVINCE OF
KWAZULU-NATAL
............................................
Appellant
and
KISHORE SONNY
..........................................................................................
First
Respondent
JAYANTHI DEVI SONNY
..........................................................................
Second
Respondent
________________________________________________________________
Neutral citation:
Premier of
the Province of KwaZulu-Natal v Sonny
(047/10)
[2011] ZASCA 6
(4
March 2011)
CORAM:
Mpati P, Navsa and Bosielo JJA
HEARD:
15 February 2011
DELIVERED:
4 March 2011
SUMMARY:
Damages claim based on medical negligence ─ cost of maintaining
child suffering from Down’s syndrome ─
hospital failing
to inform patient that fetus she was carrying might be afflicted with
Down’s syndrome ─ failure to
inform of risks attendant
upon the pregnancy and to ensure timeous conclusive chromosomal
testing to enable a termination of pregnancy
in terms of the Choice
on Termination of Pregnancy Act 92 of 1996 ─ held that doctors
ought to have involved patient fully
in her treatment and the
diagnosis of the condition of the fetus ─ medical staff held to
be negligent and liable for damages
that might be proved to have been
sustained.
______________________________________________________________
________________________________________________________________
ORDER
________________________________________________________________
On appeal from:
KwaZulu-Natal
High Court (Durban) (Levinsohn DJP sitting as court of first
instance).
The appeal is dismissed with costs
including the costs of two counsel.
________________________________________________________________
JUDGMENT
________________________________________________________________
NAVSA JA (Mpati P and Bosielo JA
concurring)
[1] On Saturday 16
November 2002 at King Edward VIII hospital in Durban, 37 year-old Mrs
Jayanthi Sonny, the second respondent,
gave birth to her second
child, a baby-girl. What ought to have been a period of unmitigated
joy for Mrs Sonny (Jayanthi) and her
husband, Kishore, the first
respondent, was short-lived. Their new-born daughter was afflicted
with Down’s syndrome.
1
Their joy turned to
anxiety and despair. A year later, during December 2003, they
instituted action against the appellant, the Premier
of the Province
of KwaZulu-Natal and the Ethekwini Municipality (the Municipality),
claiming damages, comprising, first, the cost
of maintaining their
daughter for a period of 55 years, which was estimated at R6,6m, and
second, an amount of R150 000 was claimed
by Jayanthi for what was a
bilateral tubal ligation
2
allegedly
wrongfully performed.
[2] Broadly
speaking the first and second respondents’ case against the
appellant and the Municipality in the KwaZulu-Natal
High Court was
that in treating Jayanthi during her pregnancy the nursing staff at
the Clare Estate Clinic, a primary health clinic
conducted by the
Municipality, and the medical personnel at Addington hospital, which
is under the control of the appellant, were
negligent in that they
failed to exercise the professional skill and diligence required of
them in the circumstances.
3
More particularly,
the respondents alleged that the medical staff at the clinic and
hospital failed to take reasonable steps timeously
to establish
conclusively during the second trimester of her pregnancy that there
existed a substantial risk that the fetus that
Jayanthi was carrying
would suffer from a physical or mental abnormality. The first and
second respondents contended that had the
medical staff acted with
the professional skill and diligence required of them they, as
parents–to-be, would have been informed
timeously of the risk
and would have taken the decision to terminate Jayanthi’s
pregnancy in terms of the Choice on Termination
of Pregnancy Act 92
of 1996.
[3] Furthermore,
the first and second respondents claim that when they consented to
the bilateral tubal ligation they did so after
being advised by a
doctor at King Edward VIII hospital that the results of a
cordocentesis
4
performed on the
fetus indicated that they could expect a baby healthy in all material
respects. This proved ultimately to be an
erroneous test result and
consequently their consent was not properly informed and the
bilateral tubal ligation was wrongly performed.
King Edward VIII
hospital also falls under the control of the appellant.
[4] At the outset in the court below
the parties had agreed that the question of liability be decided
first and it was directed
accordingly. The Municipality initially
disavowed liability. During the trial in the court below the
Municipality capitulated and
conceded liability for 33⅓% of
Jayanthi’s damages in relation to the birth of the child. The
appellant, however, persisted
in its denial of liability in respect
of both claims and the trial proceeded against him.
[5] After hearing evidence the court
below (Levinsohn DJP) found that the medical staff at Addington
hospital were negligent in
their treatment of Jayanthi and held the
appellant liable for such damages the respondents may prove arising
from the birth of
the child. In relation to the claim based on
Jayanthi’s sterilisation the appellant was absolved from the
instance. The appellant
was ordered to pay the respondents’
costs, including the costs of two counsel. The appellant was also
ordered to pay the
costs of consultation with experts, including
travelling time and expenses. In addition, the appellant was ordered
to pay the expenses
of necessary witnesses and the reasonable
qualifying and attendance fees of named expert witnesses. The
liability to pay the abovementioned
costs was joint and several with
the Municipality, up to and including 1 December 2008 (when liability
was conceded by the latter).
The present appeal, with the leave of
the court below, is against the orders in favour of the second and
third respondents.
[6] Before us it was contended on
behalf of the appellant that the court below had erred in its finding
of negligence. The credibility
and factual findings of the court
below were challenged. The acceptance of Jayanthi’s evidence in
preference to the evidence
of medical staff employed by the appellant
was criticised. In the alternative, it was submitted that the court
below ought, at
the very least, to have found that there was
contributory negligence on the part of Jayanthi.
[7] I proceed to consider the relevant
evidence in some detail and to deal with the assessment by the court
below.
[8] On Tuesday 25
June 2002 Jayanthi presented at the Clare Estate Clinic located close
to her home. On that date she became a patient
at the clinic. The
nurses at the clinic were made aware that her first pregnancy had
been a normal delivery. Jayanthi was diabetic
and suffered from high
blood pressure. Those two factors coupled with her relatively
advanced age of 37 unarguably made her a high-risk
patient,
5
requiring hospital
attention rather than treatment at a primary healthcare clinic. After
a blood pressure and diabetes test had
been conducted the clinic
referred her to Addington hospital. She was provided with a letter of
referral. None of the facts set
out above are in dispute.
[9] The material parts of Jayanthi’s
version of events which are disputed by the appellant, appear in this
and the following
two paragraphs. On Wednesday 26 June 2002 Jayanthi,
accompanied by her husband, called at Addington hospital. Jayanthi
testified
that she overheard a nurse at the hospital announce that
persons without a letter of referral would not be seen. After being
registered
as a hospital patient she underwent a urine, blood tissue
and diabetes test. All of this was done by a nurse. Crucially,
Jayanthi
testified that thereafter she saw a doctor. In his judgment
Levinsohn DJP noted the following material parts of Jayanthi’s

description of the doctor:
‘
She
was an Indian female. She was not a South African.
Why do you say she is not
a South African?
Because I could make out
from her tone of – the way she spoke.
LEVINSOHN DJP
Her accent?
Her accent, the way she
spoke.
Who did she speak like?
Came from India, or Mauritius? More or less India, if not India,
Pakistan or something.’
[10] The doctor examined Jayanthi and
referred her to the ultrasound room to have an ultrasound scan
performed. When that procedure
was completed, a sonographer handed
Jayanthi a computer-generated ultrasound report. She was told to take
the report to the doctor
and was informed by the sonographer that she
needed to be rescanned in two weeks’ time. Jayanthi recalled
looking at the
ultrasound report and reading the following words:
‘
The
head was low and difficult to assess.’
The report also contained the
following words:
‘
Suggest
rescan in 2 weeks.’
[11] Armed with the report, Jayanthi
went back to the doctor she had seen earlier and was told to return
in two weeks’ time.
She was not told why she had to return to
the hospital. Neither was she told that she was a high-risk patient
and that there might
be dangers in her pregnancy. When she asked the
doctor for an appointment Jayanthi was told that she had to arrange
one through
the Clare Estate Clinic.
[12] Jayanthi returned to the Clare
Estate Clinic the same day and found it closed. She knocked at the
door and told the nurse who
appeared that she was there for a letter
of referral. The nurse read the ultrasound report and informed
Jayanthi that in total
only two ultrasound scans were conducted on
expectant mothers: one early in the pregnancy and another towards the
end. The nurse
told her that her ultrasound report showed nothing
untoward. Because of this Jayanthi did not return to Addington
hospital. She
attended at the clinic on five further occasions
thereafter and during that period members of the clinic’s
nursing staff
were aware of the first ultrasound report.
[13] The first
ultrasound scan performed on Jayanthi revealed a condition in the
fetus referred to as ‘ventriculomegaly’,
which is an
increase in the lateral ventricles in the brain. Put differently, it
shows that the lateral ventricles are prominent.
In the present case
the first ultrasound scan showed ‘borderline ventriculomegaly’,
within the margin for error. The
medical experts all agreed that
ventriculomegaly is a ‘soft marker’ or indicator for
Down’s syndrome. In the
present case even though at the earlier
stage of gestation (17 weeks) it was not particularly distinctive the
experts were agreed
that at the very least it required further
exploration. In any event, the appellant admitted in his plea that
the hospital staff
had ‘picked up what they thought was an
abnormality’. Because the fetus in this case was in an awkward
position a second
ultrasound scan was required for greater certainty
and to provide a basis for chromosomal testing by way of
amniocentesis
6
or cordocentesis.
It is common cause that if Jayanthi had returned in two weeks’
time, as suggested by the ultrasound report,
the relevant tests could
have been conducted and completed within the time allowed for
termination of the pregnancy.
[14] On 22 October
2002 when Jayanthi went to the Clare Estate Clinic for a routine
examination it was discovered that her blood
pressure and her
blood-sugar levels were unusually high. This caused them to refer her
once again to Addington hospital. There
a second ultrasound scan was
conducted. It revealed a cause for concern and Jayanthi was
consequently referred to King Edward VIII,
a higher care hospital. Dr
Kirsten at King Edward VIII hospital read both ultrasound reports and
informed Jayanthi that an investigation
into whether the fetus was
afflicted with Down’s syndrome was necessary. A cordocentesis
was performed by Dr Govender and
the fetal blood was submitted to an
independent laboratory for chromosomal testing. For reasons that are
unknown the tests results
wrongly showed that there was no
chromosomal abnormality.
7
This was
communicated to Jayanthi by Dr Kirsten. She and her husband consented
to the bilateral tubal ligation on the basis that
the child they were
expecting was healthy in all material respects.
[15] Soon after the child’s
birth it appeared that something was wrong. Subsequent testing
established conclusively that the
child was afflicted by Down’s
syndrome.
[16] The appellant disputed that
Jayanthi was seen by a doctor at Addington hospital. According to the
appellant it was hospital
policy that sonographers do not communicate
with patients in respect of the contents of ultrasound reports.
According to the appellant
a return visit, for a second ultrasound
scan, did not require a patient to be in possession of a letter of
referral from a primary
health clinic. The established hospital
procedure was that after a doctor recommended a second scan the
hospital arranged an appointment
directly. The appellant theorised
that Jayanthi must have wandered off after receiving the ultrasound
report. Dr Devjee suggested
that she might have departed the hospital
without seeing a doctor because of the long queues. It was part of
the appellant’s
case that during the time Jayanthi claimed she
saw the doctor on her first visit to Addington hospital the attending
doctors were
all on ward rounds and not yet in attendance at the
hospital’s antenatal clinic.
[17] It is necessary to record that
the countries of origin of the two female doctors on duty at the
antenatal unit at Addington
hospital at material times, namely
doctors Devjee and Perveen, were India and Bangladesh respectively,
fitting the profile supplied
by Jayanthi.
[18] Before us, counsel for the
appellant was constrained to concede that Jayanthi’s testimony,
that she attended at the Clare
Estate Clinic that very afternoon and
had the discussion with the nursing staff set out in para 12 above,
could not be disputed.
[19] Stripped to its essentials the
appellant’s case is that Jayanthi had not seen a doctor on 26
June 2002 and that she was
the author of her own misfortune. It was
submitted that on her own version of events she knew she had to
return to the hospital
in two weeks’ time. She did not do so
and the responsibility for the consequences of her failure, so it was
argued, lay with
her. The appellant contended that the least that
could reasonably have been expected of Jayanthi was for her to have
shown some
concern for her own wellbeing and that of her unborn child
and that her failure to return on her own initiative to the hospital,

two weeks later, should count against her and the court below ought
to have held that there had been contributory negligence on
her part.
[20] Levinsohn DJP said the following
about Jayanthi and her husband:
‘
I
would say at once that both plaintiffs, in particular the second
plaintiff, made a very good impression on me. I have no doubt

whatsoever that they are honest witnesses. The second plaintiff gave
me the impression that she was giving an honest and spontaneous

account of what occurred on that day.’
[21] Jayanthi’s undisputed
return to the Clare Estate Clinic on the same day that the first
ultrasound scan was performed
was seen by the court below as ‘an
overwhelming probability’ in her favour. Why else, asked the
court below, would
Jayanthi have gone back to the clinic. Dr Devjee
testified that in the normal course patients would inevitably see a
doctor to
review the ultrasound scan. The court below reasoned that
having undergone the ultrasound scan it would be strange and
unexpected
behaviour for a patient to simply walk away from the
hospital.
[22] The court
below thought it significant that in response to enquiries made by
the respondents, in terms of Uniform rule 37(4),
8
the appellant
repeatedly admitted that ‘[n]ormally the [Clare Estate] clinic
makes the booking for the patient’. It
is against these
admissions that the evidence of Dr Devjee and Dr Perveen, to the
effect that the hospital itself made appointments
and that a referral
letter was not required, was held to have a hollow ring to it. The
court below reasoned that this information
could only have been
provided to the appellant’s legal representatives by the main
protagonists on the appellant’s
side and that it supported
Jayanthi’s version of events. Accordingly, the court below
rejected the appellant’s version.
[23] In deciding
whether the appellant’s servants were negligent the court below
considered it relevant to ask whether by
sending Jayanthi back to the
clinic uninformed they created the risk that she might not return to
enable the tests to determine
whether the fetus was normal. The court
below had regard to the test for negligence set out in the well-known
case of
Kruger
v Coetzee
1966
(2) SA 428
(A) at 430E:
‘
For
the purposes of liability
culpa
arises
if –
(a) a
diligens
paterfamilias
in the position of the defendant -
(i) would foresee the
reasonable possibility of his conduct injuring another in his person
or property and causing him patrimonial
loss; and
would take reasonable
steps to guard against such occurrence; and
(b) the defendant failed
to take such steps.
This
has been constantly stated by this Court for some 50 years.
Requirement (a) (ii) is sometimes overlooked. Whether a
diligens
paterfamilias
in
the position of the person concerned would take any guarding steps at
all and, if so, what steps would be reasonable, must always
depend
upon the particular circumstances of each case. No hard and fast
basis can be laid down. Hence the futility, in general,
of seeking
guidance from the facts and results of other cases.’
[24] In applying
the
Kruger
v Coetzee
test
the court below had regard to the first and second respondents’
lack of sophistication. It reasoned that one would expect
Jayanthi to
adhere to instructions by medical staff attending to her, not only at
the hospital but also at the clinic. Levinsohn
DJP took into account
that the experts who testified were agreed that Jayanthi was a
high-risk patient, more so because of her
relatively advanced age.
The risk of a fetus afflicted by Down’s syndrome was ever
present. As stated by the court below
the first ultrasound was at the
very least a ‘red flag’.
[25] Levinsohn DJP stated that a
reasonable person in the position of the doctor in attendance would
have seen the possibility of
the patient falling through the cracks
of the public health system and failing to return and that she might
be wrongly advised
or improperly directed by primary health care
staff. The court below thought it incumbent on the doctor to inform
Jayanthi in detail;
of the risks she faced and precisely what the
nature and effect was of the inconclusive scan and the absolute
necessity of undergoing
an urgent second scan. The learned deputy
judge president said the following:
‘
I
would go further. Having regard to the foreseeable consequence of
some breakdown of communication or gross misunderstanding that
may
occur in the clinic environment, I think it was at least necessary
for the doctor to have given or caused to be given some
written
instruction to the clinic to make it absolutely clear that the second
plaintiff was required to return.’
[26] In coming to
this conclusion the court below relied inter alia on Lord Nathan’s
Medical
Jurisprudence
9
(pp 46
et
seq
)
where the following appears:
‘
In
many cases it is reasonable or even necessary for the medical man to
make the patient himself responsible for the performance
of some part
of the treatment which the medical man has undertaken to give. Where,
as often happens, the medical man’s course
of action depends
upon a report by the patient as to his condition or symptoms or as to
the progress of the treatment, the medical
man has no choice in the
matter; he must rely upon the patient for the necessary information
by which to determine what action
should be taken, and must
therefore, in a sense, delegate to the patient part of his own
duties. Frequently also it would be quite
unreasonable to expect the
medical man to be in constant attendance upon the patient or to
exercise supervision over every detail
of the treatment; he is
compelled therefore to delegate to the patient the performance of
some part of the treatment or cure. .
. .
In
all these cases where the medical man justifiably delegates to the
patient the performance of some part of the treatment, there
is a
special duty towards the patient to give clear and unambiguous
instructions, to explain to the patient in intelligible terms
what is
required of him and to give him any warning which may be necessary in
the circumstances; and a failure in any of these
respects may amount
to a breach of duty and expose the medical man to liability for any
injury which occurs.
’
(My
emphasis.)
[27] Levinsohn DJP also quoted the
following extract from the Canadian case
Murrin v Janes
(1949)
4 DLR 403:
‘
I
am prepared to believe that in some kinds of cases, particularly in
this domain of medicine and surgery, the failure by a doctor
or a
surgeon to warn a patient as to the meaning of certain symptoms, the
significance of which might not be apparent to a layman,
might
properly expose a practitioner to a charge of negligence. The
physician cannot always be in constant attendance upon his
patient,
who may have to be left to his own devices; and if the former knows
of some specific danger and the possibility of its
occurring, it may
well be part of his duty to his patient to advise him of the proper
action in such emergency.’
[28] Professor Ermos Nicolaou, who was
the head of the Fetal Medicine Unit at the Chris Hani Baragwanath
Hospital of the Fetal Maternal
Medicine Centre from January 2003, and
who worked at King’s College in London, one of the most
recognised units in the field
of fetal maternal medicine and was also
the chairperson of the Maternal Fetal Medicine Society of South
Africa, during his testimony
on behalf of the first and second
respondents, said the following in relation to the information
gleaned from the first ultrasound
report:
‘
You
see, the decision for any further investigations, any further
follow-ups has to be a team decision and the patient is very central

in this team decision and therefore needs to be aware of the
problem.’
Soon thereafter he said the following:
‘
In
this particular case . . . there was something that was abnormal in
the baby’s brain and therefore this was placing this
particular
fetus on a higher risk and therefore further investigation would be
necessary and I think the patient should be aware
of this as well.’
And almost immediately thereafter:
‘
[T]he
doctor should be doing the counselling and discussing the management
of the patient.’
[29] I did not understand counsel for
the appellant to take issue with what is set out in the preceding
three paragraphs. The appellant’s
case is that the court below
erred in its assessment of the evidence, more particularly in
accepting that Jayanthi had seen a doctor
at Addington hospital.
Counsel for the appellant correctly conceded that if the material
factual conclusions of the court below
are upheld the appeal should
fail.
[30] One of the criticisms levelled
against the court below is that it erred in holding the appellant to
statements made in its
responses to the respondents’ notice in
terms of Uniform rule 37(4), referred to in para 22 above. In this
regard reliance
was placed on
Fourie v Sentrasure Bpk
1997 (4)
SA 950
(NC), where it was held that a court could ignore an admission
on the pleadings when it appeared clearly, after full investigation

of the facts, that the admission did not accord with the facts and
where an injustice would result. In
Fourie
reference was made
to the decision of this court in
Rance v Union Mercantile Co Ltd
1922 AD 312
, where the following is stated (at 315):
‘
When
an admission is formally pleaded, it as a rule corresponds to fact.
But what if it does not? In such a case the party making
the
admission is no doubt bound to the extent of that admission (as long
as it stands), but assuming that the admission is not
in accordance
with fact, a court of law by assuming its correctness and by building
upon it for the purpose of ascertaining the
limits of the contract
erroneously admitted, may find a contract proved which has no
existence in fact, and which but for such
admission it would not have
found to be proved. This shows that it is not always safe to build
further upon the mere admission
of a contract. The fact of the matter
is the party making the admission is bound by it to the extent to
which the admission goes.
To press it against him beyond that, under
all circumstances, may lead to inequitable results.’
[31] The facts alluded to in the
aforesaid dictum and those in
Fourie
are light years away from
the present circumstances. Ordinarily, a factual admission in
pleadings has the effect spelt out in the
following passage from
Fourie
(at 970B-C):
‘
Die
normale gevolg van die erkenning van ‘n feitlike bewering in
die pleitstukke is dat dié feit buite geskil geplaas
word
sodat getuienis daaroor onnodig word. Die party wat die erkenning op
die pleitstukke gemaak het kan derhalwe ook geen getuienis
aanbied in
stryd met die erkenning nie en indien hy dit wil doen, sal ‘n
aansoek eers gebring moet word om die erkenning
van die pleitstukke
te verwyder. So ‘n aansoek kan uit die aard van die saak dan
slegs gebring word namens die party wat
‘n erkenning gemaak
het.’
[32] In the present case, it was
apparent, not only from the pleadings but also right from the
beginning of the trial that a crucial
area of dispute was whether
Addington hospital had referred Jayanthi back to the Clare Estate
Clinic for an appointment to be arranged
for the second ultrasound
scan. That notwithstanding, the appellant’s legal
representatives made no attempt at all to apply
to withdraw the
admissions set out earlier in this judgment. In my view, it does not
now behove the appellant to criticise the
court below for relying on
the admissions.
[33] In our country poverty and a lack
of literacy abound. Masses of our people attend public health
facilities. Their lack of sophistication
and the vulnerability that
accompanies poverty are factors that cannot be ignored. They are
entitled to be treated in the same
way as patients who can afford
private medical assistance. That means that they should be fully
informed and should be as involved
as possible in their own
treatment. This does not require a drain on public resources. This
case is not about the availability
of material resources. It is about
a doctor communicating adequately with a patient. What is required is
a public health delivery
system that recognises the dignity and
rights of those who are compelled to use its facilities. It is that
basic sensitivity that
the Constitution demands.
[34] In my view, the court below
cannot be faulted in its reasoning as set out above nor ultimately in
its factual conclusions.
Insofar as contributory negligence is
concerned, none can be attributed to Jayanthi. As could be expected
she followed instructions,
including the directive that she return to
the clinic. The first ultrasound report was not addressed to her but
was a ‘suggestion’
from the sonographer to the doctor.
Suggestion is by its very nature something put forward in a tentative
form. Put differently,
it was put forward for consideration by the
doctor. In the present case the doctor did not tell Jayanthi why she
had accepted the
suggestion, nor did she say why the second
ultrasound scan was required. The doctor should have done so and
should have informed
Jayanthi that the second ultrasound scan was
imperative. The failure to do so, coupled with the clinic’s
reassurance that
there was nothing untoward in the ultrasound report
and the nurse’s statement that a second scan is only required
near the
end of one’s pregnancy understandably lulled Jayanthi
into a false sense of security. I can see no reason to interfere with

the conclusions of the court below.
[35] There is one further aspect that
requires brief consideration. In the appellant’s heads of
argument it was submitted
that the court below erred by not including
in its order a statement that the respondents were only entitled to
recover 66⅔%
of the damages sustained by them as they had
settled with the Municipality for the other 33⅓%. This
submission is baseless.
The parties were agreed that only the
question of liability should be decided and such a direction was made
by Levinsohn DJP. He
was not in the initial phase required to
determine the measure of damages.
[36] In light of the conclusions
reached above the following order is made:
The appeal is dismissed with costs
including the costs of two counsel.
_________________
M S NAVSA
JUDGE OF APPEAL
APPEARANCES:
For Appellant: P D Hemraj SC
N Govender
Instructed by
The State Attorney Durban
The State Attorney Bloemfontein
For 1
st
and 2
nd
Respondents: C J Hartzenberg SC
M E Van Jaarsveld
Instructed by
Lister & Lister Pietermaritzburg
Symington & De Kok Bloemfontein
1
Down’s
syndrome babies suffer from a chromosomal abnormality which usually
manifests in physical and mental abnormalities.
2
This
is a sterilisation procedure which has a reasonable chance of being
successfully reversed by way of further surgery.
3
For
the general approach followed in matters of this nature see
Blyth
v Van Den Heever
1980 (1) SA 191
(A) at 196A-F.
4
This
is a specialised procedure in terms of which fetal blood is drawn
directly from an umbilical vain for chromosomal testing
─ to
detect possible chromosomal abnormalities.
5
Advancing
maternal age, particularly over the age of 35, increases the risk of
Down’s syndrome exponentially.
6
Amniocentesis
is a procedure by which fluid containing fetal cells is drawn from
around the embryo for chromosomal testing.
7
There
was some suggestion that there was maternal blood contamination but
that was never proved.
8
This
subrule provides for formal enquiries to be directed at the opposing
party in advance of a pre-trial conference.
9
Cited
in
Dube v Administrator Transvaal
1963 (4) SA 260
(W) at
268E-H.