Cape Town - Groote Schuur Hospital, one of the country’s foremost hospitals, came in for criticism in the Supreme Court of Appeal on Friday when Judge Carol Lewis said it had been “undoubtedly negligent” in that it had taken two hours for a critically injured teenage rugby player to be seen by a doctor.
He then lay waiting in a corridor for a further four hours, the judge said, presiding over an appeal in the case of Charles Oppelt, now 29, who was left permanently paralysed and a tetraplegic after a rugby injury in 2002.
Oppelt, who was playing for the Mamre Rugby Club at the time of the incident, successfully sued the provincial Health Department in the High Court here. But the department appealed, and that challenge was heard on Friday by five appeal judges, with Judge Lewis presiding.
In the spotlight during argument on Friday were Groote Schuur’s standard admission, treatment and referral procedures as the court probed why Oppelt had not been taken immediately to Conradie Hospital, which specialised in the treatment of spinal cord injuries such as that suffered by Oppelt.
Advocate Theoniel Potgieter, SC, for the department, denied there had been any negligence in Oppelt’s case. He said the protocol Oppelt claims should have been followed in his case was appropriate for rugby injuries, but that the department could not shape its policies based on the needs of such a small group.
Potgieter said it could not be expected that the department, with its “vast public responsibilities and limited resources”, should “focus for a certain time each year – the rugby season – on an extremely limited number of patients – rugby players who suffer spinal injuries”.
In particular, it was not reasonable to expect that the department should meet the timeline for treatment of such injuries recommended by one of the department’s specialists, orthopaedic surgeon Dr Dennis Newton.
This was a reference to evidence given in the High Court by Newton who said that if a patient with a spinal cord injury like Oppelt’s was treated “within four hours”, the chances of a good recovery were far greater.
The court debated the significance of “Newton’s theory”, with both sides to the dispute, and suggested that his “theory” was not necessarily good science because of shortcomings such as the limited sample of cases.
However, all parties agreed that time was of the essence in such cases, and that the earlier the treatment the better the chances of recovery.
Willie Duminy, SC, for Oppelt, said based on agreement that treatment to spinal cord injuries should take place as soon as possible, and leaving aside Newton’s particular theory, the department still had major difficulties in showing that it was not negligent.
First, a close study of events after the accident showed that it should have been possible for Oppelt to have reached Conradie Hospital within the four hour “window” anyway.
Any time taken beyond that was evidence of negligence.
If each link in the chain had acted properly, if all the procedures had been followed correctly, the operation on Oppelt could have been completed “within three hours and with no fuss”.
Second, even without Newton’s theory, medical evidence by other experts in the trial had made the urgency of such cases clear.
According to that evidence, the physiological facts were well known: quick and urgent action was needed to reverse the interruption of blood supply caused by such an accident.
Newton had told the court that “any general practitioner” would know that if the blood supply to human neurological tissue was cut for longer than four hours it would result in irreversible damage.
In other words, Duminy argued, all reasonable medical practitioners would know that corrective procedures should be carried out as quickly as possible, and that action within the first four hours was critical.
Judge Lewis and other members of the Bench asked whether it was more probable than not that dealing with Oppelt’s injuries only 13 hours after the accident would have led to paralysis.
But Potgieter said that Oppelt’s case was tied to the first four hours.
According to Potgieter, the response of medical personnel at each step had been reasonable; and if reasonable action by the department’s personnel could still only have resulted in treatment outside that four hours, then the High Court judgment would have to be overturned. The court has reserved judgment, but its decision will be critical for Oppelt.
He has significant ongoing medical expenses and struggles to make a living selling groceries out of a garage shop. If the department wins the appeal, Oppelt will be faced with enormous legal costs; if the appeal is dismissed, the case will go back to the High Court to determine what compensation he should be paid by the department.