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[2019] ZAECBHC 24
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M.M obo E.L.M v MEC for Health Eastern Cape (517/2015) [2019] ZAECBHC 24 (19 November 2019)
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Certain
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IN THE HIGH COURT OF
SOUTH AFRICA
(EASTERN
CAPE LOCAL DIVISION, BHISHO)
Case No: 517/2015
In
the matter between:
M[…]
M[…]
obo
E[…] L[…]
M[…]
Plaintiff
and
MEC
FOR HEALTH EASTERN CAPE
Defendant
JUDGMENT
TOKOTA
J
[1]
In this matter the plaintiff, acting in her capacity as the
representative and natural
guardian of her son, E[…] L[…]
M[…],
(hereinafter sometimes referred to as E[…])
instituted an action against the Member of the Executive Council
for Health, Eastern Cape
(the MEC)
for damages arising from
the alleged medical negligence at the hands of the Frere Hospital
officials who were acting within the
course and scope of their
employment with the MEC. The MEC defended the action.
[2]
At the commencement of the hearing the parties agreed that it would
be convenient
to separate the merits of the matter from the issue of
quantum and sought an order to that effect in terms of Rule 33(4) of
the
Uniform Rules of Court. It was so ordered. The facts of the case
are largely common cause as a result the parties agreed that the
only
witnesses to be called would be expert witnesses.
BACKGROUND
:
[3]
The background facts are either noted in the available hospital
records or from expert
reports for both parties. The plaintiff was
admitted at Frere Hospital and subsequently gave birth by caesarean
section to E[…]
at 18h25 on 18 October 2010. Amongst other
things, the baby had tachypnoea
(fast breathing)
and the
paediatrician was notified to come and examine him. The baby was
admitted to the nursery for possible Transient Tachypnoea
of the new
born.
[4]
On 19 October 2010 the baby was comfortable and was transferred to
his mother. On
20 October 2010 jaundice was detected in the baby.
This was confirmed by the laboratory reports that showed that the
total serum
bilirubin (TSB) level was 506 micromol/L. The specimen
was registered at 7h41 approximately 37 hours after birth of the
baby.
[5]
The discovery of jaundice in the baby necessitated immediate exchange
blood transfusion
to prevent complications. It was discovered that
the baby’s blood group was incompatible with that of his mother
causing
the destruction of red blood cells resulting in the TSB level
to become very high. Dr Lombard’s evidence which was never
challenged was that this should have been treated as an emergency.
The baby urgently needed fresh blood for transfusion. According
to him it is not an elective treatment.
[6]
Once jaundice was identified, Frere Hospital staff commenced the
treatment procedure
by giving the baby intravenous haemoglobulin
called polygam in order to reduce the bilirubin level. In addition
intensive phototherapy
treatment was also done.
[7]
On 20 October 2010 at 23h00 the level of bilirubin was reduced from
506 to 498 and
on the morning of 21 October 2010 at 08h24 the level
was at 493.
On
21 October 2010 the hospital records disclose that ‘
no
significant drop in total serum bilirubin overnight despite triple
phototherapy and polygan. Blood for exchange transfusion ordered
from
P. E. At this stage neonatal is neurologically sound with no sign of
kernicterus and no seizure.’
At
about lunch time on the same day the plaintiff requested a transfer
of the baby to Life Beacon Bay Private Hospital. Blood transfusion
was done at Life hospital at approximately 20h00 on that day.
[8]
In his report Dr Lombard who was the only witness for the plaintiff
had this to say:
“
Hyperbilirubinemia
develops when the production exceeds the baby’s ability to
excrete it. In severe cases, the bilirubin can
then cross the blood
brain barrier and cause irreversible brain damage. In the acute phase
the condition is called bilirubin encephalopathy
and the term
kernicterus is used for the chronic manifestations. For the most part
bilirubin encephalopathy should be a preventable
condition....”
‘
According to
the guidelines, the level of TSB at which an exchange transfusion
should be done at 37 hours of life is 365. The guidelines
state:
“Immediate exchange is recommended if signs of bilirubin
encephalopathy are present or is more than 85 micromol/L
above
threshold.’’
Ethan’s
bilirubin was 141 micromol/L above the threshold. According to the
guidelines an exchange should have been done immediately.
The guidelines further
state: ‘Infants who present with TSB above the threshold should
have exchange done if the TSB is not
expected to be below the
threshold after 6 hours of intensive phototherapy.
In Ethan’s case
the TSB was repeated more than 11 hours after the initial result was
phoned to the ward.”
“
The best
opportunity to treat the hyperbilirubinemia and prevent possible
complications was on 20-10-2010.”
I
assume that the treatment referred to in his conclusion is the
exchange of blood transfusion.
Dr
Lombard and Dr Mzizana
(paediatrician of the defendant)
agreed
that “
the cause for E[…]’s cerebral palsy was
hyperbilirubinemia in the neonatal period which caused bilirubin
encephalopathy
and subsequent kernicterus. The hyperbilirubinemia
occurred due to an incompatibility between Ms M[…]’s
blood group
(0+) and that of E[…] (B+) which caused haemolysis
(destruction of red blood cells) of E[…]’s red blood
cells
resulting in an increase in the total serum bilirubin (TSB).
Both
experts concluded by saying that although E[…] received
appropriate treatment at Frere Hospital the delay in ordering
the
blood for transfusion was for an unacceptable period.
[9]
The defendant called one witness, Dr Harper, a paediatrician. He
testified that in
October 2010 he was a consultant paediatrician and
Head of the clinical unit for neonatal section at Frere hospital. He
testified
further that he recalls this case because it was quite
unusual and quite stressful. According to him when it was discovered
that
E[…]’s TSB level was extremely high they tried
other alternative treatment because there was no blood available in
East London. Blood was then ordered from Port Elizabeth.
[10]
On 20 October 2010 when the baby was jaundiced he was moved to the N3
nursery where Dr Harper
was based. The blood results came to the ward
and they realised that the TSB level was very high. Because of the
age and the “
gestational age
” of the baby it was a
“
term baby
.”
After the results came they
wanted to do exchange transfusion because the bilirubin level was
significantly beyond the exchange
transfusion level for a child at
that particular age of only 37 hours. Dr Harper believes that the
blood bank was contacted because
that would be the first line of
treatment in such a situation. The doctors were informed that there
was no fresh whole blood in
the blood bank in East London.
[11]
Dr Harper further testified that during the course of the day further
blood results came indicating
the cause of jaundice. The level of
jaundice was extremely high. The reason for this was that the blood
groups of the baby and
the mother were incompatible as a result there
was destruction of red blood cells causing jaundice level, the
bilirubin level,
to be very high. The baby was then given intravenous
haemoglobulin sometimes called polygam. During the course of that
morning
they had already started the phototherapy treatment. The baby
was also well hydrated and was given a medication called
phenobarbitone
which sometimes assists the liver process and reduces
the level of bilirubin. Despite all this there was no significant
reduction
of bilirubin level.
[12]
According to Dr Harper on 21 October 2010 whilst they were still
waiting for the blood from Port
Elizabeth and before they could
perform the exchange transfusion a request was made to transfer the
baby to a private hospital.
It was about lunch time. They facilitated
the transfer. He instructed a junior doctor in the nursery to write a
summary of what
had happened in the referral form to be completed.
ANALYSIS
:
[13]
Mr Zilwa for the defendant argued that the plaintiff’s case was
based on undue delay in
ordering the blood. He contended therefore
that she failed to prove her case in that she produced no evidence
that there was a
delay. He contended further that the plaintiff has
failed to prove that there was undue delay in ordering the blood. The
nub of
his argument was that it was clear from Dr Harper’s
evidence the blood was immediately ordered after the level of TSB was
discovered to be very high.
[14]
Regrettably, I cannot agree that the blood was ordered immediately
upon discovery of jaundice
in E[…].
[15]
The plaintiff’s case, according to pleadings, is that the
hospital staff allowed E[…]
to develop kernicterus in that
they failed to prevent bilirubin encephalopathy from developing when
they had ample opportunity
to do so. It is further alleged that the
hospital staff failed to initiate exchange transfusion when signs of
bilirubin encephalopathy
were present. I quote excerpts from
paragraph 7 of the plaintiff’s particulars of claim wherein it
is alleged that the hospital:
“
7.6
Failed generally to act as would be expected of medical
practitioners
when complications arose;
7.9
They failed to take heed of the fact that Liso was at high risk for
developing kernicterus
due to inter alia maternal blood
incompatibility, and failed to act
accordingly;
7.10
They allowed Liso to develop kernicterus;
7.11
They failed to prevent bilirubin encephalopathy from developing
when they had sufficient
opportunity to do so;
7.12
They failed to initiate exchange transfusion when signs of bilirubin
encephalopathy were present;”
[16]
In answer to the allegations by the plaintiff alluded to above the
defendant merely pleaded that
it had no knowledge of these
allegations and was not admitting the same leaving it to the
plaintiff to prove them. In paragraph
7 of his plea the defendant
pleads:
“
AD PARAGRAPH
7.1-7.17
The Defendant has no
knowledge of the allegations made herein, does not admit same and
accordingly puts the Plaintiff to the proof
thereof.”
The essence of the
defendant’s plea is therefore lack of knowledge of the
allegations constituting negligence on the part
of hospital staff.
[17]
The evidence led by the plaintiff was that the blood transfusion
process was only commenced on
21 October 2010 instead of 20 October
2010. This evidence was based on the notes retrieved from the
hospital record because an
entry about the order of blood from Port
Elizabeth only appeared on 21 October 2010. Dr Harper for the
defendant testified that
he gave instructions on 20 October 2010 that
blood should be ordered. He does not remember to whom and when
exactly such instructions
were given.
[18]
Regard being had to the pleadings, I did not understand the
plaintiff’s case to be based
on undue delay
per se
. I
pointed out to Mr Zilwa that according to the pleadings the defendant
failed to exchange blood transfusion immediately upon
detection of
jaundice. Dr Lombard’s evidence, which was not challenged, was
that once that was discovered the defendant had
no option but to
immediately exchange blood transfusion. This is not an elective
process.
[19]
Regard being had to the above, the plea by the defendant to the
plaintiff’s allegations
calls for comment. Where a party is
alleged to have failed in its duty to perform an obligation it is
expected of that party to
either deny or aver that it complied with
its obligation or if necessary, admit its failure or confess and
avoid. The defendant
simply pleaded lack of knowledge of the failure
to perform what the plaintiff alleges ought to have been done. Since
the purpose
of pleadings is to define issues so that each party knows
exactly what case it has to meet at the trial, in a case where the
defendant
pleads lack of knowledge of the allegations one wonders
what evidence will be led at the trial to rebut the plaintiff’s
evidence.
The simple answer to this question is that, depending on
facts alleged to be unknown, there is no room for evidence to
contradict
the allegations.
[20]
Litigation is not a game of chance where a party will play with its
cards close to its chest
in order to surprise or ambush the other
party. It has been held that:
“
A pleader
cannot be allowed to direct the attention of the other party to one
issue, and then at the trial attempt to canvass another.”
[1]
The purpose of the
pleadings is to bring clearly to the notice of the court and the
parties to an action the issues upon which reliance
is to be placed.
Marais AJ
[2]
(as
he then was)
stated as follows with regard to the distinction between denying and
not admitting an allegation:
“
To my mind,
there is a clear notional distinction between these two stances'
(i.e. between denying and not admitting an allegation).
A plaintiff faced with
a positive denial must anticipate and prepare for the leading by
defendant of rebutting evidence which contradicts
the allegations he
has made. A plaintiff faced with a non-admission need not anticipate
and prepare to meet contradictory evidence
to be adduced by the
defendant. Indeed, there is authority for the proposition that he
need not even anticipate a limited challenge
by way of
cross-examination of his witnesses. See Ntshokomo v Peddie Stores
1942 EDL 289
at 298. While that may conceivably be going too far (and
again I refrain from deciding the point), I think, with respect, that
the decision is undoubtedly correct insofar as it confirms that a
denial (and, I would say, a fortiori a plea of non-admission)
because
of a lack of knowledge, will not entitle the pleader to contradict
the plaintiff's averments by leading evidence to the
contrary at the
trial. In my view a plaintiff is entitled to know which of these two
stances a defendant is adopting and a plea
which leaves that in doubt
is vague and embarrassing.”'
In
the circumstances I am of the view that if the defendant intended to
adduce evidence that he indeed performed his duty by initiating
exchange transfusion within the medically accepted norms of standards
when signs of bilirubin encephalopathy were present this
should have
been pleaded.
[21]
In my view it was incumbent on the defendant to plead that indeed the
blood was ordered on 20
October 2010. The hospital records show that
an entry about the order of fresh blood was only made on 21 October
2010. Despite
the evidence of Dr Harper that he gave instructions on
20 October 2010 there is no entry to that effect on that date.
Furthermore
no witness was called to confirm this instruction.
Dr Harper wanted this court to rely on his memory. Notwithstanding
his explanation
as to why he remembers this case I am not persuaded
that this case was outstandingly different from others. He testified
that this
case “
stands out”
because as the
consultant in charge he was placed “
in a very stressful
situation where we had a new born baby who we recognised with a
particular problem, being jaundice.”
It
is highly improbable that in a big hospital like Frere, and for that
matter a referral hospital in many cases, this was a novel
situation.
Most
importantly his evidence goes on:
“
MR ZILWA: Now
just on that point at what stage did you request or order the whole
fresh blood?
Mr HARPER: M’Lord,
it was not me personally ordered it.
I would have
given an instruction to the doctor in the nursery to order the blood
in order to do an exchange blood transfusion, so I did not
personally
fill out that form so I cannot tell you exactly what time it was
completed.” (
My emphasis)
Furthermore
under cross-examination the following is recorded:
“
MR AUSTIN: Yes
Doctor, would it not have been prudent –no let me start with a
different question. You’ve given evidence
that you simply told
somebody, and you don’t know who, to order the blood;
MR HARPER: That is
correct. I would have ordered, asked one of my interns or medical
officers to order the blood from the blood
bank.”
Accordingly, I cannot
agree that this evidence of Doctor Harper was clear and ‘
undented
’.
He was specifically challenged that no blood was ordered on 20
October 2010. He is not the author of the note that shows
that blood
was ordered on 21 October 2010. The author thereof has not been
called as a witness.
[22]
Mr Austin argued that an adverse inference be drawn for failure to
call certain witnesses by
the defendant. The drawing of inferences in
favour of one party upon his opponent’s failure to call a
witness is not always
that simple.
[3]
It
depends on whether the witness would have been able either to advance
or destroy the party’s case who is failing to call
him. In
other words an inference adverse to the party who fails to call a
material witness can only be drawn where that which is
sought to be
inferred can be regarded as an inference and not mere speculation.
For an inference to be drawn there must be objective
facts from which
to infer the other facts sought to be established.
[4]
[23]
It may be that Dr Harper honestly believed that he would have given
instructions to order blood
on 20 October 2010. However, one must
bear in mind that human intellect is fallible and memories fade with
the passage of time.
In
the words of Cory J
[5]
:
“
There can be no
doubt that memories fade with time. Witnesses are likely to be more
reliable testifying to events in the immediate
past as opposed to
events that transpired many months or even years before the trial.”
The
events in this case occurred more than 8 years ago. The recorded
notes that were before this court do not support Dr Harper’s
recollection.
[24]
Documentary evidence serves many purposes. These include recording of
historical events for the
future and for those who were not initially
involved. This is particularly so in hospitals where doctors and
nurses change shifts
and those who take over are, by way of reference
to the recorded notes, put in a position to see the history of the
patient and
take the necessary steps to cater for any emergency
situations where applicable. Ailments and treatment of patients are
recorded
for verification and usually the dates and time are
specified in the notes. Keeping of such records also serves as a
point of reference
for future disputes. Documentary evidence is the
best evidence and almost invariably carries greater weight than the
unsupported
human memory.
[25]
Furthermore, the evidence of Dr Harper is not in accordance with what
was pleaded by the defendant.
In my view the hospital staff failed to
order the blood timeously for the immediate exchange blood
transfusion. Instead they decided
to treat the jaundice in E[…]
by other means in the hope that the level thereof would be reduced.
It was only after it was
observed that ‘
no significant drop
in TSB overnight despite triple phototherapy and polygam’
(during
the night of 20 October 2010) that a decision to order blood was
taken. I find that on the evidence before me this was done
on 21
October 2010 instead of 20 October 2010.
[26]
In the joint minute by Dr Mzizana and Dr Lombard the two doctors
agree that under the guidelines
immediate exchange transfusion must
be done once the baby’s TSB level is more than 85 micromol/L
above the threshold level
for exchange. They both agree that in the
case of Ethan the TSB level was 141micromol/L above the recommended
threshold. Further
the guidelines state that infants who present with
TSB above the threshold should have an immediate exchange transfusion
if the
TSB is not expected to be below the threshold after 6 hours on
intensive phototherapy but in E[…]’s case the TSB was
only repeated 11 hours later and at that stage it was still 103
micromol/L above the threshold. I therefore find that members of
staff at Frere hospital were negligent in not ordering the blood
immediately upon detection of jaundice.
[27]
Lest it be said that the joint minute should not have been taken into
account let me deal with
it. On the morning of the trial date a note
was handed up in which Dr Mzizana, a potential expert witness for the
defendant, purported
to resile from the joint minute. In this note Dr
Mzizana said: ‘
I have taken time to again consider the joint
minute that we signed on 10 October 2018, upon my reflection I have
noticed that on
the following two aspects there was no factual
evidence produced [NHLS Blood results that you referred to] in the
paginated 222
pages of medical records bundle submitted to me, to
substantiate or support these assertions:
“
paragraph
6.....Blood was only ordered for an exchange transfusion at least 21
hours after he presented (sic) with a TSB that was
high enough to
qualify an immediate exchange transfusion”.’
She
then concluded by saying she was therefore retracting from the joint
minute.
[28]
The reason for the retraction by Dr Mzizana is factually incorrect as
it is not supported by
the evidence adduced in court. On 1 August
2018 an email to which the National Health Laboratory Service results
(NHLS) were attached,
was sent to her by Dr Lombard. Besides proof
that the emails were sent to her, which formed part of the
plaintiff’s bundle
of documents, Dr Lombard confirmed that the
emails were sent by him. He also gave evidence that there were
different communications
via email and short message service (sms)
which culminated in them finally writing the agreed joint minute. Dr
Mzizana was not
called as a witness to refute this evidence and it
could not be challenged in cross-examination. Dr Lombard impressed me
as a reliable
witness who, mostly backed up his testimony either with
authority or documentary evidence. He made concessions where this was
necessary.
For example he conceded that in the absence of blood the
treatment that was given to E[…] was proper and that Life
Beacon
Bay hospital was also not free from blame. In the premises I
have no reason to disbelieve him. In any event it would be grossly
unfair and improper, in the light of his unchallenged evidence, not
to believe him.
[6]
[29]
Where the experts have reached a sensible agreement in a joint minute
limiting the disputed issues,
the plaintiff is entitled to rely on
such minute and prepare for the evidence needed to be led on the
basis thereof. If the defendant
for any reason did not wish to be
bound by such limitation, he should have given a fair warning to that
effect. In the absence
of proper repudiation (i.e. fair warning), the
plaintiff was entitled to run the case on the basis that matters
agreed upon between
the experts were not in issue.
[7]
[30]
Consequently there is no legal basis upon which the repudiation can
be accepted. The opinions
expressed in the joint minute are based on
the facts presented to the doctors. The value thereof is strengthened
by the overwhelming
evidence.
Was
the negligence of members of staff at Frere hospital linked to the
harm suffered by the plaintiff?
[31]
Corbett JA
(as
he then was)
has
on occasion stated:
[8]
“
Causation in
the law of delict gives rise to two rather distinct problems. The
first is a factual one and relates to the question
whether the
negligent act or omission in question caused or materially
contributed to . . . the harm giving rise to the claim.
If it did
not, then no legal liability can arise and caditquaestio. If it did,
then the second problem becomes relevant, viz. whether
the negligent
act or omission is linked to the harm sufficiently closely or
directly for legal liability to ensue or whether, as
it is said, the
harm is too remote. This is basically a juridical problem in which
considerations of legal policy may play a part.”
Regard
being had to the evidence of Dr Lombard and the joint minute it is
clear to me that the Frere hospital staff were negligent
in not
ordering the fresh blood immediately upon discovery of jaundice on
E[…]. The failure to act immediately contributed
and/or caused
the harm suffered by the plaintiff.
[32
In the premises I find that the plaintiff is entitled to judgment in
her favour. There remains
the question of costs.
Costs
[33]
The general rule is that costs must follow the result unless there
are exceptional circumstances
justifying a departure therefrom. The
costs of 22 October 2018 were reserved. Mr Austin for the plaintiff
argued that those costs
should be borne by the defendant. He argued
that the defendant’s expert retracted on the morning of the
trial date. The plaintiff
was at all times under the impression that
there would be no objection to the use of the NLHS reports since Dr
Mzizana was in possession
thereof.
[34]
For a fair trial no litigant should be taken by surprise in the
proceedings before a court of
law. Any party desiring to use
any document or tape must give a warning to the other party by
discovering such document or
tape if it intends to rely on it at the
trial. Rule 35(4) of the Uniform Rules of court provides that a
document or tape recording
not discovered may not, save with the
leave of the court granted on such terms as to it may seems meet, be
used for any purpose
at the trial by the party who was obliged but
failed to disclose it, provided that any other party may use such
document or tape
recording.
[35]
The mere fact that the other party was aware of the existence of the
document or in possession
thereof does not change the situation.
[36]
At the beginning of the trial Mr Zilwa brought to my attention that
he was not aware of these
reports and that they were not discovered.
I asked Mr Austin whether he wished to continue with the matter in
the circumstances.
He indicated that he was ready and would not use
the reports. In the middle of the trial he changed his mind after the
witness
had commenced with his evidence and sought a postponement in
order to discover the documents. I expressed my displeasure in
creating
a part-heard matter when he should have known that he needed
to use those documents.
[37]
In my opinion there is no reason why the defendant should be mulcted
with the costs occasioned
by the postponement of 22 October 2018. It
follows therefore that the plaintiff should bear those costs.
[38]
The plaintiff has asked for costs which will include qualifying costs
of her experts Professor
Lotz, Dr Gericke, Ms Hugo, Dr Lombard and Dr
Murray. Mr Zilwa for the defendant made no submissions in this
regard.
[39]
In the result I make the following order:
39.1
The defendant is liable to pay such damages as may be proved by
the plaintiff, in her representative capacity as the guardian of
her
minor son, E[…] L[…] M[…], arising from the
medical negligence that occurred at Frere hospital in October
2010;
39.2
The plaintiff must pay the reserved costs occasioned by the
postponement on 22 October 2018;
39.3
Save for the costs in paragraph 38.2 above, the defendant shall pay
the plaintiff's costs on a party and
party scale either as taxed or
agreed, such costs to include the costs of obtaining medico-legal
reports and joint minutes, reservation
and/or qualifying fees of the
following experts:
(i)
Professor Lotz,
(ii)
Dr Gericke,
(iii)
Ms Hugo,
(iv)
Dr Lombard and
(v)
Dr Murray
39.4
Costs of two Counsel where applicable is allowed.
39.5
Determination of quantum is postponed
sine die
.
_____________________
B
R TOKOTA
JUDGE
OF THE HIGH COURT
Appearances
:
For
the Plaintiff: Mr
G Austin
Of Gary Austin Inc.
For
the Defendant: Advocate
Zilwa SC
instructed by
State
Attorney
EAST
LONDON
Heard
on:
22 October 2018, 3 June 2019, 4 June 2019, 12 July 2019 and 21
October 2019.
Date
judgment delivered:19 November 2019.
[1]
Kali
v Incorporated General Insurances Ltd
1976
(2) SA 179
(D) at 182A;
Imprefed
(Pty) Ltd v National Transport Commission
1993
(3) SA 94
(A) at 107C.
[2]
Standard
Bank Factors Ltd v Furncor Agencies (Pty) Ltd & Others
1985
(3) SA 410
(C) at 417I-418B.
[3]
Galante
v Dickinson
1950
(2) SA 460
(A)at 465;
Jordaan
v Bloemfontein Transitional Local Authority
2004
(3) SA 371
(SCA)
[2004] 1 All SA 496
(SCA) para.20.
[4]
Motor
Vehicle Assurance Fund v Dubuzane
1984
(1) SA 700
(A) at 706B – D. See also Great River Shipping
Inc
v Sunnyface Marine Ltd
1994
(1) SA 65
(C) at 75I – 76C.
[5]
R
v Askov
(1991)
49 CCR 1 (Supreme Court of Canada at 20).
[6]
Van
Tonder v Kilian NO
1992
(1) SA 67
(T) at 73;
R
v M
1946 AD 1023
at 1028 per Davis AJA, Watermeyer CJ, Greenberg JA and
Schreiner JA concurring;
Small
v Smith
1954
(3) SA 434
(SWA) at 438E - H;
S
v Govazela
1987
(4) SA 297
(O) at 298J - 300B;
S
v Van As
1991 (2) SACR 74
(W) at 109B-G;
Van
Tonder v Killian NO en 'n Ander
1992
(1) SA 67
(T);
President
of the RSA v SARFU
2000
(1) SA 1
(CC);
(1999 (10) BCLR 1059
[1999] ZACC 11
para61.
[7]
Bee
v Road Accident Fund
2018
(4) SA 366
(SCA) para.66.
[8]
Minister
of Police v Skosana
1977 (1) SA 31
(A) at 34E-G.