Hospital responsible for child losing her vision facing multi-million rand lawsuit
GAUTENG health authorities are facing a multi-million rand damages claim after a little girl is now blind after she did not receive proper care at a state hospital after birth.
The child will turn nine later this year and her mother approached the Gauteng High Court, Pretoria, as she felt that her child’s condition is due to the alleged negligence of medical staff at the Thelle Mogoerane Hospital in Vosloorus.
It was argued on her behalf that doctors and nurses failed to adhere to the existing guidelines for the prevention, screening and treatment of the condition, known as retinopathy of prematurity.
This is described as an eye disease that can occur in premature-born babies when abnormal blood vessels grow in the retina – the light-sensitive area of the eye.
The child was born prematurely in September 2015.
Due to her extremely low birth weight and gestational age, it was mandatory in terms of the existing guidelines that she be screened for retinopathy of prematurity between four to six weeks’ chronological age and continually thereafter at one to two week intervals, as determined by the ophthalmologist.
Evidence during the trial established that the child was discharged from hospital when she was about 36 weeks old, with no follow up appointment for retinopathy of prematurity screening.
About five months later she was seen by a doctor at the hospital who diagnosed her with retinal detachment and retinal bleeds in both her eyes.
She was referred to St John’s Eye Clinic at Chris Hani Baragwanath Hospital, where it was confirmed that she is blind, due to bilateral stage five retinopathy of prematurity.
The experts were resolute in their findings that the failure of the hospital staff at Thelle Mogoerane Hospital to arrange proper and timeous screening appointments and discuss the risks and the importance of screening with her parents, led to the girl’s blindness.
The staff denied that they were negligent in any way. Judge Noluntu Bam said in what may be described as a total disregard of the guidelines, they claimed to have screened the child for retinopathy of prematurity during November 2015, when she was between four and six weeks old.
The hospital said it was not its responsibility to arrange follow-up appointments for the child upon her discharge.
A specialist explained to the court that the retina is the innermost layer of the eyeball responsible for interpreting impulses and it is photo-sensitive. When a pre-term baby is born, their eyes are not completely vascularised.
This means that the blood vessels in the retina are not completely formed. While the baby is still in the uterus, it is in an environment with poor oxygen supply.
However, the poor oxygen supply does not affect the baby as the placenta does everything for the baby, until the umbilical cord has been severed.
When a pre-term baby is born, they are suddenly in an environment that has more oxygen. As the baby starts growing and gaining weight and for complicated reasons, the vascularisation continues to grow, but in an uncontrolled fashion.
Due to the uncontrolled growth, the retina starts detaching. This is called retinal detachment and can lead to blindness.
The specialist further explained that retinopathy of prematurity is a major complication of pre-term birth. It varies from mild, which resolves spontaneously, to severe, leading to retinal detachment and blindness.
He said that irrespective of the underlying cause or additional risk factors, retinopathy of prematurity was widely regarded as a preventable cause of childhood blindness.
One of the most important aspects of prevention is ophthalmological screening and treatment of vulnerable infants.
The judge noted that the experts in this case spoke with one voice in regard to the risk of retinopathy of prematurity confronting vulnerable pre-term infants born with a low gestation age of 32 weeks and under, with a birth weight of 1 500g or less.
Even babies weighing between 1 500g and 2 000g are at risk of retinopathy of prematurity, according to the medical guidelines on the subject.
The experts were clear on the need to comply with the guidelines that existed long before the child in question was born, the need to discuss the risks of retinopathy of prematurity and the importance of screening with the parents of the infant.
They said had the guidelines been complied with, with the requisite standard of care, there was no good reason to doubt that the child, in all probability, should have vision today.
In light of this the court concluded that the medical staff were negligent and that this led to the child’s blindness.
The Gauteng Health Department was found to be liable for the damages which the mother could prove she and her child had suffered.
The amount payable will be determined at a later stage.