Judge praises staff at Red Cross Hospital
- A child was admitted to Red Cross Hospital in January.
- To survive, she needed her legs amputated, but her parents refused for cultural and religious reasons.
- After an extensive effort to resolve the situation, the hospital went to court, and the parents ultimately did not oppose the application.
- The Western Cape High Court gave the hospital the go-ahead to carry out the operation.
- Last week Judge Mas-udah Pangarker handed down reasons for her ruling.
Staff at Cape Town's Red Cross Memorial Children's Hospital have been praised for their sensitive handling of a difficult case in which the parents of a six-year-old refused to give consent for her to undergo a double-leg amputation, based on cultural and religious grounds.
But ultimately, Western Cape High Court Judge Mas-udah Pangarker said that while she would not lightly interfere with the parents' rights, intervention was necessary in terms of the Children's Act. She gave judicial go-head for the surgery.
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Pangarker made her ruling in early March following an urgent application by the hospital -- which was ultimately not opposed by the parents -- but she only handed down her reasons on Friday.
Read the judgment
The judge described the lengths that the staff had taken to accommodate the parents' wishes as "nothing short of admirable".
This included permitting traditional healers to visit the child in hospital and give their advice on treatment.
They also made contact with the family's cultural leaders in the Eastern Cape and asked the family advocate for advice.
In her founding affidavit, Dr Jessica Browne, the medical services manager, said the child had suffered from meningococcal septicaemia, a blood infection which caused poor circulation.
The little girl -- identified in the judgment as AD -- had been critically ill when admitted to the hospital in January and was in septic shock. She later developed gangrene in both feet.
The only treatment available was a below-knee amputation of the left leg and a Syme amputation (removal of the foot, leaving the heel pad to allow for mobility) of the right.
Browne said because the sepsis could spread it was imperative that the surgery take place as soon as possible.
However AD's parents had refused to give consent, saying they wished to explore traditional medicine and healing because, in their view, this would cure her.
Browne said the parents said this had to take place in the Eastern Cape and wanted AD discharged. Her father indicated that he would not bring her back to the hospital afterwards.
At that time, however, AD was on strong medication, including morphine, because of the severe pain in her feet.
After having an "ethics meeting", which included experts from the University of Cape Town, a decision was taken in her "best interests" not to discharge her and after further discussions, the medical team agreed to involve a traditional healer or cultural advisor in an attempt to accommodate and respect the parents' wishes.
The staff invited a traditional healer of the father's choice to assess AD. He said he could cure her with oral medication, topical creams and ointment.
However, the hospital made it clear that it could not allow traditional healing within its premises.
A second traditional healer, who is also a psychologist, was arranged by PaedsPal to discuss the matter with the father. But he stood firm.
Eventually in late February, the hospital's clinical team, social workers and nurses met with the father again "impressing upon him the seriousness of his daughter's condition".
A second traditional healer then assessed AD. He said he would use oral traditional medication and lotion, which would cure her feet but his plan might fail.
"As before, the difficulty which the hospital faced was that traditional healing was not allowed on the premises," Pangarker said.
Hospital staff then asked to speak to the parents' cultural elders.
A doctor and social worker spoke to the father's uncle who said he was aware of the situation but "the family had no intention of changing their minds".
The judge said on the day of the hearing, she was informed that the mother had eventually consented to the surgery.
However, the father had not. He also did not attend court.
Pangarker said Browne had approached the court under the provisions of the Children's Act because of the real and imminent risk to AD's health and life.
"It was clear that should the infection spread further in AD's right foot, the result would be a below the knee amputation instead of a Syme amputation. In those circumstances, AD's mobility would be hugely impaired if not non-existent."
The Judge said notwithstanding that the parents had not opposed the application "it was a difficult and grave matter which weighed heavily on all".
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"I was mindful that the impact on the child, the parents and the rest of the family, must surely be profound and devastating," she said, noting that applications dispensing with parental consent were rare.
She said that while the Constitution protected the right to religion, belief and opinion and to participate in a cultural life, AD also had rights to dignity, life and basic health care.
The hospital had made all efforts to respect the parents' dignity and beliefs and to obtain their consent for surgery.
"In my view, the hospital displayed a level of sensitivity and respect for the family's religious and cultural beliefs which was nothing short of admirable," the judge said.
But neither of the traditional healers who assessed AD had provided a medically accepted alternative.
The act, read with the Constitution, stated that in all matters involving minor children, the best interests of the child was paramount and the high court was the upper guardian of all children.
"The [urgent] surgical intervention requested was, in the circumstances, the best medical treatment available for AD. In view of the evidence, she would still, post-rehabilitation and with the provision of prosthetics and physiotherapy, be mobile," Pangarker said, granting the order.
