Michael and Another v Linksfield Park Clinic (Pty) Ltd and Another (1) [2001] ZASCA 55 (30 March 2001)

The plaintiff's son, Minas, suffered a cardiac arrest and brain damage during a routine nose operation. The central issue in the case was whether the cause of the cardiac arrest was cocaine toxicity, as the defendants argued, or the administration of propranolol by the second defendant, an anesthetist, as the plaintiffs alleged.

Minas, aged 17, had a sports injury that required rhinoplasty. The operation was performed at Linksfield Park Clinic by Dr Fayman, assisted by Dr Rubin, with the second defendant, Dr Thomas, acting as an anesthetist. A registered nurse, Sister Glaeser, was the anaesthetic sister assigned to the operation.

During the operation, Minas suffered a hypertensive crisis, which the second defendant attributed to insufficient anaesthesia. He administered propranolol to counter this. Soon after, Minas's heart rate and blood pressure rapidly declined, leading to a cardiac arrest. The second defendant attempted resuscitation, including using a Lohmeier defibrillator. However, Sister Glaeser observed that the defibrillator's digitally displayed charge reduced before each shock was administered, which led her and the second defendant to believe it was defective. Another defibrillator was fetched, and the fourth shock restored Minas's heartbeat.

The trial court found that cocaine toxicity likely caused the cardiac arrest. It also found that the second defendant had given untruthful evidence about the administration of propranolol and falsely claimed to have changed the ECG leads. However, the court accepted his other evidence and held that the defendants were not liable for negligence. The plaintiffs appealed.

The Court of Appeal examined the evidence in detail and found that the cardiac arrest was likely caused by cocaine toxicity, rather than propranolol. It also found that the second defendant's diagnosis of the cause of the hypertensive crisis as too light an anaesthesia and his responses to it were reasonable. Further, the Court found that the arrest was not foreseeable as a reasonable possibility and that even if it had been, it would not have been preventable.

Regarding the resuscitation process, the Court held that it could not be proved that a functional defibrillator would have restored Minas's heartbeat earlier. It was also held that the first defendant clinic had not adequately trained its staff in the use of the Lohmeier defibrillator, but that this negligence had not caused any delay in the resuscitation. The ignorance of the second defendant and Sister Glaeser about the workings of the Lohmeier was also negligent, but no delay resulted from this.

In conclusion, the Court sympathised with the plaintiffs but dismissed the appeal, finding that the defendants were not liable for negligence. Due to the second defendant's dishonesty during the trial, the question of costs was postponed to allow him to make submissions.

The ratio decidendi, or core legal principle established in this case, is that:
1. A court evaluating expert testimony in a medical negligence case must determine whether it is logically sound, and is not bound by the consensus of the experts. The court must assess the reasonableness of the defendant's conduct and the causation of the harm, even if the expert evidence supports the defendant.
2. Regarding the cause of the patient's cardiac arrest, cocaine toxicity was the most probable cause, and propranolol was not the cause or a contributing cause. The quantity of cocaine used was within safe limits, and its toxic effects were not foreseeable. The defendant's diagnoses and treatments were reasonable.
3. Regarding the resuscitation process, it was not proved that a functional defibrillator would have restored the patient's heart beat earlier. Though the defendants were negligent in not adequately training staff in using the defibrillator, this negligence did not cause any delay. The second defendant's ignorance about the defibrillator was also negligent, but it did not result in any delay.
4. The plaintiffs' claim for negligence was not proven, and therefore the appeal against the dismissal of the claim fails. The dishonesty of the second defendant (the anesthetist) during the trial merits consideration of a special costs order and a referral to the Health Professions Council.



The court referred to the general test for professional negligence, which is the standard of conduct of a reasonable practitioner in the particular professional field. The court emphasised that this criterion can be difficult to apply in practice, especially when the experts themselves disagree on what is reasonable.

The judges agreed with the principles established by the House of Lords in Bolitho v City and Hackney Health Authority ([1998] AC 232), a medical negligence case. The court highlighted that the logical basis of expert opinion should be examined, and the court is not bound by expert opinion supporting the defendant's conduct. The opinion of professionals must be capable of logical support, and the court should not simply prefer one expert over another.

The judgment also referred to a warning issued by the House of Lords in a Scottish case, Dingley v The Chief Constable, Strathclyde Police (200 SC (HL) 77), about the risk of "being seduced into a position" where the court applies the standards of proof used by the expert.

Finally, the court referred to the principle that expert witnesses tend to assess likelihoods in terms of scientific certainty, which can differ from the judicial standard of proof.