Case Law[2023] ZAGPPHC 1219South Africa
Mulder v Dr. Kuhn (41405/2019) [2023] ZAGPPHC 1219 (22 September 2023)
High Court of South Africa (Gauteng Division, Pretoria)
22 September 2023
Judgment
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# South Africa: North Gauteng High Court, Pretoria
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## Mulder v Dr. Kuhn (41405/2019) [2023] ZAGPPHC 1219 (22 September 2023)
Mulder v Dr. Kuhn (41405/2019) [2023] ZAGPPHC 1219 (22 September 2023)
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sino date 22 September 2023
IN THE HIGH
COURT OF SOUTH AFRICA
GAUTENG
DIVISION, PRETORIA
Case
number: 41405/2019
Date
of hearing: 14 August- 25 August 2023
Date
delivered:
22
September
2023
REPORTABLE:
YES
/NO
OF
INTEREST TO OTHER JUDGES:
YES
/NO
REVISED
DATE:
22/9/22
In
the matter between:
ANDRIES
HERMANUS MULDER
Plaintiff
and
DR.
A.W.D. KUHN
Defendant
JUDGMENT
SWANEPOEL
J:
[1]
Plaintiff, a 69 years
old male, sues the defendant, a specialist orthopaedic surgeon, for
damages allegedly arising from a total
right knee replacement
which defendant performed on 17 May 2016. Plaintiff alleges various
grounds of negligence. They can
all be summarized as follows:
Plaintiff alleges that in the period 30 May 2016 to 15 June 2016
defendant failed to recognize the
threat of infection in the knee,
and he failed to take proper and more aggressive steps to deal with
an infection. Plaintiff says
that he is a type-2 diabetic, and that
added care had therefore to be taken in treating possible infections.
The result is, plaintiff
says, that the undiagnosed infection
culminated in the amputation of plaintiff's right leg above the knee
on 21 May 2018.
[2]
At the commencement
of the trial, at the
instance of the parties, I granted an application in terms of rule 33
(4) for the separation of the merits
and quantum. Therefore, only the
issue of liability is before me.
It is common cause that
defendant had a duty of care to act with the skill and expertise
reasonably expected from a specialist orthopaedic
surgeon. Two
questions have to be answered. The first is whether it can be held
that the amputation of plaintiff's leg was the
result of an infection
which was present when defendant examined plaintiff post-operatively
on 31 May 2016 and 6 June 2016, in
other words, whether the
defendant's alleged failure to recognize the infection during the
examinations, and to aggressively act
to treat the infection, has
been proven to be causally connected to the loss of plaintiff's leg.
The second question is whether
defendant was negligent, in other
words, whether the standard of care was less than that expected of a
specialist orthopaedic surgeon.
[3]
The outcome of this
matter revolves substantially around a consideration of the evidence
as there are two diametrically opposing
versions presented by the
parties. Plaintiff says that although he had had knee problems in the
past, by 2016 the pain in his knees
had become worse, and that his
right knee was especially painful. Plaintiff approached defendant,
and after he was examined, defendant
recommended a total right-knee
replacement. In anticipation of the operation, plaintiff was required
to attend a presentation by
defendant in order to prepare him (and
other patients) for the operation. At the presentation defendant
explained exactly what
the operation entailed, and what possible
complications may arise.
[4]
The operation on 17 May
2016 evidently went well, and plaintiff was discharged on 20 May
2016. A follow up consultation was scheduled
for 30 May 2016. It is
at this point that the parties' versions start to differ. Plaintiff
says that the dressing on his wound
was removed by the wound nurse,
who was later identified as Sister Helen Wolfaardt. Plaintiff's wound
was adhered by metal clips.
When Sister Wolfaardt looked at the
wound, plaintiff says, she remarked that it did not look good. He
says the defendant also examined
the wound, and that he also told
plaintiff that the wound did not look good. He said that he ought to
take plaintiff to theatre,
but would rather wait another week. The
clips were not removed, and plaintiff left
the
rooms with only a crepe
bandage covering the wound.
[5]
Plaintiff says he was
told to come back again on 6 June 2016, but in the meantime
the wound was to be
cleaned every second day with a salt-water solution. Plaintiff was
told to purchase bandages and to apply them
after the wound had been
cleaned. On 6 June 2016 plaintiff again attended at defendant's
rooms. He says that the wound looked rotten
at the bottom of the
wound, and there was a rotten bloody fluid discharging from the
wound. The clips were removed, a transparent
plaster was applied, and
plaintiff was sent home. Plaintiff says that his wife continued to
clean the wound with the salt-water
solution every second day, and
she also applied a BC 56 solution as prescribed by defendant.
Plaintiff says that the
wound continued to discharge a fluid at the distal end of the wound.
He says that the wound kept opening
up. On 15 June 2016 defendant was
seen by Dr. Dindar, his local doctor. Dr. Dindar was evidently
concerned at the appearance of
the wound. He sent defendant a
photograph of the wound. whereupon defendant insisted on admitting
plaintiff to hospital immediately.
[6]
Upon admission to
hospital plaintiff was taken to theatre, and a debridement of the
wound was performed. Various debridements of
the wound followed
later, and a skin transplant was performed. Eventually, some four
weeks after being admitted to hospital for
the second time, defendant
referred plaintiff to Dr. Charles Olivier for treatment. Plaintiff
says that defendant
told him that Dr.
Olivier was a friend of his, and that defendant would take it on
himself (sal dit op horn vat), intimating that
defendant had admitted
to some wrongdoing. Plaintiff's further treatment has no bearing on
this case, save to say that, tragically,
plaintiff's leg had to be
amputated on 21 May 2018.
[7]
Various photographs of
the wound were entered into evidence by the plaintiff. The
photographs only came to the fore shortly before
the matter was to be
heard on 9 May 2022, and their production resulted in the matter
having to be postponed. On 22 September 2022
plaintiff deposed to an
affidavit in terms of rule 35 (3) in which he stated that he was
unaware who the author of each photograph
was, nor did he recall the
dates on which they were taken. It was only later that plaintiff was
able to determine on what days
the photographs were taken, and that
they had been taken by his daughter. He was adamant that Photograph 1
was taken on 1 June
2016, Photograph 2 on 8 June 2016, and Photograph
3 on 13 June 2016.
[8]
Plaintiff also entered
a document titled "Mislukte knie vervanging" into evidence.
Evidently, after plaintiff was referred
to an attorney, he was asked
to prepare a summary of events. He testified that he compiled the
document on 18 July 2017. He dictated
the document, and his daughter
typed it for him. In cross-examination plaintiff testified that the
document was produced in 2016.
He then corrected himself and said
that it was drafted in July 2017. When it was pointed out that the
document contained a reference
to his amputation, which happened in
2018, plaintiff was adamant that it had been drafted in 2017. When
the Court asked him whether
the document had been drafted in one
sitting he confirmed that it had, only later to change his version to
say that the document
had been supplemented afterwards.
[9]
It was put to plaintiff
that defendant would deny saying, on 31 May 2016, that he should take
plaintiff to theatre, but rather to
wait a week. It was also
put
to
plaintiff
that
when
the
wound
was
examined
on 6
June 2016 it was
healthy and dry, and consequently the clips were removed. Plaintiff
denied the allegation and stated that the wound
was still 'septic' at
that stage.
[10]
It was also put to plaintiff that the history of events upon which
plaintiff's experts, Drs. Birrel and Naude,
a specialist orthopaedic
surgeon had partially based their conclusions, and which had been
provided to them by plaintiff, differed
substantially from the
plaintiff's version in court. For instance, Dr. Birrel was told that
at the first post-operative examination
(presumably on 30 May 2016)
some clips were removed but the remainder of the clips remained in
situ for another two weeks. In fact,
no clips were removed on 30 May
2016. According to Dr Birrel plaintiff was told to go to his general
practitioner for wound care
every two to three days. Plaintiffs
evidence was that he was told to clean the wound himself with a
salt-water solution every two
days. Dr Birrel makes no mention at all
of the examination on 6 June 2016 when the clips were taken out. In
re-examination plaintiff
tried to repair the damage done by these
contradictions by saying that Dr. Birrel must have misunderstood him,
or he misinterpreted
what was said to him.
[11]
Mrs Mulder attended
both the examinations on 30 May and 6 June 2023 respectively.
She
essentially
confirmed
plaintiff's
version.
Mrs. Mulder says that
on both occasions
she
sat in the examination
room in close proximity
to the examination bed. She heard Sister Wolfaardt remark on 30 May
2016 that the wound did not look good.
She also heard defendant say
that he should take plaintiff to theatre, but would rather wait a
week to see how the wound then looked.
Mrs. Mulder said that they
were told to go home and wait a week, but that the wound should be
cleaned with a salt-water solution
every two days. She says that the
wound was only covered with a crepe bandage, and not a clear plaster
as it had been when plaintiff
was discharged on 20 May 2016. She
testified that the wound had a dark colour to it at the bottom of the
wound, which she found
concerning. She was also present at the second
post operative examination on 6 Ju8ne 2016. On this occasion the
clips were
removed, although she could not remember who removed them.
They were told to purchase a salve, 856, to apply to the wound, and
to keep on cleaning the wound with the salt-water solution. Mrs
Mulder says that the wound was not healthy and dry on 6 June 2016,
but that it was wet, draining a dirty fluid, and that it did not look
healthy.
[12]
With regard to the
photographs, Mrs. Mulder testified that she and plaintiff had had
discussions regarding the dates on which the
photographs were taken.
She could not remember whether her daughter was part of those
discussions. They also discussed the events
that had occurred. She
admitted that when they could not remember a certain aspect, they
would talk about it and would jog each
other's memories. With regard
to the summary document, she said that she could not remember when it
was drafted, but she was certain
that it had been drafted before the
amputation, which is obviously not possible.
[13]
Dr.
Charles
Olivier
testified
for
plaintiff.
He
specializes
in complicated
orthopaedic surgeries. Defendant is well known to him as they
specialize in
the
same field. Dr.
Olivier
was handed the
report
of Prof. A.L. van Gelder (who is deceased), and was asked to provide
comment on its findings. Professor van Gelder based
his opinion on
facts of unknown origin. The most significant
facts that he
considered are that when plaintiff went to see defendant on 30 May
2016 the wound was allegedly draining and 70 mm
of the wound was
still open. Prof. Van Gelder reported that some of the clips were
removed on 30 May 2016, which is not correct.
He says that on 6 June
2016, at the second examination, the wound was swollen, red and
tender.
[14]
Prof. Van Gelder
believed, based on the facts at his disposal, that defendant had been
negligent in not diagnosing an underlying
deep wound sepsis. Whether
Prof. Van Gelder examined plaintiff and obtained the above history
from him is uncertain. Suffice it
to say that Dr. Olivier based his
opinion fully on the report of Prof. Van Gelder. Having studied Prof.
Van Gelder's report Dr
Olivier was of the opinion that Prof. van
Gelder correctly believed that defendant had
"underestimated
the high risk for infection in diabetic patients;
as
a
Joint infection it
is
a
severe
complication that needs early and aggressive management. Earlier
follow-up after post-operative discharge
was
indicated. He missed
a
golden
opportunity to recognize the beginnings of deep wound
sepsis
when he
saw
the patient the 30th
May 2016."
[15]
Dr. Olivier also
examined the photographs. In a joint minute he agreed with Dr. Vlok,
defendant's expert, that Photograph 1 was
likely taken on 1 June
2016, Photograph 2 between 10 and 12 June 2016, and photograph 3
between 12 and 15 June 2016. With regard
to photograph 1, Dr. Olivier
said that the main area of concern was in the distal (bottom) part of
the wound, where there was early
sign of necrosis of the soft tissue.
He said that this area is generally particularly precarious due to
its reduced vascularity.
He believed that the wound broke down in
this area (Zone 3) which compromised
the healing of the
wound, and could have caused necrosis of the tissues.
[16]
In cross-examination it
was pointed out to Dr. Olivier that a number of the assumptions upon
which Prof. Van Gelder based his opinion
were incorrect. For
instance, the wound was not gaping open 70 mm on 30 May 2016, no
clips were removed on that date, and the wound
was found to be red
and swollen on 15 June 2016, and not on 30 May 2016. Dr. Olivier had
never seen the defendant's clinical notes
until they were presented
to him in cross-examination. They record the following on 30 May
2016:
"Clips not
removed. Wound oozing. To come back at 1/52. Robert Jones applied
with postop opsite."
On 6 June 2016 the notes
recorded:
"Clips removed.
Wound healthy and dry. To come back at 6/52. Postop Opsite applied."
[17]
It was put to Dr.
Olivier that when defendant saw plaintiff on 30 May 2016 the wound
was mildly draining a clear fluid. There was
no visible necrosis, but
the wound had not healed sufficiently that that the clips could be
removed. There was no sign of infection.
Dr Olivier could not dispute
this. Dr Olivier said that if a wound is draining slightly, it would
be appropriate to immobilize
the wound to give it a chance to heal,
which is exactly what defendant did by applying a Robert Jones
dressing. Dr. Olivier said
that it was reasonable practice to then
schedule a consultation a week later, as defendant
did. Dr. Olivier could
not fault defendant for not conducting blood tests given the
condition of the wound as it was described in
the clinical notes.
[18]
Dr.
Olivier
expressed
his
disbelief
that
defendant
would
instruct plaintiff to
wash the wound every two days, and he said that it specifically did
not make sense to clean the wound with
a salt-water solution. He
confirmed that Photograph 1 did not show any necrosis.
It was put to Dr
Olivier that on 6 June 2016 the wound was healthy and there was no
sign of infection. He could not dispute that
this may have been so.
In essence, Dr Olivier confirmed that if defendant's evidence, and
his clinical notes were to be believed,
no negligence could be
ascribed to defendant. Dr. Olivier testified that he could not say
that defendant should have taken any
other course of action. He also
said there could have been multiple reasons why plaintiff's leg was
eventually amputated.
[19]
Defendant
testified that he is a
specialized
general
orthopaedic surgeon.
Currently,
some 70%
of his surgeries are
elective in nature, with an emphasis on arthroplasty. He confirmed
that he operated on plaintiff on 17 May
2016, and discharged him on
20 May 2016 after a postop opsite dressing was applied. He scheduled
a consultation with plaintiff
for 30 May 2016. On 30 May 2016
plaintiff was first examined by Sister Wolfaardt, who had been in
defendant's employ since approximately
2002.
[20]
Sister Wolfaardt
reported that there was slight oozing from the wound. When defendant
examined the wound, he found it to be largely
well-healed. The distal
1/3 of the wound was, according to Sister Wolfaardt oozing fluid,
although defendant did not obseNe the
oozing himself. The wound edges
were aligned and there were no indications of skin problems.
Defendant said that if a wound is
oozing fluid, it is not fully
healed. Most of the wound was healthy, not swollen nor red, but the
distal part of the wound was
concerning. Defendant wanted to check
the oozing at a later date, and decided to leave the clips in and to
examine the wound a
week later. He says that it is important to keep
a wound waterproof, and that is why a postop opsite dressing is
applied.
[21]
Defendant saw plaintiff
again on 6 June 2016. The wound was healthy and dry and the clips
were removed. A postop opsite dressing
was applied, and an antibiotic
cream (BC 56) was prescribed. Defendant vehemently denied that he
would ever instruct a patient
to clean the wound with a salt-water
solution. When plaintiff returned on 15 June 2016 the wound was in
need of debridement and
plaintiff was immediately taken to surgery.
[22]
In cross-examination
defendant
vehemently
denied the Mulders'
version. He said that, although he was somewhat concerned at the
state of the wound on 30 May, 2016, when he
saw it on 6 June 2016 it
was healthy and dry. When he was asked to comment on Photograph 1,
which was taken two days after the
examination on 30 May, defendant
said that it had clearly deteriorated
between 30 May and 1
June 2016. Defendant said that had he seen the wound as it was
depicted on Photograph 1, he would not have
taken plaintiff to
theatre, but he would have performed blood tests. He says that the
wound must have improved between 1 June and
6 June 2016. Photograph
2, which was taken between 10 and 12 June 2016 showed a clearly
unhealthy wound, defendant testified.
[23]
It
was put to defendant
that on 30 May 2016 the
wound
was red, swollen and
hot. He testified that had the wound been in that condition, he would
have picked it up, but he had no reason
for concern on 30 May 2016.
Defendant confirmed that on 30 May a Robert Jones bandage was
applied, but he denied that plaintiff
would have left the
consultation without an opsite dressing being first applied directly
to the wound. Defendant testified that
he believed that plaintiff had
a hematogenous infection which spread internally, but, he said, he
never saw any signs of infection.
[24]
Sister Wolfaardt has
been a qualified nurse since 1977, and she confirmed that she was the
author of the clinical notes written
on 30 May and 6 June 2016. She
explained that on 30 May 2016 she observed slight oozing
of
fluid
from
the
wound, which
caused
her to
call defendant
to examine plaintiff.
Defendant decided to leave the clips in situ, and to see plaintiff
again a week later. Sister Wolfaardt testified
that if she wrote on
the clinical note that she had applied a dressing, she would have
done so. She is adamant that she applied
a postop opsite dressing and
a Robert Jones pressure bandage. She denied that she would ever tell
a patient to wash a wound with
a salt-water solution. She told
plaintiff to return in a week. She always tells patients to advise
defendant if they have any concerns
about a wound. She saw plaintiff
again on 6 June 2016, at which time the wound was healthy and dry. If
it had been wet, open and
swollen she would have noticed, and she
would have written her observations
on the clinical notes.
Similarly, had there been any sign of necrosis she would have
recorded same. She was shown Photograph 3 (taken
on or about 13 June)
and she said that the wound did not look at all on 6 June 2016 as it
is depicted on the photograph.
[25)
Dr Vlok testified on behalf of defendant. He is also an orthopaedic
surgeon. He said that if there were copious amounts
of drainage from
the wound, it could be an indication of an infection. It would be
appropriate not to operate immediately, but
rather to monitor the
wound. Mild oozing, in Dr Vlok's opinion, is not indicative of
infection. He said that one has to have regard
to the smell of the
fluid, its volume and colour, and also at the state of the
surrounding tissue. It is quite possible for the
knee to be infected
without any clinical signs being present. Dr Vlok is of the view
that, given defendant and Sister Wolfaardt's
description of the
wound, it would not have been necessary to perform blood tests.
[26]
Importantly, Dr. Vlok
confirmed Dr. Olivier's evidence that it is possible that a wound
could display certain characteristics on
30 May 2016, then
deteriorate within a matter of two days, and then recover to appear
well healed some five days later. It is therefore
quite possible that
the wound did not merit great concern on 30 May 2016, deteriorated
slightly and then recover so as to appear
healthy and dry on 6 June
2016.
[27]
In my view the issues
to be determined are the following:
[27.1] Which version is
to be believed, that of plaintiff and Mrs Mulder, or that of
defendant and Sister Wolfaardt?
[27.1] If the version of
plaintiff and Mrs. Mulder is to be believed, then has plaintiff
proven:
[27.1.1]
that the probable cause of the amputation was an infection in the
wound that existed between
30 May 2016 and 6 June 2016? and,
[27.1.2]
if the answer to paragraph 28.1.1 is in the affirmative, then has
plaintiff proven on a balance of probabilities
that defendant was
negligent in not identifying a possible infection, and in not taking
more aggressive action to treat a possible
infection?
[28]
Plaintiff
referred me to the case of
Stellenbosch
Farmers' Winery Group Ltd
and
Another
v
Martell
ET
Cl
and
Others
[1]
which
provides
guidelines
at
to
the
manner
in
which
disputes
of
fact
should
be
approached. In that case the judgment commences with the words
"Recollection
can be fallible",
which
seems to me to be equally as applicable to this case. As in
Stellenbosch,
we
have irreconcilable disputes of fact in this matter.
[29]
In
Stellenbosch
the Court said:
"To come to a
conclusion on disputed issues a court must make findings on (a) the
credibility of the various factual witnesses;
(b) their reliability;
and (c) the probabilities. As to (a), the court's finding on the
credibility of a particular witness will
depend on its veracity of
the witness. That in turn will depend on a variety of subsidiary
factors, not necessarily in order of
importance such as (i) the
witnesses' candour and demeanour in the witness box, (ii) his bias,
latent and blatant, (iii) internal
contradictions in his evidence,
(iv) external contradictions with what was pleaded or put on his
behalf, or with established fact
or with his own extracurial
statements or actions, (v) the probability or improbability of
particular aspects of his version, (vi)
he calibre and cogency of his
performance compared to other witnesses testifying about the same
incident or events. As to (b),
a witness' reliability will depend,
apart from the factors mentioned above, on (i) the opportunities he
had to experience or observe
the event in question and (ii) the
quality, integrity and independence of his recall thereof. As to (c),
this necessitates an analysis
and evaluation of the probability and
improbability of each party's version on each of the disputed issues.
In the light of its
assessment of (a), (b) and (c) the court will
then, as a final step, determine whether the party burdened with the
onus of proof
has succeeded in discharging it."
[30]
At the outset
I
must say that
I
believe
that the plaintiff
and Mrs. Mulder were
honest witnesses,
who
were relaying what they believe to be the true version of events.
What does concern me regarding their evidence is the reliability
thereof. Mrs. Mulder testified that plaintiff had suffered many
injuries over the years, and they had attended many doctor's
appointments
together. It would not be surprising if they were to
conflate different doctor's visits. They could hardly have known,
when they
attended the examinations by defendant, that they would
have to testify about the events some eight years later. There is no
reason
to believe that they would have a particular recollection of
these two consultations, what was said, and how the wound looked at
each stage.
[31]
What
is
concerning
about
their
evidence
is
the
fact
that
Mrs. Mulder testified
that they did in fact have memory lapses regarding the events of May
and June 2016, but that they spoke to
one another about their
recollections, and where necessary, they jogged each other's memory.
I do not think, in those circumstances,
that they can be said to have
an independent recollection of the events about which they are
testifying.
[32]
Plaintiff's evidence
concerns
me
on two
specific
aspects. Firstly, he
was adamant that the document titled
"Mislukte
knie vervanging"
was
drafted on 17 July 2017. Mrs. Mulder was also certain that the
document was drafted before the plaintiff's leg was amputated
on 21
May 2018. When plaintiff was confronted in cross-examination with the
fact that the document could not possibly have been
drafted in 2017,
as it referred to the amputation in 2018, plaintiff refused to
concede that he was wrong. When the Court asked
plaintiff whether the
document had been
compiled on one occasion, plaintiff said that it had been. Shortly
thereafter plaintiff testified that the document
had not been drafted
in one sitting, but had been supplemented later.
[33]
It concerns me that
plaintiff was prepared to adapt his evidence in this manner.
Furthermore, on 22 September 2022 plaintiff deposed
to an affidavit
that he did not know when the photographs referred to above were
taken, or by whom. After some discussion, it seems,
plaintiff
remembered that his daughter had taken the photographs and exactly on
what days they were taken. These discussions between
plaintiff, his
wife and his daughter hardly fills one with confidence as far as
plaintiff and his wife's independent recollection
of events is
concerned.
[34]
As
far
as
defendant
and
Sister
Wolfaardt
are
concerned,
I
take heed of the fact
that it would be virtually impossible for them to remember each
patient that they see, and that the eight-year
delay in bringing the
case to trial must of necessity have had an effect on their
recollections. However, it must be borne in mind
that less than two
weeks after the 6 June consultation, defendant was faced with a
patient with serious complications to his wound.
After treating
plaintiff for some weeks, defendant decided to refer him to Dr.
Olivier for more specialized assistance. The particular
case must
have made some impact on defendant, probably making it easier for
defendant to recollect the events of May and June 2016.
Furthermore,
defendant's recollection is supported by his clinical notes (albeit
that they were written partially by defendant and
partially by
Sister Wolfaardt).
Defendant also drafted three contemporaneous reports, and one written
on 9 May 2017, which described the plaintiff's
condition and the
treatment that was administered.
[35]
There
is
no
suggestion
that
the
clinical
notes
are
false.
The suggestion is
simply that they are not accurate. However, in respect of the
important aspects of the case, they are clear. When
defendant saw
plaintiff on 30 May 2016 the wound had not healed fully, and was
oozing fluid. Sister Wolfaardt testified that if
there had been
continuous draining of fluid from the wound, she would have made a
note thereof. When defendant saw plaintiff on
6 June 2016 the wound
was healthy and dry. I cannot believe that Sister Wolfaardt would
make such a note when the exact opposite
was the case.
[36]
The probabilities also
favour defendant. It was evident that he is a careful surgeon. He
went out of his way to hold pre-operative
briefings to describe in
detail to each patient what each procedure entailed, and what the
possible pitfalls may be. It is improbable
that on 30 May defendant
would be so concerned about the wound that he would say that he
should take plaintiff to theatre, and
then not do so. It is also more
probable than not that had defendant seen a wound on 6 June 2016 that
appeared as the Mulders described,
he would have taken immediate
steps to determine the cause of the problem. It is improbable that he
would have simply taken out
the clips and sent the Mulders on their
way.
[37]
Dr. Olivier testified
that if the accepted facts are as defendant testified, then there is
no basis to believe that defendant was
negligent. His view was
confirmed by Dr. Vlok. There is nothing to gainsay their evidence. I
accept the defendant's
version of events.
[38]
Having
made
the
above
finding,
that
is
the
end
of
the
matter. However, it is
possibly important to deal with defendant's contention that plaintiff
did not establish causation; that at
the time of the examinations on
either 30 May 2016 or 6 June 2016 there was an infection present in
plaintiff's knee joint, and
that the infection was caused the
plaintiff to lose his leg. That would normally be the first question
to be decided, because,
if causation is absent, negligence
is irrelevant.
[39]
I cannot find any
evidence to suggest that, on the probabilities, there was an
infection present in the plaintiff's leg on either
30 May or 6 June
2016. There is, moreover, no evidence that an infection that was
present during either
of those consultations eventually resulted in the loss of plaintiff's
leg. If there had been evidence to the
effect, for example, that the
knee had been infected on 6 June, and that a delay in treating the
infection resulted in the amputation
of the leg, that would have been
sufficient evidence to find for plaintiff on the probabilities.
However, there was no such evidence,
and in Dr. Olivier's own words,
there may be multiple reasons why the leg had to be amputated. In my
view, plaintiff has also not
established causation.
[40]
In the premises I make the
following order:
Plaintiff's claim is
dismissed with costs.
SWANEPOEL
J
JUDGE
OF THE HIGH COURT
GAUTENG
DIVISION PRETORIA
COUNSEL
FOR PLAINTIFF:
Adv.
S Joubert
SC
ATTORNEY
FOR PLAINTIFF:
Kriek
Wassenaar & Venter Inc.
COUNSEL
FOR DEFENDANT:
Adv.
E Botha
ATTORNEYS
FOR DEFENDANT:
MacRobert
Inc
DATE
HEARD:
14
-
25
August 2023
DATE
OF
JUDGMENT:
22
September
2023
[1]
2003
(1) SA 11
(SCA)
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