SAFLII Note: Certain personal/private details of parties or witnesses have been redacted from this document in
compliance with the law and SAFLII Policy
REPUBLIC OF SOUTH AFRICA
IN THE HIGH COURT OF SOUTH AFRICA
GAUTENG DIVISION, PRETORIA
Case number: A13/2024
(1) REPORTABLE: NO
(2) OF INTEREST TO OTHERS JUDGES: NO
(3) REVISED
08/08/2024
In the matter between:
WYNAND JOHANNES DERCKSEN APPELLANT
ID. 6[...]
And
HEALTH PROFESSIONS COUNCIL OF
SOUTH AFRICA 1ST RESPONDENT
DR. PARMANAND NARAN 2ND RESPONDENT
CORAM: MABESELE AND BAM JJ
JUDGMENT
MABESELE J:
[1] This is an appeal against the decision of the first respondent in which it
exonerated the second respondent from a professional negligence in
performing the angiogram on the appellant. The appellant appeared in
person. This appeal is launched in terms of section 20 of the Health
Professions Act1. The section reads:
(1) “Any person who is aggrieved by any decision of the council, a
professional board or a disciplinary appeal committee, may appeal to
the appropriate High Court against such decision.”
[2] The first respondent dismissed the appellant’s complaint on the
grounds that : (i) the complication that occurred (on the part of the
appellant) was an expected one, and (ii) the second respondent
managed the complication appropriately and made a follow up
consultation to assess the aggression of the complication.
[3] The appellant raises four grounds of appeal as follows:
1. The first respondent’s inquiry-
(a) did not take all explanation, replies, notes and facts into
consideration;
(b) were based on the second respondent ’s explanation and was
not factually evaluated;
(c) did not afford the appellant opportunity to reply to the documents
presented by the second respondent;
(d) failed to take into consideration that the clinical notes presented
by the second respondent had multiple misrepresentations.
[4] Both parties presented their cases in writing to the board of inquiry of
the first respondent.
1 56 of 1974.
[5] The complaint against the second respondent was based on a duty of
care, according to the appellant. The appellant argued that the second
respondent, well knowing his (appellant) medical history, complications,
and risk factors of a coronary angiogram procedure, did not
contemplate the finding of an alternative saver method of testing other
than the coronary angiogram, or postponed the coronary angiogram
procedure for a more suitable day and time seeing that the second
respondent experienced a day wit h a long list with numerous complex
cases. The appellant argued that the second respondent did not refer
him t o a cardio vascular specialist for further evaluation of the
abdominal aorta dissection, and the second respondent did not
properly explain to him what abdominal aorta dissection or false lumen
is, and has failed to make follow ups which resulted in the deterioration
of the abdominal aorta dissection.
[6] The second respondent is a cardiologist. He holds MBBCh and MMed
degrees. He first consulted the appellant on 9 April 2018. At the time
the appellant was 5 2 years old. The appellant had a coronary artery
bypass graft and mitral valve repair in 2016 by Dr Martin Bruwer. In
March 2017 the appellant had a lengthy admission at Life Groenkloof
Hospital for tiredness and shortness of breath. Bilateral small flued
collections were detected and a presumptive diagnosis of an
autoimmune condition was made. Regional wall motion abnormalities,
a marker of underlying cardiac dysfunction, were already detected at
this point. The appellant was seen with similar complaints during at
least two admissions at Life Groenkloof Hospital.
[7] The symptoms of the appellant’s illness suggested a cardiac origin,
especially since his lungs had been assessed three times previously.
Clinical examination did not show any cross cardiac failure. The
regional wall motion abnormalities, as had been noted in 2017 already,
where the anterior wall and septum were moving less than the lateral
wall were noted when performing an echo cardiogram. The appellant
was admitted with a diagnosis of angina equivalents. Further
investigations were ordered. The appellant was started on optimal
medical therapy for his angina equivalents.
[8] On 18 April 2018, stress ECG as well as cervical spine MRI were
performed. The cervical spine MR I did show some degenerative
disease but not enough to fully explain the appellant’s symptoms. The
stress ECG did show changes which implied potential narrowing of his
coronary artery disease. A diagnostic coronary angiogram was
advised.
[9] A lengthy discussion on 11 April 2018 ensued regarding the procedure
including the fact that coronary angiograms on patients with previous
bypass grafts take longer, have higher complications rates and are
more complex. The appellant agreed, that in view of his ongoing
symptoms without diagnoses, to undergo the proposed procedure.
The procedure was scheduled for 11 April 2018 to be done l ater during
the cause of the day. Due to a long list with numerous complex cases
the appellant was taken to theat re at 23h30. The diagnostic procedure
showed all grafts to be patent, poor condition of his native vessels and
his cardiac function and values to be within normal limits. The feel on
the wires had changed towards the end of the procedure. The
suspicion of an arterial dissection was entertained. The appellant was ,
however, asymptomatic. A diagnostic fluoroscopy was taken and
confirmed the presence of a dissection but with noted good flow and
with the appellant being asymptotic. A Doppler of the appella nt’s distal
pulses confirmed triphasic flow in theatre. The appellant was
immediately informed of the complication. He was transferred to the
ICU for monitoring and dual anti-platelet therapy.
[10] On 12 April 2018 the appellant was again advised of the
aforementioned complication. He was also given an overview of the
complication including the risks and management that was embarked
on. A CT coronary was performed, confirming the suspected
dissection. The seriousness with which the condition was treated was
emphasised by the fact that the appellant was kept in ICU until 14 April
2018 for close monitoring. The reason for the prolonged ICU
admission was also explained to the appellant. A repeat angiogram
was also performed on 14 April 2018 to ensure no extension of the
dissection. The appellant was discharged on 16 April 2018. After the
appellant was discharged in a satisfactory, stable condition on 16 April
2018, he was readmitted on 25 April 2018, complaining of symptoms of
shortness of breath and tiredness.
[11] On 26 April 2018 an arteria Doppler of the appellant’s lower limbs was
performed. This confirmed triphasic flow in both legs. The appellant
was requested to follow up on 15 May for review and discussion of the
outstanding blood results. The appellant failed to arrive for his
consultation on the said day. The consultation was rescheduled for 28
May 2018. Once again, the appellant failed to arrive for the
consultation.
[12] On 7 February 2019, an e -mail was received from the appellant,
complaining that he had developed chest pain. He was requested to
be consulted earlier than his scheduled consultation of 20 February
2019. He was also requested to have blood investigations performed .
On review of the results of the b lood investigations the appellant was
admitted to the hospital on 8 February 2019. Besides all the routine
tests requested, the condition of the appellant’s right lower limb was
emphasised. Pulses were again noted to be equal and palpable ,
implying no flow limitations around the appellant’s right leg.
[13] During the appellant’s admission from 8 February 2019 to 13 February
2019, an MIBI scan was performed, confirming no change in his
cardiac condition. Due to the ongoing unexplained symptoms, an
opinion was request from Dr R Kalpee, a certified rheumatologist at
Life Groenkloof Hospital. Dr Kalpee made special arrangements to
review the appellant at Zuid Afrikaans Hospital. Dr Gideon Naudé,
pulmonologist at Zuid Afrikaans Hospital also reviewed the appellant
and performed lung function tests. Both these specialists were of the
opinion that there was ongoing respiratory involvement from a
rheumatological condition. The appellant was not happy with the
opinion and had expressed his desire to seek another opinion. The
appellant was also not satisfied with the medication which had been
prescribed. The appellant was subsequently discharged from hospital.
[14] Between March and June 2019 the appellant consulted Dr Peet Viviers
and Dr Martin Bruwer. He underwent a lung biopsy on 19 March 2019
at the Wilgers Hospital. Two weeks after discharge the appellant
developed a bleed into his lung. He required emergency open lung
surgery which complicated with a fistula. He required 20 days of
drainage and hospitalisation. This, left the appellant with a right lung
that has been damaged, distorted and under expanded to the extent
that the appellant was consulted b y Dr Paul Williams at Milpark
Hospital in May 2019 with a view towards a lung transplant.
[15] The appellant argued in his grounds of appeal that the explanations
and facts presented by him to the board of inquiry were not taken into
consideration. There is no merit in this ground of appeal. For
example, the issues of negligence which was raised by the appellant
with regard to angiogram was equally considered with the response of
the second respondent who mentioned that the angiogram procedure
was performed by Dr Kurian and him, both being specialists.
[16] The appellant failed to demonstrate , clearly, his point that the clinical
notes presented by the second respondent had multiple
misrepresentions.
[17] The appellant argued also that he was not afforded an opportunity to
reply to the documents presented by the second respondent to the
board of inquiry. The appellant failed to explain whether the board of
inquiry was obliged to afford him an opportunity, and if so, in terms of
which rules of the board, is the board of inquiry obliged to do so. What
is crystal clear is that the appellant’s complaint was entertained by the
first respondent. The appellant acknowledges that his sickness is
complicated. He was sent from one specialist to another. A CT
coronary angiogram was performed on him on several occasions. For
all these reasons, we are unable to disagree with the decision of the
second respondent.
Therefore, the following order is made:
1. The appeal is dismissed.
2. No order as to costs.
M M MABESELE
JUDGE OF THE HIGH COURT, PRETORIA
I agree
BAM
JUDGE OF THE HIGH COURT, PRETORIA
Date of hearing: 6 August 2024
Date of judgment: 8 August 2024
APPEARANCES:
On behalf of the appellant: In Person
On behalf of the second respondent: Ms. Unity Ramaifo
Instructed by: MacRobert Attorneys
Brooklyn, Pretoria