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[2024] ZAFSHC 143
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Kanunu v Member of the Executive Council: Free State Department of Health (4268/2015) [2024] ZAFSHC 143 (6 May 2024)
IN
THE HIGH COURT OF SOUTH AFRICA
FREE STATE DIVISION,
BLOEMFONTEIN
Reportable:
NO/YES
CASE NO.: 4268/2015
In
the matter between:
THABO
ISHMAEL KANUNU
Plaintiff
[1]
and
THE
MEMBER OF THE EXECUTIVE COUNCIL:
FREE
STATE DEPARTMENT OF HEALTH
Defendant
[2]
Coram:
M Opperman J
Heard
:
17, 18 & 20 October 2023 and 2 February 2024
Delivered:
6 May 2024. This judgment was handed down in court
and electronically by circulation to the parties' legal
representatives
via
email
and release to SAFLII on 6 May 2024. The date and time of hand-down
is deemed to be 15h00 on 6 May 2024
Summary:
Trial
-
merits -
medical
negligence
JUDGMENT
[1]
The plaintiff claims delictual damages from the defendant. The issues
of liability and quantum were separated at the commencement
of the
trial. The merits on liability are to be adjudicated here.
[2]
The plaintiffs left leg was amputated above
the knee on 14 July 2015. This was due to sepsis that was localized
to the left foot
of the plaintiff. It became systemic and potentially
fatal, hence the amputation.
[3]
The
claim is limited to alleged medical negligence of a doctor and/or
nursing personnel at the Boitumelo Hospital in Kroonstad on
Monday, 6
July 2015. The defendant denies all negligence and pleaded that the
plaintiff himself negligently caused and/or contributed
to any
damages he
may
have suffered.
[3]
[4]
The plaintiff has the burden to prove every
element and requirement of the alleged delict on a balance of
probabilities.
[5]
No reliance is placed by the plaintiff on
the conduct of other medical practitioners that treated the plaintiff
and undisputedly
so, played a vital role in the chain of events.
Their evidence was not adduced and there hangs a legally
uncomfortable silence
over this aspect and their non joinder.
[6]
Counsel for the plaintiff is however
correct that:
3.
Based on the available evidence and
the opinions of the medical
experts, the conduct of the private
practitioners admittedly did not comply with the general standard of
care expected of them.
But the question in this trial is whether Dr
Thejane exercised the reasonable skill and care of a practitioner in
his field.
The answer turns on a
remarkably straightforward factual question: did the plaintiff tell
Dr Thejane that he was stabbed in the
foot with a fork?
...
(Accentuation added)
[7]
The following evidence served before the
court:
1.
The plaintiff
tendered
viva voce
evidence
before court. The evidence of this witness is that of a single
witness without any corroboration on the vital issue whether
he
informed
Dr.
Thejane of the incident at the dam with the hayfork. His evidence as
a whole is questionable. He did testify that there was
not any open
injury or bleeding on his ankle after the stabbing.
He was vague in that he
alleged that he cannot remember who he spoke to at the hospital as he
"was in pain". He could
remember that it was a male person
with a stethoscope around his neck. The plaintiff conceded that due
to the pain and the time
that lapsed since the incident, it is
possible that he cannot remember everything.
2.
An orthopaedic
surgeon,
Dr. F.P. Du Plessis,
presented expert
testimony. His report was entered into evidence. Counsel for the
plaintiff accepted in their heads of argument
that:
26.
Dr Du Plessis, the plaintiffs expert witness
conceded that if the wound was no
visible,
and Dr Thejeane (sic) did not know of the circumstances of the
plaintiffs injury, it would not be expected of Dr
Thejane to have been particularly vigilant about the danger of an
infection in
the plaintiff's foot. Conversely, if Dr Thejane had
knowledge of the plaintiff's injury, he ought to have realised the
risk of
an infection and should have treated the plaintiff
accordingly.
3.
Dr. Thejane testified on behalf of the
defendant.
He was the medical
practitioner who examined and treated the plaintiff during his first
visit to the hospital on 6 July 2015. Dr.
Thejane confirmed that he
completed portions of the hospital records and he confirmed the
contents to be correct. No evidence was
adduced to gainsay the
evidence that the hospital records are accurate but for the evidence
of the plaintiff. Dr. Thejane denies
any liability or negligence. He
treated the plaintiff on the information and facts as it were
available at that instance. He is
steadfast in his evidence that he
was not informed of the incident with the hayfork.
4.
Dr. Thejane was a good witness that
impressed the court as one that is willing to take responsibility for
his actions. His evidence
that the plaintiff did not inform him of
the stabbing incident is corroborated by the records that he made.
There is not any room
for the speculation that he completed the
records after the fact. The probability that none of the medical
practitioners treated
the plaintiff for possible infection after he
told them that he was stabbed with a fork whilst fishing in a farm
dam, is almost
zero.
5.
Prof. Becker prepared a medico-legal
report,
which was accepted into
evidence by agreement between the parties but conditionally so.
Counsel for the defendant correctly stated
that:
10.16 The revised report
of Prof. Becker was entered into evidence by agreement between the
parties on the basis that certain portions
thereof are not agreed to
by the Plaintiff.
10.16.1 However, the
portions m Becker's report which were not accepted, were to a large
extent conceded by Dr. Du Plessis. And
insofar as Prof. Becker relied
on the notes in the medical records of Dr. Thejane, these were
con.firmed as correct by Thejane.
The credibility of Prof. Becker and
the logic of his reasoning is not attacked by the Plaintiff.
10.16.2 In as far as
Prof. Becker comments on the negligence of Dr. Ne!, his observations/
opinions stand as undisputed in the light
of the fact that the
Plaintiff did not call Dr. Nel to testify. In any event, Dr. Du
Plessis effectively agreed that Ne! administered
suboptimal treatment
to the Plaintiff, and further, that the visit to Ne! on the Wednesday
was the turning point (when it became
clear that the ankle was
infected).
10.17 Dr. Du Plessis
agrees with Prof. Becker that-
(i)
The amputation of the Plaintiffs leg
saved his life;
(ii)
When the Plaintiff was examined /
assessed by Dr. Thejane, the classic signs of sepsis were not
present;
(iii)
Had Dr. Ne! / Stander treated the
Plaintiff aggressively with antibiotics after the visit on the
Wednesday, the outcome might have
been different, and the Plaintiff's
leg may have been saved.
6.
A document bundle was utilized throughout
by both parties. Not all documents included in the bundle were
referred to during evidence.
The court will only have regard to the
documents utilised during the case. Both expert witnesses referred
extensively to the hospital
notes and records in their reports. The
referral letter from Dr. Stander, also became part of the evidentiary
material during the
trial and the authenticity
and veracity of the contents were not
disputed.
[8]
The case will in the main be adjudicated on
the evidence that is common cause. As indicated; the only real issue
is whether the
plaintiff informed Dr. Thejane on the 6
th
of July 2015 of the incident with the hayfork. I will deal with it
during the evaluation
of
the case.
[9]
Both counsel in their heads of argument
gave extensive summaries of the evidence and it cannot be faulted. I
will not regurgitate
it in the judgment since the adjudication of the
case turns on what is common cause and a ruling on the probabilities
presented
by the objective proven facts.
[10]
This is the undisputed evidence:
1.
On Sunday, 5 July 2015 the plaintiff was
accidently "stabbed" near the back of his ankle by a co -
worker with a fork.
2.
This occurred in a farm dam. The co -
worker was using the fork to spear fish in the dam. The plaintiffs
feet were submerged
in
the water at the time.
3.
The fork was one typically used for loading
hay. It had a long handle with four thin prongs.
4.
The co - worker(s) never testified to
confirm the incident. It is only the version of the plaintiff that
lies before court on this
fact.
5.
Professor
J.H.R
Becker
whose report was conditionally admitted into evidence for the
defendant is correct when he reported
[4]
that:
"The
port of entry of the bacteria was never established,...
"
[5]
6.
The plaintiff got out of the water, washed
and checked where he was stabbed. There was no
visible wound according to the plaintiff
himself.
7.
When the plaintiff woke up later that
night, his left foot was swollen and, as the plaintiff
put it, his foot was "no longer
functional".
8.
The next day, which is Monday, 6 July 2015,
the plaintiff called his foreman (as he put it) who took him to the
private practice
of Dr. J.N. Nel in Kroonstad. The plaintiff was
consulted by a female medical practitioner whose name he could not
recall.
9.
It is undisputed
that one Dr. Stander diagnosed the
plaintiffs injury on that day as a fracture. The plaintiff was then
referred to the Boitumelo
Hospital in Kroonstad and he ended up at
the casualty unit of the hospital. She did not mention any open wound
or stabbing incident
in her referral to the hospital.
10.
The plaintiff was then seen by Dr. Thejane.
Dr. Thejane diagnosed the plaintiff with a "left ankle fracture"
and applied
a "back slab" to the plaintiffs left foot; it
is a form of plaster splint. It is unlike a full plaster cast, which
would
have encircled the plaintiffs foot and ankle. This is also used
to stabilise and address pain. Dr. Thejane then referred the
plaintiff
for x-rays to be taken.
11.
Dr. Thejane did not detect a fracture on
the x-rays' and discharged the plaintiff that same evening.
12.
The plaintiff was given a health education
form by one of the nursing personnel which would have informed the
plaintiff how he must
look after the back slab and he was told to
return to hospital the same Thursday; that is within three days. The
plaintiff did
not do this.
13.
By the Wednesday, the plaintiff experienced
increased pain in his injured foot. The plaintiffs foreman took him
to the practice
of Dr. Nel that same day.
14.
It must be noted that this foreman was not
called to testify to corroborate any of the evidence of the
plaintiff.
15.
During this visit, the plaintiff consulted
with an, according to the plaintiff, unidentified male, likely a
medical practitioner.
This practitioner, believing that the bandages
were too tight and causing discomfort, made vertical incisions in the
bandages around
the top of the ankle to alleviate the pressure. This
was on all evidence Dr. Nel that treated the plaintiff on this day.
The medical
practitioner on the evidence at this instance clearly did
not consider infection at all. This is again indicative of the fact
that
the stabbing did not come to the attention of the medical
practitioners that treated the plaintiff.
16.
The day after this, the plaintiff
experienced intense pain, leading him to remove the entire back slab
himself. The pain persisted
to the extent that he could not manage
his own needs. Consequently, his foreman brought him to his wife's
care in Steynsrus that
same day.
17.
The plaintiff's foot had become severely
swollen and was giving off a foul odour. On Saturday,
11 July 2015, his wife requested an
ambulance which took him to the hospital. The plaintiff was admitted
to the hospital's surgical
ward.
18.
The plaintiffs left leg was amputated above
the knee three days later, on 14 July 2015.
[11]
Several medical practitioners were
involved in the treatment of the plaintiff over several days and at
different instances and does
it not make sense why nobody treated the
plaintiff for infection if the plaintiff alerted them to the
stabbing.
[12]
The case turns on what must be an
injury so small that it was beyond any doubt not visible to the naked
eye. That is if there was
any "breaking of the skin" or
injury on the 5
th
or 6
th
of July 2015.
[13]
The open wound or injury that caused
the infection was not visible on the evidence of the plaintiff
himself. This was admitted to
in the evidence of the plaintiff as
quoted by his counsel
in
their heads of argument.
8. The
plaintiff got out of the water, washed and checked where he was
stabbed. There was
no visible wound.
[14]
Whether the plaintiff conveyed that
he was "stabbed" was not reported anywhere on any of the
reports that were handed
into evidence. It is highly improbable that
if the plaintiff reported the incident as he maintains; that it would
not be recorded
by any of the medical practitioners; not even the
nurse that admitted him.
[15]
Again; there is not any corroboration for
the evidence of the plaintiff that he told of the hayfork incident.
The evidence supports
the evidence of Dr. Thejane that the plaintiff
did not report that he was stabbed with a hayfork; it
is
just not probable that so many medical practitioners will not heed
the information and act on it. This, not even when the plaintiff
presented to Dr. Nel with a severely swollen leg. He was so
unsuspecting of any infection that he merely cut the plaster for
relief
of the swelling.
[16]
Neither the plaintiff nor Dr. L Stander
(the private practitioner that saw the plaintiff on 6 July 2015), Dr.
Thejane at the hospital
and the nursing personal at the hospital on 6
July 2015 were able to see any wound or "breaking of skin".
[17]
Professor Becker describes the situation,
that is undisputed, best on the sepsis that
caused the
amputation of the leg
of
the
plaintiff when he
stated as
follows:
07
Signs
of sepsis.
The
classic stigmata are,
-
Rubor = red.
-
Tumor=
swelling.
-
Calor = warmth.
-
Dolor= pain.
-
Suppuration=
pus
formation, liquefaction.
The
above criteria are classic in what is experienced with the
development of a pimple, (ask any teenager), red, swelling, pain,
local warmth, "ripen" pus that needs to be drained.
08i
A
pimple is a localized small infection, abscess, that the body can
isolate to one area. Depending on the degree of the infection
the
body can isolate the area and form an abscess that can be drained, or
the body cannot isolate the sepsis then the infection
will become
systemic, involving the entire body.
08ii
In
the case of the plaintiff the sepsis was localized to the foot and
later to the leg and was on its way to become systemic and
kill the
patient. The latter manifested with the admission on the 11
th
/07/15-
14
th
/07/15 when he became disorientated.
The amputation
was done in time and saved his life. if it was delayed for a
few hours. he would have been dead.
(Accentuation added)
09
Delict?
Keeping
in mind the discussion above vis.
A
Invasion
of organisms,
There
have to be a place where the organisms, bacteria, entered the tissue
via broken skin, presence of a wound.
1)
Dr L Stander did not document any wounds.
06/07/15, par 02i.clinically diagnosed a fracture.
2)
Dr Thejane, 06/07/15, par 02i, document no
breach of the skin, treat the possible fracture with a back-slab. POP
(Plaster of Paris)
behind the ankle to prevent movement secured with
circular bandages.
3)
The nursing notes, p2, 12/07/15, 07:38,
did not record a wound.
4)
It has now transpired according to multiple
versions that be was injured with an iron/fork just behind the medial
malleolus. It
is clear that the environment was not clean and a mixed
flora of organisms contaminated the "wound". (Either in the
river,
dam or on
the farm while
"spitting"). By
"spitting" is meant tilling the
ground.
10
B
The
next phase is swelling.
After
the organisms entered the wound, whereof there is no proof that there
was an open wound, the port of entry was not established,
but nobody
can deny that there were bacteria present, the organisms will
multiply and cause an inflammatory response, vis. pain,
swelling and
redness, we have proof that pain and swelling must have been present
on 06/07/15.
In
the absence of an open wound and the history of an injury, the
diagnosis of a fracture was a possibility, Dr Stander and Dr Thejane
thought so.
I
would have expected that there would also have been redness with the
pain and swelling, it is not recorded.
If
the
diagnosis
of
an
infection
was
made
at
this
time,
and
an
aggressive
antibiotic
treatment regimen followed, the course of events might have been
different, and the limb preserved.
Dr
Stander and Dr Thejane stand to answer about the presence or absence
of inflammation, Dr Stander is not part of the defense,
but will have
to explain what the condition of the foot was when it was
examined.
[6]
C
The
next phase, symptoms get worse. Vis. pain, swelling, warmth and
redness.
The
plaintiff reports at Dr Nel, between 06-11/07/15, exact date not
known, the diagnosis was that the bandages were too tight.
1)
But what actually happened was that the
swelling increased within a closed compartment and gave the
impression that the bandages
were too tight.
2)
The pain increased with the increased
swelling of the foot due to the progressive
nature
of the sepsis.
3)
A thorough examination of the foot and
ankle would have shown the clinician that
the
swelling was due to an infection. Apropos par 07 supra the foot would
be red, swollen, warm and painful.
The classic stigmata of an underlying infection.
4)
With the advantage of the retro
spectroscope, knowing what the ankle looked like on 11/07/15, black
skin, blisters, offensive discharge,
it can with a degree of
certainty and accuracy, be postulated that there were clear signs of
sepsis when Dr Nel saw the patient,
unless he did not examine the
patient.
5)
These signs and symptoms were missed by
the practice of Dr Nel, a serious delict,
Dr
Nel must accept responsibility.
This
omission cannot be laid on the account of the staff at Boitumelo
Hospital, the
staff were not
afforded the opportunity to examine the patient at the same time as
his visit to Dr Nel
6)
Had the doctors at Boitumelo Hospital
seen the patient at the same time as Dr Nel
the
course of events might have been totally different. The visit to the
practice of Dr Ne! is a "Novus actus lnterveniens"
and
cannot be ignored.
-
The diagnosis of sepsis was missed.
-
The patient was sent home without antibiotics.
-
The
patient
was
given
a
false
sense
of
security
by the
doctor
"that
everything
was under control" "the bandages were too tight", and
reported later back at the Hospital when the foot
became black, full
of blisters and offensive discharge.
-
Had Mr. Kanunu been treated aggressively with antibiotics after
the visit to Dr Nel as well as a surgery consultation to drain
possible
pus. the outcome might have been different, and the limb
maybe saved.
D
Overt
sepsis, presence of pus and systemic inflammatory response syndrome
SIRS.
On admission on the 11
th
/07/15
the "horse had already bolted".
Mr Kanunu had an overt necrotizing infection with him rapidly going
into SIRS. The treatment that was given from the 11
th
late afternoon
until
the 14
th
was a "last ditch" effort to
try and salvage the limb,
that turned
out to be a futile exercise.
The
urgent amputation saved his life.
11
In
Summary.
1)
Mr. I Kanunu was injured with a fork/iron
in the river/dam or while working on the farm cultivating (spitting).
2)
A mixed flora of micro-organisms got
inoculated into the tissue,
the
mechanism is unknown.
3)
The
micro-organisms
rapidly
proliferated
and
caused
infective
response
with
swelling and pain.
4)
A private practice was consulted, Dr L
Stander saw him, the history was obviously not clear, and a fracture
was diagnosed by Dr
Stander (private GP) and the Dr Tbejane at
Boitumelo Hospital and treated with a back-slab by the doctor at
Boitumelo Hospital.
X-rays did not confirm the fracture.
5)
The swelling increased and caused
compression of the lower limb, Dr Nel was consulted, he diagnosed
tight bandages, he does not
pick up signs of sepsis, swelling,
redness, pain, and warmth. It is postulated that be did not examine
the patient. Had be, it
could have made a difference in the course of
events, commencement of an aggressive antibiotic regimen and a
surgery consultation.
6)
When Mr. Kanunu reported at Boitumelo
Hospital, the ankle was, swollen, skin turning black with blisters
and an offensive discharge.
7)
Mr. Kanunu rapidly deteriorated, within 3
days became confused and was going into septic shock.
8)
A life-saving emergency above knee
amputation was performed.
9)
The amputation achieved source control and
it was possible to save his life.
10)
He was very catabolic, BMI of 18, S-Albumin
of 18, the surgery team need to be complemented
with the result.
11)
A typical case
of
life over limb was the
end
result.
12)
Aggressive
early
intervention
by
the
practitioners
that
treated
him
prior
to admission on the 11
th
/07/15
might have made a difference.
(Accentuation added)
[18]
The law on the incident of the 6
th
of July 2015 is clear. Given the facts it was proven on a balance of
probabilities that there was not any presentation of infection
or
history that there might be infection.
[19]
That said, the defendant was under a legal
duty to dispense proficient medical care to the plaintiff. The
Constitutional Court in
Oppelt v Head:
Health, Department of Health Provincial Administration: Western Cape
2016 (1) SA 325
(CC) at paragraph [54]
held that:
There is no doubt that
the legal convictions of the community demand that hospitals and
health care practitioners must provide proficient
healthcare services
to members of the public. These convictions also demand that those
who fail to do so must incur liability.
[20]
The question is
if
the
service rendered on the
6
th
of
July 2015 at
the
Boitumelo
Hospital in Kroonstad was not proficient?
1.
In
Topham
v
MEC
for
the
Department
of
Health,
Mpumalanga
(351/2012)
[2013] ZASCA 65
(27 May 2013) it was held that:
[6] Professional
negligence is determined by reference to the standard of conduct of
the reasonably skilled and careful practitioner
in the particular
field and in similar circumstances. A medical practitioner diagnosing
and treating a patient is expected to adhere
to the general level of
skill, care and diligence possessed and exercised at that time by the
members of the branch of the profession
to which he or she belongs.
It follows that a wrong diagnosis does not per se amount to
negligence on the part of the medical practitioner concerned. It will
only be negligence if the practitioner's conduct does not comply with
the general standard of care to which I have referred.
(Accentuation
added)
2.
The
test for medical negligence was aptly captured in November 2023 by
Joubert
[7]
when he discussed the
cases of
Chapeikin
and Another v Mini
(103/2015)
[2016] ZASCA 105
(14 July 2016) and
Oppelt
v Head: Health, Department of Health Provincial Administration:
Western Cape
(CCT185/14)
[2015] ZACC 33
;
2016
(1)
SA
325
(CC);
2015 (12) BCLR 1471
(CC) (14 October 2015). He
concluded
that:
a.
The existence of negligence for the purpose
of liability is that fault arises if a reasonable person in the
position of the defendant
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 the defendant failed to take such steps.
b.
There are two steps, the first is
foreseeability -
would
a reasonable person in the position of the defendant foresee the
reasonable possibility of injuring another and causing loss.
The
second is preventability -
would
that person take reasonable steps to guard against the injury
happening.
c.
Negligence must be
evaluated in light of all the
circumstances.
d.
Because the test is defendant-specific the
standards are upgraded for medical professionals. The question for
them is whether a
reasonable medical professional would have foreseen
the damage and taken steps to avoid it.
e.
The appellate division noted that this
standard does not expect the impossible of medical personnel.
f.
A medical practitioner is not expected to
bring to bear upon the case entrusted to him the highest possible
degree of professional
skill, but he is bound to employ reasonable
skill and care and he is liable for the consequences
if he does not.
g.
A practitioner can only be held liable if
his diagnosis 1s so palpably wrong as to prove negligence, that is to
say, if his mistake
is
of
such a nature as
to
imply
absence of
reasonable
skill and care on his part, regard being had to the ordinary skill in
the profession.
h.
The test is always whether the practitioner
exercised reasonable skill and care or put differently, whether his
or her conduct fell
below the standard of a reasonably competent
practitioner in the field.
i.
If the error is one that a reasonably competent
practitioner might have made it will not constitute negligence.
[21]
The final conclusion lies in the words of
the expert for the plaintiff as he was quoted in the heads of
argument for the plaintiff.
Dr. Du Plessis concluded unequivocally
that if the wound was not visible, and Dr Thejane did not know of the
circumstances of the
plaintiffs injury, it would not be expected of
Dr Thejane to have been particularly vigilant about the danger of an
infection in
the plaintiffs foot. The wound was not visible and it
was proven that there was no information that the plaintiff was at
risk of
infection available to Dr. Thejane.
[22]
I
ruled that there is not any evidence that support the allegation that
Dr. Thejane was warned of the incident with the hayfork
that took
place. This is supported
by
the medical
reports
that served as evidence as well as the conduct and treatment of the
plaintiff by the other medical practitioners.
[8]
The
plaintiff failed to make out a proper case on which the defendant may
be found liable for any damages suffered
by
him.
[23]
Finally:
As Lord Denning remarked in
Roe
v Ministry of Health
[1954] EWCA Civ 7
;
[1954]
2 All ER 131
(CA) at 139:
[9]
But we
should be
doing
a disservice to the
community at large if
we were to
impose
liability on hospitals and doctors for everything that happens to go
wrong
…
we must not condemn as
negligence that which is merely a misadventure.
[24]
ORDER
The plaintiffs' claim is
dismissed on the merits with costs.
M OPPERMAN J
Appearances
For
plaintiff:
W van
Aswegen
Instructed
by:
Symington
& De Kok Attorneys
BLOEMFONTEIN
For
defendants:
G
Wright
Instructed
by:
Office
of the State Attorney
BLOEMFONTEIN
[1]
"The
plaintiff'/ "Mr. Kanunu".
[2]
"The
defendant''. The defendant was cited
incorrectly.
The citation
was
corrected by agreement between
the
parties at the start of the trial. See the heads of argument for the
defendant at paragraph 1.2.
[3]
See
the heads of argument for the defendant at paragraph
1.3.
[4]
Pages
213 to 216 of the bundle marked: INDEX - EXPERT
NOTICES
-
12/6/2023
at specifically paragraphs 9 to 11 of his report.
[5]
See
paragraph 06 of Professor Becker's report
supra.
I
will deal with this statement later.
[6]
Imperative
is that Dr. Thejane did not observe any signs of redness or
infection. This stands unrefuted on his evidence. It confirms
the
evidence that the "port of entry" of the infection
was
never established nor that there existed any indication of infection
or potential infection during the treatment by Dr. Thejane.
[7]
https://
www.millers.eo.za/Ourlnsights/ArticleDetail.aspx?ArticlelD=3121
accessed
on
2
May
2024.
Also
see
Joubert,
W:
WHEN
CONSTITUTIONAL GUARANTEES
MEET
REALITY
IN
HEALTH
CARE,
29
April
2016,
Medical
Negligence, De Rebus in 2017 (June) DR 42,
https://vzlr.co.za/2016/04/29/when-constitutional-guarantees
meet-reality-in-health-care/
accessed on 2
May
2024.
[8]
Also
see the heads of argument of
the
defendant from paragraphs 6 to 13.
[9]
Also
see
Medi-Clinic
v Vermeulen
2015
(1) SA 241
(SCA) at [33].