Lee V Minister of Correctional Services (2011) JOL 27141 (WCC) PDF

LeevMinisterofCorrectionalServices
[2011]JOL27141(WCC)
Reportedin: JudgmentsOnline,aLexisNexisElectronicLawReportSeries
CaseNo: 10416/04
JudgmentDate(s): 11/03/2011
HearingDate(s): NoneIndicated
Markedas: Reportable
Country: SouthAfrica
Jurisdiction: HighCourt
Division: WesternCape,CapeTown
Judge: DeSwardtAJ
Bench: AMdeSwardtAJ
Parties: DudleyLee(P)TheMinisterofCorrectionalServices(D)
Appearance: AdvIJTrengove,JonathanCohen&Associates(P)AdvIJamieSC,
MsDPillay,TheStateAttorney(D)
Categories: ActionCivilSubstantivePrivate
Function: ConfirmsLegalPrinciple
Relevant
UniformRulesofCourt
Legislation:
KeyWords
DelictClaimfordamagesNegligentomissionUnlawfulness
MiniSummary
Theplaintiffwasdetainedinthemaximumsecurityprisonforaperiodofapproximately4yearsfromNovember
1999to27September2004whilehewasontrialintheregionalcourt.Whileincarcerated,hebecameillandwas
diagnosedassufferingfrompulmonarytuberculosis("TB").Afterhisreleasefromprison,pursuanttohisacquittal
onthecriminalchargeswhichhadbeenpreferredagainsthim,theplaintiffinstitutedanactionfordamagesagainst
thedefendantonthebasisthatthedefendant'sservantsattheprisonhadbytheirconduct,whetheractingwith
doluseventualisornegligently,causedhimtobecomeinfectedwithTB.Thatwasbasedontheallegationthat
prisonerswereusuallyhousedincloseproximitytoeachotherandthattherewaswidespreadinfectionwithTB.He
alsocomplainedofinadequatenutritionandtreatmentreceived.
Thedefendantdeniedthatheorhisemployees,orpersonsorlegalentitiesrepresentinghim,actedunlawfully,
committedanynegligentactsoromissions,orbreachedanystatutoryand/orcommonlawdutyvisavisthe
plaintiff.
Heldthatalthoughtheplaintiff'stestimonywasnotalwayspreciseorclear,thecourtacceptedhisevidenceashe
cameacrossastryingtohonestlygiveanaccurateaccountofhistimeinprison.
Inordertoestablishaclaimindelict,aplaintiffhastoprovethatthedefendantnegligentlycommittedanactwhich
wasunlawfulandthattheactsocomplainedofwascausallyrelatedtotheharmwhichensued.
Onthebasisoftheevidencebeforeit,thecourtfoundthattheconductofthedefendantandhisofficialsinomitting
totakestepstoguardagainstthespreadofTBinthemaximumsecurityprisonwasunlawful.Thedefendantwas
declaredliableindelicttotheplaintiff.
Page1of[2011]JOL27141(WCC)
DESWARDTAJ:
[1]PollsmoorPrison("Pollsmoor"),asitiscommonlyknown,isinfactaprisoncomplexconsistingoffivedifferent
prisons:theadmissionscentrewhichisalsoknownasthemaximumsecurityprison,thewomen'sprison,the
juvenileprisonandthemediumsecurityprisonsBandCforsentencedprisoners.
[2]Theplaintiffwasdetainedinthemaximumsecurityprisonforaperiodofapproximately4yearsfrom
November1999to27September2004whilehewasontrialintheRegionalCourt(hewastemporarilyoutonbail
fromJanuarytoApril2000).InJune2003,whilsthewasincarcerated,hebecameillandwasdiagnosedassuffering
frompulmonarytuberculosis
("TB").Aftertheplaintiff'sreleasefromprison,pursuanttohisacquittalonthecriminalchargeswhichhadbeen
preferredagainsthim,theplaintiffinstitutedanactionfordamagesagainstthedefendantonthebasisthatthe
defendant'sservantsattheprisonhadbytheirconduct,whetheractingdoluseventualisornegligently,causedhim
tobecomeinfectedwithTB.ByagreementbetweenthepartiesandintermsofUniformRule33(4)thecourtgranted
anorderthatthemeritsoftheplaintiff'sclaimweretobeadjudicateduponseparately,priortothequantumofthe
plaintiff'sallegeddamagesbeingdealtwith.
[3]TheplaintiffwasrepresentedintheactionbyMrIJTrengove,actingoninstructionsofMrJCCohenofattorneys
JonathanCohen&Associates.ThedefendantwasrepresentedbyMrIJamieSC,assistedbyMsDPillay,actingon
instructionsofMrCJBenkensteinoftheStateAttorney.
[4]Thetrialofthematterranforaperiodofsome21daysfrom210December2009andfrom125February
2010.Argumentwasheardon16March2010.Theevidenceanddisputesbetweenthepartieswillbedealtwith
hereinascomprehensively,butsuccinctly,asispossible.Thefactthataparticularaspectofevidenceorargument
whichwasraised,isnotdealtwithexpressly,however,doesnotmeanthatithasnotbeenconsidered.
Theissuesonthepleadings
[5]TheplaintiffallegedthattheresponsibleauthoritieswereemployeesoftheStateandoftheDepartmentof
CorrectionalServices("theDCS"),whoactedwithinthecourseandscopeoftheiremployment.Thedefendant,in
hisplea,interalia,admittedresponsibilityforthecontrolandmanagementofthecorrectionalfacilitywherethe
plaintiffwasdetained,thathewasresponsiblefortheaccommodationandmanagementofallprisonersandthat
hewastheemployerofthepersonswhotreatedtheplaintifffromabout23November1999until27September
2004.Defendant,however,averredthatthemanagementoftheprisonanditsinmates,inclusiveofthepolicies
whichwereapplicableatthetime,wasconductedwithintheambitoftheCorrectionalServicesAct111of1998and
oftheConstitutionoftheRepublicofSouthAfrica,1996("theConstitution").
[6]Intermsofhisamendedparticularsofclaim,theplaintiffformulatedhisclaim(asfarasthemeritsare
concerned)asfollows:
"7. DuringtheperiodofthePlaintiff'simprisonment:
7.1 itwascommonforprisonersintheprison,includingthePlaintiff,tobecongregatedinclose
proximitytooneanotherandtobehousedinmasscells
7.2 aconsiderableproportionofprisonersintheprisonwereactivelyinfectedwithtuberculosis
7.3 itwasconsequentlyinevitablethatsomeoftheprisonersactivelyinfectedwithtuberculosis
wouldinfectnoninfectedprisonersincloseproximitytothemwithtuberculosis.
8. DuringtheperiodofthePlaintiff'simprisonmenttheresponsibleauthoritieswereawareofthe
presenceoftuberculosisintheprisonandoftheconcomitantriskofnoninfectedprisonersbeing
activelyinfectedtherewith,shouldinfectedprisonerscomeintoand/orremainincloseproximity
withthem.
9. DuringtheperiodofthePlaintiff'simprisonmenttheresponsibleauthoritiescouldhave:
9.1 eliminatedorcurtailedthespreadoftuberculosisbycreatingconditionsintheprisonwhich
madeitimpossibleordifficultfortuberculosistobespread
9.2 avoidedorminimisedtheriskofinfectionwithtuberculosisby:
9.2.1 separatingactivelyinfectedprisonersfromnoninfectedprisoners
9.2.2 regularandeffectivecheckupsofprisonerstodeterminewhetherornottheywere
activelyinfectedwithtuberculosis,andifso,byprovidingregularandeffective
treatmentforthecontrolandeliminationofthedisease.
10. DuringtheperiodofthePlaintiff'simprisonmenttheresponsibleauthoritiesfailedtotakeanyor
adequatesteps:
10.1 toeliminateorcurtailthespreadoftuberculosisor
10.2 toavoidortominimisetheriskofinfectionwithtuberculosis.
11. DuringtheperiodofthePlaintiff'simprisonmenttheresponsibleauthoritiesinstead:
11.1 failedtoactandignored(sic)andallowedtuberculosistobespreadamongstprisoners
unabatedand
11.2 failedtoadheretotherequestsofprisonersforproperand/oradequatetreatmentto
preventand/ortreatand/orcurethoseactivelyinfectedorpotentiallyactivelyinfectedwith
tuberculosis.
12. Thefailureonthepartoftheresponsibleauthoritiestoactasaforesaidwasnotnecessaryforthe
achievementofanyofthepurposesforwhichtheywerevestedwiththeirpowersofcontroland
managementoftheprison
13. Throughouttheperiodoftheplaintiff'simprisonment:
13.1 hewasincarceratedincellswithmorethanoneprisoner
13.2 itwasalwayslikelythathewouldbecomeinfectedwithtuberculosisbyactivelyinfected
prisoners
13.3 hewasconsequentlyatriskoftuberculosisinfection
13.4 heremainedinconstantcloseproximitytoprisonersactivelyinfectedwithtuberculosis
13.5 hewasnotspecificallyawarewhichprisonerswereactivelyinfectedwithtuberculosis
14. DuringtheperiodofthePlaintiff'simprisonmenthebecameinfectedwithtuberculosis.ThePlaintiff
doesnotknowwhenthishappenedbutbecameawareofitduringoraboutJune2003.
15. DuringtheperiodofthePlaintiff'simprisonmenttheresponsibleauthorities:
15.1 failedtotakeanyoradequatestepstoprotectthePlaintiffagainsttheriskoftuberculosis
infection
15.2 failed,oncethePlaintiffhadbeendiagnosedasactivelyinfectedwithtuberculosis,to
providethePlaintiffwithadequatemedicaltreatmentand/ormedicationtocureand/or
preventthefurtherspreadthereof
15.3 failedtoadheretothePlaintiff'snumerousrequestsforadequatetreatmentforthecureof
and/orpreventionofthefurtherspreadofthetuberculosiswithwhichhehadbecome
contaminated.
16. Theconductoftheresponsibleauthoritieswasunlawfulinthat:
16.1 theconductoftheresponsibleauthoritiesduringtheperiodofthePlaintiff'simprisonment
violatedthePlaintiff'srightsdescribedbelow,atcommonlaw,undertheCorrectional
ServicesAct8of1959('theAct')andundertheConstitution
16.2 theirconductviolatedhiscommonlawrightstorespectforandprotectionofhisphysical
integrityduringhisimprisonment
16.3 theirconductviolatedhisrightsimpliedbytheActandparticularly,Sections2(2)a(sic),
2(2)b(sic),23(2),69(a)and79(1)e(sic)thereoftorespectforandprotectionofhisphysical
integrityduringhisimprisonment.[TheseprovisionsofthesaidActwerestillapplicableuntil
31July2004whentheprovisionsofthenewCorrectionalServicesActNo111of1998with
regardtothetreatmentofprisonerscameintooperation.]
16.4 Theirconductviolatedhisrightsundertheconstitution(sic)andparticularly,thefollowing:
16.4.1 hisrightsintermsofSection35(2)e(sic)thereoftobedetainedunderconditions
consistentwithhumandignity,andtobeprovidedwithadequateaccommodation,
nutritionandmedicaltreatmentatstateexpense
16.4.2 hisrightsintermsofSection12(1)thereoftofreedomandsecurityoftheperson
16.4.3 hisrightsintermsofSection12(1)(d)and(e)thereofnottobesubjectedto
tortureofanykind,whetherphysical,mentaloremotional,andnottobesubjected
tocruel,inhumanordegradingtreatmentorpunishment
16.4.4 hisrighttolife,intermsofSection11thereof
16.4.5 hisrightintermsofSection10thereoftorespectforandprotectionofhisdignity.
17. Theresponsibleauthoritiesknewduringtheperiodoftheplaintiff'simprisonmentthattheir
conductplacedprisonersatriskoftuberculosisinfectionand,inthepremises,theyactedasthey
diddoluseventualis,alternativelynegligently.
18. Butfortheconductoftheresponsibleauthorities:
18.1 thePlaintiffwouldnothavebeenexposedtoprisonersactivelyinfectedwithtuberculosis
18.2 thePlaintiffwouldhavehadaccesstoandsoughtpropertreatmentofactiveinfectionby
(sic)tuberculosis
18.3 thePlaintiffwouldnothavebecomeactivelyinfectedwithtuberculosis
18.4 thePlaintiff'sactivetuberculosisinfectionwouldhavebeentreatedandcuredearlier
19. Inthepremises,theconductoftheresponsibleauthoritiescausedtheplaintiff'sactiveinfection
withtuberculosis."
[7]Defendantdeniedtheaforegoingallegationsmadebytheplaintiffinhisparticularsofclaimanddenied,in
particular,thatheorhisemployees,orpersonsorlegalentitiesrepresentinghim,actedunlawfully,committedany
negligentactsoromissions,orbreachedanystatutoryand/orcommonlawdutyvisvistheplaintiff.Inhisplea,
thedefendantdenied"theallegationsofwidespreadtuberculosisinfectionandspreadoftuberculosisamongst
prisoners"andalleged,interalia,that:
" 5.1.1 IncompliancewiththeprovisionsoftheActandtheConstitutionalframework,Defendantis

responsiblefortheaccommodationandmanagementofallprisoners.[TheActreferredtoby
DefendantisthenewCorrectionalServicesActNo111of1998.]
5.1.2 Defendantprovidesprimaryhealthcareservicesinlinewiththerequirementsofthe
NationalDepartmentofHealth.
5.1.3 Inadministering,controllingandminimisingthegeneralriskoftuberculosisinfection,
Defendantutilisesthenationalhealthpolicyandtreatmentguidelinesissuedbythe
relevanthealthauthorities.
5.1.4 Defendant'shealthandmedicalpolicies,proceduresandimplementationstrategiesarein
fullcompliancewiththeNationalTuberculosisControlProgramme.
5.1.5 Atallmaterialtimes,prisoners,includingPlaintiff,whoexhibitsymptomsoftuberculosis
infectionand/orarediagnosedwithtuberculosisinfection,arehenceforthconfinedand
treatedwithinthemedicalunitsofthecorrectionalfacilityuntiltheperiodofsuchinfectivity
elapses.
6.1.2 AtallmaterialtimesDefendantprovidesanddispensesmedicaltreatmenttoprisonersin
accordancewiththeprovisionsoftheActandConstitution.
6.1.3 IndealingwithtuberculosisspecificallyDefendantimplementstheNationalTuberculosis
ControlProgramme,andutilisesthefollowingproceduresandpoliciesinminimisingtherisks
oftuberculosisinfectionandpreventingfurtherproliferation:
6.1.3.1 Defendantpleadsthatearlydetectionordiagnosisoftuberculosisoccurswhen
prisonersshowordisplaysymptomsofthe(sic)activetuberculosis.
6.1.3.2 Followinguponthediagnosisoftuberculosisinfection,theprisonerisimmediately
quarantinedinthemedicalunit,awayfromotherprisoners,andatreatmentphase
commences.
6.1.3.3 Medicalofficersincontrolofthemedicalunitswithinthecorrectionalfacilitymonitor
andtreatinfectedprisonersduringtheisolationperiodandthetreatmentphase.
6.1.3.4 Prisonersaresenttothenormalprisonunitsand/orcommunalareaoncethe
customaryperiodofriskofinfectiontootherprisonershaspassed.
6.2 DefendantpleadsthatatallmaterialtimesheretoDefendantand/orDefendant'semployees
utilise(sic)allreasonablecareanddiligenceinimplementingrelevanthealthproceduresand
policies,includingabidingbythenationalhealthproceduresandpolicies,inordertominimisethe
riskofinfectionandproliferationoftuberculosisamongstprisoners.
...
7.1.4 Plaintiffwasdiagnosedwithtuberculosisonorabout10June2003.
7.1.5 Plaintiffwasconfinedtothemedicalunitandbegantuberculosistreatmentonthesame
day.Theabovementionedmedicalsectionisseparateandgenerallyisolatedfromother
prisonsectionsandgeneralcommunalareas.
7.1.6 Thetuberculosistreatmentwassuccessfullycompletedwithinsixmonthsofcommencement.
Plaintiffrespondedtoalltreatmentandvarioussputumtestsconductedaftercompletionof
Plaintiff'streatmentyieldednegativeresultsfortuberculosisinfection.
7.1.7 DefendantpleadsthatitutilisedallreasonablecareanddiligenceduringPlaintiff's
imprisonmentandinthediagnosisandtreatmentoftheplaintiff'stuberculosisinfection."
ThenatureandtreatmentofTB
[8]Itwascommoncausebetweentheparties'respectiveexpertsthatTBisacontagiousinfectionwhichiscaused
byanairbornebacterium,mycobacteriumtuberculosis.Itisadiseasewhichhasbeenaseriouspublichealth
problemforhundredsofyears.Itisfoundworldwide,althoughitappearstobemorecommonindeveloping
countriessuchas,forexample,
SouthAfrica,wherethemajorityofthepopulationtendstobepoorandtendstoliveincrowdedconditionsthatare
conducivetothespreadofthedisease.Indeed,SouthAfricaappearstohaveoneofthehighestincidenceratesof
TBintheworld.
[9]Apersonwhoisactivelyillwiththediseaseisabletotransmitthedisease,becausebacteriawouldbeexpelled
fromthebodyduringsneezing,coughing,orspitting.Thebacteriumisvulnerabletosunlightandfreshair,butifitis
expelledinaclosedenvironmentsuchas,forexample,bysomeonecoughinginapoorlyventilatedroom,itcandrift
aroundforhours.Similarly,ifphlegmisspatontothegroundandisnotcleanedbymeansofspecialantibacterial
antisepticsincircumstanceswherethereisalackofsunlightandagooddraughtofair,itcouldremaininfectivefor
anextendedperiodoftime.SomepersonswhoareillwithTBshedmorebacteriathanothersandareknownas
"supershedders".
[10]NoteverypersonwhohasbeenexposedtotheTBbacteriumbecomesillwiththedisease.Indeed,ifaperson
isexposedtothebacterium,oneofthreethingsmayhappen:
1 thebody'simmunesystemmaydestroythebacterium,inwhicheventtherewillsubsequentlybenosignthat
thepersonwaseverexposedtoit
2 thebody'simmunesystemcouldwalloffthebacteriuminatinypieceofscartissue,referredtoasa
granuloma.Insuchevent,thebacteriumwouldremaindormantandthepersonwouldnotbe
awareofthefactthatinfectionhasoccurred.Thesubclinicalinfectionwould,however,remainandthe
dormantbacteriumcouldsubsequentlybecomeactive,evenmanyyearslater.Inthelatterevent,theperson
wouldbecomeillwiththedisease
3 thebacteriumcouldtakeholdandmultiply,causingthepersontobecomeactivelyillwithTB.
[11]ItisnotionallypossibletoestablishwhetherornotapersonhasinthepastbeeninfectedwiththeTB
bacteriumevenifhe/shedidnotbecomeillwiththedisease.Askintestmaybeperformed,whichentailsthe
injectionofanextractmadeofthecellwallofthebacteriumundertheskinoftheforearm.Suchinjectioncausesa
swellingtoappearandapproximately36hourslater,theswellingismeasuredinordertoestablishwhetherornot
apositiveresulthasbeenobtained.Inthenormalcourseofevents,however,personsarenotsubjectedtoskin
tests,interalia,becauseitinvolvesaninvasiveprocedure.WhenapersonbecomesillwithTB,itisaccordinglynot
usuallypossibleestablishdefinitivelywhethersuchillnessistheresultofdormantbacteriahavingbecomeactive
(referredtoinevidenceasreactivation),orwhetheritistheresultofafreshinfection(referredtoinevidenceas
reinfection).
[12]TherearealsothreefactorsthathaveabearingonwhetherornotapersonwhohasbeenexposedtotheTB
bacteriummaydevelopasubclinicalinfectionorbecomeactivelyillwiththedisease:
1 thevirulenceofthebacterium
2 thedoseofthebacteriumwhichhasbeeninhaledthelargerthenumberof
bacteriawhichhavebeeninhaled,thegreaterone'schancesofdevelopingthediseaseand
3 theresistanceofthepersonconcernedtotheoffendingbacteriumpersonswhoseimmunesystemhave
beencompromised,orwhosufferfromanotherillnessthatmightcontributetotheloweringoftheirimmunity,
suchas,forexample,thosesufferingfromdiabetesmellitus,cancerorHIVareatgreaterriskfordeveloping
thedisease.SmokersalsohaveahigherriskfordevelopingTB.
[13]PulmonaryTBisdiagnosedbymeansofsputumtestsandcultures,aswellasXRaysofthelungs.XRay
findingsontheirownare,however,notnecessarilyconclusive.Sputumsamplesareaccordinglynormallysentoffto
alaboratoryforanalysis.Thelaboratoryfirstperformsamicroscopicanalysisofthesputumsample.Suchprocedure
takesatrainedtechnicianapproximately1hourtoperform.Microscopicanalysisrevealswhetherornotthe
bacteriumispresentandthelaboratorycustomarilyprovidesapreliminaryreportoncesuchanalysishasbeen
completed,usuallywithinaperiodofapproximatelytwodays.Microscopicanalysis,however,doesnotdisclose
whetherthebacteriumisaliveornot.Ifbacteriaarepresent,theseareaccordinglygrowninaculture,aprocess
whichcantakeuptosixweeks,becausetheTBbacteriumisveryslowgrowing.Ifthecultureyieldsapositive
result,itisindicativeofactiveTBinfection.
[14]ThestandardtreatmentforTBconsistsofacombinationoffourdifferent
antibiotics,referredtoas"RegimenI".MultidrugresistantTB("MDRTB")istreatedwithdifferentantibioticswhich
arereferredtoas"RegimenII".Aftertwoweeksoftreatmentwithsuchantibiotics,thepatientwouldnolongerbe
contagiousorinfective,butpatientsonRegimenIhavetocontinuetakingthemedicationonfivedaysoftheweek
foraperiodofsixmonths.Ifpatientsdonotcontinuetreatmentforthefullperiodofsixmonths,thediseasecould
flareup,causingthemtobecomeinfectiousagain.Moreimportantlythough,failuretocompletethefullcourseof
antibioticsoversixmonthscouldcausethebacteriumtobecomeresistanttotheantibioticswhicharenormally
used.Insuchacase,thepatientwoulddevelopMDRTB.PatientswithMDRTBhavetocontinuetreatmentfora
periodinexcessofsixmonths.ThereisevenafurtherconditionknownasXTRTB(extremeresistanceTB),whichis
particularlydifficulttotreat.
[15]ByreasonofthefactthatTBisanairbornedisease,itsspreadisfacilitatedifmanypeopleliveinclose
proximitytoeachother.Poorventilationandinadequatesunlightfurthercontributetothespreadofthedisease.
PoornutritionalsoplaysaroleinthetransmissionofTB,inasmuchaspersonswhoaremalnourishedfrequently
sufferfromacompromisedimmunesystem.
[16]TBisanotifiabledisease.IfapersonisdiagnosedasbeingillwithTB,suchfactmustbereportedtothe
authoritiesintheinstantcase,totheMedicalOfficerofHealthoftheCityofCapeTown.
[17]In2000,theDepartmentofHealth("theDOH")atNationallevelpublishedamanualentitled"TheSouth
AfricanTuberculosisControlProgrammePracticalGuidelines"("theguidelines").Theguidelinesacknowledgethat
thecureratefordetectedsmearpositivecasesofTBhasnotexceeded50%inmanypartsofthecountryandthat
thisisaseriousproblem.Theguidelinesrecognisethat:
"(A)nimportantfactorcontributingtoalowcurerateispoorpatientcomplianceindetectedcases.Once
thesymptomsoftuberculosislessen,patientsfinditdifficulttocontinuetreatment.Incomplete
treatmentcanresultininfectiouspatientswithchronictuberculosiswhocontinuetotransmitthe
infection.Itmayalsoleadtothedevelopmentofdrugresistantstrainsoftuberculosis.Therefore,itis
importanttoincreasepatientcompliance."
[18]TheguidelinesforthetreatmentoftuberculosisarebasedonaDirectlyObservedTreatmentShortcourse
Strategy("DOTS").Accordingtotheguidelines:
"DOTSputsthepriorityoncuringinfectiouspatientsanditscoreelementsare:
sustainedTBcontrolactivities.
Sputumsmearmicroscopytodetecttheinfectiouscasesamongthosepeopleattendinghealth
carefacilitieswithsymptomsofTB,mostimportantlycoughofthreeweek's(sic)duration.
StandardizedshortcourseantiTBtreatmentwithdirectobservationoftreatment.
AnuninterruptedsupplyofTBdrugs.
Astandardizedrecordingandreportingsystemwhichallowsassessmentoftreatmentresults.
...
Shortcoursechemotherapyisacombinationofpotentantituberculosisdrugs(isoniazid,rifampicin,
pyrazinamide,streptomycinandethambutol).Ithasaninitialintensivephaseof23monthsanda
continuationphaseof47moremonths.Everydoseofrifampicinshouldbeobserved,atleastinthe
intensivephaseofthetreatment...."
[19]TheDOTSsystemoftreatment,asthenameimplies,iscalculatedtoensure
thateveryTBpatienthasthesupportofanotherperson"toensurethattheyswallowtheirmedicationdaily".Such
asupporterneednotbeahealthcareprofessional,butanyresponsiblememberofthecommunitymayactassuch.
[20]IntermsoftheDOTSsystem,eachpersonwhoisdiagnosedasbeingillwithTB,receivesaPatientTreatment
Card(suchasExhibitK)which,intheinstantcase,wasgreen.Thecardhasbeendesignedtoreflectthepatient's
personaldetails,suchashis/hernameandidentitynumber,whetherthepersonisanewpatientoronewhohas
previouslydefaulted,theresultofsputumtests,theidentityofthetreatmentsupervisorand,mostimportantly,a
dailyrecordofthemedicationbeingadministered.Thepatientissupposedtocarrythiscard.Inadditiontothe
patienttreatmentcard,theclinicorhospitaltreatingthepatientisalsosupposedtocompleteaClinic/HospitalCard
(suchasExhibitL)which,inthiscase,wasblue.Thehospitalcardhasbeendesignedtoreflectinformationsimilar
tothatprovidedforonthepatienttreatmentcard,butinadditionisintendedtoprovide,interalia,arecordofother
medicalconditionsandprogressnotes.
[21]Hospitalsandclinicsapparentlyalsousea"TBTreatmentWheel"(suchasExhibitN)tokeeptrackof
treatment.Thetreatmentwheelconsistsofthreeplasticcoatedcirclesofpaperwhichhavebeenclampedtogether.
Thecentrecirclecontainsdetailsofthemonthsandweeksoftheyear,muchlikeacalendar,printedonbothsides.
Oneithersideofthecalendarsoprovided
isanothercircleonedealingwiththetreatmentofnewpatientsandtheotherdealingwithretreatments.The
treatmentwheelhasbeendesignedsoastoshowataglancethedateswhenfollowupsputumsmearswouldbe
dueandthedateswhenadjustmentswouldneedtobemadetothemedication.
Thewitnesses
[22]Theplaintifftestifiedinsupportofhiscaseandfourwitnesseswerecalledonhisbehalf:DrsTheronand
Craven,twomedicaldoctorswhohadbeenemployedasparttimedistrictsurgeonsatPollsmoorprisonMrFrans
Muller,amalenurseformerlyemployedattheprisonandMrsJudyAnneCaldwell,aTBProjectManageremployed
bytheCityofCapeTown.Twowitnessestestifiedonbehalfofthedefendant:MrJeromeGertse,aprofessional
nursewhostillworksatthemaximumsecurityprisonandProfessorPaulDavidvanHelden,aprofessorinthe
employoftheUniversityofStellenbosch,whospecialisesintuberculosisresearch.
[23]Theplaintiffwas63yearsoldatthetimeofthetrialandwouldturn64on13April2010.Asachild,helivedin
EdenvaleuntilhereachedStandard1.Somewhatlater,hemovedtoSedgefieldbeforerelocatingtoCapeTownin
1996.InCapeTown,heinitiallylivedinHarfieldVillage,Claremont,foraperiodof2or3years,whereafterhe
movedtoPlumstead(amiddleclasssuburbSouthofCapeTown),wherehesharedahousewithafriend.
[24]Theplaintiffwasselfemployed.Hehadacarpetandupholsterycleaningbusinessandsoldwatches,which
broughthimanincomeofatleastR10000permonth.Healsoboughtpreownedcars,repairedtheseandsold
themon.Theplaintifflikedtoplaydartsandpoolandspentafairamountoftimeinpoolhallsandbars.
[25]DrPaulAlexanderTheronobtainedaBScdegreeinMedicinefromtheUniversityofCapeTownin1969and
obtainedthedegreesMBChBfromthesameuniversityin1974.Hehasbeenaqualifiedmedicalpractitionerfor35
yearsandwasemployedasaparttimedistrictsurgeon(nowreferredtoasaclinicalforensicpractitioner)forthe
WynbergareainCapeTownforaperiodof24years.Inhisaforesaidcapacity,heworkedatPollsmoorfrom1997
2007.HewasanemployeeoftheProvincialDOHaswellasofDCS.
[26]DrTheroncommencedhispractiseofmedicineintheruralhospitalsinKwaZuluNatal.Oneofthesewasthe
CharlesJohnsonHospitalwhereaDrAnthonyBarkerwasincharge.DrBarkerwashighlyregardedinthemedical
communityforhisworkwithTBpatientsandalthoughitwasasmall,lowcost,communityhospital,itattracted
doctorsfromallovertheworld.DrTheronworkedthereonthreeseparateoccasionsfortwotothreemonthsata
time.TherewasahighincidenceofTBinthecommunityandduringthecourseofhisworkatsuchhospital,
DrTheronwasexposedtoDrBarker'sapproachtothepreventionandtreatmentofTB.
[27]DrTheronwasessentiallyemployedinthe"MediumA"prison.Hewas,however,alsoinvolvedwiththe
maximumsecurityprisonwheretheplaintiffwasdetained.HewasthechairpersonoftheClinicalForensic
PractitionersAssociationfortheperiod19982008.ThemembersoftheaforesaidAssociationheldmeetingsona
regularbasisandthesituationatPollsmoorwasdiscussedatthesemeetings.Hewasaccordinglyinformedwith
regardtothehealthsituationinthedifferentsectionsoftheprisonand,inhiscapacityasthechairpersonofthe
Association,liaisedwiththeauthoritiesinthisregard.DrTheronalsoworkedinthemaximumsecuritysectionofthe
prisonfromtimetotimewhenhestoodinforDrCraven.Indeed,DrTheronworkedinalloftheprisonsatPollsmoor
atonetimeoranother.
[28]DrTheroncameintoconflictwiththeDCSoverthehealthissuesatPollsmoorwhichwerereportedtothe
PortfolioCommitteeofParliamentandtotheInspectingJudgeofPrisons.Litigationfollowedandinsettlement
thereofhewasappointedtoSomersetHospitalinFebruary2008.
[29]DrTheronconsidershimselftobeanexpertinregardtothecontracting,transmissionandspreadofTBand
hashadmanyyearsofexperienceinthetreatmentofthedisease.Hehaslecturedonthetopicatuniversitylevel.
[30]DrStephenAdrianCravenqualifiedattheUniversityofOxfordinEnglandin1970.Hehasbeenpractisingasa
medicaldoctorforaperiodof30years.
HeisalicentiateoftheRoyalCollegeofPhysicians,aswellasamemberoftheRoyalCollegeofSurgeons.After
obtaininghismedicalqualifications,heworkedinEnglandbeforespendingsevenmonthsingeneralpracticein
Lagos,Nigeria.Subsequently,heworkedinEnglandagain,spentsometimeasaship'ssurgeonfortheUnion
CastlelineandactedaslocumforadoctorinCapeTown,whereafterhemovedtoAlgeriaandeventuallymovedto
SouthAfricapermanently.HehasworkedfortheProvincialAdministrationinvariouscapacities,bothonafulltime
andparttimebasisatGrooteSchuur,atahospitalinPortElizabethandattheBrooklynChestHospital,wherehe
wasinchargeofTBpatients.In2003hewasappointedasanhonorarylecturerinfamilymedicineattheUniversity
ofCapeTown.
[31]DrCravenworkedasaparttimedistrictsurgeonatthemaximumsecurityprisonfrom1988toSeptember
2003.Hisworkinghourswereconfinedto5hoursinthemorningonweekdays.Heiscurrentlyengagedinaprivate
medicalpracticeinWynberg,inadditiontobeingtheprincipalmedicalofficerattheLadyMichaelis,aProvincialday
hospitalwhereprimarymedicalcareisprovided.HestillcomesacrossTBpatientsatthedayhospital,butpatients
whoarediagnosedasbeingillwithTB,arereferredelsewherefortreatment.
[32]DrCravenacquiredhisknowledgeandexperienceinregardtoTBatmedicalschool,byattendinglecturesand
readingtextbooks,byworkingattheBrooklynChestHospitalforaperiodofapproximately18monthsandthrough
hisworkattheprison.
[33]DrTheronandDrCraventestifiedasfactualwitnesses,butalsoasexpertsinrelationtothetreatmentand
preventionofTB.
[34]MrFransMuller,aprofessionalnurse,wasemployedatPollsmoorforaperiodof10yearsastheAreaCo
ordinator,HealthCare.HeiscurrentlyworkingasatemporaryemployeeattheDPMaraisHospitalinRetreat,Cape
Town,aTBhospital.Hetestifiedthathehasbeenunabletoacceptapermanentposition,becauseheisstillin
disputewiththeDCS.
[35]MrJeromeGertsequalifiedasaprofessionalnursein1998,completedacourseinprimaryhealthcarein2002
andin2003hecompletedacourseinTBmanagement.HestartedworkingatPollsmoorasajuniornursein
February2001,afterhavingworkedatVoorbergPrisoninPortervilleandatGoodwoodPrison.In2006hewas
deployedtotheMediumCprisonatPollsmoorwhereheworkedwithDrTheron.MrGertseiscurrentlystillemployed
bytheDCSatPollsmoor,whereheisinchargeofthehospitalinthemaximumsecurityprison.
[36]ProfPaulDavidvanHeldenobtainedaBScdegreeinBiochemistry,ChemistryandMicrobiologyfromthe
UniversityofCapeTownin1973,aswellasaBScHonoursdegreeinBiochemistryin1974andaPhDin
Biochemistryin1978.
From19791981hewastheSeniorProfessionalOfficeratTygerbergHospitalintheDepartmentofMedical
PhysiologyandBiochemistryoftheUniversityofStellenbosch.HeremainedintheemployoftheUniversityof
Stellenboschandin1992hebecametheChairoftheDepartmentofMedicalBiochemistryandDirectorofthe
MedicalResearchCouncil'sCentreforMolecularandCellularBiology.HisresearchhasbeenfocussedonTBforthe
past20yearsandhehasbeeninvolvedinmanypaperswhichhavebeenpublishedinpeerreviewjournalssuch
as,forexample,theNewEnglandJournalofMedicine.
Theplaintiff'sevidence
[37]TheplaintifftestifiedthathewastestedforTBonceortwicewhenhewasachild.Avanusedtocomearound
inEdenvaleandallofthechildrenweresubjectedtoXRays.Hecould,however,notrecallwhetheranysputum
testswereconductedatthattime.Hewasalwaysafitandactivepersonandboxedformanyyears.Apartfrom
sometroublewithhisheartandprostate,hewashealthyandhehadneverbeenillwithTBpriortohis
incarceration.Hecooked,asdidhishousemateandhelookedafterhimself,becausehehadbeentaughttolook
afterhisbody.Hedid,however,admitthathewasasmokerpriortobeingdetainedatPollsmoorprisonandduring
theperiodofhisincarceration.
[38]Theplaintiffdeniedthathewasachainsmoker.Whilstinprison,hecutdownfrom30tofivecigarettesper
dayatonestage,buthetestifiedthatonegenerallytendstosmokemoreinprisonandthatsmokingwasvery
prevalent.Asheputit,"everybodyandhisbrothersmokesthere"andtheprisonreekedofsmoke.Theplaintiff
statedthatsomeoftheinmatesmadecigarettesoutofnewspaper,somesmokeddaggawrappedinnewspaper
andsomemadea"hondjie"outoftoiletpaper.(DrTherondescribeda"hondjie"asconsistingoftightlyrolledup
toiletpaperwhichislitandlefttosmouldersothatprisonerscanlightuptheircigarettes.)The"hondjie"stinksand
closesone'schest.Smokefromthecellsinasectionoftheprison,driftsdownthecorridor.DrCravenadvisedhim
tostopsmokingandhestoppedforalongtime,buthewasundermuchpressurepriortothetrialtakingplace,
whichcausedhimtostartsmokingagain.
[39]UponarrivingatPollsmoorforthefirsttime,theplaintiffwastakentoaholdingcellintheadministrative
sectionofthemaximumsecurityprison.Oneoftheinmates,aTrevorBlignault,conductedabasicscreening
procedureby,interalia,askingpersonswhohadmedicalconditionstostepforwardandtomakethemselves
known.Thereafter,Blignaultalsoconductedtheregistrationprocessandtheplaintiffwasissuedwithaprisoncard.
AlthoughMrGertseaverredthatthenursestookturnstododutyatadmissionsandthatthescreeningwas
conductedbythenursewhowasonduty,theplaintiffstatedcategoricallythatheneversawanursedoingsoon
anyoftheoccasions
whenhecamebacktotheprisonfromcourt.
[40]Uponcompletionofthenecessaryadministrativeprocess,theplaintiffwasadmittedtothehospitalinthe
maximumsecurityprison,becausehesufferedfromaheartcondition.Thefollowingmorninghewentonmedical
paradeandsawDrCraven,whomheinformedofthemedicationhewasusingatthetime.DrCravenissueda
prescriptionforsuchmedicationandofficiallybookedhimintothehospital,wherehestayeduntilhewasreleased
onbailinFebruary2000.Hewasdescribedas"wellobese"inhismedicalrecordandDrCravenputhimonhalf
rations.
[41]Afterbeingrearrested,theplaintiffwassentbacktothemaximumsecurityprisonwherehewasdetainedin
aholdingcellinthereceptionarea,beforespendingthenightinaholdingcellinCsection.Hedescribedthecellas
havingbeenfilthyanddisgusting,somuchsothathesatonhisclothesduringthenight.
[42]Theplaintiffthereafterspentsometimeincommunalcellsintheprison,buteventuallysucceededinbeing
placedinasinglecell,whichhesharedwithtwootherinmates.Hetestifiedthatoneoftheinmatesintheprison
hadtoldhimtohavehimselfcheckedforTBeverysixor12monthsandhethereforeregularlyhadsputumtests
performed.Theresultsofallofthesetestswerenegativeuntil2003.
[43]In2003theplaintiffexperiencedheavingcoughswhichcontinuedforweeks.Inaddition,hestartedlosing
weightandexperiencednightsweats.Hebecameconcernedandaskedforasputumtesttobeconducted,butthe
testresultswerenegative.Whenthecoughstillpersisted,hehadanothersputumtest,whichalsoproduced
negativeresults,shortlybeforehesustainedaherniawhichcausedhimtobeadmittedtoVictoriaHospital.Hesaid
thatoneafternoonwhenhecamebackfromcourt,he"feltsomethinggo"inthelowerpartofhisabdomen,near
thescrotum.Thefollowingmorning(27May2003accordingtothenoteinhishospitalfile)hewastakentosee
DrCravenattheprisonhospital,whoreferredhimtoVictoriaHospitalforsurgicalrepairofaninguinalhernia.Prior
tosurgerybeingconductedatthesaidhospital,XRaysweretakenofhischestandstomachandtheXRayofthe
lungsrevealedthathesufferedfromTB.
[44]TheplaintiffwasdischargedfromVictoriaHospitalapproximatelythreedaysaftersurgeryandwasthen
admittedtothehospitalinthemaximumsecurityprison,wherehewasplacedinacommunalcellwitheightornine
otherprisoners.Thefollowingday,DrCravencalledforanothersputumtestandsuchtestyieldedapositiveresult
forTB.HewasplacedonmedicationwhichhehadtotakefromMondaytoFridayofeachweek.Afterspending
approximately10daysinthehospitalsectionoftheprison,hewentbacktothesinglecellwhichhesharedwith
twootherprisoners.Whilsthewasinthehospitalsection,hewasnotatanystageseparatedfromtheother
patientsthereand
hetestifiedthathewasnotawareofanisolationsection,whetherintermsofaseparatewardinthehospitalor
anyseparatecell(s)inthesectionwhichwasdesignatedforTBpatients.Althoughtheplaintiff'shospitalrecords
tendtoshowthatheremainedinthehospitalforaperiodofapproximatelyfivemonthsatonetime,hecouldnot
clearlyrecallthat,butwaspreparedtoacceptthathemighthavestayedinhospitalforuptofourmonths.
[45]TheplaintiffacceptedthatsputumtestswereperformedforprisonerswhoaskedtobetestedforTBandthat
thenurses,iftheythoughtsomeonewassufferingfromTB,wouldcausethatpersontobetested.Hedidmention,
however,thattheganginfluencewasstrong.Asheputit,thegangsters"runtheprison,thewardersarethere
justtolockthedoors".Ifthegangmembersdecidedthatanyparticularpersonwouldnotbepermittedtoundergo
asputumtest,thatwastheendofthematter.Moreover,prisonerswhowerediagnosedwithTBtendedtokeep
quietaboutit,becausetherewasstigmaattachedtothecondition.Consequently,hewasnotinapositiontoknow
whohadTBandwhodidnot.Coughingwasnoreliableindication,becausealmosteverybodyinprisoncoughedas
aresultofthesmoking.
[46]Theplaintiffalsoagreedthatacomplaintsregisterwasmaintainedintheprison.Thebookwaskeptinthe
officeofthesectionheadandifanyinmatehadacomplaintorrequest,itwouldbenotedintheregister.Hemade
oneortworequestshimselfandthesehadbeenattendedto.
[47]Theplaintifftestifiedthatduringhishospitalisationhewouldreceivehismedicationdaily.Oncehewassent
backtohiscell,however,heexperiencedsomedifficultyinobtaininghismedication.Hedeniedthatanursehanded
outmedicationinthesectiononadailybasis.Accordingtohisrecollection,anursewouldconduct"pillparade"in
thesectiononceaweek,butiftherewasastaffshortage,aweekortwowouldsometimespasswithoutanypill
paradebeingconducted.Indeed,ononeoccasionpriortobecomingillwithTB,hedidnotreceiveanyofhischronic
medicationforaperiodofthreeweeks.Thisfactwasnotedonhismedicalfileafterhehadcomplainedto
DrCraven.
[48]Gettingtothehospitalwasalsonosimplematter.Inthenormalcourse,onedayperweekwasreservedfor
prisonersineachsectiontoseethedoctor.Prisonershadtobeaccompaniedbyawarderandhadtopassthrough
aboutsevengatestogettothehospitalsection.Sometimestheplaintiffmanagedtogothroughtothehospitalfor
hismedicationinthemorningswhenthediabeticprisonersweretakenthroughfortheirinsulininjectionsandon
otheroccasionshebribedoneofthewarderstotakehimthrough.Theplaintiffhadbeenwarnedthathecouldbe
reinfectedandcoulddevelopdrugresistantTBifhefailedtotakethemedicationasprescribedforthefullperiodof
sixmonthsandheaccordingly"begged,bulliedandbribed"togethismedication.Thenurseinthehospitaltrusted
himandifshewasgoingtobeoffduty,hewouldaskherforafewdays'supplyofmedication,whichshewould
handovertohim.Attimeshehadasmuchasaweek'ssupplyofhisTB
medicationinthecellwithhim.
[49]TheplaintiffadmittedthatonoccasionswhenhereceivedhisTBmedicationatthehospital,hewouldhaveto
swallowthetabletsinthepresenceofthenurse.However,onoccasionswhenhewenttocourt,orwhenhewas
nottakentothehospital,nobodysupervisedhimsoastoensurethathetookhismedication.Theplaintiffdenied
thathehadeverreceivedagreenpatienttreatmentcardandsaidthathehadnotknownthathewassupposedto
beinpossessionofsuchacard.
[50]Theplaintiffattendedcourtinexcessof70timesduringtheperiodofhisincarceration.Thestandardroutine
wasthatprisonerswouldbewokenupat4:30amor5amtogetreadytogotocourt.Theywerethentakentothe
corridornearthekitchenwheretheyreceivedbreakfast,fromwheretheyweretakentoreception.Theretheywere
heldinseparateholdingcellsdependingonthecourttheyweretoattend,beforebeingloadedontotrucksorvans
whichtookthemthroughtocourt.PrisonersgoingtotheCapeTownCourtwere"stuffedintovanslikesardines".
Atthecourt,theywereplacedintocellswhichwere"jampacked"andprisonerswhohadtoappearbeforethe
RegionalCourtweretakentoaseparate,smallercell,whichwasnotoverlyfull.Theplaintiffinitiallyappearedinthe
lowercourtandoncehistrialstarted,intheRegionalCourt.
[51]Uponarrivingbackattheprisonaftercourt,prisonersarecountedandsearchedbeforebeingletintothe
receptionareaandthecommunalcellswheretheyhadwaitedtogotocourtinthemorning.Newprisonersare
registeredandexistinginmatesaretakentotheovernightcell.Theplaintiffstatedthatonoccasionswhenhewas
notfeelingwell,someofthewarderswould,however,makeaplantogethimbacktohiscell.Hereadily
acknowledgedthatthewardersassistedhimasmuchastheycould.
[52]TheplaintiffwasdetainedinEsectionalmostthroughouttheperiodofhisincarcerationandwasinasingle
cell(occupiedbyhimselfandtwootherprisoners)formostofthetime.Atonestage,however,thewholesection
wasmovedtotheMediumBprisonwherehewasdetainedinacommunalcellwithabout25Moslemprisonersfora
while.OnbeingmovedbacktoEsection,hewasheldinacommunalcellagain,untilhemanagedtobuyhimselfa
spaceinasinglecelloncemore.
[53]Prisoners,suchastheplaintiff,whoareincarceratedwhileontrial,spentupto23hoursadayintheircells.
Weatherpermitting,theywouldbetakenoutintoaconcreteyardforexercisefor3060minutes.Theconcreteyard
wasalways"packed"andattimesothersectionswereletintotheyardatthesametimeasEsection.When
prisonerslineduptogototheexerciseyard,theywereconfinedincloseproximitytoeachotherinapassage
leadingtotheyard.Theplaintiffcomplained,becausehegotrobbedoutsideintheyardand
hewaseventuallyallowedtoexerciseinsidethesection.
[54]Foodwasbroughttothesections.Prisonerswouldfetchthefoodandeatintheircells.Lockdowncameat
around4pmor4:30pm.Thatmeantthatnotonlythebarredgatetothecellwouldbeclosed,butalsothesolid
metaldoor.Thedoorwouldremainshutuntilthenextmorning.
[55]TheplaintiffreadilyadmittedthatafterhehadbecomeillwithTB,hefrequentlystatedthathewouldbetaking
thedefendanttocourtafterhisreleasefromprison.
TheevidenceofMrFransMuller
[56]MrMullercametotestifypursuanttohavingreceivedawitnesssubpoena.InhiscapacityastheAreaCo
ordinator:HealthCare,hewasresponsibleforcoordinatinghealthcarebetweenthefivedifferentprisonsat
Pollsmoor.Hisdutiesincludedtheoptimalutilisationofstaffateachoftheprisonsandhehadtoensurethateach
institutionwasadequatelystaffed.Healthservicesatthemaximumsecuritysectionalsoultimatelyfellunderhis
supervision.
[57]EachofthefiveprisonsatPollsmooralsohadaCentreCoordinatorwhowasresponsibleformanagingthe
dailyoperationsinthatparticularprison.MrMuller,however,wasinoverallchargeofnursingservicesatPollsmoor
and,intheordinarycourseofperforminghisduties,hevisitedeachoftheprisons
onaregularbasis.Hewasaccordinglyawareofanyincidentswhichhadoccurredandknewwhichmembersofstaff
wereonduty.
[58]MrMullertestifiedthattherewasacriticalshortageofnursingstaffatPollsmoorthroughoutthetimeofhis
employmentthereandthatthenumberofstaffmembershadbeeninadequatetodealwiththeworkload.The
problemwasparticularlysevereinthemaximumsecurityprisonwhichwasoverpopulatedandwhereeachofthe
staffmembershadtocarrytheworkloadofthreeorfourpersons.Thisfrequentlycausedthemtobeoffworkdue
toillnesswhich,inturn,placedanevengreaterburdenonthosestaffmemberswhoremained.MrMullerhaddirect
knowledgeofconditionsatthemaximumsecurityprisoninasmuchashehadtostandinonoccasionwhenother
staffmemberswerenotatwork.
[59]AsthepersoninchargeofnursingservicesatPollsmoor,MrMullerwasresponsibleforensuringthatan
acceptablehealthstandardwasmaintained.Theshortageofstaffmilitatedagainstthemaintenanceofproper
standards.Forthatreason,heregularlytookuptheissuerelativetostaffshortageswithhissuperiors.Henotonly
helddiscussionswiththeareacommissionerinthisregard,hewroteseveralletterstotheresponsibleauthorities,
bringingthismattertotheirattention.So,forexample:
59.1 On4February2000hewrotealettertotheAreaManager,Pollsmoor,
theProvincialCommissionerandtheCommissionerofCorrectionalServicesbearingtheheading"CRITICAL
SHORTAGEOFNURSINGPERSONNELPOLLSMOORMANAGEMENTAREA".Inthisletter,hehighlighted, interalia,
thatthestaffwasoverworkedandthatadditionalpostsforregisterednurseswhichhadbeenapprovedafter
discussionsin1997and1998,hadnotbeenfilled.Theletterreferredtothefactthattheaveragedailylockup
totalwas3200andthatalthough15postsforregisterednurseshadbeenapprovedpursuanttoawork
studyhavingbeenconducted,only7registerednurseswereemployedandthe"infrastructureandover
population"madeitdifficultfornursingstafftodotheirworkeffectively.Healsopointedoutthatalthoughthe
admissionscentre(maximumsecurityprison)wasunderstaffed,staffmembersworkingtherehadtohelpout
intheotherprisonsonthepropertyonaregularbasis.Overall,thePollsmoorManagementAreaoperated
with22approvedpostsforregisterednurses,althoughthestaffestablishment,accordingtoaWorkStudy
whichhadbeenperformed,required40registerednurses.Thisequatedto55%ofthenumberofstaff
membersrequired.Insummary,MrMuller'sletterstated,interalia,that:
"(W)earesittingonatimebomb.Membersareoverworkedandfrustrated."
59.2 On25July2000MrMullerwrotetotheAreaManager,ProvincialCommissionerandtheCommissioneragain.
Theletterreiteratedthat
therewasadrasticstaffshortageandpointedout,inparticular,that"personnelareexposedtomany
MedicoLegalhazardsthatcanleadtosevereembarrassment(sic)forourdepartment"andthat:
"(D)uring1998,postsfor18additionalregisterednurseswereapproved,butnothinghappened
subsequently.The3vacantpostsinourcurrentestablishmentarestillnotfilledalthough
candidateswereinterviewedinFebruary2000."
Inthesummaryprovidedatthefootoftheletter,MrMullerstated, interalia,that"althoughtheprison
populationhasincreaseddrasticallysince1996,thenursingstaffhasdecreasedbyalmost40%".Underthe
heading"RECOMMENDATION"hestated"wearesittingonatimebomb.Pleaseletusavoidtheexplosion."
59.3 On27September2001,morethanayearaftertheletterreferredtointheimmediatelyprecedingparagraph,
MrMullerforwardedareporttoaMrJSinclairattheProvincialCommissioner'sofficebyfacsimile,aftera
meetingwiththePortfolioCommittee.Inthereport,hepointedout,interalia,thatthe"criticalshortageof
nursingpersonnel"leftthestafftocopewith"anenormousworkloadunderdifficultconditions"andthatthe
"massiveovercrowdingincreasesthepressureonournursingstaffandaggrevates(sic)thepoorconditions
underwhichourinmatesaredetained".Atthatstage,sixapprovedpostsforregisterednursesremained
vacant,whichincludedthreevacantpostsatthemaximumsecurityprison.Noneofthe15additional
postswhichhadbeenapprovedforthemaximumsecurityprisonin1998pursuanttheworkstudywhichhad
beenperformed,hadbeenfilled.PostshadbeenadvertisedinAugust2001butnointerviewshadbeenheld.
59.4 On28November2001MrMulleraddressedalettertoMsMMagoro,theDirector:Health&PhysicalCare,at
theheadofficeoftheDCSaskingthattheappointmentprocessbespeededupinviewofthecriticalshortage
ofnurses.
59.5 On16January2002MrMuller,onceagain,tookupthecudgelsinwritingwhenhewrotetoMsMariaMabena,
theNationalHealthCareCoordinatoratthesaidheadofficeinregardtothecriticalshortageofpersonnel
andthefailuretofillvacantposts.Itappearsfromtheletterthatafterthevacantpostshadbeenadvertised
inAugust2001,interviewswereheldfrom29Octoberuntil2November2001,whereafterthelistof
candidateswassenttoheadquartersforapproval.Atthattime,sixpostswerevacantatPollsmoor.No
appointmentshad,however,beenmadeandafurtherfournurseshadresignedinthemeantime,bringing
thetotalnumberofvacantpoststo10.
[60]MrMullertestifiedthatthesituationhadnotimprovedmuchby2002and
2003,althoughadditionalnurseshadbeenemployedonatemporarybasis.Indeed,thevacantpostsonthestaff
establishmentwerenotfilledduringhisentiretermofemploymentatPollsmoor.Themaximumsecurityprisonwas
noexception.Ithadonlyapproximately50%ofthenurseswhowererequiredand,ashasbeenreferredtoabove,
notallofthenurseswhowereemployedwereatwork.Onlyonenursingsisterwasonstandbydutyforthenight
shift,ieafter4pmintheafternoonandsuchnursingsisterhadtocoverallfiveoftheprisonsatPollsmoor.Inthe
result,screeningofprisonerswhocameintotheprisonfromcourtcouldnotbeconductedbythenurse.Indeed,the
screeningofincomingprisonersdidnotformpartofthedutiesthatthenightnursewasexpectedtoperform.
Instead,thewardershadtoensurethatpersonswhohadmedicalproblemswerereferredtothedoctorthe
followingmorningandifsomeonewasobviouslyillorinjured,thewarderhadtosummonthenursewhowason
duty.Ifthestandbynurselivedontheproperty,he/shewouldremainathomeuntilsummoned.Ifnot,thestandby
nursewoulddodutyattheprisonwherehe/shenormallyworkeduntilhe/shewascalledouttooneoftheother
prisons.MrMullerwasthepersonwhopreparedthedutyrosterforthenightshiftandaccordinglyhaddirect
knowledgeofthestaffpositionafterhoursaswellasofthedutieswhichthenightnursewasexpectedtoperform.
[61]MrMullerconfirmedthattheidealinsofarastreatmentforTBwasconcerned,wasthatclinicswouldbe
conductedineachofthesectionsofthe
prisonandthattheDOTSsystembeapplied.Inpractice,however,thereweren'tenoughstaffmembersavailable
anditfrequentlyhappenedthatstaffcouldnotreachthesectionsonadailybasis.Insuchinstances,wardershad
totakeinmatestothehospitalinordertoobtaintheirmedication.
[62]MrMullercouldnotrecallwhetherthe"suspectregister"whichcontainedthedetailsofpersonswhowere
suspectedofhavingTB,wasmaintainedduring2002and2003.Hedidconfirm,however,thatallTBtestresults,
whetherpositiveornegative,oughttohavebeenreferredtotheattendingdoctorinorderthatthepatient'scase
mightbemanaged.HealsoconfirmedthatpersonswhowereintheinfectiousstageofTBoughttohavebeen
separatedfromotherinmates,butthatinpracticeitwasnotlogisticallypossibletodoso,becausetherewas
insufficientaccommodationavailable.Thenumberofsinglecellsavailablewerealsoinadequatetocopewiththe
demand.
TheevidenceofDoctorTheron
[63]DrTherontestifiedthathelearntfromDrBarkerduringthetimeheworkedwiththelatterin19711973,that
controlofTBwasarelativelysimpleandinexpensivematter.ThehospitalrunbyDrBarker,despitebeingalow
cost,communityfacility,hadgreatsuccesswiththetreatmentofTB,becausepeopleweremotivatedtodealwith
theproblemswhichunderpinnedthedisease.Emphasiswasplacedontheearlyidentificationofpersonswhowere
deterioratingandwhowouldbecomevulnerabletoTB,onearlydiagnosisofthediseaseandonpropernutrition.
[64]DrTheronexplainedthatthediagnosisofTBis,inthefirstinstance,basedonsymptomatologyifapatient
weretoreportacertainpatternofsymptoms,thedoctorwouldbealertedtothefactthathe/shemaypossibly
haveTB.Thesecondlevelofdiagnosisinvolvesthephysicalexaminationofthepatientand,inparticular,achest
examination,aswellasdeterminingthepatient'sheightandweight.Thethirdlevelofdiagnosisinvolvesasputum
testandoneneedstrainedstafftoassistinobtainingthesputumsamples.Ifasputumtestyieldspositiveresults,
treatmentwouldstart.Atthatstage,thepatientwouldbeinfectiousandwouldpresentariskofpassingthe
diseaseontoothers.InaninstitutionsuchasPollsmoor,onecouldcontroltheprocessofinfectionbyisolating
peopleimmediatelyuponthembeingsuspectedofhavinganactiveTBinfection,oruponbeingdiagnosedassuch
andbykeepingthemisolateduntilsuchtimeastheyhadbeenontreatmentforlongenough.
[65]DrTherontestifiedthatbefore1997therewerenocasesofTBattheMediumAprisonwhereheworked.The
situationchangeddramaticallywiththechangeoftheMediumAprisonfromanadultsentencedprisontoajuvenile
facility.Themaximumsecurityprisondidnotundergosuchachange,butthelatterprisonhadalwaysbeen
subjectedtoseriouslyhighpressuresinterms
ofnumbersandthemanagementofpatientswasinthehandsofthewardersratherthanofthenursingstaff.
TherewerefrequentproblemsingettingaccesstopeoplewithTB,inisolatingthemandinprovidingtreatmentfor
them,notbecausethewardersweredeliberatelyobstructive,butbecausetherewasinsufficientcooperationfora
varietyofotherreasons.Themaximumsecurityprisonisamassivebuildingwhichiscontrolledbyvariousgatesand
accesspoints.Thehospitalsectionliesatthefarendofthebuildingonthelowerlevel.Inordertogetthere,one
hastowalkthroughtheentireprisonandpassthroughsixorsevengates.Inmatesarescatteredthroughoutthe
prisonandareidentifiednotbytheirnames,butbynumberswhichappearonalistwhichisheldatdifferentpoints
withintheprison.Itwasaccordinglyextremelydifficulttogetholdofaparticularprisoner,becausetheexercisewas
dependentonthefullcooperationofthesecuritystaff.Suchcooperationwasnotalwaysforthcoming,duetostaff
shortagesandthenatureofthedutiesthatwardershadtoperform.Warderswerenotinapositiontoknow
whetheraprisonerwhowascoughingconsistentlywasdoingsoasaresultofsmoking,orbecausehewasillwith
TBandtheycouldnotalwaysbringprisonerstothedoctor.DrTheronhadseveralcasesintheMediumAprison,as
wellasinthemaximumsecurityprison,whereprisonerswithactiveTBandsymptomsofTBhadbeenincarcerated
for3or4monthswithouthavingbeenreferredtohospital,becauseofdifficultywithaccess.
[66]IncrossexaminationitwasputtoDrTheronthatMrGertsewouldtestifythat
wardersaswellasnursingstaffcooperatedwellandthattherewasnoresistancetogettinginmatessuspectedof
havingTBtothedoctor,becausethey(thewardersandnurses)wouldbeputtingthemselvesatrisk.DrTheron
disagreed.Hestatedthathehadseenmanycaseswherepeoplehadbeencoughingformonthswithoutgettingto
thehospital,thatitwasverydifficulttomovearoundwithoutsecuritystaffandthatthelackoffullcooperationby
securitystaffwasapersistentproblem.
[67]AccordingtoDrTheron,therewasadirectcorrelationbetweenthebreakdownofthehealthsysteminthe
prisonandtheincreasingspreadofTB.InordertoobtaingoodcontroloverTB,oneneedsagoodnursingteam,
madeupofasufficientnumberofdoctorsandnurses,tofollowanagreedprotocolinordertoreducethepoolof
infectionbykeepingacordonaroundthosewhoarebeingtreatedandbypreventingnewcasesfromcomingin
withoutcontrol,throughadequatescreeningprocedures.Suchprotocolisdependentonnursingstaff.AtPollsmoor,
thereweresimplynotenoughmembersofstafftoconductadequatescreeningproceduresortoadministerthe
necessarymedicationaccordingtotheDOTSsystem,norwasitpossibletogettopersonswhowereillwithTB,or
toisolatethem,consistently.DrTheronexplainedthattheaforesaidproblemsexistednotonlyintheMediumA
prisonwherehenormallyworked,butalsointhemaximumsecurityprison.Hewasaufaitwiththeconditionsinthe
maximumsecurityprison,becausehestoodinforDrCravenfromtimetotimewhenthelattercouldnotbeon
dutyandbecause,inhisroleaschairmanoftheClinicalForensicPractitionersAssociation,hewasinandoutofthe
maximumsecurityprisononaregularbasisintheperformanceofhisdutiesandhadregularcontactwiththe
nursingstaffandtheadministrationatPollsmoorprison.
[68]DrTheronreferredtoChapter3oftheStandingCorrectionalOrders("theStandingOrders")whichhavebeen
compiledsoastogiveeffecttotheprovisionsoftheCorrectionalServicesAct.TheStandingOrdersdeal,interalia,
withhealthservicesandthephysicalcareofprisoners.Clause4ofthesaidchapterdealswiththescreeningof
prisonersandprovides,interalia,that:
"4.1 Admissions
(a) Alladmissionstotheprison,includingparolees,transfersfromotherprisons,personsunder48
hourincarcerationandbabies/childrenshouldbeseenonadmissionbyaregisterednursein
privacy,withthepolice/custodialstaffinwaiting,forthefollowing:
anymedicalproblems,eitheracuteorchronic...
presenttreatment...
documentation(screeningformtobefilledandbeattachedtothemedicalfileduringthe
medicalexaminationprocess)."
[AtthisstageitmustbementionedthatbothpartiestreatedtheextractfromtheStandingOrders,whichwas
beforecourtaspartofExhibitA,astheStandingOrderswhichhadbeeninforceatthetimeoftheplaintiff's
incarcerationandillness.Duringthecourseofpreparingthisjudgment,itbecameapparentthatthesaidextract
fromtheStandingOrderscontainednumerouscrossreferencestotheCorrectionalServicesAct111of1998,but
thatnomentionwasmadeoftheCorrectionalServicesAct8of1959
("the1959Act").TheprovisionsofthenewActwhichdealwiththetreatmentofprisonershad,however,notbeen
putintooperationuntil31July2004,iesubsequenttotheplaintiffbecomingillwithTB.Theproblemwasbroughtto
theattentionoftheparties'legalrepresentativesandplaintiff'sattorneyofrecordmadefurtherenquiriestothe
DCS.On28January2011MrCarelPaxton,theDirector:CodeEnforcementoftheDCSadvisedthattheStanding
Ordersintermsofthe1998Actareidenticaltothosethatappliedintermsofthe1959Act,onlythecross
referenceshadbeenchangedtoreflectthecorrespondingprovisionsinthelaterAct.Suchinformationwasplaced
beforemebyagreementbetweentheparties'legalrepresentatives.]
[69]DrTherondescribedthescreeningorderasthemostimportantofalloftheprovisionsoftheStandingOrders
withregardtohealth.Screening(whichisalsoreferredtoas"theadmissionprocedure"),meansthatanursewho
issuitablyqualifiedbytrainingandexperience,interviewsincomingprisoners,identifiesthosewithhealthproblems,
removesthosewhoaresufferingfromsevereinjuriesoractivehealthproblemswhichmightendangerothersand
refersthemtothehospital.Aprescribedprocedurehadtobefollowedandanofficialformhadtobecompleted
duringthescreeningprocess.Suchformhadtobeattachedtothemedicalnotes.Ifthescreeningprocesshad
beeninplaceandhadbeenmaintainedinthepropermanner,itwouldhaveensuredthatthosewithmedical
problemswerenotonlyidentified,butalsoreceivedappropriatemedicalcare.Effectivescreeningwouldhave
prevented
personswhowereillwithTBfromenteringthegeneralprisonpopulationandwouldthereforehaveplayedan
importantpartinpreventingthespreadofthedisease.InDrTheron'sexperience,suchprocedureswere,however,
notimplementedinMediumAwhereheworked,otherthanrightatthebeginningofhistenureofofficeandrightat
theend.Fromtheinformationhehadbeenabletoobtain,hebelievedthattheprocesswasalsonotperformedin
therecommendedmanneratthemaximumsecurityprison.
[70]DrTheronbroughttheunacceptablyhighincidenceofTBinPollsmoortotheattentionoftheauthoritiesofthe
DCS,aswellasoftheProvincialDOH.Afterrepeatedrequestsforactionoveraperiodofapproximatelyayear,an
assessmentoftheprisonwaseventuallyconductedbytheDOHin2000.Certainrecommendationsweremade,a
specialtaskteamwassetupandvariouspeoplewereeducatedintheimplementationoftheDOTSsystem.In
practice,however,thepersonswhowereappointedtosupervisethetakingofTBmedication,atleastinthe
MediumAprisonwhereheworked,wereinmates.Suchasystemwasboundtofail,becausesoonerorlaterthe
gangswouldtakeoverandwouldusethemedicationfortheirownpurposes,sothatveryfewprisonerswere
gettingtheirmedicationasprescribed.Prisonerssmokedalmosteverything,includingdrugs.DrTheronagreedthat
DOTSmayworkverywelloutsideofprisonandthatitwouldworkinprisonifonehadenoughnursestocarryitout,
butin2000,2003and2004therewerenotenoughnursestogoroundatPollsmoorinordertoperformordinary
nursing
tasks,sothatDOTSwasnotpractisedonawidescale.
[71]DrTherontestifiedthatdespitetheformationofthetaskteamreferredtointheimmediatelypreceding
paragraphandthesubmissionofreports,nochangesinthesystemwereeffected.Whenheenquiredaboutthe
lackofresponse,theheadoftheprisontoldhimthathe(Theron)wasnotpermittedtoapproachtheMinister(ie
thedefendant)andhethenresignedfromthetaskteam.DrCravenhadasimilarproblematthemaximumsecurity
prisontherewerediscussions,butnoeffectivechangesweremade.Theproblemcame,notfromtheauthoritiesat
Pollsmoor,butfromhigherup,becauseheadofficepermissionwasrequiredtomakechangesandsuchpermission
wasnotforthcoming.DrTheronwasawareofthefactthatmoneywasspenttorepairablutionblocks,dormitories
andthelike,butnoadequatehealthplanwasdevelopedorimplemented.
[72]Thenumberofnursesemployedatthehospitalduringthe10yearperiodthatDrTheronworkedthere,
steadilydeclined.Indeed,fromapproximately35or36nurses,thenumberseventuallydeclinedtotwo.Therewas
actuallyonlyonenurseondutyonthedaywhentheInspectingJudgeconductedaninspectionatthemaximum
securityprisonandthatpersonwasnotaqualifiednurse,butonlyanurseassistant.DrTheronstatedthatthere
wereenoughdoctorsatPollsmoor,butthatTBtreatment,inparticular,requiredconsistentapplicationofthe
treatmentprotocolorpolicy.Itwasimpossibleto
implementortomaintainsuchprotocolwithoutsufficientnumbersofnursesandsecuritystaff(thesecuritystaff
wereneededtobringthepatientstothehospitalinordertogetmedicalattentionortreatment).Unlesssufficient
numbersofnurseswereavailable,thechainofsupportwasbroken,personsnolongerreceivedtheirtreatment
andasaresult,theywerereinfectedorbecameresistanttotheusualdrugregimen.Thefactthatnurseswere
alsoobtainedfromanoutsideagencytofillpositionstemporarilydidnotprovideforcontinuityoftreatment,which
wasessentialinthemanagementofTB.
[73]InDrTheron'sview,Pollsmoor"exhibitedadisastrouslypoorcontrolofTB".MDRTBhadbecomeprevalent
withinPollsmoor,whichwasindicativeofthebreakdownofthehealthcaresystem(oneofthestaffmembersdied
ofcomplicationstoherlungswhichwerecausedbyMDRTB).Indeed,bothMDRTBandXTRTBwerepresentin
Pollsmoor.ThepresenceofXTRTBwasindicativeofthefactthattherewasalargenumberofpatientswhohad
beeninappropriatelytreated.SomepeoplewithMDRTBorXTRTBcouldclearlyhavecomefromoutsideofthe
prison,butthatiswhyscreeningoughttohavebeenconductedeffectivelysothatthosepersonscouldhavebeen
treatedappropriately.
[74]Around2002or2003thedoctorsandnursesworkingatPollsmoorrequestedtheCityofCapeTowntogive
assistancewiththecontrolofTB.Certainchangeswereintroduced,inasmuchasthenursessubsequentlyhadclear
guidelinestofollowandregisterswhichhadbeenfallingintodisusewerereintroduced.Thesechanges,however,
producedonlymarginalimprovementsandwerenotmaintained,becausethenumberofnursingstaffcontinuedto
decline.Theauthoritieshadalsonotcooperatedtoprovideanysupportsystem.
[75]DrTheronhadraisedissuesaroundhealthcareintheMediumAprisonwiththeauthoritiessince1999.
Eventually,hemadecontactwiththeInspectingJudgeofPrisonsandamemberoftheParliamentaryPortfolio
CommitteeinordertoreportinpersononthepoormanagementandcontrolofhealthatPollsmoor.Theproblems
whichhehadhighlightedinrespectoftheMediumAprisonwerenotuniqueandDrCravenwas,atthesametime,
raisingissuesabouthealthmanagementinregardtothemaximumsecurityprison.Alloftheprisonsformingpartof
PollsmoorwerehavingproblemsinmanagingTB.
[76]InJanuary2002DrTheron,inhiscapacityasthechairpersonoftheCapeClinicalForensicPractitioners
Society,preparedareportforDrLSBitalo,theofficialresponsibleforthedistrictsurgeons'serviceatProvincial
level.ThereportwaswrittenwiththecollaborationandcooperationofallofthedoctorswhoworkedatPollsmoor
andappliedtothewholeofthePollsmoorprisoncomplex.Inthereport,DrTheronhighlightedtheissuesthatwere
problematicalinprovidinghealthcaresuchas,forexample,grossovercrowding,understaffing,gangrelated
behaviourandthecorrectional
serviceshierarchy.So,forexample,thereportreferredtothefactthatthenumbersofbothnursingstaffand
securitystaffhaddeclined.Moreimportantlythough,thereportsuggestedsolutionsbasedonthecreationofanew
partnershipbetweentheDCSandtheDOHintermswhereoftheDOHwouldprovidestaffandhealthfacilitieswithin
theprisonsystem.
[77]Theaforesaidreportappearedtohavesomepositiveresults.TheDOHcametoPollsmoortoeducatethe
nursesinregardtothemanagementofTBandtodrawupaprogrammeaimedatimprovingTBmedicationandTB
controlthroughoutthevariousprisonsatPollsmoor.Unfortunately,theseinitiativesbrokedownagain,becauseof
theshortageofnursingstaff.
[78]Indescribingthetypeofovercrowdingthatoccurredatthemaximumsecurityprison,DrTheronreliedonthe
averagefiguresprovidedbytheDCS.Theseindicatedthattheaverageovercrowdingin2003wasaround234%to
236%.Overcrowdingmeantthatdiseasecouldbespreadmoreeasilyand,asfarasTBwasconcerned,themore
peoplewerepackedintoacell,thegreatertheprospectsthatbacteriawhichwerecoughedupwouldinfectother
inmates.DrTheronregularlysawovercrowdedcellsinthemaximumsecurityprison,alsoduringthecourseof2003,
andtestifiedthathisfirstimpressionwasoneofdinginessandsqualor,becauseblanketsareoftenusedtoprotect
orcoverupplaceswithinacell.Hedescribedthesituationasdehumanising.
[79]DrTherontestifiedthatthesizeofcellsinthemaximumsecurityprisonvaried,butafairlystandardcellwith
4060peopleinit,wouldhaveinmatescrowdedoneontopoftheother,sittingontheirdoubleortriplebunks,with
verylittleplaceforthemtomove.Inadditiontothecellsbeingdingyanddirty,theywereusuallyfilledwith
cigarettesmoke.Prisonersalsousedtoiletpapertomakea"hondjie"toiletpaperwouldbetakenofftherolland
wouldthenbetightlyrolledup,twistedandcompressed,whereafteritwouldbelitandlefttosmouldersothatit
couldbeusedasaperpetualcigarettelighter.Thehondjiewouldburnforseveralhoursandwhenitburntlow,it
wouldbereplacedbyanother.Itproducedapungent,toxicgaswhichwasirritatingtotherespiratorytissuesand
accordinglyaddedtotheriskofgettingTB.
[80]TheovercrowdingcontravenedtheprovisionsoftheStandingOrderswithregardtotheaccommodationof
prisoners.So,forexample,clause2ofChapter2oftheStandingOrdersprovidesthattheminimumpermissiblecell
areaperprisoner,excludingareastakenupbyablutionfacilities,walls,pillarsandpersonallockerswhichhavenot
beenbuiltin,mustbe3,344m2 inrespectofordinarycommunalcellsand5,5m2 inrespectofordinarysinglecells.
AlthoughDrTheronhadnottakenanymeasurementsinthisregard,hewassurethattheserequirementscouldnot
havebeencompliedwithincircumstanceswheretheovercrowdingranto234%.Themerefactthattherewere
threepersonsinasinglecellwasindicativeoftheovercrowdingand
theholdingcellswhereprisonersweredetainedwhentheyreturnedfromcourt,housedfrom60to120persons.
[81]DrTheronstatedthatovercrowdingwas"discussedceaselessly,fromthetimethatIwasthere,rightthrough
untilthetimeIleft".Manyoptionsweresuggestedtoimprovethesituation,suchas,forexample,settingprisoners
freewhowereunabletopaythebailamountssetbythecourtsandliaisonwiththecourtssoastoensurethat
fewerprisonerscametoPollsmoorontrivialcharges.Therewassomereductionintheoverallprisonpopulation,but
theactualovercrowdingwasnotreducedinanysignificantway.Prisonerswouldfrequentlybesenttosmaller
prisonsintheWesternCape,butthenumberofpersonssodivertedwassmall,becausethesmallerprisonsonly
acceptedalimitednumberofprisoners.
[82]DrTheronstatedthatbothheandDrCravenhadregulardiscussionswithaMrEngelbrecht,theAreaManager
ofPollsmoor,whowasinoverallchargeofthePollsmoorprisoncomplex.Duringthesediscussions,MrEngelbrecht
wasapprisedoftheprevailingconditionsatthemaximumsecurityprisonandhemadenumerousattemptstoget
theHeadOfficeandtheRegionalOfficeoftheDCSinvolved.So,forexample,on22January2002MrEngelbrecht
forwardedafacsimiletotheCommissionerdealingwiththecriticalshortageofnursesandtheappallingworking
conditionsatPollsmoor(ExhibitAat2980).Atthatstage,MrEngelbrechtrecommended,interalia,that10
ProfessionalNursesbeappointedimmediately.DrTheronstatedthatfromthelevelofAreaManagementdown,
nobodydisagreedwithhiscriticismofthehealthsystemorwiththecommentsofMrMuller,whowasinchargeof
nursingservices.
[83]DrTheronstatedthatthenurseswere,generallyspeaking,dedicatedandeffective.Inadequatetrainingand
educationofnursesinregardtoTBanditsmanagement,however,causedeffectivetreatmenttobreakdown.
NursesworkedfortheDCSonafulltimebasisanddoctorswerecominginparttime.Thismeantthatdoctorswere
notintegratedintothesystemandthattherewasinadequateopportunityfordiscussingproblems.Asa
consequence,instructionsgivenbythedoctorswereeasilydisregardedifthenursesthoughtthesetobe
inappropriate.DrTheron'sviewwasthattheguidelineswerenotclearenough,becausetheprisonenvironment
presentedamoredifficultsituationinregardtothemanagementofTBthantheoutsideworld.Educationwould
havehelpedtobridgethedividebetweendoctorsandnursesandthat,inturn,wouldhavefacilitatedbetter
managementofTB.
[84]DrTheronreferredtotheworkstudywhichrecommendedastaffcomplementof53nursesforPollsmoor.This
wasinfactneverachievedduringtheperiodofhisemploymentthere.Thesteadydeclineinthenumberofnurses
employedattheprisonswasbroughttotheattentionoftheauthorities,butthesituationfailedtoimprove.
Pursuanttoaninspectionbythedefendant
in2000,itwasrecommendedthatafulltimedoctorbeappointedforPollsmoor,butthisrecommendationwasalso
notcarriedthrough.In2001oneDrTropewasappointedonafulltimebasistovisitPollsmoorregularly,tomonitor
thesituationandtoliaisewithDrJano,theChiefMedicalOfficerattheProvincialAdministration:WesternCape.
AfterspendingonemorningatthemaximumsecurityprisonintheplaceofDrCraven,DrTropeleft,nevertoreturn.
[85]Incrossexamination,DrTheronwasconfrontedwithatable,preparedbythedefendant'sofficials,reflecting
theemploymentstatisticsatPollsmoorduringtheperiodMarch2002toDecember2004.Thesestatisticsshowed
thatthenumberofnursingandsupportpersonnelvariedfrom18to29duringthesaidtime.DrTheronstatedthat
hehad"everyreasontodoubt"thestatistics,inasmuchasthesecouldnotbeverifiedbyreferencetoany
supportingdocumentation.Hewasnotpreparedtoacceptanyfiguresthatdidnotcorrelatewiththefiguresthat
MrMullerhadsupplied.Hestatedthathehad22years'experienceofworkinginthesystemandthatthetreatment
hehadbeensubjectedtoshowedhimthat"anymeans"wouldbeemployedtodiscreditpersonswhobrought
uncomfortablethingstolight.Hewasavictimofsuchaprocess,aswasDrCraven,MrMullerandMrSlinger(the
headnurseinchargeofthemaximumsecurityprisonhospitalwhohadspokenoutaboutthecircumstancesat
PollsmoorbeforetheParliamentaryPortfolioCommittee).Intheabsenceoftheoriginaldocumentsfromwhichthe
statisticshadbeencompiled,hewasunabletoevaluate,ortotrust,thefiguresthatwereprovided.Theoriginal
documentswere,however,notproducedatthetrial.
[86]DrTheronwasatpainstoexplainthathehadnowishtocriticisetheDCS,hejustwantedtoberealistic.He
didnothaveanypersonaldifficultywiththeDCSandwasmindfulofthefactthatheneededtobecareful,
circumspectandguardedinhisevidence,whilebeingobjective,becausehewasanexpertwitness.Headmonished
himselftogivethebestaccountthathecould.Hisconcernwasforthetruthandhehadtobeasbalancedinhis
evidenceashecouldmanage.
[87]Insummary,DrTheronstatedthat:
87.1 ConditionsatthemaximumsecurityprisonwereconducivetothespreadofTBinasmuchas:
(a) Overcrowdingincreasedtheriskthatthediseasewouldspread,becauseitconcentratedand/or
increasedthepoolofbacteriaemanatingfrompersonssufferingfromactiveTB.Personssubjectedto
theovercrowdinggetlessrestandaremorepressurised,sothattheirimmunesystemsmaybe
negativelyaffected,makingthemmoresusceptibletobecomingillwithTB.
Overcrowdingmadeitdifficultforsecuritystaffandfornursestogetintothebackofcellstocheckon
inmatesandtoadministermedication.Moreover,itmadeitdifficultforinmatestoreachthedoctoror
medicalclinic,sothatpatients'symptomswerenotreportedonadailybasisasonewouldexpect
(b) Adequatenutritionisvitaltomaintainthebody'simmunesystemandgangsstolefoodortookitaway
(c) TheindoorenvironmentismorefriendlytoTBbacteria,becausethesebacteriaarevulnerableto
sunlightandfreshair.Themostcommonfeatureofacell,apartfromtheovercrowding,wasthattheair
wasvirtuallyunbreathableasaresultofthesmokinghabitsofprisoners.Inadditiontothesmouldering
"hondjies"whichpollutedtheair,prisonerssmokedtheshortendsofcigarettesor"endjies"which
tendedtoemitpungentandtoxicwasteintotheair.Thepreventionofsmokingandtheprovisionof
properventilationwascrucial.Onavisittothemaximumsecurityprisonduringthecourseofthetrial,
DrTheronnoticedthatspecialultravioletlights,whichareusedtokillbacteria,hadbeeninstalledinthe
TBwardatthemaximumsecurityprison.Theinstallationoftheselampshadbeenunderdiscussion
whilstheworkedattheprison,buthadnotbeen
introducedatthattime.Duringtheaforesaidvisit,healsonoticedthatthewardwasbetterorganised,
blanketswereofgoodqualityandthattherewasawellorderedatmosphereintheward.Hedescribed
theseassignificantchanges
(d) Bacteriawhichareexpelledbyspittingorcoughinglandonthefloor.Unlesstheflooriscleaned
immediatelywithagermicidalantiseptic,thebacteriabecomeairborneasthesputumdriesout,a
processwhichcan,inDrTheron'sopinion,continueforupto2or3months.Spittingwascommon,ithad
notbeenthehabittocleanthecellswithagermicidalantisepticandDrTheron'svisitstocellsbothin
theMediumAandmaximumsecurityprisons,revealedthattherewasnoconsistencyabouthygiene.
87.2 ThecontrolofTBintheprisonwasdependentupontheeffectivescreeningofinmatesupontheiradmission
sothatthosewhowereillwithTB,orwereindangerofdevelopingTB,couldbeisolated.Effectivescreening
wasnotpossiblewithoutadequatenumbersofproperlytrainednursingstaff.Nurseshadtobeableto
performthescreeningprocesswhenpersonswereadmittedtotheprison,toadviseinmatesofthesymptoms
ofTB,toidentifythoseinmatesinthesectionswhomighthaveactiveTBandtocollectsputumfor
testing.Thelatterprocessrequiredalotoftrainingandexperience.Noneofthesemeasureswere
implementedinanyeffectivemannerduringthetimethatDrTheronservedatPollsmoor.
[88]DrTherontestifiedthatscreeningcouldnotbeperformedproperlybyaninmate.Itwouldevenbedifficultfor
atrainednursetoperformthescreeningprocessadequately,becauseonaverage60personswouldreturnfrom
thecourtsbetween5and6pm,whichmeantthattheworkhadtobeperformedinanhourortwo.DrTheron
recommendedthemassscreeningofprisonersfromtimetotime,becauseithadbeenusedinthepastasameans
ofidentifyingpeoplewithactiveTB.Oneofthewaysinwhichamassscreeningcouldbeperformed,wasbyusinga
portableXRaymachine.Suchscreeningneveroccurred,becausetherewereproblemsinobtainingtheparticularX
RaymachinesandbecausetheobjectionwasthatonewouldonlypickupsomeoftheTBcasesandnotall.
[89]WhenDrTheronoriginallystartedworkingattheprison,adoctorscreenedprisonersenmasseupontheir
admission.Thedoctorwouldgofromoneprisonertothenext,listeningtochestsoundswithastethoscopeand
wouldscreenalargenumberofprisonersinthismannerinaveryshorttime.Itwas,however,onlypossibletodo
suchascreeningwhilstthemilitaryformofdisciplinewasappliedintheprison.Oncethedemocraticprocesswas
adopted,suchscreeningcouldnolongerbeconducted.Whereasitwas
notionallypossibleforadoctortolineupeveryinmateinEsectiontocheckhimforTB,suchprocedurewasnotvery
efficient,wouldbeexhaustingforthedoctorandwouldrequiregoodnursingandclericalteamsasbackup.Ifan
organisedsystemhadbeeninplaceandsufficientnumbersofnursesandsecuritystaffhadbeenavailableitwould,
however,havebeenpossibletoscreenalloftheinmatesintheprison.Onecouldhavecalledprisonersoutinsmall
groups,couldhaveidentifiedeachoneandcouldthenhavecheckedforTB,muchasonewoulddointriage.With
adequateeducation,itwouldhavebeenpossibletoproduceateamofqualifiedpeoplewhowereabletoidentify
themajorityofTBcasesintheprison,whichwouldhavefacilitatedthegainingofcontroloverthespreadofthe
disease.
[90]DrTheronstatedthatifthefactorswhichhehadhighlightedhadbeenaddressedinaconsistentandeffective
manner,theincidenceofTBaswellastheriskofcontractingTBintheprisonwouldhavebeengreatlyreduced.The
healthsystematPollsmoorwas,however,notefficient.Thedoctorsaswellasthenursesstruggledtomanagethe
situationwhichDrTherondescribedas"anightmarethatnoneofuscouldwakeup"from.
[91]DrTheronconductedaclinicalexaminationoftheplaintiffon17November2009toestablishwhetherornot
theplaintiffhadsufferedtraumaasaresultofhisarrestandincarcerationwhichcontributedtohisvulnerabilityand
subsequentTBinfection,toinvestigatehispresenthealthandtoevaluatehis
futurehealthprospectsrelativetohisincarcerationexperience.Hefoundthattheplaintiffstillsuffersfromcough
withphlegmandwheeze,whichsignssuggestedanongoingdisabilityrelatedtotheoriginalTB.
[92]AccordingtoDrTheron,theplaintiffdidnotfittheTBpatientprofilethathehaddevelopedovertheyearsof
hispractice.Heexplainedthateverymedicalconditionthatadoctorencountersinpractice,includingTB,hasaset
ofguidelinesastotheprobabilityofthatcondition.So,forexample,malesintheirmid40swhocomplainedof
swellingintheinguinalarea(theareanexttothescrotum),werelikelytohaveaninguinalhernia.Hecouldidentify
personswithasusceptibilityforTBatadistance,inasmuchascertainclinicalfeatureswouldsuggestthataperson
eitherhadTBorwasindangerofdevelopingthedisease.Specificfeaturesthathewouldwatchoutforwere
personswho,bytheirbodilyhabitus,appearedtobebrokendownintermsoftheirabilitytocopeandpersonswho
appearedtobethin,underweightandundernourished.Hehadrecentlyseenapatientwhohadbeenreferredby
theHighCourtandatadistanceof5metresidentifiedhimasprobablyhavingTB.AsubsequentXRayconfirmed
thatthepatientsufferedfromthedisease.HisprofilingofpotentialTBpatientswasnothingotherthanaclinical
assessmentandevaluationofapatientintermsofhisriskfordevelopingTB,justashewould,forexample,
performaclinicalassessmentofpatientsintermsoftheirriskofdevelopingheartconditionsordiabetes,inthe
courseofmakingadifferentiateddiagnosis.
[93]DrTheronneversawtheplaintiffbeforehebecameillwithTB,buthisretrospectiveexaminationshowedthat
theplaintiffdidnotfittheTBpatientprofile.Theplaintiffappearedtohavebeenrelativelyrobustandwell
nourished.DrTheronwasoftheopinionthattheplaintiffwouldnoteasilyhavebecomeillwithTBintheoutside
world,butthatthesituationinprisonmadehimvulnerabletoTB.Thisassessmentwasbasedonhisexperienceas
wellashisclinicalknowhowandexpertise.
[94]DrTheronagreedwithProfVanHeldeninsofarasthelatter'sreportrelatedtoscientificdescriptionsand
standardmedicalopinionrelatingtothemannerinwhichTBiscontractedandspread.DrTheronalsoagreedthat
infectionwiththeTBbacteriumintheWesternCapecommonlyoccursduringthefirsttwoyearsoflife.Such
infectionisreferredtoastheprimaryinfection/focusortheGhonfocus(namedafterapathologist,AntonGhon).He
partedcompanywithProfVanHeldeninsofarastheprofessorwasoftheopinionthatconditionsintheprisonhad
beenideal.Inthisregard,hepointedoutthatProfVanHeldenhimselfmadeitclearthatpovertyandsimilarsocio
economicstresscouldcausepeople'simmunesystemstobreakdownsothatdiseasecantakehold.DrTheronalso
differedfromProfVanHeldeninasmuchasDrTheronwasoftheviewthatreactivationofsubclinicalTBwhichhad
remaineddormantinthebody,islesslikelythanreinfection,ieafreshTBinfection.Mosthumanbeings,however,
haveaninnateorbasicimmunityagainstTB,asisalludedtoinProfVanHelden'swork.Bothreactivation
andreinfectionwouldrequireabreakdownofthepatient'simmunesystembeforeactivediseasewouldresultand
inDrTheron'sopinion,theenvironmentwithinwhichtheplaintifffoundhimselfinthemaximumsecurityprison,was
afactorinhimbecomingillwithTB,inasmuchastheconcentrationofTBintheenvironmentandthevirulenceofthe
bacteriawereimportantfactorsinthedevelopmentofthedisease.
[95]ProfVanHeldenwasoftheviewthattheplaintiff'sexposuretoTBcasesinprisonwasprobablyverylowor
nonexistent.Asisevidentfromhisreport,hecametosuchconclusiononthebasisofinformationprovidedtohim
byofficialsoftheDCStotheeffectthattheplaintiffhadbeendetainedinasinglecellformostofthetime,thatthe
personswithwhomhesharedsuchcelldidnotappeartohaveactiveTBatanystageandthattheplaintiffhadlittle
contactwithotherinmates.DrTheronheldanopposingview.Hetestifiedthatfromhisexperienceinwalkingthe
corridorsoftheprison,therewerelargenumbersofprisonersmovingabout.Oneneedsonlyonepersonwith
activeTBtospreadthebacteriaanditwaslikelythatonewouldbeexposedtoactiveTBinthecourseofmoving
aboutintheprison.
[96]DrTheronemphasisedthattheriskofpersonsbeinginfectedwithTBbacteriaincreasedinaclosed
environment,suchasaprisoncell,wheretherewasanabsenceoffreshairandsunlight.Bacteriacoughedoutina
cellwheretheairwasstagnantandpollutedcoulddriftaroundforhours,infectingand
reinfectingeverypersonexposedthereto.Moreover,inprisonpeopleliverightnexttoeachotheranddiseaseis
accordinglyeasilyspread.Forthesereasons,hedifferedfromProfVanHelden'sviewthatindividualsexposedto
activeTBbacteriainopensocietyexperiencedthesameriskasthosewhowereincarcerated.DrTheronheldthe
viewthatalthoughtheTBguidelinesdidnotrequireisolation,soundclinicalprinciplesdictatedthatprisonerswho
wereillwithTBbeisolatedattheonsetofthediseaseandduringtheinfectiousstage,becausetheclosed
environmentwithinwhichprisonersfoundthemselves,coupledwiththefactthattheylivedincloseproximityto
eachother,facilitatedthespreadofthedisease.
[97]DrTheronalsotookissuewithProfVanHelden'sopinionthatactiveTBcasesweremovedtoaseparate
facilitywhichremovedtheriskofinfectionforotherinmates.DrTheron'sevidenceinthisregardwasthatprisoners
sufferingfromactiveTBwerenoteffectivelyisolatedfromothers.Inthehospitalsection,forexample,therewere
cellswhichhadbeenearmarkedforisolationpurposes,butifthesolidmetaldoorwasshut,theinmateinsuchcell
wasunabletohavenormalcontactwithothersanddidnothaveadequateventilation.Inpracticetherefore,the
solidmetaldoorswerenotnormallyshutandprisonersinthosecellswereseparatedfromothersonlybyabarred
gate.NoformalbarrierwasinplacetopreventthespreadofTBbacteria.DrTheronalsostatedthatheneversaw
anysinglecellsbeingusedforthepurposeofisolatinginmates,buthecouldnotcategoricallystatethatthiswas
notdone.
[98]ProfvanHelden,inhisexpertsummary,statedthatitwasnotpossibletodeterminescientificallywhetherthe
plaintiff'sTBepisoderesultedfromreactivationorreinfection.TotheextentthatProfVanHeldenimpliedthatthe
plaintiff'sdetentioninprisonhadnothingtodowithhimbecomingillwithTBandthattheplaintiff'sTBjust
happenedtooccurwhilehewasincarcerated,DrTheronheldadifferentview.Hereferredtoaletterpublishedon
theinternetbytheAmericanRntgenRaySocietyinwhichitwaspointedoutthatrecentmolecularepidemiologic
studiesprovideddefinitiveevidencethatreinfectioncontributessubstantiallytotheTBdiseaseburden.Studies
usingaspecialfingerprintingtechniqueestablishedthatmostinfectionscausingactiveTBinadultsfromTBendemic
areas,representcurrentlycirculatingstrainsthatwererecentlytransmitted.Studieshavealsoshownthatmore
than50%ofrecurrentdiseaseoccurringinendemicsettingsresultsfromreinfection.DrTheronwasoftheopinion
thattheplaintiff'sillnesswithTBresultedfromreinfection,ratherthanreactivationofanearlierinfection.Inhis
view,itdoesnotmattermuch,however,whethertheplaintiff'sillnesswithTBresultedfromreactivationorre
infection,inasmuchasreactivationnormallyonlyoccurredincircumstanceswhereaperson'simmunesystemwas
severelycompromised.Environmentalstressorsorpressurescouldcausetheimmunesystemtobreakdownand,in
hisview,thepeculiarcircumstancesofthemaximumsecurityprisoncausedtheplaintiff'simmunesystemtobecome
compromised,sothathesuccumbedtothedisease.
[99]DrTheronalsodifferedfromProfVanHelden'sviewthatonecouldnotpreventTB.DrTheronstatedthatone
couldpreventTBbyapplyingappropriatemeasuressuchas,forexample,screeningandtheprovisionofproper
ventilation.Ashasbeenalludedtoabove,thescreeningofindividualswouldhaveidentifiedthosewhowere
vulnerabletoTBandtheycouldthenhavebeenassistedinbecominglesssusceptibletothedevelopmentofthe
disease.Inthisregard,DrTheronpointedoutthatProfVanHeldenisnotamedicaldoctorandthathisapproachis
accordinglylesspractical.Medicaldoctorshave,forcenturies,identifiedpeoplewhowereatriskandhaveadopted
appropriatemeasurestominimisesuchrisk.
TheevidenceofDrCraven
[100]DrCravenworkedatthemaximumsecurityprisonfrom1988toSeptember2003.Hewasthedoctor
responsiblefortheprimarymedicalcareofalloftheinmatesatsuchinstitution.
[101]AccordingtoDrCraven,diseasemanagementwaswellrunwhenhewasfirstappointedtotheprison.There
wasanadequatenumberofwelltrainednursesandhewasconfidentthathisrequestswouldbecarriedout.In
thelate1990s,however,thesystemslowlystartedtodeteriorate.Thedeteriorationofthesystemwasan
importantevent,becausediseasemanagementisdependentuponteamworkandinaprisonsettingtheteam
includesnursesaswellaswarders.
[102]Eventually,thedeteriorationinthemanagementsystemreachedsuchastagethatDrCravenstartedto
keepadailycontemporaneousrecordofmanagementfailuresor"derelictionsofduty",ashecalledit.These
derelictionsofdutyincluded,forexample,prisonersnotbeingreparaded(iebroughtforfollowupconsultation)on
duedate,specimensnotbeingcollectedpromptly,laboratoryreportsnotbeingpresentedtohimpromptlywiththe
patient'sfoldersothathecouldtakeaction,TBtreatmentnotbeingsupervisedandrecorded,etcetera.DrCraven
madenotesofthesefailuresatthetimewhenitcametohisattentionintheordinarycourseofhisduties.The
notesweremadeinduplicateandhewouldleavethetopcopyattheprisoneachdayinthehopethat
managementwouldtakeappropriateactionandinordertoprovidetheprisongovernor(theheadofthemaximum
securityprison,MrJansen)withevidencetomotivateformorestaffandfewerprisoners.Whenhewenthome,he
transferredthenoteshehadmadetohiscomputerandforpurposesofthetrialheextractedalloftheinformation
relevanttothemanagementofTB.Thisextractwasattachedtothesummaryofhisevidence,includedentries
regarding947prisoners,ranto44pagesandconstitutedarecordofdeficienciesinthemanagementofcertainTB
patientsandthemanagementofTBintheprison.
[103]Undercrossexamination,DrCravenacknowledgedthathehadnotseentherelevantfilessinceleavinghis
positionattheprison,thathehadnoindependentrecollectionofindividualcasesandthatthecontextwithinwhich
thenotesweremade,wereofrelevance.Hisnotesweresomewhatdifficulttointerpretwhenhewasinthe
witnessbox.
[104]DrCravenattributedthelargenumberof"derelictionsofduty"whichherecordedtothefactthattherewas
ashortageofstaffamongwardersaswellasnurses.Thereweresimplynotsufficientwarderstobringpersonsto
thehospitalsectionandthereweretoofewnursestoperformthetasksthatwererequiredofthem.
[105]DrCravenwasemployedtoworkatthemaximumsecurityprisonfor5hoursperdayfromMondaysto
Fridays.Headmittedthathesometimesleftearlyforprivatecommitmentsandtestifiedthathehadineachsuch
casegivenadvancenoticeofthefact.Healsosometimesleftearlywhenthenoiseatthehospitalwassuchthathe
couldnotperformhisjobandbecamesoirritablethathewouldbecomeabusive.Heexplainedthatprisonerswere
frequentlysonoisyinthevicinityofthehospitalthathecouldnothearapatient'schestorbloodsounds,which
impingeduponhisabilitytotreathispatients.Headmittedthathedemandedabsolutesilencewhilehewasseeing
patientsandstatedthathewasbynomeansunreasonabletoexpectsilenceithadbeenthenormintheold,
military
style,ofmanagementattheprison.
[106]Typically,DrCravenwouldstarthisdaybyattendingtoincomingcorrespondencesuchas,forexample,
laboratoryreportsandlettersfromprisoners,theirsolicitorsorthecourts.Hewouldthenattendtoanyprisoner
whowasparaded,iebroughtfromthesection,processedbythenursesandbroughttoseehim.Thenurseswould
assessanyprisonerwhosaidthathewishedtoseethedoctororanyprisonerwhomtheyobservedtobe
obviouslyinjuredorill.Asheunderstoodthesystem,intheoryanursewassupposedtogototheappropriate
sectioneachmorningtoaskifanybodyhadmedicalproblemsandanurseoughttohavebeenavailableinthe
afternoonstoassessincomingprisonerswhocamefromthecourts.
[107]Intheordinarycourseofperforminghisduties,DrCravenwouldmakeanoteonthepatient'sfileifhehadto
comebackforafollowupconsultation.Thenursewouldhavetoworkwiththerelevantwardertoensurethatthe
patientwasreparadedontheappointedday.IfDrCravenwantedsamplessuchas,forexample,sputumorblood,
tobesenttothelaboratory,hewouldsimilarlymakeanoteinthepatient'sfileandthenursewouldhavetocollect
thespecimenandsenditofftothelaboratory.Thelaboratorysentarunnertotheprisononadailybasistocollect
specimensandtodeliverreports.Itwasaccordinglyreasonabletoexpectareporttobetabledwithin2daysafter
thedateuponwhichthereporthadbeen
prepared.Itwasimportantthatreportsbepresentedtohimpromptlysothathecouldtakeappropriateactionat
anappropriatetime.
[108]Oncethesickparadehadbeencompleted,theprescriptionsformedicationwhichDrCravenhadprepared,
wouldbesenttothepharmacysothatthemedicationcouldbeissued.Therewasonlyonepharmacistwhowas
responsibleforalloftheprisonsatPollsmoor,aswellassomeofthecountryprisonsandthisfrequentlyresultedin
theissuingofmedicationbeingdelayed.Evenifmedicationwasissuedonthesameday,prisonerswerelockedup
at4o'clockandsometimesthenursehadgonehomebythensothatprisonersonlyreceivedthemedicinethe
followingday.Prisonersoftencomplainedthattheyneverreceivedthemedicationthathadbeenprescribed.
[109]DrCraventestifiedthatthemanagementofTBisdifferenttothemanagementofotherdiseasessuchas,for
example,pneumonia,becauseTBisaformidableinfectiousdisease.ThelawrequiresthattheMedicalOfficerof
HealthbenotifiedandtheNationalDOHhasprescribedguidelinesforthetreatmentofTBwhichrequirethatthe
takingofeverytabletbesupervised.Thepatientmustbewatchedwhiletakingthemedication,theperson
supervisingmustcheckthepatient'smouthtomakesurethatthetabletshavebeenswallowedandmustthentick
offtherelevantboxonthepatient'streatmentcard.Intheoutsideworld,thesupervisionisnot
normallyrequiredtobeperformedbyanurse.Afamilymember,friend,neighbourorcolleagueactsassupervisor.
[110]DrCraventestifiedthatthepracticeintheoutsideworldisforsomebodytovisitthehomeofanewly
diagnosedTBpatientinordertotesttheothermembersofthehouseholdforTB.Hedidnotknowwhetherthiswas
doneinthemaximumsecurityprison,buthewasawareofthefactthatsomeprisonerswereparadedafterhaving
beenidentifiedaspossibleTBpatientsbyoneofthenurses.Onhisvisittothemaximumsecurityprisonduringthe
courseofthetrial,hewasshownsocalled"suspectregisters"whichcontaineddetailsofpersonswhohadbeen
suspectedofhavingTBandinrespectofwhomsputumtestswereobtained.Theregistersthathesaw,however,
relatedtothetimeperiodsubsequenttohisemploymentattheprison.
[111]DrCravencorroboratedtheevidenceofDrTheroninregardtothemannerinwhichTBisdiagnosed.Thefirst
stepinmakingadiagnosis,involvesthetakingofahistorytodeterminewhatsymptomsthepatienthasnoticed.A
clinicalexaminationisthenperformed.Suchexaminationconsistsofobservingthepatienttodeterminewhetherhe
iswellnourishedoremaciatedandwhetherheiscoughing.Thepatient'stemperaturewouldbetakenanda
physicalexaminationwouldbeconducedby,interalia,percussionofthechestandbylisteningtothechestwitha
stethoscopeto
ascertainwhetherairwasmovinginandoutofthelungsonbothsidesequally.Onpercussionanormalchest
soundshollowandifthereissolidmaterialitsoundsdull.Ifairflowisnotequalonbothsides,itisindicativeof
underlyingpathologyinthelung.AfterthephysicalexaminationanXRaymaybetakenand,ifTBissuspected,two
sputumsamplesareobtainedwhicharesentforlaboratoryanalysisand,ifappropriate,culture.Ifaprisoneratthe
maximumsecurityprisonrequiredanXRay,hewouldbesenttoVictoriaHospitalassoonastransportand
guardingcouldbearranged.
[112]DrCraventestifiedthathisdecisionwhetherornottosendaninmateforachestXRaywoulddependon
theclinicalstateofthepatient.IfhewasnotsurethatthepatienthadTBafterperformingaclinicalexamination,he
wouldwaituntilthesputumtestresultwasobtained.IftheclinicalexaminationrevealedsignsofTB,hewouldsend
thepatientforanXRaystraightaway.Likewise,thestageatwhichDrCravenwouldprescribemedicationwould
dependontheresultsoftheclinicalexamination.IftheclinicalexaminationrevealedstrongevidenceofTB,he
wouldstarttreatmentbeforethelaboratoryresultscametohand.Thedecisionwouldbemadeineachcaseinlight
ofthepatient'scondition.OnceaprisonerwasdiagnosedwithTBandreceivedhismedication,hewouldbesent
backtothesection,becausetheisolationsectionintheprisonhospitalwasusuallychockablock.Undercross
examinationDrCravendid,however,
concedethatTBpatients,uponbeingdiagnosed,wereseparatedasfaraswaspossible.
[113]DrCravenusedtovisitthesectionsinthemaximumsecurityprisonaspartofhispublichealthinspections.
Hestatedthattherewassevereovercrowding,totheextentthathewouldregularlyseeuptofourprisonersina
celldesignedforoccupationbyonepersonandupto60personsinacelldesignedforoccupationby20.Thecells
hadnarrowslattedwindowsalongoneoutsidewall.Thedoortothecellwassituateontheoppositesideofthe
cellandhadasolidsteeldooraswellasabarredgateorgrille.Oncelockdownoccurredatapproximately4pm,the
steeldoorwasclosed,sothattherewasnocrossventilationuntilsuchtimeasthedoorwasopenedthefollowing
morning.
[114]Chapter2oftheStandingOrdersprovidesfortheminimumpermissiblecellareaperprisonerintermsoffloor
spaceandairspace.Duringthevisittotheprisonwhichwasconductedbytheplaintiff'slegaladvisorsandexperts,
DrCravenmeasuredsomeofthecellswheretheplaintiffhadbeendetained,moreparticularlyasinglecell,an
overnightcommunalcellwhereprisonersweredetainedwhenreturningfromcourtandanordinarycommunalcell.
Hethenusedthosemeasurementstodeterminethenumberofprisonerswhichoughttobehousedinthosecells
accordingtotheStandingOrders.DrCravenfoundthatifoneappliedtheformulae
providedintheStandingOrders,differentresultswereobtaineddependingonwhetheronehadregardtosurface
areaorvolume.Theovernightcellsyieldedamaximumcapacityof17whencalculatedwithreferencetosurface
areaand23whencalculatedintermsofvolume.Asinglecellwhichhadbeenoccupiedbytheplaintiff(aswellas
twootherinmates)yieldedamaximumofoneinmatewhencalculatedwithreferencetosurfaceareaandtwo
inmateswhencalculatedintermsofvolumeandacommunalcellinthesectionyieldedresultsof12and16
respectively.
[115]DrCravenwasreferredtoaletterunderthehandof,interalia,MrEngelbrecht(theAreaManagerat
Pollsmoor),MrJansen(theHeadofthemaximumsecurityprison)andMrMuller,whichhadbeenforwardedtothe
defendantandtheCommissionerofCorrectionalServicesbyfacsimileon3October2003.Thesubjectheadingof
theletterread:"POLLSMOORAHEALTHHAZARDFORWESTERNCAPE".Theletterstated,interalia,thatthe
approvedaccommodationofthemaximumsecurityprisonat100%occupancywas1619prisoners,butthatthe
lockuptotalforthepreviousdaywas3052whichconstituted189%occupation.DrCravenconfirmedthathehad
notpersonallyverifiedthesefigures,butthattheywereconsistentwithhisobservations.DrCraventestifiedthat
hehadvisitedotherprisons,suchasGoodwoodandaprivatisedprisonatBloemfontein.Whathadstruckhim
aboutbothofthose,wasthelackofovercrowding.
[116]DrCraventestifiedthatapplicationoftheDOTSsystemwasextremelyimportant,becauseprisonersoften
didnotwanttotaketheTBmedication.Thereweretwomainreasonsfortheirreluctancetotaketheprescribed
drugs.Firstly,nauseawasacommonsideeffectofthemedicationandsecondly,prisonersfrequentlydidnot
understandtheneedtotakethemedication.Asfarastheywereconcerned,theywerenotill,theysimplyhada
cough.Failuretotakethemedicationfortheprescribedperiodcausedpatientstosufferarelapsewhich,inturn,
causedthemtobecomeinfectiveagainand,inaddition,couldleadtothemdevelopingMDRTBwhichwasextremely
difficulttotreat.
[117]DrCravenexpectedtheadministrationoftheTBmedicationinprisontobeperformedbyanurse.Indeed,he
expectedthenursetoissuethetablet,togivethepatientaglassofwater,towatchthepatientswallowthe
tablets,toinspectthepatient'smouthandthentotickofftheboxonthetreatmentcardandonthehospitalfolder.
Treatmentalsohadtoberecordedinatreatmentregisterwhichwasheldinquadruplicate.Thebottomcopywas
retainedintheclinicandonecopywastobesentofftotheMedicalOfficerofHealth.Inmanycases,however,
DrCravenfoundthatthedocumentswhichweresupposedtohavebeenforwardedtotheMedicalOfficerofHealth
werestillintheregister.TheDOTSsystemwasalsonotappliedconsistently.So,forexample,treatmentcardswere
sometimescompletedinadvanceofthemedicationhavingbeensupplied,
orsubsequenttheretoandsometimespatientsdidnotreceivetheirmedicationatall.Rifampicin,oneofthedrugs
containedinthestandardtreatment,colourstheurinebrightorangeandDrCravenaccordinglycheckedpatients'
urinetoascertainwhetherornottheyhadtakentheirmedication.
[118]UndercrossexaminationDrCravenhadtoconcedethatalthoughRifampicincanbedetectedinthebodyby
chemicalmeansforupto24hours,hecouldnotfindanyinformationindicatingforwhatperiodoftimeaftertaking
themedicationaperson'surinewouldbeorange.Thecolouroftheurinewoulddependupontheparticular
patient'smetabolism,thetimewhenthemedicationhadbeentakenandthefoodwhichhadbeenconsumed.The
colourofaperson'surinewasaccordinglynotnecessarilyareliableindicatorastowhetherornotthemedication
hadbeentaken.DrCraven,however,pointedoutthathisobservationsofapatient'surinenotbeingorange,had
tobeseenagainstthebackgroundofalargenumberofpatientswhoseurinewasorange.
[119]DrCravenalsoconcededincrossexaminationthatnoteverymanagementfailureor"derelictionofduty"
necessarilyresultedinharmtoaparticularprisonerortotheprisonpopulationatlarge.Indeed,insomeinstances
patients,whohadonoccasionostensiblynotreceivedtheirmedication,wereeventuallycuredofTB.An
unsatisfactorylevelofcarewould,however,
haveresultedininadequatetreatmentofpersonswhowereillwithTBsothattheplaintiffwouldhaveinhaledfar
morebacteriathanhewouldhaveintheoutsideworld.DrCraven'sopinioninthisregardwasbasedonhispractice
ofmedicineover30yearsandtheperiodof16yearsduringwhichhehadworkedatthemaximumsecurityprison.
[120]DrCravenfurtherconcededthatitcouldnotbesaidthattherewasnofunctioningmedicalsystematthe
maximumsecurityprisonduringtheperiod19992003.Therewasasystemandsometimesitworked,whileat
othertimesitdidnot.Hesawitashisethicaldutytogetthesystemimprovedandthatiswhyhemade
representationstoavarietyofpeople,includingtheParliamentaryPortfolioCommittee.
[121]DrCravenagreedthatthenurses,despitebeingunderstaffed,prioritisedchronicillnesses,TBandattending
todressings.HealsoagreedthatsomeproactivescreeningofpotentialTBpatientsdidtakeplace.Indeed,hewas
preparedtoacceptthatpersonswithpersistentcoughingwereofferedaTBtestbythenurses,whenitwasputto
himthatGertsewouldtestifytothiseffect.DrCraven,however,testifiedthatheneversawany"suspectregisters"
whilehewasemployedatthemaximumsecurityprisonanddidnotknowthatsuchregistersexisted.
[122]DrCravenagreedwithDrTheronthatcertainpeopleareatriskfor
becomingillwithTB,notablypersonsofthelowersocialorderssuchastheunemployed,povertystricken,homeless
andvagrants.ThereasonwhythesepeoplearemoresusceptibletoTB,isbecausetheyareoftenmalnourished
andtendtoliveinovercrowdedflatsorshantiesoneontopoftheother.DrCravenalsoexplainedthatpersonsof
thelowersocialordersoftenonlyseeadoctoroncetheyhavebeenillwithTBforsomeconsiderabletime,because
peoplewholiveinovercrowdedconditionsandwhosmoke,frequentlycoughanddonotregardacoughas
pathological.Therefore,theydonotseekmedicalhelpuntilsuchtimeasfurthersymptomshavepresentedsuchas,
forexample,substantialweightloss,coughingofblood,ornightsweats.
[123]DrCravenconfirmedthatmostpeopleinSouthAfricainhaleTBbacteriainearlylife.Thosewhosubsequently
becomeillwithTBeithersufferareactivationofthebacteriumwhichhadbeeninhaledearlier,orbecomere
infectedwhenafreshdoseoftheTBbacteriumisinhaled.Thereisadifferenceofopinioninmedicalcirclesasto
whetherreinfectionismorecommonthanreactivation.
[124]Asfarastheplaintiffhimselfisconcerned,DrCravenconfirmedthathesawtheplaintiffonthemorningafter
thelatter'sadmissiontothemaximumsecurityprison,ieon23November1999.Hewasconcernedaboutthe
plaintiff'sischaemicheartdisease,advisedhimtostopsmokingandtolose
weightandorderedthattheplaintiffreceivehalfrations.Thereafter,hesawtheplaintifffromtimetotimewhenthe
latterhadmedicalcomplaintsandheorderedappropriatetreatment.
[125]On14April2003theplaintiffcomplainedofTBsymptomsandsputumsamplesweretakenwhichproduceda
negativeresult.On20May2003theplaintiffcomplainedthathehadnotreceivedhischronicmedicationfora
periodof3weeksandon27May2003theplaintiffpresentedwithaninguinalhernia,whichwasasurgical
emergency.DrCravenorderedhisimmediateremovaltoVictoriaHospital.Hesawtheplaintiffagainon2June2003
afterhisdischargefromVictoriaHospital,whenitwasreportedthattheplaintiffhadpulmonaryTB.DrCraven
orderedthatsputumsamplesbetaken,thattheplaintiff'sXRaysbeobtainedfromVictoriaHospital,thatthe
plaintiffbeadmittedtothehospitalsectionandbeseenagainin8days'time.On3June2003DrCravensawtheX
Raywhichhadbeentaken,whichshowedthattheplaintiffhadbilateralinfiltrationandcavitiesinthelungs,which
wasindicativeofTB.
[126]On9June2003DrCravenreceivedalaboratoryreportwhichindicatedthatbothoftheplaintiff'ssputum
samplestestedpositiveforTB.Onthestrengthofthepositivesputumtests,DrCravenorderedthattheplaintiff's
illnesswithTBbereportedtotheMedicalOfficerofHealth,thattheplaintiffbestartedonthestandardtreatment
forTB,RegimenI,andthatthe
plaintiffbegivendoublerations.TheplaintiffstartedhisTBtreatmenton10June2003andwassentbacktohis
section,becauseitwasnotlogisticallypossibletoisolatehim,nospaceforisolationbeingavailable.On18June
2003thelaboratoryreportedapositiveculture,whichconfirmedthediagnosisofTBwhichhadbeenmadeandon
14August2003afurtherlaboratoryreportwasobtainedwhichshowedthatthebacteriaweresensitiveto
RegimenI.ThelasttimeDrCravensawtheplaintiffinprisonwason19September2003.
[127]DrCraventestifiedthatthemeasureswhichwererequiredtocontrolthespreadofTBattheprisonincluded
thefollowing:
127.1 SeparatingprisonerswhohadactiveTBfromthegeneralprisonpopulation
127.2 Havingasufficientnumberofproperlytrainednursesavailablewhohadknowledgeofthebasicmanagement
ofTB,thetestingforTBandthetreatmentofTB,sothatTBcasescouldbepromptlydiagnosedandtreated,
therebyreducingthenumberofTBbacteriaintheenvironment
127.3 ProperapplicationoftheDOTSsystemthatcouldeasilyhavebeenachievedbythenurses.Warderscould
havebeenaskedtoassist
inthisregard
127.4 Reducingtheovercrowdingofcells
127.5 Increasingthenumberofnurses
127.6 Imposingandmaintainingdiscipline.
[128]Inregardtothenecessityfordiscipline,DrCraventestifiedthatinadisciplinedsituationprisonersdidwhat
theyweretold,wardersandnursesdidwhattheyweretoldandprisonersreceivedtheirprescribedmedication.In
acontrolledenvironmentsuchastheprison,ifadoctororderedtheisolationofaprisoner,theprisonerwouldbe
isolatedandifalogisticalproblemaroseinthisregard,theproblemwouldbediscussedbetweenthewardersor
governorandthedoctorandeffortswouldbemadetoresolveit.Infact,duringthepreviousmilitarystyleof
management,thiswasexactlywhathappened.
[129]InDrCraven'sopinion,thefailuretomanageTBinthemaximumsecurityprisoninaccordancewiththe
guidelinesoftheDOHwouldhavecaused,orcontributedto,theplaintiffbecomingillwithTB.Suchfailurewould
haveincreasedthenumberofbacteriapercubicmetreofairandtheplaintiffwouldaccordinglyhaveinhaledmore
oftheTBbacteriathanhewouldhave
intheoutsideworld.Theincreaseddoseofbacteria,inotherwords,wouldhaveincreasedhischancesofbecoming
infectedwithTBifhehadnotbeeninfectedpreviouslyandwouldhaveincreasedtheriskofanydormantTB
bacteriabecomingreactivated,therebyleadingtotheplaintiffbecomingillwiththedisease.
[130]DrCravenwasaskedtocommentontheplaintiff'sevidencethathehadgonetocourtonsome70occasions,
whereafterhewasusuallyplacedinacommunalcellwithotherprisonersuntilthefollowingday.DrCraventestified
thatintheorywhenprisonerscamebackfromthecourts,newlyarrivedprisoners,iethosewhocameintothe
prisonforthefirsttime,oughttohavebeenseparatedfromexistinginmates.Inpractice,however,hebelievedthat
thishadnotbeendoneforlogisticalreasons.
[131]DrCravenconcededthatwhiletheplaintiffwasdetainedinasinglecellhisexposuretoTBbacteriawould
havebeenlessthanifhehadbeeninacommunalcell.However,theplaintiffwouldstillhavebeenexposedto
bacteriadriftinginthepassageonhiswaytotheshower.
[132]DrCravenwasunabletocommentonthedaytodaysystemwhichthenursesadoptedinseeingpatientsin
thesectionsandonwhetherornotanurseconductedscreeningofincomingprisoners,becausehehadno
personalknowledgeoftheseevents.DrCravenonlyheardofa
computerisedTBmonitoringsystematthemaximumsecurityprisonduringthecourseofthetrial,whenhewas
shownanextractfromthecomputerisedrecord.HealsosawtheTBwheel,whichthenursesusedtomonitor
treatmentofTBpatients,forthefirsttimewhenhewasincourt.
[133]AswasthecasewithDrTheron,DrCravenmademanywrittenandverbalrecommendationsthroughthe
appropriatechannelstothegovernorofthemaximumsecurityprison,totheMinister,totheProvincialDOH,the
InspectingJudgeofPrisons,theMedicalOfficerofHealth,theMedicalAssociationandtotheParliamentaryPortfolio
Committee.Theserecommendationsrelatedtotheemploymentofadditionalwardersandnurses,thereductionof
thenumberofprisonersandtheimpositionofbetterdiscipline.
[134]Shortlybeforehewascalledtotestify,DrCravenbecameawareofaletterwhichthedefendanthadwritten
totheCommissionerofCorrectionalServicesdated4October2001whichreferredtothereportwhichDrCraven
hadprovidedtotheParliamentaryPortfolioCommitteeandcertaincorrespondencewhichhadbeenexchanged
betweenvariousofficialsintheDepartmentasaconsequencethereof(ExhibitH).Inhisletter,thedefendant, inter
alia,instructed"theActingProvincialCommissioner,MrNxele,theAreaManageratPollsmoor,MrEngelbrechtand
theentirePollsmoorManagementtotreatthishealthproblemasamatterofextreme
urgency"andstated:
"Thishorrendoussituationasreportedmustnotbeallowedtocontinueany(sic)dayfurther,
particularlywheretheManagementhasthepowerstotakeimmediateremedialsteps."
Inaletterdated9October2001writtenbytheCommissionerofCorrectionalServices,MrMti,totheActing
ProvincialCommissioner,MrNxele,theformerstated:
"IfthesituationasdescribedbyDrCraven,isnotaddressed,weareheadingforanunprecedented
catastrophe.Iurgeyoutoplacethematteratthetopofyourprioritiesand(sic)reportbacktome
beforetheendofOctober2001."
[135]Despitetheserioustenoroftheaforesaidletters,DrCraventestifiedthatnovisibleimprovementwas
broughtaboutinthehealthserviceatthemaximumsecurityprison.Althoughhehadmademanyrepresentations
aimedatimprovingthehealthcaresystem,nobodyliaisedwithhim,orsoughthisadviceinthisregard.Instead,he
wasdismissedbytheProvincialDOHandtestifiedthathisdismissalhadbeencalledforbytheDCS.He
subsequentlytookhiscasetotheLabourCourtandwasreinstated.Pursuanttosuchreinstatement,hehasbeen
workingattheLadyMichaelisHospital.
[136]DrCravencouldnotrecallavisittothePollsmoorPrisoncomplexbytheDirectorofHealth&PhysicalCare
andtheProvincialHeadsoftheHealthCareServiceduringMarch2001.Hesawthereportwhichhadbeendrawn
subsequenttosuchvisitforthefirsttimewhilehewasinthewitnessbox.
[137]IndealingwithTBstatisticsatthemaximumsecurityprison,DrCravenwasreferredtoaschedulecovering
theperiod19982009whichhadbeenpreparedbytheauthoritiesattheprison.DrCravendrewattentiontothe
factthatthecopyoftheactualregisterswhichhadbeenprovided,clearlyshowedthescheduletobeincorrect.So,
forexample,thetotalnumberofTBcasesfor2001,accordingtotheregister,was177whereastheschedule
referredtoonly69cases.Theschedulewasalsopatentlyincompleteinasmuchasnofigureswereprovidedfor
certainmonths,suchas,forexamplethemonthsofApriltoOctoberin2001.
TheevidenceofMrGertse
[138]AccordingtoMrGertse,theDCSusesthreecategoriesofnursesassistantnurses,staffnursesand
professionalregisterednurses.EachofthefiveprisonsatPollsmoorhasitsownhospitalandeachhasitsown
healthcarepersonnelconsistingofclerks,nursesandadoctor.Duringthetimeoftheplaintiff'sincarceration,a
totaloffourdoctorswereemployedonanagencybasisandtheyworkedinthemorningsuptolunchtime.Nurses
workeddayshiftsfrom7amto4pm.
[139]From20012003theheadnursewasMrSlinger.Hewasinchargeatthe
maximumsecurityprisonandhadanofficeinthehospital.HissecondincommandwasMrHillier,whoworkedinthe
hospitalitself,asdidSisterNdzabe.MrErasmuswasthenurseinEsection,MrTiervleiwasinDsectionand
MrSibeko,whowasastaffnurse,wasinchargeofCsection.AsectionwasheadedbyMrAysleyandMrVan
Stadenusedtoworkinthehospitalsection,butthelattermovedtothemediumBprison.MrGertseworkedatB
section.Thenurseswereassistedbyfourclerksandapproximatelyfournursesfromanagency,whowere
employedonatemporarybasis.
[140]MrGertsetestifiedthatthehealthsystematthemaximumsecurityprisonisnursedriven,withadoctor
providingsupport.Inpractice,thatmeansthatallcaseshavetobeseenbynursesandthatonlythosecaseswhich
arenotwithinthenurses'scopeofpracticeareseenbyadoctor.
[141]Intheordinarycourse,nursescameondutyat7am.ThenurseswouldgatherinMrSlinger'sofficeinorderto
shareinformationrelativetotheday'sprogramme,whereaftermedicationwouldbecollectedfromthestore.Each
prisoner'sprescribedmedicationwouldbeplacedinaseparateplasticbag."Pillparade"wouldthenbeconducted
inthesections.TherewasasubclinicforeachfloorsothatsectionsE1,E2andE3,forexample,wouldshareone
cliniconEfloor,suchclinicbeingconductedinacellreservedforthispurpose.Forpurposesofpillparade,each
nursewasprovidedwitha
specialtrolley,whichwasdividedintocompartmentsintowhicheachprisoner'smedicationwasplaced,aringbinder
containingcopiesoftherelevantprescriptionsandamedicineadministrationcardforeachinmateonwhichdetails
ofthemedicationadministered,hadtoberecorded.Oncethecardwasfull,itwouldbeplacedintotheperson's
hospitalfile.Inadditiontotheprescribedmedication,thenursehandedoutordinaryoverthecountertype
medicationsuchasPanado,coughmixture,footpowder,ointments,bandagesandplasters.AccordingtoMrGertse
allprisoners,exceptthosewhowereinhospital,receivedtheirmedicationinthesectionsduringpillparade.So
called"wardstock"consistingofPanado,bandages,ointmentsandthelikewerekeptinthecellwheretheclinic
wasconducted.
[142]MrGertsetestifiedthatawarderwouldnormallyrecordprisoners'complaintsinacomplaintsbook.Inmates
whohadmedicalcomplaintswouldbesenttothenurseinthesectionforassessment.Thenursewouldhandout
medication,ifappropriate.Iftheprisoner'scomplaintfelloutsideofthescopeofthenurse'spractice,hewouldbe
referredtothedoctorinthehospitalsection.Aparticulardayoftheweekwasreservedforinmatesofeachsection
tovisitthedoctor.Ifamedicalemergencyarose,aninmatewould,however,besentthroughtothehospital
immediately.
[143]DuringaspecialcourseinthemanagementofTBwhichMrGertsecompletedin2003,hewastaughtthe
signsandsymptomsofTBand
receivedtrainingaroundthetakingofsputumsampleswhichhadtobesenttothelaboratoryforanalysisinorder
tomakeadiagnosis.MrGertsestatedthatoncethedoctorhadprescribedtheapplicableTBmedication,itwasthe
responsibilityofthenursetomanagethetreatment.TheTBwheelwasusedasanaideforthenursetocalculate
whenfollowupsputumtestshadtobeconductedandtomonitorthenatureofthemedicationthathadtobe
administered.Afterthefirsttwomonths,ortheintensivephase,ofthetreatmentthepatient'smedicationwouldbe
adjusted.Thenursewasresponsibleforhandingthemedicationtothepatientandformarkingofftheapplicable
boxonthepatient'streatmentcard.MrGertsesaidthathedidnotknowthattheinfectiousphaseofthedisease,
accordingtothedoctors,lastedforaperiodoftwoweeksaftertreatmentstarted.
[144]MrGertsetestifiedthatthedoctorssawpatientsinthehospitalsectionandthattheydidnotgotothe
sectionswheretheinmateswerehoused.Thedoctorsdidnotknowwhatthetaskswerethatthenurseshadto
perform.
[145]Inregardtothescreeningofprisoners,MrGertsetestifiedthatoffenderscomingintoprisonfromthecourts
wouldwaitintheyardoutsidetheprisonbuildingtobecounted.Thenurseonnightdutywouldaskwhetherthere
wereanymedicalcomplaintsandthenamesofthosewhosaidtheydid,werenoted.Prisonerswouldthereafterbe
calledtoenterthebuildingindividuallyinordertobesearched,whereaftertheywouldbedetainedin
aholdingcell.Ordinarilyprisonerscouldnotbetakenbacktothesections,becausethelastvehiclesonlyreturned
fromcourtataround6pmor6:30pmandbythattimethecellshadbeenlockeddown.Thenightnursewould
receiveaprintoutcontainingthenamesofpersonswhohadbeenadmittedtotheprisonandwouldthengotothe
holdingcellstodealwithmedicalcomplaints.Minorcomplaintswouldbedealtwiththereandthenandprisoners
whohadmoreseriouscomplaintswouldbesenttothehospitalsothatthedoctorcouldseethemthefollowing
day.Iftherewasamedicalemergency,theprisonerwouldbesenttoVictoriaHospital.Thefollowingday,returning
prisonerswouldbetakenbacktotheircellsandnewarrivalswouldbescreenedbythenursesinthecourtyardat
thehospitalsection.
[146]MrGertsewasreferredtotheforms(ExhibitsOandP)whichhadtobecompletedduringthescreening
processwhenpersonsfirstenteredthemaximumsecurityprison.Hecouldnotexplainwhycertainprisonerswho
hadostensiblybeenallocatedtoaparticularsectionhadapparentlynotbeenscreened,becausetheirdetailsdid
notappearontheform.ItisalsonotclearfromMrGertse'sevidencewhentheseformswerecompleted.Inhis
evidenceinchiefhetestifiedthatprisoners'nameswererecordedoncomputerastheycameintothesystem,
prisonnumberswereallocatedtothemandtheirmedicalcomplaintswerenoted.Thecomputerisedrecordwouldbe
printedassoonasalloftheprisonerswhohadarrivedfromcourt
wereinsideandthelistwouldthenbegiventothenurse.Hisanswerclearlysuggestedthattheformwas
completedthatevening.Undercrossexamination,however,hestatedthatprisoners'medicaldetailswereonly
filledoutontheformwhentheywerescreenedatthehospitalthefollowingday.Hethen,forthefirsttime,stated
thattherewasaseparatebookinwhichthenamesofpersonswhohadmedicalcomplaintswouldbenotedupon
admissionandthatsuchbookwouldbegiventothehospitalthefollowingday.
[147]MrGertsetestifiedthatthemaximumsecurityprisonreliedonaselfreportingsystemintermswhereof
inmateshadtotaketheinitiativeandhadtoreportiftheywereillorrequiredmedicalassistance.Suchsystemalso
appliedininstanceswhereinmatessuspectedthattheymighthaveTB.Inmates'complaintswouldbelodgedwitha
warder,whowouldmakeanoteinthecomplaintsregister.Eithertheinmateorthewardercouldthenbringthe
complainttotheattentionofanurse.IfTBwassuspected,theinmatewouldberequestedtoprovideasputum
sampleinthepresenceofthenurseandthelatterwouldnotesuchprocedureinthesuspectregisterwhich,
accordingtoMrGertse,wasalreadybeingusedwhenhefirstcametoPollsmoorin2001.Ifthesputumtestyielded
apositiveresult,suchfactwouldbenotedinthesuspectregisterandthereportwouldbeforwardedtothedoctor.
Negativeresultsweresimilarlynotedinthesuspectregister,butthereportsinsuchcaseswouldnotbeforwarded
tothedoctor.Theinmatewouldbeinformedofthenegativerestresultandwouldbeadvised
toreturninsixmonths'timeforafurthersputumtest.Onlyifaprisonerpersistedincomplainingafteranegative
resulthadbeenobtained,wouldhebereferredtothedoctorsothatthelattercoulddecidewhetherornothe
neededtobereferredforXRays.
[148]WhenaskedwhyMrMuller,DrTheronandDrCravenappearedtohavebeenunawareoftheexistenceof
thesuspectregister,MrGertsetestifiedthatMrMullerwasnotworkinginsidethemaximumsecurityprison,hehad
anofficeoutsideoftheadmissioncentreandheonlyworkedinthemaximumsecurityprisonoverweekends.
DrsCravenandTherondidnotknowabouttheseregistersandneveraskedtoseethem,butthenursesweretold
tokeeptheregistersduringtheirtraining.AlthoughMrGertsetestifiedthatsuspectregisterswereusedduringthe
timewhentheplaintiffbecameillwithTB,hestatedthathecouldnotfindthese.
[149]MrGertsetestifiedthatonceaninmatehadtestedpositiveforTB,hewouldbeseenbythedoctor,who
wouldissueaprescriptionfortherequiredmedication.Thedoctorwouldmakeanoteofthemedicationrequired,
forexampleRegimenI,onthehospitalfile,aswellasanotethatthepersonhadtoreceivedoublerations.The
nursewouldfilloutthegreenpatienttreatmentcardaswellasthebluehospitalcardandwouldimmediatelystart
themedication.Ifthepersonwasveryill,hewouldbeadmittedtohospital,butotherwisehewouldbesentbackto
oneofthesinglecellsreservedforisolationinthesections.Afteraperiodoftwoweeks,whentheywereno
longerinfectious,inmateswouldgobacktothecellswhichtheynormallyoccupied.(MrGertse'sevidenceinthis
regardclearlyimpliedknowledgeofthefactthatpersonswerestillinfectiousduringthefirsttwoweeksof
treatmentandcontradictedhisearlierevidenceinthisregard.)
[150]UndercrossexaminationMrGertsewasreferredtoChapter7oftheTBguidelineswhichcontainsadiagram
indicatingthatbroadspectrumantibioticsoughttobeprescribedfor7daysandthatrepeatmicroscopywas
indicatedininstanceswherebothsputumtestsyieldednegativeresults,butthepatient'sconditionfailedto
improve.MrGertsestatedthatinmateswhocontinuedtocomplainafternegativeresultshadbeenobtained,would
begivencoughmixtureandwouldbereferredtothedoctorthefollowingday.Thedoctorwouldthendecidewhat
hadtobedone.However,hesubsequentlyconcededthattheprisonerwouldonlybereferredtothedoctorat
somelaterstageifthecoughdidnotstoponcethecoughmixturehadbeenusedandthattheparticularprisoner
wouldnotbeisolatedintheinterim.
[151]IncrossexaminationMrGertsewasalsoreferredtotheprovisionsofclause7.1.15oftheStandingOrders
whichprovidesthatprisonerswhoaresuspectedofhavingacontagiousdisease,suchasTB,shouldbekept
separatelyfromhealthyprisonersuntilsuchtimeastheattendingmedicalofficerhascertifiedthattheynolonger
poseathreattothehealthofothers.MrGertseconfirmedthatpersonswhosenameswereincludedin
thesuspectregisterwerenotisolatedpriortostartingtreatment.
[152]AccordingtoMrGertse,thefirstthreesinglecellsinasectionwouldnormallybeallocatedtoisolation.The
singlecellinwhichtheplaintiffhadbeendetained,wasfurtherdownthecorridor.Heconcededthattheplaintiffhad
notbeenisolatedwhilehewasinthehospitalsection,butsaidthatthenurseinthesectionwasresponsiblefor
isolatinghim.MrGertsedifferedfromMrMuller'sevidencethatisolationwasoftennotpossiblebecausetheprison
wasoverflowing.Hesaidthatpeoplewentinandoutallofthetimeandthathetriedhisbesttoisolatepeople
whotestedpositiveforTB.
[153]MrGertsetestifiedthattheDOTSsystemwasappliedwhenprisonershadtotaketheirTBmedication.The
inmatehadtotakethemedicationinthepresenceofthenurse,thenursewouldcheckthatthemedicationhad
beenswallowedandtheinmatewouldinfactbeaskedtomakeaspecialclickwithhistonguewhichwouldensure
thatthemedicationwasswallowed.Thenursewouldthentickofftheapplicableboxonthebluehospitalcard.
[154]Incrossexamination,MrGertsewasalsoconfrontedwiththefactthattheplaintiff'sTBhospitalcard
reflectedthathehadbeenobservedtakinghismedicationondayswhenhehadappearedincourtandthathe
couldnothavebeensoobserved.Hethenconcededthatthenursewouldtickoffthecardevenifhe/shehadnot
observedthetakingofthemedicationaswas
required,ininstanceswheretheprisonerwastrustedtohavedoneso.Heidentifiedthesignatureatthefootof
thehospitalcardasthatofMrSlinger,theheadnurseatthetime.Heacknowledged,however,thatMrSlingerwas
notthepersonwhowouldhaveadministeredtheplaintiff'smedicationitwouldhavebeenSisterNdzabeor
MrErasmusandidentifiedthehandwritingonthefrontofthehospitalcardasthatofSisterNdzabe.Whenitwas
pointedouttohimthatSisterNdzabeworkedinthehospitalandnotinthesections,hesaidthatshewouldcheck
withMrErasmus,whoperformedthepillparadeinthesection,eachdayandwouldthentickoffthecard.MrGertse
subsequentlychangedhisevidenceinthisregardagainandstatedthatSisterNdzabeandMrErasmusbothticked
offthecard.
[155]MrGertsetestifiedthatacomputerisedrecordismaintainedatthemaximumsecurityprisoninorderto
recordreportablediseasesandthatthissystemhadalreadybeeninplacewhenhefirststartedworkingat
Pollsmoor.Theinformationrecordedonthesystemincludestheinmate'sname,prisonnumber,dateofbirth,
diagnosis,dateofdiagnosis,datewhentheillnesswasreportedtotheDOH,theplaceandsourceofinfectionand
thepreventativemeasurestaken.Hestatedthatitispossibletoextractinformationfromthisdatabaseinregard
tothenumberofTBcaseswhichwerereportedattheprisoninanygivenyear.Amonthlyreportwouldinfactbe
sentofftotheProvincialofficeoftheDCS.Noextractfromsuchdatabasewas,however,submittedinevidence.
[156]AccordingtoMrGertse,therewasagoodrelationshipbetweenthewardersandnursesandnurseshadno
difficultygainingaccesstothesections.Ordinarily,however,nursesonlywentintothecellsifaprisonerwastooill
towalktothesubclinicinthesection.
[157]MrGertsestatedthathedidnotseeDrTheroninthehospitalandthatthelatterdidnotworkinthe
sections.
[158]MrGertsecontradictedDrTheron'sevidencethatthenumberofnursesattheprisonatonestagedropped
toonlytwo.AccordingtoGertse,thatwasneverthecase.Atthemaximumsecurityprison,therewerealwaysat
leastfivetosixnursesonadailybasisandtheonlytimewhentheremighthavebeenonlyoneortwonurseson
dutywouldhavebeeniftherewasateambuildingsession.Teambuildingsessions,however,wereheldafter
paradesataround1pmor2pmand,accordingtoMrGertse,mostofthetimeoffenderswerelockedupby2pm.
Althoughheadmittedthattherewasashortageofnursestotheextentthattheactualstaffcomplementwasonly
approximately50%ofthenumberofapprovedpostsonthestaffestablishment,hedeniedthatsuchshortagewas
severe.Hewas,however,eventuallyconstrainedtoadmitthattherewerebarelyenoughnursestostaffthe
hospitalandthesections,thatthereweredayswhentherewerenotenoughnursestodotheworkinthesections
andthatthewardersthenhadtobringtheprisonerstothehospital.
[159]WithreferencetotheTBregisterswhichDrTheronallegedhadnotbeenproperlykept,Gertsetestifiedthat
theregisterswerekeptandthatneitherDrTheronnorDrCraveneverlookedatthese.Gertsealsodeniedthatthe
healthsysteminthemaximumsecurityprisonhadbrokendown,aswasallegedbybothDrTheronandDrCraven.
Undercrossexamination,MrGertseallegedthatatsomestagea"TBblitz"wasconductedwhenthenurseswent
fromsectiontosectiontotakesputumsamplesfromanyprisonerwhowantedtobetestedforTB.(Thisevidence
hadnotbeenputtoeithertheplaintifforanyofthewitnesseswhotestifiedonhisbehalf.)Whenplaintiff'scounsel
referredhimtothefactthattheTBguidelinesprescribedthetakingofsputumsamplesontwoconsecutivedays,
MrGertse,forthefirsttime,allegedthatsampleswereinfactsoobtained.
[160]MrGertsetestifiedthatDrCraveninsistedonabsolutesilence,becausehecouldnotassesspatientsifitwas
toonoisy.Attimeswhenitwastoonoisy,DrCravenwouldleaveearly.SometimesDrCravenwouldhavelongtalks
withsomeofthepatientswhichresultedinhimnothavingtimetoattendtoalloftheprisonerswhoneededtosee
himbeforeheknockedoff.MrGertsedid,however,confirmthatDrCravenmadenotesofthingsthathadnotbeen
doneandthathewouldleaveacopyofsuchnotesonthedeskofMrSlinger,thenurseinchargeofthemaximum
securityhospital.
[161]Asregardstheafterhoursnursingservice,MrGertsetestifiedthatanurse
hadtobeonstandbyatthePollsmoorpremisesfrom4pmuntil7amthefollowingday.Ifthenurseonstandbydid
notliveonthepremises,he/shehadtocomeintobetherephysically.Theafterhoursshiftwasdividedintofirst
watch,from4pmtomidnight,andsecondwatch,frommidnightto7am.Duringfirstwatchthenursewouldhaveto
seeallofthenewprisonerswhocameinfromthecourtsandafterthatthesamenursewouldbeonstandbyfor
callstoanyoftheprisonsonthePollsmoorpremisesuntil7amthefollowingday.
[162]Afterhours,ifaprisonercomplainedtothewarderondutyinhissectionthathewasnotfeelingwelland
neededtoseethenurse,thewarderwouldinformthepersoninchargethatanursewasrequired.Thenursewho
wasonstandbywouldbecalledtoseetheinmateconcerned.Thiswasthecaseevenifaprisonercomplainedofa
headache.Iftheprisonerwhocomplainedoftheheadachewasinoneofthecommunalcells,thewarderondutyin
thatsectionwouldcallthewardersondutyintheothersectionsoftheprisontoassistintakingtheparticular
prisoneroutofsuchcell,becausetherewasonlyonewarderondutyineachsectionafterhours.
[163]MrGertsedeniedthatoneoftheinmates,Trevor(Blignault),conductedthescreeningofprisonerson
admission,aswasallegedbytheplaintiff.HetestifiedthatTrevorusedtoassistinwritingouttheprisoncardwhich
ishandedouttoeachunsentencedprisoner.
TheevidenceofProfVanHelden
[164]ProfVanHeldentestifiedthat65%80%ofadultsinSouthAfricaarethoughttobeinfectedwithTB,which
meansthattheyareatriskfordevelopingthedisease.However,notallofthepeoplewhohavebeeninfectedwith
thebacteriumbecomeill.Onlyapproximately10%ofpeoplewhohavebeeninfectedwiththeTBbacterium,develop
infectivedisease.SouthAfrica,however,hasoneofthehighestincidenceratesofTBintheworld(600per100000
personsperannum)andincertainareasoftheWesternCapethefiguresarehigher.InKhayelitsha,forexample,
MedicinesSansFrontiershavemeasured1600per100000.
[165]AccordingtoProfVanHelden,theannualriskofinfectioninSouthAfricahasbeenmeasuredandestimatesof
between3.5and4.8%havebeenmade.Inhisopinion,thetrueriskishigher.Theproportionofpeopleinfectedin
somecommunitiesRavensmeadandMasiphumelelehasbeenmeasuredusingtheskintestreferredtoabove
andithasbeenshownthat52.5%ofchildrenintheagegroupbetween1417havebeeninfected.Thereis
accordinglylessthana40%chancethatanadultSouthAfricanhasnotbeenexposedtoTBinfectionbyage53(the
ageatwhichtheplaintiffcameintotheprison).
[166]Undercrossexamination,ProfVanHeldenstatedthattheannualriskofinfectionasaforesaidhadbeen
calculatedbytestingchildrenbetweentheagesof5and7inRavensmeadandMasiphumelele(Ravensmeadisone
of
theformersocalled"ColouredTownships",oneofthelessaffluentcommunitiesintheBellvilleareaand
MasiphumeleleisaninformalsettlementnearKommetjie).Heconcededthatonewouldexpectahigherrateof
infectionandpossiblyahigherrateofdiseaseinlowersocioeconomicgroupssuchasthose.Childrenin
Constantia,BishopsCourtorPlumstead(upperandmiddleclasssuburbsinCapeTown)havenotbeentestedand
the3.5%or4.8%riskofinfectionwouldalmostcertainlynotbeapplicableinthoseareas.Personswholivein
middleandhighersocioeconomicclassesgenerallyhavealowerincidenceofTB.ProfVanHeldenwould,however,
notconcedethatpersonslivinginthemiddleandhighereconomicclasseswouldbelessrepresentedintheoverall
groupof10%ofinfectedpersonswhoactuallybecameillwiththedisease.Inthisregard,hestatedthatwhether
ornotapersonbecomesillwiththedisease,dependsongeneticfactorsandinherentsusceptibility.Hisreasoning
inthisregardisclearlyflawedinasmuchasitdoesnottakeintoaccountthatonhisownevidencefarlesspeople
fromthemoreaffluentcommunitieswouldbeincludedinthepoolofpersonswhohadbeeninfectedwithTB.
[167]TheresearchwhichhasbeendonebyProfVanHelden'sunithasshownthatpersonswhohavehadactive
TBareinnatelysusceptibletothediseaseandthattheirriskofdevelopingthediseaseagainis4to7timeshigher
thanthatreferredtoabove.
[168]Asregardsthedifferencebetweenreactivationandreinfection,ProfVan
HeldentestifiedthatifapersonhasarecurrentepisodeofTB,onewouldnotordinarilyknowwhetherithasbeen
causedbyreinfectionorbyreactivation.Ifaperiodofmorethantwoyearshaselapsedafterthefirstepisodeof
TBdisease,itisusuallyreferredtoasacaseofreinfection.Intheplaintiff'scase,itwasnotpossibletostate
unequivocallywhetherhisTBepisoderesultedfromtransmissioninprison,orfromreactivationofpreviousinfection
whilsthelivedinopensociety.OneofthestudieswhichwasreferredtoinapublicationinwhichProfVanHelden
participated,however,foundthat56%ofactivediseaseepisodesinthatstudycommunitycouldbeascribedto
recenttransmission.
[169]WhilstProfVanHeldenwascriticalofcertainportionsofthearticle,ExhibitE,heagreedthatinhighendemic
societies,suchasKhayelitsha,mostinfectionscausingactiveTBinadults,representedcurrentlycirculatingstrains
ofTBthatwererecentlytransmitted.Healsoagreedthatinalllikelihood,ongoingtransmissioncausesrepeated
episodesofinfection.
[170]ProfVanHeldenpointedoutthatitwasnotknownwhetherornottheplaintiffhadbeeninfectedwiththeTB
bacteriumpriortohisadmissiontoprison.Inasmuchastherewasnoevidencethattheplaintiffhadnotbeen
infectedpriortoenteringprison,ProfVanHeldenstatedthatheprobablyfellintothecategoryofpersonswhohad
alreadybeeninfected,because80%ofadultSouthAfricanshavehadexposuretothebacterium.Indeed,ProfVan
Heldenstatedthatthechancesofplaintiffhavingbeenexposed
toTBbacteriapriortoenteringtheprisonwere"exceptionallyhigh",becauseSouthAfricahasthedubious
distinctionofhavingoneofthehighestincidencesofTBintheworld.Undercrossexamination,however,it
transpiredthatProfVanHeldenhadbeenunawareofthefactthattheplaintiffhadbeendetainedinthemaximum
securityprisonforapproximately3yearsbeforehedevelopedthediseaseandthathehadaccordinglynottaken
suchfactintoaccountinarrivingathisconclusions.
[171]ProfVanHeldenstatedthattheplaintiff'sexposuretoactiveTBcasesinprisonwasprobably"verylowor
nonexistent".Hisreasonsforcomingtothisconclusionwerethefollowing.MrGertsehadinformedProfVanHelden
thattheplaintiffhadmostlybeenkeptinasinglecell,whichhesharedwithpersonswhohadnothadactiveTBat
anystagethatinmatesinsinglecellswereletouttofetchfoodtwiceperdaybeforeinmatesfromcommunalcells
werereleasedandthattheplaintiffstayedintheprisonhospitalforsometime.ProfVanHeldenaccordingly
surmisedthatplaintiff'sexposuretootherinmateswaslowinnumbersandshortintime,sothathisexposuretoTB
caseswouldprobablyhavebeenverylow.ProfVanHeldenhadalsobeeninformedthatinmateswhowere
diagnosedwithTBreceivedprompttreatmentandknewthatwhenpatientsreceivedtheprescribedtreatment,
theybecamelessinfectiousquiterapidly.Theaforesaidinformationandknowledgeledhimtobelievethatevenif
theplaintiffhadbeenexposedtopersonsregardedasactivewithTBaftertheyhadbeenontherapy,those
personswereprobablynotinfectious.
[172]ProfVanHeldenwasoftheviewthattheplaintiffhadreceivedthebeststandardofcarethatwaspossiblein
SouthAfrica.Hewasimmediatelyplacedonappropriatetherapyoncethepositiveresultofthesputumtestwas
obtainedandtherewasnodelaypendingtheresultoftheculture.Hereceivedthefullrecommendedamountofhis
medicationregularlyandfortherequiredperiodoftime.Indeed,ProfVanHeldenstatedthatinhisviewthe
standardofcareintheprisonwasbetterthanthatintheoutsideworld.Hebasedthisconclusiononinformation
providedbyMrGertsethatprisonerswhohadbeendiagnosedasbeingillwithTBwereallmovedtoaseparate
facility,whichremovedtheriskforothers,whereasintheoutsideworldTBpatientsusuallyremainedathomewith
theirfamilies.Hewas,however,constrainedtoconcedethatinmatescouldneverthelessbecomeinfectedthrough
contactwithfellowprisonerswhohadbecomeillwiththediseasebuthadnotyetbeendiagnosedandthatthe
plaintiffcouldhavebeeninfectedwithTBifhehadbeenincloseproximitywithactivelyillpeople.ProfVanHelden,
however,heldtotheviewthatindividualsexposedtopersonswithactiveTBinopensocietyexperiencedthesame
risk.Healsoconcededthatifisolationcellswerenotsealedofffromthemainareaorsectionoftheprison,itwould
beundesirable.
[173]ProfVanHeldenwasscepticalaboutDrTheron's"TBpatientprofile"andthelatter'sstatementthatthe
plaintiffdidnotappeartofallintothecategoryofpeoplewhowerelikelytodevelopTB.ProfVanHeldenstatedthat
DrTheron'sobservationsinthisregardhadnotbeenpeerreviewed,thathehadnotheardofsuchaprofileand
thatevenatopclassathletecoulddevelopTBifhe/shehadthewronggenes.Hedoubtedthatonewouldbeable
torecogniseacandidateforTBatadistanceanddidnotthinkthatone'smentalattitudewouldaffectone's
susceptibilitytothedisease.ProfVanHelden,however,agreedwithDrTheron'sevidencethatstressaffectsthe
immunesystemandthatprisonpresentsastressfulenvironment.Healsoconcededthatheisnotaclinicianand
thathehasneverdiagnosedanypersonwhohadactiveTB.
[174]ProfVanHeldenconcededthatinareaswithpoorventilation,TBbacteriawhichhadbeenexpelledcoulddrift
aroundandwouldpossiblyremainaliveforhours.Healsoconcededthatinovercrowdedcommunalcellsthe
chancesofsomebodybeinginfectedwithTBbacteriathatwerecoughedupweremuchhigherthanitwouldbeina
cellwhichwasnotovercrowded.Theriskwasalsopresentwhenprisonerslinedupinthepassagetogooutfor
exercise.Inshort,ifonewasinanyareawithahighconcentrationofTBbacteria,theriskofbecominginfectedwas
higher.
[175]ProfVanHeldenfurtherconcededthathehadnotvisitedtheprisontofamiliarisehimselfwithconditionsand
thathehadformulatedhisopinionsonthebasisofinformationgiventohimbyMrGertseandothers,whichhe
assumedtobetrue.
Evaluationoftheevidence
[176]Theplaintiffclearlydidnotalwayslistencarefullytothequestionsthatwereputtohim,withtheresultthat
hisanswerswerenotalwaysgermanetotheissueandquestionsoftenhadtoberepeated.Thisfactwas
particularlyapparentwhenhewascrossexaminedaboutthedurationofhisadmissiontotheprisonhospitaland
thecorrespondingnotesinhismedicalfile.Attimes,hewassomewhatlongwindedandappearedtobecome
confusedabouteventsduringtheperiodofhisincarceration.
[177]Giventhatprisonerswhowereawaitingtrialspentapproximately23hoursoutofevery24intheircells,
theremustclearlyhavebeenlittletodistinguishonedayfromanother.Indeed,theplaintiffhimselfsaidthatone
daywasmuchlikethenext.Theplaintiffspentapproximately4yearsinprisonawaitingtrialandattendedcourt
onapproximately70occasionsduringthattime.Inthesecircumstancesitdoesnotappeartometobesurprising
thattheplaintiffbecameconfusedattimes.
[178]Itwasreadilyapparentthattheplaintifffeelsaggrievedbythefactthathewasincarceratedandthathis
imprisonmentresultedfromwhatheregardsastrumpedupcharges.However,heblameshisincarcerationonthe
investigatingofficerandnotonthedefendant,orthelatter'sofficials/employees.Theplaintiffwasfairtowardsthe
defendantinhistestimonyanddidnotappeartobegildingthelily.So,forexample,he
readilyadmittedthatwarderstriedtohelphimasfarastheywereabletoandthatsomeofthemwentoutoftheir
waytodoso.Healsomadeadmissionsthatcouldcountagainsthim,suchas,forexample,thathehadtold
everybodyinprisonthathewasgoingtosueasaresultofthefactthathehadbecomeillwithTB.
[179]Onthewhole,theplaintiffcameacrossasawitnesswhowashonestlytrying,tothebestofhisability,to
giveanaccurate,truthfulandreliableaccountofthetimehespentinprisonand,inparticular,ofthecircumstances
surroundinghisillnesswithTB.Ihavenohesitationinacceptinghisevidence.
[180]DoctorsTheronandCravenaswellasMrMullerhavebeeninconflictwiththeDCSandforthisreasontheir
evidencewasapproachedwithameasureofcircumspection.Theirconductinthewitnessboxwascarefully
observedandscrutinised,aswastheevidencethattheyproffered.
[181]AlbeitthatDrTheronwascriticaloftheDCSanditsmanagementofTB(orlackthereof)intheprison,hewas
verymuchawareofthefactthathewascalledasanexpertwitnessandthathehadtobeunbiasedinthegiving
ofhisevidence.HemadeitclearthathedoesnothaveanydifficultiesorproblemswiththeDCSinhispersonal
capacity,thathisconcernwasforthetruthandthathewasnottakingsides.
[182]DrTheronwastakentotaskinregardtohisevidencethathedoubtedthestatisticsrelatingtothenumber
ofnursesemployedattheprison,whichhadbeenprovidedbythedefendantduringthecourseofthetrial.Inthe
event,however,hisevidenceregardingtheshortageofnurseswassupportedbyMrMullerandtheletterswhich
thelatterforwardedtotheauthoritiesatthetime.EvenMrGertsehadtoconcedethattherewasadrasticnursing
shortage.Moreover,noneofthesourcedocumentswhichhadbeenusedtocompilethestatisticsweremade
availablesothatthefigurescouldbeverified.Insuchcircumstances,DrTheron'sreservationsabouttheveracity
andreliabilityofthedefendant'sstatisticsdoesnotstrikemeasuntoward,orunfair,nordoesitdetractfromthe
valueofhisevidence.
[183]DrTheron'sevidencerelatingtohisdevelopmentofaTBpatientprofilewasthesubjectofmuchscrutiny
undercrossexamination.Itbecameclearfromtheevidence,however,thatsuchprofileconsistedofcertainclinical
observationsandobjectivelyascertainablecriteriawhichheappliedinhispracticeofmedicine,suchas,forexample,
anundernourishedappearance,andclinicalsignsofdepression,whichtendedtoundermineapatient'simmune
system.Inthefinalanalysis,thevariouselementsoftheTBpatientprofilewhichhedevelopedconsistedofvarious
symptomsandbehaviourwhichhewouldconsiderinarrivingatadifferentiateddiagnosis,justashewoulddoifhe
hadtodeterminewhetherornotapatientsufferedfrom,forexample,heartdisease.Hismedicaltrainingand
clinical
experiencecausedhimtotakeaccountofthevariousfactorswhichmadeuptheTBpatientprofileinmakinga
diagnosisofhispatient'scondition.
[184]OnanoverallconspectusoftheevidenceofDrTheronandofhisdemeanourinthewitnessbox,Iam
satisfiedthathewasanhonestandobjectivewitnesswhogaveareliableaccountofthehealthsysteminthe
prisonandoftheimpactwhichithadonthemanagementandspreadofTB.Hismainconcernduringtheperiodof
hisemploymentatPollsmoorwasclearlythewelfareofhispatientsanditwashisconcernforhispatientsthat
broughthimintoconflictwiththeDCS.Ihavenohesitationinacceptinghisevidence.
[185]ItwasreadilyevidentthatDrCravenissomewhatofamartinet.Heisclearlyastrictdisciplinarianwhosets
highstandardsofperformanceforhimselfandothers.Heobviouslybelievesthatifajobisworthdoing,itisworth
doingwell.Itappearsthatattimeshemayhavebeensomewhatinflexibleinhisapproachtomatters,suchas,for
example,hisinsistenceonabsolutesilencewhenhehadtoseepatientsattheprison.Hedid,however,havea
validreasonfordoingso,inasmuchashecouldnotperformhisjobadequatelyifhecouldnothearapatient'slung,
heartandbloodsoundssufficientlyclearly.
[186]DrCraven,likeDrTheron,appearedtohavebeengenuinelyconcernedaboutthedisintegrationofthehealth
systeminthemaximumsecurity
prison,becausethishadadirect,negativeimpactonthewelfareofhispatients.HisfrustrationwiththeDCSand
themannerinwhichthehealthsystemintheprisonwasapproached,wasreadilyevident.Heclearlytookthe
responsibilitywhichvestedinhimbythenatureofhispositionattheprisonveryseriouslyandwas,forthisreason,
verycriticaloftheDCS.Hetestifiedinacalmandforthrightmanneranddidnotpullanypunches.
[187]UndercrossexaminationDrCravenwasreferredtoanumberofpatients'hospitalfileswhichhadbeen
selectedatrandom,inordertodeterminethereliabilityandaccuracyofhislistofderelictionsofduty.Itwas
sometimesdifficulttoreconcilethederelictionswhichDrCravenhadlistedwiththecontentsoftheindividual
hospitalfile.Forthisreason,MrJamiesubmittedthatDrCraven'sevidencewasunreliable.
[188]DrCraven'snotesaboutthevariousderelictionsofdutywererathercrypticandheconcededthatthesehad
tobeinterpretedincontext.Hewas,however,atsomewhatofadisadvantagewhenhewasconfrontedwiththe
varioushospitalfilesinthewitnessbox,withouthavinghadaprioropportunityofrefreshinghismemoryfromsuch
files.Heconcededthathecouldnotinallinstancestieinthenoteshehadmadewiththecontentsofthefiles.
[189]Inmyview,thefactthatitwasnotpossibletoreconcileDrCraven'snoteswiththerelevanthospitalfiles
fully,doesnotservetodetractfromthe
overallvalueofhisevidence.Iacceptthathemaywellhavebeenfairlystringentinhisrequirementsonsome
occasions,becauseheclearlyexpectedaveryhighstandardofperformanceandbecameextremelyfrustratedby
thecircumstancesunderwhichhehadtoperformhisworkattheprison.Atnostage,however,didIgetthe
impressionthatDrCravenwasanythinglessthanopenandfrankwiththecourt,orthathewasbeingdeliberately
unfairorbiasedagainstthedefendant.Thehighstandardsofperformancewhichhesetforhimselfandothersmay
nowadaysappeartobesomewhatoldfashionedandmaybeirritatingtopersonswhotendtohaveamorerelaxed
attitude,butsuchfactdoesnotdetractfromthehonesty,veracityorreliabilityofhisevidence.Hisevidenceis
accordinglyaccepted.
[190]MrMullerwasalsoagoodwitness.AlbeitthatheisstillinconflictwiththeDCS,hetestifiedinacalmand
balancedmannerandtherewasnoindicationthathewaspartisan.Hedidnotvolunteertosupporttheplaintiff's
case,hecametocourttotestifyunderawitnesssubpoena.Hisevidenceinregardtothecriticalnursingshortage
andtheimpactwhichthishadonthehealthsystemattheprison,wasborneoutbytheletterswhichhehad
writtenatthetime.Therewasnoindicationthathewasbiasedagainstthedefendant,orthathewasdeliberately
paintingableakerpicturethanwasnecessary.Iamsatisfiedthathegaveanhonestaccountofthesituationatthe
prisonandthathisevidenceisbothcredibleandreliable.Hisevidenceisaccordinglyalsoaccepted.
[191]ThereisnoreasontodoubttheveracityorcredibilityoftheevidencegivenbyMsCaldwell.Herevidence,
however,didnotsubstantiallycontributetothedeterminationoftheissuesherein.
[192]MrGertsewasapoorwitness.Heobviouslyhadmuchtoloseifhegaveevidencewhichdidnotfavourthe
defendant'scaseanditwasobviousthathetriedtoputtheDCSinthebestpossiblelight.Ifhisevidencewereto
bebelieved,thedefendanthadahealthsysteminplacewhichfunctionedperfectly,despitethefactthattheprison
wasnotonlyextremelyovercrowded,butalsosufferedfromacriticalshortageofnurses.Moreover,despitethe
massiveovercrowding,hewouldhavethecourtbelievethatallTBpatientswhowereintheinfectiousstageofthe
disease,wereisolated.Inaddition,hewasobviouslypreparedtodrawconclusionsfavourabletothedefendant's
caseeventhoughhehadnopersonalknowledgeofevents.Hisevidencerelatingtothecompletionoftheplaintiff's
TBhospitalcardoffersaprimeexampleofthisfact.
[193]MrGertsealsofrequentlycontradictedhimself.Someofthesecontradictionshavealreadybeenalludedto
hereinabove.Therecordwillrevealmanymore.Moreover,itwaspatentlyobviousthathetailoredhisevidenceto
suitthecase.Hisevidence,referredtoabove,relatingtothecompletionoftheplaintiff'sTBhospitalcard,theTB
blitzwhichhadallegedlybeenconductedandthetakingofsputumsamplesonconsecutivedays,clearly
demonstrateshispenchantformodifyingthetruth.
[194]Onthewhole,MrGertsewasclearlynotanunbiasedwitnessandhisevidenceistaintedbymanydefects.I
amnotsatisfiedthathewastruthful,noramIsatisfiedthathisevidencewasreliable.Insofarashisevidenceis
contradictedbythewitnesseswhotestifiedfortheplaintiff,hisevidenceisaccordinglyrejected.
[195]ProfVanHeldensufferedthemisfortuneofhavingbeenbriefedbyMrGertse.Intheresult,manyofthefacts
whichunderpinnedhisopinionsaresuspect,incorrectandunreliable.So,forexample,ProfVanHeldenwastold
thatpersonswhowerediagnosedashavingactiveTBwereallisolatedsothattherisktootherinmateswas
reduced,thattheDOTSsystemwasconsistentlyfollowedandthattheplaintiffhadbeenkeptinasinglecelland
hadnotbeenexposedtoinfectionbyotherprisoners.Onthebasisofsuchinformation,allofwhichwasfactually
incorrect,ProfVanHeldenconcludedthatthecareofTBpatientsinprisonwasbetterthanintheoutsideworld.The
evidenceoftheplaintiffaswellasthatofDrTheronandDrCravenisclearthatduetoovercrowdingbynomeans
allTBcaseswereisolated.Indeed,theplaintiffhimselfwasnotisolated.
[196]ProfVanHeldenalsoappearedtofallintothetrapoflosinghisobjectivity.So,forexample,heused
statisticalevidencewhichwasobtainedinlowersocioeconomicareassuchasRavensmeadandMasiphumeleleto
justifyhisopinionthattheplaintiff,whocamefromamiddleclassenvironment,hadprobablybeeninfectedwithTB
priortocomingintotheprison,in
circumstanceswherehehimselfhadadmittedthatthosestatisticswouldnotbeapplicableinmiddleandhigher
socioeconomicareas.Indeed,ProfVanHeldenwentsofarastosaythattheplaintiff'schancesofhavingbeen
infectedwithTBpriortoenteringprisonwere"exceptionallyhigh".
[197]ThereisnodoubtthatProfVanHeldenisanexpertishisfield,butheisnotamedicaldoctorandhashadno
experienceinthediagnosisandtreatmentofTB.Hisexperiencerelatestoresearch.Onthewhole,ProfVan
Helden'sevidencewastaintedwithbiasandmisinformation.Asaconsequence,hisevidenceis,inmyview,inmany
instancesunreliableandinaccurate.
[198]BothDrTheronandDrCravenhavehadmuchexperienceinthediagnosisandtreatmentofTBduringthe
yearsthattheyhavepractisedmedicineandtheirexpertiseinthisregardisbeyondquestion.Byvirtueoftheir
expertiseandthefactthattheyweredirectlyinvolvedinthehealthsystemattheprison,theywereinaunique
positiontoprovideaninsightintothecircumstancesattheprisonwhichimpacteduponthemanagementofTB
duringtheplaintiff'sincarceration.WhenevertheevidenceofProfVanHeldenisinconflictwiththatofDrsTheron
andCraven,Iunhesitatinglyacceptthelatterversions.
Thelegalposition
[199]Inordertoestablishaclaimindelict,aplaintiffhastoprovethatthe
defendantnegligentlycommittedanactwhichwasunlawfulandthattheactsocomplainedofwascausallyrelated
totheharmwhichensued.
[200]Intheinstantcase,itwasnotdisputedthattheactsofomissionwhichhadbeenallegedbytheplaintiffin
hisparticularsofclaim,ifestablished,wouldconstituteactsforthepurposesofliabilityindelict.Thedefendanthas,
however,takenissuewiththeplaintiffinregardtotheelementsofunlawfulness,faultandcausation.
[201]Negligentomissionsareunlawfulonlyiftheseoccurincircumstancesthatthelawregardsassufficientto
giverisetoalegaldutytoavoidnegligentlycausingharm(MinisterofSafety&SecurityvVanDuivenboden
2002(6)SA431(SCA)[alsoreportedat[2002]JOL10162(SCA)Ed]at441EF).AswasstatedinMinisterofPolisie
vEwels1975(3)SA590(A)at597AB,negligentomissionswillonlyberegardedasconstitutingunlawfulconductif
thecircumstancesofthecasearesuchthattheomissionnotonlyevokesmoralindignation,butthe"legal
convictionsofthecommunity"requirethatitberegardedasunlawful.Theenquiryisabroadoneinwhichallofthe
relevantcircumstancesmustbetakenintoaccount(MinisterofSafety&SecurityvVanDuivenboden,supra,at442BE
paragraph[13]andcasestherecited).
[202]AstheConstitutionalCourthaspointedoutinCarmichelevMinisterofSafety&Security2001(4)SA938(CC)
[alsoreportedat[2001]JOL8613(CC)Ed]at961FtheConstitution,whichisthesupremelaw,embodiesan
objective,normativevaluesystemwhich
pervadesallareasofthelaw.Moreover,section39(2)oftheConstitutionexpresslyprovidesthat:
"(W)heninterpretinganylegislation,andwhendevelopingthecommonlaworcustomarylaw,every
Court,tribunalorforummustpromotethespirit,purportandobjectsoftheBillofRights."
InapplyingthetestlaiddowninthecaseofEwelsreferredtoabove,acourtmustaccordinglyhaveregardtothe
factthatthe"legalconvictionsofthecommunity"mustnowbeinformedandguidedbythenormsandvalueswhich
havebeenenshrinedintheBillofRights,becausenormsorvalueswhichareinconsistentwiththeConstitution,
havenovalidity(MinisterofSafety&SecurityvVanDuivenboden,supra,at444EHparagraph[17]).
[203]AsNugentJApointedoutinVanDuivenboden'scase1thegeneralreluctancetoimposeliabilityforomissions,
whichisunderpinnedbytheconceptthatindividualsarefreeto"mindtheirownbusiness",mayhavebeen
strengthenedbytheBillofRightsinsofarasindividualsareconcerned.Publicofficials,however,appeartofind
themselvesinalessadvantageousposition.
"TheprotectionthatisaffordedbytheBillofRightstoequalityandtopersonalfreedomandtoprivacy
mightnowbolsterthatinhibitionagainstimposinglegaldutiesonprivatecitizens.However,those
barriersarelessformidablewheretheconductofapublicauthorityorapublicfunctionaryisinissue,for
itisusuallytheverybusinessofapublicauthorityorfunctionarytoservetheinterestsofothersandits
dutytodosowilldifferentiateitfromotherswhosimilarlyfailtoacttoavertharm.Theimpositionof
legaldutiesonpublicauthoritiesandfunctionariesisinhibitedinsteadbytheperceivedutilityof
permittingthemthefreedomtoprovidepublicserviceswithoutthechillingeffectofthethreatof
litigationiftheyhappentoactnegligentlyandthespectreoflimitlessliability.Thatlastconsideration
oughtnottobeundulyexaggerated,however,
bearinginmindthattherequirementsforestablishingnegligenceandalegallycausativelinkprovide
considerablepracticalscopeforharnessingliabilitywithinacceptablebounds."
[204]TheConstitutionitselfrecognisesthattheStatehasadutytoactinordertopromoteandtoprotectthe
rightswhicharethesubjectoftheBillofRights.Section7(2)oftheConstitution,readwithsection2thereof,
expresslyprovidesthattheState"mustrespect,protect,promoteandfulfiltherightsintheBillofRights"andthat
theobligationsimposedbytheConstitution"mustbefulfilled".Section8(1)oftheConstitutionprovidesthatthe
"BillofRightsappliestoalllaw,andbindsthelegislature,theexecutive,thejudiciaryandallorgansofstate".
[205]Indeterminingwhetherornotthereisalegaldutytoactonthepartofapublicofficial,therelevantfactors
mustnowaccordinglybeweighedinthecontextofthespirit,purportandobjectsoftheBillofRightswhich
recognisesaconstitutionalStatefoundedondignity,equalityandfreedom,inwhichthegovernmenthaspositive
dutiestopromoteandupholdsuchvalues.GiventheprovisionsoftheConstitutionwhichhavebeenreferredtoin
theimmediatelyprecedingparagraph,theConstitutionalCourthasfoundthatthereisadutyimposedontheState
andallofitsorgansnottoperformanyactthatinfringestheBillofRights.Indeed,insomecircumstancestheState
anditsorganswouldbeobligedtoprovideappropriateprotectiontoeveryonethroughlawsandstructureswhich
havebeendesignedtoaffordprotectionagainstinfringementoftherights
containedintheBillofRights(seeCarmichelevMinisterofSafety&Security,supra,at957BDandF).
[206]Section41(1)(c)oftheConstitution,moreover,providesthat:
"(A)llspheresofgovernmentandallorgansofstate...must...provideeffective,transparent,
accountableandcoherentgovernmentfortheRepublicasawhole."
AswaspointedoutbytheSupremeCourtofAppealinOlitzkiPropertyHoldingsvStateTenderBoard&another
2001(3)SA1247(SCA)[alsoreportedat[2001]JOL8203(A)Ed]at1263E:
"(T)heprincipleofpublicaccountabilityiscentraltoournewconstitutionalculture,andtherecanbeno
doubtthattheaccordofcivilremediessecuringitsobservancewilloftenplayacentralpartinrealising
ourconstitutionalvisionofopen,uncorruptandresponsivegovernment."
[207]Theprincipleofaccountability,however,doesnotnecessarilytranslateintoacivilremedyintheformofan
actionfordamages.Otherappropriateremedies,whetherjudicialornonjudicial,mightbeavailable.2Aswassaid
byNugentJAinVanDuivenboden:3
"However,wheretheState'sfailureoccursincircumstancesthatoffernoeffectiveremedyotherthanan
actionfordamagesthenormofaccountabilitywill...ordinarilydemandtherecognitionofalegalduty
unlessthereareotherconsiderationsaffectingthepublicinterestthatoutweighthatnorm.Foras
pointedoutbyAckermannJinFosevMinisterofSafetyandSecurity...
'withouteffectiveremediesforbreach...thevaluesunderlyingandtherightentrenchedinthe
Constitutioncannotproperlybeupheldorenhanced.Particularlyinacountrywheresofewhave
themeanstoenforcetheirrightsthroughthe
Courts,itisessentialthatonthoseoccasionswhenthelegalprocessdoesestablishthatan
infringementofanentrenchedrighthasoccurred,itbeeffectivelyvindicated.TheCourtshavea
particularresponsibilityinthisregardandareobligedto"forgenewtools"andshapeinnovate
remedies,ifneedsbe,toachievethatgoal.'"
[208]Indeterminingwhetherornotthebreachofastatutorydutyistoberegardedasunlawfulsothatitwould
giverisetoaprivatelawclaimfordamages,CameronJAstatedthepositionasfollowsintheOlitzkiProperty
Holdingscase:4
"Wherethelegaldutytheplaintiffinvokesderivesfrombreachofastatutoryprovision,the
jurisprudenceofthisCourthasdevelopedasuppletest.Thefocalquestionremainsoneofstatutory
interpretation,sincethestatutemayonaproperconstructionbyimplicationitselfconferarightof
action,oralternativelyprovidethebasisforinferringthatalegaldutyexistsatcommonlaw.The
processineithercaserequiresaconsiderationofthestatuteasawhole,itsobjectsandprovisions,the
circumstancesinwhichitwasenacted,andthekindofmischiefitwasdesignedtoprevent.Butwherea
commonlawdutyisatissue,theanswernowdependslessontheapplicationofformulaicapproaches
tostatutoryconstructionthanonabroadassessmentbythecourtwhetheritis'justandreasonable'
thatacivilclaimfordamagesshouldbeaccorded.Theconductiswrongful,notbecauseofthebreachof
thestatutorydutyperse,butbecauseitisreasonableinthecircumstancestocompensatetheplaintiff
fortheinfringementofhislegalright.Thedeterminationofreasonablenesshereinturndependson
whetheraffordingtheplaintiffaremedyiscongruentwiththecourt'sappreciationofthesenseof
justiceofthecommunity.Thisappreciationmustunavoidablyincludetheapplicationofbroad
considerationsofpublicpolicydeterminedalsointhelightoftheConstitutionandtheimpactuponthem
thatthegrantorrefusaloftheremedytheplaintiffseekswillentail"(footnotesomitted).
[209]CameronJAaddedthat,ininstanceswherethecourthastodeterminewhetherornotadelictualclaimarises
fromthebreachofastatutoryprovision,thefactthattheprovisionisembodiedintheConstitutionmay,depending
onthenatureoftheprovision,attractadutymorereadilythanifithadbeeninanordinarystatute.5
[210]Evenifthelawrecognisestheexistenceofalegaldutytoactandevenifsuchdutyhasbeenbreached,with
theresultthattheconductcomplainedofisunlawful,theelementoffaultmuststillbesatisfiedbeforeliabilitywill
attachtothedefendant.Inorderforfaultorculpabilitytoattachtoanomission,thetestreferredtoinKrugerv
Coetzee6isapplied,whichmeansthatliabilityarisesifareasonablepersoninthepositionofthedefendantwould
haveforeseenthathisconductwouldreasonablypossiblycauseharmtoanotherandwouldhavetaken
reasonablestepstoavertit,butthedefendantfailedtodoso(MinisterofSafetyandSecurityvVanDuivenboden,
supra,at441G442).Thetestisanobjectiveonewhichdoesnotdependonthesubjectiveintentormindsetof
thedefendant,butratherontheparticularcircumstancesofeachcase.
[211]Lastbutnotleast,theremustbeacausalconnectionbetweentheunlawfulandnegligentconduct
complainedof,andtheharmwhichisallegedtohaveensued.Theelementofcausationinvolvestwodistinct
enquiries.Firstly,inregardtotheissueoffactualcausation,itmustbedeterminedwhetherornotthepostulated
causecanbeidentifiedasthesinequanonofthelossinquestion.Thishasbecomeknownasthe"butfor"test.In
applyingsuchatest,onemakesahypotheticalenquiryastowhatwouldprobablyhavehappened,butforthe
wrongfulactofthedefendant.Iftheplaintiff'slosswouldstillhaveensuedabsentthedefendant'sconduct,factual
causation
islackingandthatistheendofthematter.Secondly,iffactualcausationhasbeenestablished,itmustbe
determinedwhetherthewrongfulactislinkedsufficientlycloselytothelossconcernedforliabilitytoensue.Ifthe
damageistooremote,noliabilitywillaccrue.7
Issuestobedecided
[212]Inordertodeterminewhetherornotthedefendantisliabletotheplaintiffintheinstantcase,itappearsto
methatthefollowingunderlyingissuesneedtobedecided:
1. WhetherornottheprevailingconditionsinthemaximumsecurityprisonatPollsmoor,duringtheperiod
November1999toJune2003,weresuchthatthespreadofTBwasfacilitatedthereby.Iftheanswertothis
issueisintheaffirmative,
2. Whetheritismoreprobablethannot,thattheplaintiff'sillnesswithTBwasoccasionedby,orresultedfrom,
theprevailingconditionsinthemaximumsecurityprisonatPollsmoorduringhisincarceration.Ifso,
3. Whetherareasonableperson,inthepositionofthedefendant,would
haveforeseenthattheprevailingconditionsinthemaximumsecurityprisonwouldreasonablypossiblyspread
TBamongsttheinmatesinthesaidprisonandcauseinmates,suchastheplaintiff,whohadnotpreviously
beenillwithTB,tosuccumbtothedisease.Ifso,
4. Whetherornotareasonablepersoninthepositionofthedefendantwouldhavetakenstepstoguard
againstthespreadingofTBasaforesaid.Ifthelatterquestionisansweredaffirmatively,
5. WhetherornotthedefendanttookreasonablestepstoguardagainstthespreadofTBinthemaximum
securityprisontoinmates,suchastheplaintiff,whohadnotbeenillwithTBand,ifnot
6. Whetherornotthedefendant'sfailuretotakesuchstepswasunlawful,therebygivingrisetoaprivatelaw
claimfordamages.
DidtheprevailingconditionsinthemaximumsecurityprisonfacilitatethespreadofTB?
[213]WhentheplaintifffirstcameintothemaximumsecurityprisonatPollsmoorinNovember1999,TBwas
alreadyprevalentintheprison.TheevidenceofDrTheronisclearinthisregard.Indeed,throughoutthetimeofthe
plaintiff'sincarceration,TBremainedaproblemintheprison.ThismuchisclearfromtheevidenceofbothDrTheron
andDrCraven.
[214]DrTheronandDrCravenwereagreedthatcontroloverTBintheprisonenvironmentwasdependentupon
theeffectivescreeningofincomingprisoners,theisolationofinfectiouspatientsandtheproperadministrationof
thenecessarymedicationovertheprescribedperiodoftime.Allofthesemeasureswereheavilydependentupona
sufficientnumberofsuitablyqualifiednursingstaffbeingavailable.Theprovisionofadequatenutritionand
ventilationalsoplayedanimportantrole.
[215]Ashasbeenreferredtoabove,clause4.1(a)ofChapter3oftheStandingOrdersprovidedthatallpersons
admittedtoprison,shouldbeenseenonadmissionbyaregisterednursefor, interalia,medicalproblems,whether
acuteorchronic.Suchprovisionisreiteratedinclause4.4(a)whichstatedthat:
"(A)lladmissionsmustbescreenedbyaregisterednurseonadmissionusingthescreeningform."
Clause6.1ofthesaidStandingOrdersstatedthat:
"(F)ollowingscreeningatthereception,alladmissionsmustbetakentotheprisonhealthfacilitybythe
unitmanagerorreceptionmanagerwithin24hours,foramedicalexaminationbytheregisterednurse
ormedicalofficer/practitionerasprescribed."
Clause6.2providedthatatprisonswherethereareprimaryhealthcareclinicsatthehousingunits,themedical
examinationmaybeperformedatsuchclinics.TheintentionoftheStandingOrdersappearstometobeclearand
unambiguous.Everyincomingprisonermustbescreenedbyaregisterednurseonadmissionandeverysuch
prisonermustbemedicallyexaminedwithin24hoursofadmission.Thereasonswhysuchastrictobligationwas
imposedare,in
myview,selfevident.Firstly,prisonerswhowereillorinjuredhadtoreceivemedicalattention.Secondly,prisoners
whoposed,orcouldreasonablypose,ahealthrisktoothershadtobeidentifiedinorderthatthenecessarysteps
mightbetakentopreventotherinmatesfrombecomingill.Indeed,clauses14and15ofthesaidChapterofthe
StandingOrderscontained,interalia,thefollowingprovisionsinregardtocommunicableandcontagiousdiseases:
"14.6.1 Wheneverthereisasuspicionthataprisoner...couldbesufferingfromacommunicable,or
contagiousdisease,thecasemustimmediatelybebroughttotheattentionoftheSupervisor:
Nursingandtheattendingmedicalofficer/practitioner.
14.6.3 Iftheregisterednurseorattendingmedicalofficer/practitionerdeemsitnecessaryto
isolate/segregatetheprisoner...suspectedtobesufferingfromacommunicable,or
contagiousdisease,therecommendationsorprescriptionsmustalwaysbeadheredto.
15.1 Allprisonerswithcommunicableconditionsmustbeisolatedinstrictaccordancewiththe
medicalofficer's/practitioner'sandregisterednurse'sordersissuedineachcase.
15.3 Eachprisonmusthavewrittenordersoninfectioncontrolwhichmustbemonitoredand
reviewedannually."
[216]MrGertseinitiallytestifiedthatincomingprisonerswerescreenedbythenursewhowasonnightduty.He
subsequentlychangedhisevidenceinthisregardandsaidthatthenightnurseconductedaprescreeningandthat
incomingprisonerswhovolunteeredthattheyhadmedicalproblemswerescreenedatthehospitalthefollowing
day.Theplaintiff'sevidencewasthatonadmissiontotheprisononeoftheinmates,TrevorBlignault,wouldask
personswhowereilltocomeforward.MrMullertestifiedthattherewasonlyonenurseondutyatPollsmoorafter
4pmandthatnurse
wasresponsibleforallfiveoftheprisons.Thescreeningofprisonerswhocamefromthecourtsintheafternoons
couldaccordinglynotbeperformedbythenightnurseanddidnotformpartofthedutieswhichsuchnursewas
expectedtoperform.MrMullerknewthistohavebeenthecase,becausehewasinchargeofnursingservicesat
Pollsmoorandpreparedthedutyroster.DrCraven'sworkinghoursdidnotextendtotheafternoonandtherewas
accordinglynodoctorondutyatthetimewhenprisonerswerebroughtbackfromthecourts.Itisaccordinglyclear
fromtheevidencewhichhasbeenaccepted,thatduringtheperiodoftheplaintiff'sincarceration,prisonerswere
notscreenedbyaregisterednurseormedicalpractitioner,whetherforTBoranyotherdisease,upontheirarrival
attheprison.
[217]MrMullertestifiedthatthenursesensuredthatincomingprisonerswerescreenedonthemorningaftertheir
admissionandthatthosewithmedicalcomplaintswerethenreferredtothedoctor.Undercrossexamination
MrGertsestatedthatthescreeningforms,suchasExhibitsOandP,containingthedetailsoftheincoming
prisonerswereprintedoutoncompletionoftheadmissionprocess.Thenursewouldthenfilloutthemedicaldetails
onsuchformthefollowingdaywhenincomingprisonerswerescreened.Asisevidentfromtheaforesaidexhibits,
theformscontainonlythemostbasicinformationinregardtoprisoners'healthstatustheirbodymassand
whetherornottheyhadanymedicalcomplaints.Itappearsthatthenurseswhoconductedthescreeningprocess
didnotphysicallyexamineanyofthe
incomingprisoners.Theymerelynotedwhetheraprisonerprovidedapositiveornegativeanswertothequestion
astowhetherhehadanymedicalcomplaints.Onlythoseprisonerswhostatedthattheyhadmedicalcomplaints
werereferredtothedoctorforexamination.
[218]Inthecontextoftheaforesaidscreeningprocess,itisimportanttobearinmindDrCraven'stestimonythat
personsfromthelowereconomicclasseswhosmokedandlivedincrowdedconditions,frequentlycoughedanddid
notregardacoughaspathological.Theyonlywenttothedoctorwhenadditionalsymptomsmanifested.The
aforesaidevidenceisclearlybasedonDrCraven'sexperienceandaccordswiththeprobabilities.Itisaccordingly
unlikelythatincomingprisonerswhowerealreadyillwithTB,butwhohadnotyetexperiencedmarkedsymptoms
otherthancoughing,wouldhavevolunteeredthattheywereill.Hadtheseprisonersbeenproperlyscreened,a
simplechestexaminationwouldhaverevealedthattherewasanunderlyingpathologyandtheycouldhavebeen
separatedoutfromthegeneralprisonpopulation.TheevidenceofDrsCravenandTheronareclearinthisrespect.
Asaresultofthemannerinwhichthenursesimplementedthescreeningprocess,whichamountedtonomorethan
askingwhetherornotanincomingprisonerhadanymedicalcomplaints,thevastmajorityofsuchprisonerswere
accordinglynotmedicallyscreened,inasmuchasnophysicalexaminationwasconductedunlessaprisonerwas
referredtotheattendingdoctor.
[219]Theaforesaidscreeningprocess,suchasitwas,appearstohaveconstitutedtheonlyscreeningthatwas
conducted.DrsTheronandCraventestifiedthatmassscreeningofprisonershadbeenconductedinthepastwhen
theold,militarystyleofmanagementwasinplace,butnotduringthetimeoftheplaintiff'sincarcerationwhenthe
morerelaxedmanagementstylehadbeenadopted.DrTheron,however,testifiedthatitwouldhavebeenpossible
foradoctortoconductthescreeningofalloftheinmatesfromtimetotimeonacellbycellbasis,althoughsuch
screeninghadnottakenplace.
[220]Insteadofscreeningprisonersforinfectiousdiseases,suchasTB,fromtimetotimeaftertheiradmission,the
authoritiesatthemaximumsecurityprisonreliedonaselfreportingsystemintermswhereofprisonershadto
makeitknowniftheywereillorrequiredmedicalattention.WithregardtoTBinparticular,theauthorities,
accordingtoMrGertse,maintaineda"suspectregister".IfaninmatewassuspectedofhavingTB,whetherbecause
hereporteditorwhetheranursewasoftheopinionthataprisonermightbesufferingfromTB,asputumtest
wouldbeconductedandtheinmate'snamewouldberecordedintheregister.AlthoughMrMullertestifiedthatall
testresultsoughttohavebeenreferredtothedoctorforfurtherattention,MrGertse'sevidencewasthatonlythe
caseswhichyieldedpositiveresultswouldbereferredtothedoctor.IftestresultswerenegativeforTB,thenurse
wouldmerelycounseltheinmateand,ifnecessary,treatthecough.Itisbynomeansclearthatthesuspect
registerwasusedduringtheperiodpriortotheplaintiffbecomingill.MrGertse'sevidencewasextremelyunreliable,
forthereasonsalreadyadvertedto.MrMullercouldnotrecallwhetherthesuspectregisterwasusedduring2002
and2003.NeitherDrCravennorDrTheronhadknowledgeofsucharegisterduringtheirperiodofemploymentat
Pollsmoorandtheplaintiffalsodidnotknowofitsexistence.DrCravenonlyhadknowledgeofasuspectregister
whichhadbeenmaintainedafterhehadlefttheprison.Evenifasuspectregisterhadbeenmaintained,however,it
isbynomeansclearwhatpurposeitwasintendedtoserve.Thereisnoevidencethatpersonswhosenameshad
beenenteredintotheregisterandwhosesputumtestsproducednegativeresultswerefolloweduponanyregular
basisoratall.IntheabsenceofappropriatemonitoringofprisonerswhoweresuspectedofhavingTB,butwho
testednegative,thekeepingofsucharegisterappearstohavebeenawhollyuselessexercise.
[221]Theprisonauthorities'failuretoscreenincomingprisonersadequatelyappearstometohaveconstituteda
contraventionofclause4ofChapter3oftheStandingOrders.Suchfailureobviouslypermittedpersonswhowereill
withaninfectiousdisease,suchasTB,tominglewithotherprisoners,attheveryleastwhiletheywereheldinthe
overnightcell.IftheydidnotvolunteerthattheywereillwithTB,orthattheyweresufferingfromsymptomswhich
wereindicativeofTB,upontheirarrivalatthemaximumsecurityprison,theywouldremaininthegeneralprison
populationuntilsuchtimeastheydidrequestmedicalassistance,oruntil
suchtimeastheyweresoillthatoneofthewardersornursesnoticeditandcausedthemtobemedically
examined.Inthemeantime,thosewhowereillwithTBwouldbeexpellingTBbacteriaintotheirovercrowdedcells
everytimetheysneezed,coughedorspat.
[222]ItisalsoclearontheevidenceofDrTheronandDrCraventhatvariousfurtherfactorsplayedaroleinthe
transmissionofTBinthemaximumsecurityprisonovercrowding,alackoffreeflowingair,lackofisolationfacilities,
inadequateapplicationoftheDOTSsystemintheadministrationofthenecessaryTBmedicationandasevere
shortageofnurses.
[223]TheevidenceofDrsTheronandCraveninregardtoovercrowdingwasconfirmedbyMrMullerandbythe
officialcorrespondenceatthetime.Althoughtheapprovedaccommodationatthemaximumsecurityprisonwas
1619inmates,thelockuptotalonoccasionwasasmuchas3052,whichconstituted189%occupation(ExhibitA
at58).Singlecellsregularlyhousedthreeinmatesandcommunalcellswerefilledwithdoubleandsometimestriple
bunks.GiventhatTBbacteriaareairborne,thesecircumstancesmustclearlyhavefacilitatedthetransmissionof
thedisease.Indeed,theevidenceofDrsCravenandTheron,aswellasofProfVanHelden,wastotheeffectthat
TBspreadsmoreeasilyincrowdedconditions,especiallyinaclosedenvironment.(Inthelightofsuchevidence,
ProfVanHelden'srefusaltoacknowledgethenecessityofisolationintheprisonenvironmentwasparticularly
unconvincing.)
[224]Inadditiontotheovercrowding,theevidencewasclearthattherewasalackoffreeflowingairinthecellsof
themaximumsecurityprison.DrTherondescribedtheatmosphereincommunalcellsasoneofdinginessand
squalor.Theairwasthickwithsmokefromcigarettesand"hondjies".Thecellshadwindowsalongoneofthecell
wallswithadoorwayontheoppositeside.Oncelockdownhadoccurredatapproximately4pm,therewasnocross
ventilationatalluntilthenextmorningatapproximately7amwhenthesteeldoortothecellwouldbeopened.
DrCravenconfirmedthatduringsuchtimeprisonerswouldbecoughing,sneezingandspittingovereachother.
Prisonerswereconfinedtotheircellsfor23hoursadayunlesstheywenttocourtandwereonlyletoutfor
exerciseforanhour.
[225]ItisalsoclearfromtheevidencethatisolationofinfectiveTBpatientswasnotroutinelypractised.DrCraven
andMrMullertestifiedthatisolationofinfectiousTBpatientswasnotpracticallypossible,duetotheovercrowding
ofthemaximumsecurityprisonandtheconcomitantlackofsuitableaccommodation.Moreover,althoughsocalled
isolationcellswereavailableinthehospitalsectionofthemaximumsecurityprison,DrTherontestifiedthatthesein
factdidnotprovideisolationinthetruesense.Theevidencewasthatthesolidmetaldoorstosuchcellswere
seldomclosed,becausetheprisonersdetainedinsuchcellswouldthenbecutofffromcontactwithothersand
wouldhaveinadequateventilation.MrGertsewouldhavethecourtbelievethatallprisonerswhowereinfective
wereisolated,whether
inthehospitalsectionorinsomeofthesinglecellsinthesectionswhichhadbeenreservedforthispurpose.His
evidenceinthisregardwas,however,contradictedbyMrMullerandDrCraven,doesnotaccordwiththe
probabilitiesifregardishadtothemeasureofovercrowdinganddoesnotfitinwiththeplaintiff'streatment.
[226]TheplaintiffwasnotisolatedatanystageafterhehadbeendiagnosedassufferingfromTB.Duringthe
periodofapproximately4yearswhilehewasawaitingtrial,theplaintiffwasdetainedintheEsectionofthe
maximumsecurityprisonatPollsmoor,saveforafewmonthswhenhewasheldintheMediumBprison.Albeitthat
hespentsometimeincommunalcells,hewasincarceratedinasinglecellformostofthetime.Hewas,however,
alwaysincontactwithotherprisoners.Hesharedhissinglecellwithtwootherinmates.Ontheapproximately70
occasionswhenhewenttocourt,hewasconfinedwithotherinmatesinaholdingcellatPollsmoor,inthetruck
thatconveyedhimtocourtandinthecourtcells.Onoccasionswhenhewashospitalisedintheprison,hewasina
communalward.Whenprisonerswereletoutforexercise,theycongregatedinthepassagebeforebeingletoutin
theexerciseyard.Indeed,evenwhentheplaintiffwasdiagnosedassufferingfromTB,hewasnotisolatedfrom
otherprisoners,butreturnedtohiscell.
[227]Itisclearfromtheplaintiff'sevidenceaswellasthatofMrGertsethattheDOTSsystemoftreatmentwas
notadheredtointhemaximumsecurity
prison.AswasexplainedbyDrCraven,theDOTSsystemisparticularlyimportantinthetreatmentofTB,because
patientsarefrequentlynotinclinedtotaketheirmedicationonaccountofthesideeffects.Patientsarealso
frequentlypoorlymotivatedtocontinuetakingtheirmedicationoncetheyfeelbetter.Unlesstheentireperiodof
treatmentiscompleted,however,thepatientmaydevelopMDRTBorevenXTRTB.DrTheronheldthesameview.
Indeed,DrTherontestifiedthatthefactthattherewerecasesofbothMDRTBandXTRTBinthemaximumsecurity
prisonwasindicativeofthefactthatpatientshadnotcompletedtheentirecourseofmedication.Theevidenceof
theplaintiffandofMrGertseestablishedthatpatientswerenotalwaysseentotaketheirmedication.Theplaintiff
testifiedthathewassometimesgivenasmuchasaweek'smedicationinadvance.MrGertse'sevidence
establishednotonlythatthepatienttreatmentcardsweresometimesfilledoutinadvanceofmedicationbeing
taken,orsubsequentthereto,butthatsuchcardsmightbemarkedoffbyapersonwhohadnodirectknowledgeof
theadministrationofthemedication.
[228]TherewasasubstantialnursingshortageatalloftheprisonswhichformpartofthePollsmoorprison
complex.Themaximumsecurityprison,inparticular,hadapproximately50%ofthenurseswhichwererequired.The
letterswrittenbyMrMullerinthisregardprovidegraphicdetailofsuchfact.DrTherontestifiedastosuchshortage,
asdidDrCraven.Asadirectresultofthefactthatthenumberofavailablenurseswasinsufficient,clinicswere
notheldinthesectionsonadailybasisandpatientshaddifficultyinobtainingtheirTBmedication.DrCraven
testifiedthatitwaslogisticallyimpossibleforthenursestodowhatwasrequiredofthem.Theshortageofnurses
wasexacerbatedbyashortageofwardersandasaresult,inmateswhowereillandwhorequiredmedical
attentionsometimescouldnotgettoseethedoctor.DrTherontestifiedthatinmateshadsometimesbeenillwith
TBformonthsbeforebeingbroughttothedoctor.
[229]Giventhenatureofthediseaseandthemannerinwhichitistransmitted,eachofthefactorsadvertedto
above,onitsown,wascapableoffacilitatingthespreadofTBinthemaximumsecurityprison.Whentheseare
regardedcumulatively,astheymust,becausenoneofthesefactorsoperatedinisolation,theconclusionis
inescapablethatthespreadofTBwasindeedfacilitatedbytheprevailingconditionsinthesaidprison.
Isitmoreprobablethannotthattheplaintiff'sillnesswithTBwasoccasionedby, orresultedfrom, theprevailing

conditionsinthemaximumsecurityprison?
[230]Theplaintiffwas53yearsoldwhenhewasfirstadmittedtothemaximumsecurityprison.Hisevidencethat
hehadnoteverbeenillwithTBpriortosuchadmissionwasnotchallenged.Uponhisadmission,hewasfitand
well,saveforsomeheartandprostateproblemsandheappearedtobewellnourished.DrCravenregardedhimas
obeseandorderedthathereceive
halfrations.Althoughtheplaintiffsmoked,afactorwhichwouldmakehimmoresusceptibletoTB,hisevidencethat
hewasfitandwellandhadalwayslookedafterhisphysicalhealthwasalsouncontested.Evenwhenhewasin
prison,hekeptaneyeonhishealthbyrequestingregularsputumtests.
[231]WhentheplaintiffismeasuredagainstthetypicalTBpatientprofilewhichDrTheronreferredto,thelatter
wasoftheopinionthattheplaintiffhadnotbeenatypicalcandidateforthedevelopmentofTB.Percontra,the
plaintiffappearedtohavebeenrobustandwellnourished.Therewasnoevidencethathedisplayedanyofthe
clinicalsignsandsymptomswhichwere,inDrTheron'sexperienceasaclinician,indicativeofTBorofsusceptibility
thereto.
[232]TheplaintiffbecameillwithTBafterspendingsome3yearsinthemaximumsecurityprison.Giventhe
plaintiff'smedicalhistory,coupledwiththeprevailingconditionsinthemaximumsecurityprison,DrTheron
concludedthattheprisonsituationcausedhimtobecomevulnerabletoTB,becausehisimmunesystemhadbroken
downasaresultofthestressfulenvironment.DrCraventestifiedthattheplaintiffwouldhaveinhaledfarmoreof
theTBbacteriainprisonthanhewouldhaveintheoutsideworldandthattheincreaseddoseofbacteriawould,in
turn,haveincreasedtheplaintiff'schancesofbecomingillwiththedisease.DrCravenalsocametotheconclusion
thattheplaintiffbecameillwithTBasaresultofhis
imprisonment.
[233]ProfVanHeldentookissuewiththeviewsofDrCravenandDrTheron,buthisevidenceinthisregardwas
whollyunreliable.Notonlydidheattempttoapplyinappropriatestatisticstotheplaintiff'scase,buthisopinionthat
theplaintiffhadinalllikelihoodbeeninfectedwithTBpriortobeingadmittedtotheprison,didnottakeintoaccount
thefactthattheplaintiffhadbeenincarceratedforaperiodofapproximately3yearsbeforehesuccumbedtothe
disease.
[234]Duringthecourseofthetrial,muchtimewasspentonthereactivationofTBasopposedtoreinfection.It
appearstomethatsuchdebatebetweenDrsTheronandCravenontheonehand,andProfVanHeldenonthe
other,isofacademicimportanceonly.FactofthematteristhattheplaintiffhadbeentestedforTBwhenhewasa
childandlivedinEdenvale.HehadneverbeenillwithTBthroughouthisentirelife.Hedidnotfitthepatientprofile
forpersonswhowouldbevulnerabletoTB.HecameintoaprisonwhichhadanunacceptablyhighincidenceofTB
and3yearslaterhewasdiagnosedwiththedisease.Whenregardishadtothesefactorsandtothemannerin
whichthediseaseisspread,theconclusionis,inmyview,inescapablethatbutforhisincarcerationinthemaximum
securityprison,theplaintiffwouldprobablynothavebecomeillwithTB.
[235]ThefactthattheplaintiffhadbeenawarethatTBwasprevalentinthe
prisonwherehewasdetainedandthathesmoked,doesnottakethematteranyfurther.Theplaintiffwas
unawareastotheidentityoftheinmateswerewhowereillwithTB,becausethemajorityoftheinmatessmoked
andcoughed.However,evenifhehadknowntheidentityoftheprisonerswhowereillwithTB,hecouldnot
necessarilyhaveavoidedthem.Althoughhespentmostofhistimeinasinglecell,whichhesharedwithtwoother
inmates,hewasincarceratedincommunalcellsforsometimeduringhisincarcerationand,inparticular,whenhe
hadtoattendcourton70separateoccasions.Healsocameintocontactwithotherprisonerswhenthey
congregatedinthepassageleadingtothecourtyardwheretheyexercised.Justassmokedrifteddownthe
corridorduringtheday,afactwhichwasnotdisputed,DrCravenexpectedtheTBbacteriatocomedriftingdown
thecorridor.ThefactthattheplaintiffsmokedmighthavecausedhimtobemoresusceptibletoTB,butevenifhe
hadnotsmoked,hecouldnothaveavoidedcomingintocontactwithsmoke.
[236]Onthetotalityoftheevidence,Iamaccordinglysatisfiedthatitismoreprobablethannotthattheplaintiff
contractedTBasaresultofhisincarcerationinthemaximumsecurityprisonatPollsmoor.
[237]OncetheplaintiffhadbeendiagnosedassufferingfromTB,hewaspromptlytreatedbymeansofthe
requiredprescriptiondrugs.HecompletedthefullcourseoftreatmentandwascuredofTB.Inthesecircumstances,
theallegationsmadeinparagraphs15.2and15.3ofthe
plaintiff'sparticularsofclaim,totheeffectthattheresponsibleauthoritiesfailedtoprovidetheplaintiffwith
adequatemedicaltreatment,arewithoutfoundation.
Wouldareasonableperson, inthepositionofthedefendant, haveforeseenthattheprevailingconditionsinthe

maximumsecurityprisonwouldreasonablypossiblyspreadTBamongsttheinmatesandcauseinmates,suchasthe
plaintiff,tosuccumbtothedisease?
[238]Ashasbeenalludedtoabove,TBisaformidableinfectiousdiseasewhichiseasilyspread.Itisalsoa
notifiableorcommunicablediseasewhichmustbereportedtotheMedicalOfficerofHealth,becauseofthedanger
whichitposestosociety.Itis,moreover,adiseasewhichisdifficulttotreat,becausepatientsarefrequentlynot
compliantoncethesymptomshavelessened.IncompletetreatmentmayresultininfectiouspatientswithchronicTB
andinthedevelopmentofresistantstrainsofTBsuchasMDRTBandXTRTBwhicharemoredifficulttotreat.
[239]ItiswellacknowledgedthatTB,becauseitisanairbornedisease,spreadsmoreeasilyinconfined
environmentswhicharenotexposedtoadequatesunlightandventilation.Thecellswhichhousedprisonersatthe
maximumsecurityprisonarenotproperlyventilatedforagreatpartofthedayandthereisinadequatesunlight.
Notably,crossventilationisabsentafterlockdownandthefreeflowofairandlightinthecommunalcellsare
further
restrictedbyblanketsandthelikewhichareputuptoprovideprivacy,therebycausingsuchcellstobedarkand
dingy.Prisonersareconfinedtosuchcellsfor23hoursperdayinseverelyovercrowdedconditions.WhereastheTB
guidelinesdonotstipulatethatpersonsintheoutsideworldwhoareillwiththediseasemustbeisolatedfrom
theirfamilies,DrTheronandDrCravenwereagreedthatisolationwasextremelyimportantintheclosedprison
environment.Theirevidenceinthisregardislogicaland,inmyview,anypersonwithamodicumofcommonsense
wouldappreciatethatintheprisoncontext,orforexampleinanarmycamp,oranyotherplacewherepeopleare
confinedinclosequarters,TBpatientshavetobeseparatedoutlesttheyspreadthedisease.
[240]GiventheprevalenceofTBinthemaximumsecurityprison,itappearstomethatanyreasonablepersonin
thepositionofthedefendantwouldalsohaverealisedandappreciatedthatthemeasureofovercrowdingwould
facilitatethespreadofthedisease,especiallyincircumstanceswheretherewasinadequatescreeningofincoming
prisoners,inadequatetreatmentofthosewhowereillwithTBandinadequatenumbersofnursingstaff,inaddition
toovercrowdingandthelackofisolationfacilities.Onceagain,itisamatteroflogicandcommonsense,having
regardtothenatureofthediseaseandthemannerinwhichitistransmitted.
[241]TheevidenceofDrsTheronandCravenestablishedthatthegreaterthepoolofbacteria,thegreaterthe
chancesareofbecominginfectedwiththe
disease.PersonswhohadpreviouslyhadTBwerealso,accordingtoProfVanHelden,moresusceptibletoa
recurrence.Evenpersonswhohadnotpreviouslybeenill,butwhoseimmunesystemhadbecomecompromised,
wereatriskfordevelopingthedisease.Areasonablepersoninthedefendant'sposition,whowasresponsiblefor
thehealthandwelfareofprisoners,wouldnodoubthaveensuredthathe/shehadbeeninformedoftherisk
factorsandwouldaccordinglyhaveappreciatedthesefacts.Defendant'sattentionhadbeendrawntotheproblems
posedbyovercrowding,nursingshortagesandthespreadofTB,asisevidencedbytheletterswrittenbyMrMuller
andthealarmsraisedbyDrTheronandDrCravenwhichculminatedintheapproachtotheparliamentaryportfolio
committee.
[242]Intheresult,Iamsatisfiedthatareasonablepersoninthepositionofthedefendantwouldhaveforeseen
thattheprevailingconditionsinthemaximumsecurityprisonatPollsmoorwouldreasonablypossiblyspreadTB
amongstinmatesandcauseinmates,suchastheplaintiff,whohadnotpreviouslybeenillwithTB,tosuccumbto
thedisease.
Wouldareasonableperson,inthepositionofthedefendant,havetakenstepstoguardagainstthespreadofTB?
[243]Giventheseriousnatureofthedisease,theeasewithwhichitistransmittedandtheriskwhichthedisease
posedtothehealthofthe
generalprisonpopulation,wardersandnursesincluded,areasonablepersoninthepositionofthedefendant
would,inmyview,havetakenstepstoguardagainstthespreadofthedisease,ifitwasatallfeasibletodoso.It
hastobedetermined,however,whatstepscouldreasonablyhavebeentaken.
[244]Itisreadilyevidentthatthelackofproperventilationandsunlightinthecellsofthemaximumsecurityprison
wasduetothemannerinwhichthebuildinghadbeendesignedandconstructed.Incarcerationundersuch
circumstancesisclearlyundesirableandmayconstituteabreachoftheplaintiff'srightintermsofclause12ofthe
Constitutionnottobetreatedorpunishedinacruel,inhumanordegradingway.Thereisnodoubtthatthelackof
properventilationandsunlightintheprisoncellsmateriallycontributedtothespreadofTBintheprison.The
plaintiff,however,profferednoevidencethatsuchdesignflawispracticallycapableofremediationanditisnotthe
taskofthisCourttospeculateonmeasuresthatcouldorcouldnothavebeeninstitutedtoremedysuchdefect.
[245]OvercrowdingoftheprisonwasclearlyamajorproblemandcertainlycontributedtothespreadofTBinthe
prison.Itis,however,bynomeansclearwhatstepscouldhavebeentakentoalleviatethesituation.Reference
wasmadetothefactthatsomeprisonerswereletoutonearlyparoleinordertoreducethenumberofinmates
andthatotherprisons,suchasGoodwood,didnotsufferfromovercrowding,butthemaximumsecurity
prisonremainedovercrowded.Whilstitistruethatthedefendantdidnotofferanyreasonableexplanationasto
whytheovercrowdingwaspermittedtocontinue,otherthanforMrGertse'sevidencethatthecourtssentprisoners
thereandthattheauthoritiesatPollsmoorhadnochoiceinthematter,theplaintifffailedtotenderanyevidenceas
toreasonablestepsthatcouldhavebeentakentoreducetheovercrowding.Onceagain,thecourtisnotentitled
tospeculateaboutthestepsthatcouldorcouldnotreasonablyhavebeentakentodoso.
[246]TheevidencetenderedbyDrTherondoes,however,establishthatthespreadofTBcanbecurtailedby
introducingsomerelativelysimple,costeffective,measuresashadbeendemonstratedduringhisexperienceatthe
lowcost,communityhospital,runbyDrBarkerinKwaZuluNatalduringtheperiod19711973.Whatisrequiredis
earlyidentificationofpersonswhoaredeterioratingandwhomayaccordinglybecomevulnerabletoTB,early
diagnosisofthedisease,effectivetreatmentandpropernutrition.
[247]ItappearstomethatinthecontextofthemaximumsecurityprisonatPollsmoor,theaforesaidmeasures
wouldtranslateintotheproperscreeningofincomingprisoners,inclusiveofaphysicalchestexamination
separatingoutthosewhohad,orweresuspectedofhavingTB,orwhowereobviouslyundernourishedand
vulnerabletoTBtheprovisionofadequatenutritiontothosewhowereundernourishedandotherwisevulnerable
toTBregularandeffectivescreeningoftheprisonerpopulation,inclusiveofexaminations
bymeansofXRaysand/orphysicalchestexaminationsbymeansofastethoscope,toidentifypossibleTBinfection
isolationofinfectiousinmatesandeffectiveimplementationoftheDOTSsystemovertheprescribedperiodoftime.
[248]Themeasuresreferredtointheimmediatelyprecedingparagraph,otherthanisolation,areallobviously
dependentonsufficientnumbersofnursingstaffanddoctorstoperformthevarioustasks.Theshortageofnursing
staffhadbeenamajorproblematPollsmooringeneraland,atthemaximumsecurityprisoninparticular,fora
considerableperiodoftime.ThecorrespondencebyMrMullerandMrEngelbrechtwhichformpartofExhibitA
referredexpresslytotheunderstaffingofthehealthcareserviceintheprisonandtheeffectthereofonthe
standardofcare.ThereportbyMsMagoro,theDirectorHealth&PhysicalCaredatedMarch2001(ExhibitAat53et
seq)similarlydrewattentiontothesematters.However,asisapparentfromsubsequentcorrespondence,posts
remainedvacant.Byfacsimiledated21January2002forwardedtotheCommissionerofCorrectionalServices,the
AreaManager,MrEngelbrecht,drewattentiontothefactthat10postsforprofessionalnurseswerevacantand
thatamemorandumregardingtheappointmentofadditionalnurseswhichhadbeensentinOctober2001,hadnot
beenanswered(ExhibitAat2930).FacsimilessentbyMrMullertotheaforesaidCommissioneron28November
2001and16January2002,drewattentiontothefactthatvacantpostsforregisterednurseshadbeenadvertised
inAugust2001,
interviewshadbeenconductedfrom29Octoberto2November2001,butappointmentshadnotbeenmade
(ExhibitAat3234).
[249]Accordingtotheevidencegivenatthetrialofthematter,staffshortagesremainedaproblemthroughoutthe
timeoftheplaintiff'sincarceration.Inmyview,areasonablepersoninthedefendant'spositionwouldhaverealised
thatadequatestaffingwasthekeytothepreventionandcontrolofTBandwouldhavetakenstepstoameliorate
thestaffshortageasamatterofsomeurgency.
[250]Theovercrowdingofthemaximumsecurityprisonobviouslymadeitdifficult,ifnotimpossible,toisolateallof
thepersonswhowereintheinfectiousstageofTBintheprisonhospital.TheevidenceofDrTheronandDrCraven
madeitclearthatisolationwasanimportantelementinthepreventionofthespreadofTBinaclosedenvironment,
suchastheprisonandlogicdictatesthatinfectiousprisonersoughttohavebeenseparatedfromthegeneral
prisonpopulationifthespreadofTBwastobecurtailed.
[251]Whilsttheevidencehasestablishedthatsomesocalledisolationfacilitieswereavailableinthehospital
section,itwasapparentfromDrTheron'sevidencethatthedesignofthesocalledisolationcellswassuchthat
isolationwasnotcapableofpracticalimplementation.Thereisnoevidencethatsuchproblemwascapableof
remediation,giventhephysicalconstraintsoftheprisonbuilding.MrGertse,however,testifiedthatsome
ofthesinglecellsinthesectionswerealsousedasisolationfacilities.Ifitisacceptedthatsomeofthesinglecells
weresetapartforisolationpurposes,ittendstoindicatethatwithameasureofreorganisation,morecellscould
havebeenusedforsuchpurpose.However,noevidenceastowhetherornotitwouldhavebeenfeasibletodoso,
waspresented.
[252]Inconclusion,areasonablepersoninthedefendant'spositionwould,inmyview,havetakenstepstoguard
againstthespreadofTBinthemaximumsecurityprison,becauseitissuchaformidablediseasewhichiseasily
spread.Moreparticularly,areasonablepersonwouldhaveensuredthatsufficientnumbersofnursingstaffwere
employedtoperformthevarioustasksinvolvedinthecontrolandpreventionofTBinthesaidprison.
DidthedefendanttakereasonablestepstoguardagainstthespreadofTB?
[253]Ontheevidencebeforethecourt,onecouldnotreasonablyhaveexpectedthedefendanttoredesignthe
prison,ortoremedythedesigndefects.Theevidencetenderedisalsoinsufficienttodeterminewhetherornotthe
defendantcouldreasonablyhavegainedcontrolovertheovercrowding.
[254]ThefailuretoisolateinfectiousTBpatientsmaywellhavebreachedthedefendant'sobligationsintermsof
clause15ofChapter3oftheStandingOrderswhichprovidesthatprisonerswithcommunicableconditionsmustbe
isolated.GiventheconstraintsimposedbyinadequateaccommodationandovercrowdingIam,however,not
satisfiedthatithasbeenestablishedthatitwouldhavebeenreasonablypossibletoprovideisolationforallofthe
infectiousprisoners.
[255]Theevidencehas,however,establishedthatifsufficientmembersofnursingstaffhadbeenavailable,proper
andeffectivescreeningcouldhavebeenconducted,whichwasoneofthekeyelementsingainingcontroloverthe
spreadofTBintheprison.Inaddition,nurseswouldhavebeenabletoconductclinicsinthevarioussectionsona
dailybasis,whichmeansthatitwouldhavebeenpossibletoidentifypotentialTBpatientsmoreexpeditiouslyand
toimplementtheDOTSsystemeffectively.Inshort,theevidencehasestablishedthatsufficientnumbersofnursing
staffwereessentialincombatingandcontrollingTBintheprison.Putdifferently,theseriousshortageoftrained
nursingstaffwasoneofthemainfactorswhichresultedinthelossofcontroloverTBinthemaximumsecurity
prison.
[256]Thedefendantobviouslyhadthepowerandauthoritytoappointadditionalstaff,butfailedtodoso.The
reasonswhyvacantpositionswerenotfilled,areobviouslywithintheexclusiveknowledgeofthedefendant,but
thedefendanttenderednoevidencetoshowthatitwasimpossible,inappropriate,orunreasonable,tofillvacant
postsonthenursingstaffestablishment,orthattherewerealternativemeansofcurtailingthespread
ofTBinthemaximumsecurityprison.Thehighwatermarkofthedefendant'scasewasthataselfreportingsystem
wasinplaceintheprison,thatitwasuptoinmatestoreportiftheywereillandthatsputumtestswereconducted
forprisonerswhorequestedthese.
[257]Theauthorities'relianceuponaselfreportingsystem,intermswhereofprisonershadtocomeforwardif
theywereill,appearstometohavebeenilladvised,inappropriateandwhollyinsufficientinthefightagainstTBin
theprisonenvironmentfor,interalia,thefollowingreasons:
257.1 Accordingtotheevidence,mostoftheinmatessmoked,cellswerefilledwithsmokeanddrifteddownthe
corridorandmostoftheinmatescoughed.Merecoughingwasaccordinglyunlikelytoprecipitateanyactionon
thepartofanaffectedinmate.Indeed,DrCraven'sevidencewasthatpeoplewhousuallycoughdonot
regardacoughaspathologicalandonlygotothedoctoronceadditionalsymptomshavemanifested.Such
evidencealsoaccordswithcommonsenseandwiththeprobabilities.Ininstanceswherepeoplehavebecome
illwithTB,theyaccordinglycoughupbacteriauntilsuchtimeastheyhavemanifestedadditionalsymptoms
whichmakethemrealisethattheyareill.Intheclosedprisonenvironmentwhichischaracterisedbypoor
ventilationandalackofsunlight,thismeansthatthebacteriaremainactiveforsome
time.Moreover,witheachpersonwhohasbecomeillwithTB,buthasnotbeendiagnosed,thepoolofTB
bacteriaincreases.FellowinmateswhoarenotillwithTBare,however,exposedtotheTBbacteriawhichmay
bepresentinacellfor23hourseachday
257.2 Accordingtotheevidence,prisongangshadtheirown"doctors"or"inyangi",whoexercisedcontrolover
inmatesandwhodictatedwheninmatescouldseetheprisondoctor.InmateswhowereillwithTBcould
accordinglybepreventedfromseekingtimeousmedicalassistance,therebyincreasingthepoolofbacteriain
theprisonenvironment
257.3 Thenumberofnursesemployedatthemaximumsecurityprisonwaswhollyinsufficienttocaterfortheneeds
ofinmates.AsMrMullertestified,itwasaccordinglynotpossibleforanursetovisiteachofthesectionsona
dailybasissoastoattendtoinmates'complaints.Itwasalsopracticallydifficultforinmatestogettothe
hospitaltoseethedoctor,aswastestifiedtobyDrTheronandtheplaintiff.Thenumberofwarderswas
insufficientandthereweremanygatesandcheckpointstotraverse.DrTherontestifiedthattherehadbeen
severalcasesinthemaximumsecurityprisonwhereprisonerswithactiveTBhadbeenincarceratedfor3or4
monthswithouthavingbeenreferredtothehospital,becauseof
difficultieswithaccess
257.4 TherewasinsufficientmonitoringofsuspectedTBcases.Nursesdidnotgettoseeinmatesinthesectionson
adailybasis,duetothestaffshortage.AlthoughMrGertsetendedtosuggestthatthe"suspectregister"
wasalreadybeingusedatthetimeoftheplaintiff'sincarceration,itisbynomeansclearthatthiswasthe
case.MrGertse'sevidencewastaintedbyunreliabilityonaccountofhisbiasinfavourofdefendant'scase
andthefactthathedidnotappeartohavemuchrespectforthetruth.However,evenifoneweretoaccept
thattheregisterwasbeingmaintained,MrGertsetestifiedthatininstanceswheresputumtestsproduced
negativeresults,suchresultswerenotbroughttotheattentionofthedoctor.Sputumtestsdonotalways
producepositiveresultsininstanceswhereapatientisalreadyillwithTB.Thiswasillustratedintheplaintiff's
owncase.Ifprisonerswhosesputumtestsproducednegativeresultswerereferredtothedoctor,thelatter
would,atleast,havebeenabletoperformaproperchestexaminationinordertodeterminewhetherthere
wasevidenceofanyunderlyingpathologywhichrequiredfurtherinvestigationand/ortreatment.Giventhe
failuresinthesystemalludedtoabovetherewas,however,noproperfollowupofsuspectedTBcases.
[258]Inlightofthecircumstancesadvertedtoabove,thecrispanswertothequestionastowhetherthe
defendanttookreasonablestepstoguardagainstthespreadofTB,ortocurbitsspreadinthemaximumsecurity
prison,isno.Thereisnoevidencethatthedefendant,ormembersoftheDCStookanystepswhatsoevertoguard
againstthespreadofTBinthemaximumsecurityprison.Itfollowsthatthedefendant'somission(s)referredto
above,constitutednegligence.
Allegationsofnegligencefoundtohavebeenproved
[259]Onthetotalityoftheevidence,atappearstomethattheplaintiffhasprovedthefollowingelementsofhis
claimonpreponderanceofprobabilities:
259.1 Thatitwascommonforinmates,includingtheplaintiff,tobecongregatedincloseproximitytooneanother
andtobehousedinmasscells
259.2 ThataconsiderableproportionofprisonerswereillwithTBandwereinfectious,butthattheywerenot
isolatedfromthegeneralprisonpopulation
259.3 Thatitwasreasonabletoexpectthatpersonswhowereinthe
infectiousstageofthedisease,wouldexpelTBbacteriabycoughing,sneezingorspittingandthatsuch
bacteriawouldinfectfellowinmateswhowereincloseproximitytothem
259.4 ThatitwasreasonabletoexpectthatsomeoftheinmateswhowereinfectedwithTBbacteriaasaforesaid,
wouldthemselvesbecomeillwiththedisease
259.5 ThattheplaintiffwasinfectedwithTBbacteriaduringhisimprisonmentandbecameillwiththedisease
259.6 Thattheresponsibleauthoritiescouldhaveprevented,orcurtailed,thespreadofTBinthemaximumsecurity
prisonbyprovidingsufficientnumbersofadequatelytrainednursingstafftoproperlyscreenincoming
prisonersforTB,toscreeninmatesregularlyforTB,toeffectivelycounselthoseinmateswhohadbeenin
closecontactwithfreshlydiagnosedTBpatientsandtoapplytheDOTSsystemeffectively
259.7 ThattheresponsibleauthoritiesfailedtopreventorcurtailthespreadofTBasaforesaidandfailedtoprovide
adequatenumbersofnursingstafftoperformtheaforesaidtasks.
Wasthedefendant'sfailuretotakereasonablestepsasaforesaidunlawful?
[260]Asappearsfromtheextractoftheplaintiff'sparticularsofclaimwhichhasbeenreferredtoinparagraph[6]
above,theplaintiffhasallegedthattheconductoftheresponsibleauthoritieswasunlawfulinthattheplaintiff's
rightsatcommonlaw,undertheCorrectionalServicesAct8of1959andundertheConstitution,wereviolated.
[261]Ifitisfoundthatanomissionisculpable,becauseareasonablepersoninthepositionofthedefendant
wouldnotonlyhaveforeseentheharm,butwouldalsohaveactedtoavertit,thatisnottheendofthematter.
Negligentconductconsistingofanomissionisonlyvisitedwithliabilityincircumstancesthatthelawregardsas
sufficienttogiverisetoalegaldutytoavoidnegligentlycausingharm.Whetherornotsuchalegaldutyistobe
imposedmustbedeterminedbythecourtsuponaconsiderationofpublicandlegalpolicywhichisconsistentwith
constitutionalnorms.8
[262]AswaspointedoutinVanDuivenboden9thereluctancetoimposeliabilityforomissionsisoftenfoundedon
theconceptthatindividualsarefreetomindtheirownbusinessandtheprotectionwhichisaffordedbytheBillof
Rightstoequality,personalfreedomandprivacymayfurthermilitate
againstimposinglegaldutiesonprivatecitizens.Differentconsiderations,however,applyininstanceswherethe
conductofapublicauthorityorfunctionaryisinissue.Publicfunctionariesare,afterall,usuallychargedwithserving
theinterestsofthecommunitysothattheirfailuretoactcannotbedealtwithonthesamefootingasanomission
onthepartofprivateindividuals.Intheinterestsofeffectivegovernment,publicfunctionariesmustbeaffordedthe
freedomtoarrangetheiraffairsandtoprovidepublicserviceswithouttheconstantthreatoflitigationiftheywere
toactnegligently.Thepositionofpublicfunctionariesis,however,differentfromthatofprivateindividualsinamost
importantrespect.TheConstitutionexpresslyimposescertainobligationsupontheState.So,forexample,section7
oftheConstitutionrequirestheStatetoprotect,promoteandtofulfiltherightsembodiedintheBillofRights.
Section2oftheConstitutiondemandsthattheobligationsimposedbytheConstitutionbefulfilledandsection
41(1)expresslyprovidesthatallspheresofgovernmentandallorgansofStatewithinsuchspheresmustprovide
governmentthatisaccountable,inadditiontobeingeffective,transparentandcoherent.
[263]Thedefendantisultimatelyresponsibleforthesafety,healthandwellbeingofprisoners.Infulfillingthat
responsibilitythedefendant,inaccordancewithhisobligationsintermsofthe1958Act(sic)andtheConstitution,
mustclearlytakesuchstepsanddosuchthingsasmaybenecessarytoensure
thattherightofaprisonertotreatmentwhichisnotinhumanordegrading,ispreserved,aswellashisrightto
dignity.
[264]Intheinstantcase,itappearstomethattheplaintiff'srightsasaforesaidhavebeenviolated.Theevidence
clearlyshowsthattheplaintiffwasdetainedinextremelyovercrowdedandpoorlyventilatedcells.Althoughthe
plaintiffreceivedadequatemedicaltreatmentoncehehadbeendiagnosedwithTB,thesevereshortageofqualified
nursescausedhealthservicesintheprisontobreakdown.Asaconsequence,personswhowereillwithTBwere
notroutinelyprovidedwithadequatetreatmentandTB,inclusiveofMDRTBandXTRTBbecameprevalentinthe
prison.Inaddition,thedefendantand/orhisofficialsatthemaximumsecurityprisonfailedtoactinaccordancewith
theprovisionsofsection23ofthe1959ActandtheStandingOrders,inasmuchprisonerswithinfectiousdiseases,
suchasTB,werenotroutinelyseparatedfromtheremainderoftheprisonpopulation,therebyfacilitatingthe
spreadofthedisease,giventhattheinmatesfoundthemselvesinaclosed,poorlyventilatedenvironment.Instead
ofadoptingmeasurestocurtailthespreadofTBinthemaximumsecurityprison,suchasadequatescreening,the
authoritiesreliedonawhollyinappropriateselfreportingsystemwhichpermittedpersonswithTBtoremaininthe
generalprisonpopulation.TheauthoritieshadbeenwarnedingraphictermsthatthesituationatPollsmoor,
inclusiveofthemaximumsecurityprison,wasgravecauseforconcernandthatconditions
attheprisonwereconducivetotheriskofspreadingTB,butfailedtoaddresstheproblemsinanymeaningful
manner.
[265]Theconditionsunderwhichtheplaintiffwasdetainedshowconsiderablesimilaritywiththoseinthecaseof
KalashnikovvRussia,anapplicationdecidedbytheEuropeanCourtofHumanRightsundertheConventionforthe
ProtectionofHumanRightsandFundamentalFreedoms.Kalashnikovhadbeendetainedinapretrialprisonwhich
wasparticularlyovercrowded.Hiscellwassoovercrowdedthatinmateshadtotaketurnstosleep.Therewasan
absenceofadequateventilation,butdespitesuchsituationprisonerssmokedinthecell.Hewasallowedoutside
forexercisefor1or2hoursperday,butspenttherestofthetimeinthecellwithlimitedspaceforhimselfandina
stuffyatmosphere.Thecellwasinfestedwithpestsandhecontractedvariousskindiseasesandfungalinfections
throughouthisdetention.OnoccasionhewasdetainedwithpersonssufferingfromTBandsyphilis.
[266]AlbeitthattheEuropeanCourtofHumanRightsfoundthattheRussiangovernmenthadnothadthedirector
positiveintentionofhumiliatingordebasingtheapplicant,itfoundthattheconditionsofdetention,inparticularthe
severelyovercrowdedaninsanitaryenvironmentanditsdetrimentaleffectontheapplicant'shealthandwellbeing,
combinedwiththelengthofhisdetention(fromJune1995toOctober1999,ieaperiod
ofapproximately4years)amountedtodegradingtreatment.
[267]ThecircumstancesunderwhichKalashnikovwasincarcerated,appeartohavebeensomewhatworsethan
thosewhichprevailedatthemaximumsecurityprisonwheretheplaintiffhadbeendetained.However,whereas
therewasevidencebeforetheEuropeanCourtthattheRussiangovernmentweredoingtheirbesttoimprove
conditionsofdetentioninRussia,thedefendanthasnotprofferedanysuchevidence.AlthoughMrJamiementioned
inargumentthatthedefendantwassubjecttocertainfinancialconstraints,therewasinfactnoevidencetothat
effect.
[268]Prisoninmatesliveinanenvironmentwhichisclosedandwhichputsthematthemercyofdefendantandhis
officials.Itwasthedutyofthedefendantandhisofficials,intermsofthe1958Act(sic)andtheConstitution,to
provideprisonerswithtreatmentwhichisneitherinhumanenordegradingandtopreserveprisoners'rightto
dignity.Thefailureofthedefendantandhisofficialstodosois,inmyview,notjustifiable,whetherintermsof
section36oftheConstitutionorotherwise.Theseconsiderationsmustweighheavilyinfavourofafindingthatthe
defendant'sconduct,andthatofhisofficials,wasunlawful.Afurtherfactorwhichmustbeborneinmindisthatthe
plaintiffwouldhavenomeansofredressifthedefendant'sconductandthatofhisofficialswasheldtobelawful.
Theresultwouldbethattheresponsibleauthoritiescouldignore
theirdutiestoprisonerswithimpunity.Inmyview,neitherpublicnorlegalpolicy,northeprovisionsofthe
Constitution,couldhaveintendedsuchawhollyinequitableandunjustifiableresult.
[269]Itfollowsthat,inmyview,theconductofthedefendantandhisofficialsinomittingtotakestepstoguard
againstthespreadofTBinthemaximumsecurityprisonasaforesaid,wasunlawful.
[270]Intheresult,thefollowingorderisherebymade:
1. ThedefendantisdeclaredtobeliabletotheplaintiffindelictpursuanttotheplaintiffhavingbecomeillwithTB
whilsthewasincarceratedinthemaximumsecurityprisonatPollsmoor
2. Theregistrarisrequestedtosetthematterdownforhearing,inconsultationwiththeJudgePresident,in
orderforthepartiestoleadevidencepertainingtothequantumoftheplaintiff'sdamagesinrespectofhis
illnesswithTBasaforesaidandthesequelaethereof
3. Defendantistopaytheplaintiff'scostsofsuitasbetweenpartyandparty.
Footnotes
1 At445BFpara[19].
2 MinisterofSafetyandSecurityvVanDuivenboden,supra,at446GH.
3 At447BE.
4 At125BFpara[12].
5 At1258EFpara[14].
6 1966(2)SA428(A)at430EF.
7 mCubedInternational(Pty)Ltd&anothervSingerNO&others2009(4)SA471(SCA)[alsoreportedat[2009]JOL
23270(SCA)Ed]at479FJandcasestherecited.
8 MinisterofSafetyandSecurityvVanDuivenboden, supra,paras[12][17]at441E444G.SeealsoMcIntoshv
PremierKwaZuluNatal&another[2008]4AllSA72(SCA)[alsoreportedat[2008]JOL21806(SCA)Ed]at77df.
9 Supra,paras[19][20]at445B446E.

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" 5.1.1 IncompliancewiththeprovisionsoftheActandtheConstitutionalframework,Defendantis

Isitmoreprobablethannotthattheplaintiff'sillnesswithTBwasoccasionedby, orresultedfrom, theprevailing

Wouldareasonableperson, inthepositionofthedefendant, haveforeseenthattheprevailingconditionsinthe

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