Sunday, May 22, 2022

New twist in malpractice suit as gynaecologist, GPH trade negligence accusations

Godfrey Ganetsang


Media personality Kagiso Malepa and his wife, Wally Malepa have been relegated to the sidelines and reduced to mere spectators in the case in which they are demanding P16 million in damages from Gaborone Private Hospital (GPH) for the death of their baby after delivery.


As the suit rages on, a bitter war of words has erupted between GPH and Dr Baron Matonhodze, the practicing obstetrician and gynaecologist who delivered the baby, as the two are accusing each other of negligence and breach of legal obligation to provide care, which led to the baby’s death. GPH has denied liability and filed a third party application for Dr Matonhodze to be declared the wrongdoer, or alternatively a joint wrongdoer. The gynecologist hit back with a scathing affidavit last week, in which he accused GPH’s midwifery, nursing and ancillary personnel of abdicating on their legal duty to render professional services to the couple. In his founding affidavit, Dr Matonhodze explained that he is one of the three specialist obstetricians and gynaecologists who lease consulting services to GPH. However, he said, by virtue of the obstetric model that prevails at GPH, there is no specialist obstetrician and practising gynaecologist permanently present at all times in the hospital’s labour ward.


“Consequently, patient care is premised upon independent yet synergic professional services by the admitting obstetrician and gynaecologist on the one hand and the midwives, registered nurses and ancillary personnel on the other,” he said.


He further explained that the midwives and nursing staff have their own professional obligations and independent scopes of practise. He added that he was informed of Mrs Malepas’ admission on the morning of 8th September and also received information concerning her maternal and foetal well being. He later performed a clinical examination of Mrs Malepa at around 15h00, assessed and perused the then available CTG and performed vaginal examination, which informed him that she had not yet commenced with contractions.

Before admission, Dr Matonhodze said he had extensively counselled Mrs Malepa on the fact that she was post dates and what that implied for her foetal wellbeing and future progress of her pregnancy.


“The entire consultation lasted approximately one hour. I also counselled the Malepas concerning induction of labour and they later decided upon using Misoprostol for induction,” he said.


After admission, he instructed the GPH nursing staff to continue with induction of labour by administering 25ml of Misoprostol in two hour intervals, and monitoring Mrs Malepa’s progress. The nursing staff was also instructed to await the artificial rupturing of Mrs Malepa’s membranes until her contractions were more regular and her cervix dilated to more than 3cm. They were also to notify Dr Matonhodze of any changes in her condition and foetal wellbeing. By 18h56, the nursing staff had still not communicated with Dr Matonhodze. He then phoned the hospital to ask after Mrs Malepa’s wellbeing and was informed, for the first time, of deterioration in her condition, which included deep decelerations in her CTG. He arrived at the hospital at approximately 19h10 and after examination immediately scheduled an emergency caesarean section. Dr Matonhodze said he has extensive experience in using Misoprostol and has authored publications on its use. He denied that the Misoprostol which he prescribed resulted in rupture of Mrs Malepa’s uterus.


“Whatever the cause of the uterine rupture, I believe the nursing staff did not timorously diagnose and inform me of the emerging indications of foetal distress,” said Dr Matonhodze.


He accused the GPH nursing staff of not informing him that they were administering pethidine on Mrs Malepa and failing to inform him of the occurrence of shallow decelerations on CTG.


“Had I been informed, I would have performed emergency caesarean section, thereby preventing occurrence of uterine rupture and preventing foetal mortality. In the premises, I deny that I am liable to make payment to the Malepas and that I was negligent in the execution of my professional obligations to them. I did not cause the death of Malepa’s infant,” said Dr Matonhodze.


He further argued that the Malepas were admitted to the care of qualified, registered and practicing midwives employed by and acting in furtherance of the interests of GPH, for the purposes of induction of labour. In admitting the Malepas, said Dr Matonhodze, GPH and its nursing staff acquired a legal duty to render professional midwifery, nursing and associated services with the degree, skill and expertise they possessed and without negligence. Such legal duty was also owed by GPH staff to himself, as the obstetrician and practising gynaecologist.


“In executing those nursing services, GPH staff was enjoined to perform all reasonably indicated clinical assessments, at reasonable intervals to satisfy themselves upon the maternal and foetal conditions of Mrs Malepa,” he said.


He also argued that GPH nursing staff were enjoined to perform CTG monitoring of Mrs Malepa and her unborn foetus at reasonable intervals and for appropriate periods; and to correctly assess the CTG tracings. Further, they were enjoined to administer treatment that he had prescribed from time to time and subject to their independent, professional knowledge and expertise and their scopes of practice. Dr Matonhodze further argued that GPH personnel were enjoined to report on Mrs Malepa’s maternal well being at reasonable intervals and to immediately and timeously inform him of any alteration on her condition. Dr Matonhodze went on to accuse GPH personnel of breaching their legal duty to the Malepas by rendering nursing services in a negligent manner.


“GPH’s midwifery, registered nursing and ancillary personnel did not perform reasonably indicated clinical assessments of Mrs Malepa at reasonable intervals, and thereby failed to satisfy themselves concerning her maternal and foetal well being,” he said.


Further, said Dr Matonhodze, because they failed to perform and correctly assess CTG monitoring of Mrs Malepa at reasonable intervals and for appropriate periods, GPH personnel were unable to timeously notify him of her foetal condition. He also accused GPH personnel of failing to comply with his prescription and protocol and exercise their professional knowledge and expertise in circumstances where they could have done so.


Dr Matonhodze further revealed that when he performed an emergency caesarean section on Mrs Malepa, he established that she had suffered a sustained vertical, anterior and midline rupture of the uterus from the fundus to the lower segment, and that her baby was intra-abdominal and later died on September 9th 2014. In conclusion, Dr Matonhodze argued that he never breached his legal and professional obligation to the Malepas, saying their child died because of the negligence of GPH personnel. He further denied that he is a wrongdoer, or alternatively a joint wrong doer with GPH in respect of the damages suffered by the Malepas and said he was not entitled to contribution or indemnity of GPH. He therefore pled with the court to dismiss GPH’s third party application with costs.


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