High Court: Woman awarded €63K for negligent post-operative care

About this case:

• Citation:
  [2019] IEHC 172
• Judgment:
  External link
• Court:
  High Court
• Judge:
  Mr Justice Anthony Barr

Mr Justice Robert Barr rejected the first part of the woman’s claim, in which she argued that the hospital staff were negligent in not fitting a temporary pacemaker when her permanent pacemaker was removed; but found that the post-operative instructions should have ensured that the woman did not move around the ward unsupervised.

Background

On 15 May 2014, Concepta Anderson was admitted to St. James’s Hospital under the care of a Consultant Cardiologist, to have a replacement pacemaker inserted.

On 17 May 2014, Ms Anderson’s permanent pacemaker and lead wires were extracted by a Consultant Cardiothoracic Surgeon in St. James’s Hospital. The Consultant Cardiologist and the Consultant Cardiothoracic Surgeon decided not to insert a temporary pacemaker due to the risk of infection, and Ms Anderson was scheduled to have a new permanent pacemaker implanted in the following days.

On 18 May 2014, Ms Anderson had an episode of syncope (a stoppage of her heart leading to a blackout), causing her to fall while in the en-suite of her hospital room, striking her head against the sink.

Ms Anderson had a history of syncope, collapsing and losing conscious a number of times, in the years prior to having her pacemaker implanted in 2003.

High Court

In the High Court, Ms Anderson brought a medical negligence action against Lorcan Birthistle as representative of the medical and nursing staff at St. James’s Hospital, Dublin. Ms Anderson alleged that, having regard to her prior history of syncope, there was negligence on the part of:

1. The Consultant Cardiologist and the Consultant Cardiothoracic in failing to insert a temporary wire when her permanent pacemaker was removed.
2. There was negligence on the part of the medical and nursing staff in the hospital in respect of her postoperative management, for failure to ensure that she was confined to bed and only allowed to ambulate around the ward with assistance. It was further alleged by Ms Anderson’s experts, that she should not have been placed in a coronary step down ward, as in fact happened, but should have been sent to the Coronary Care Unit postoperatively.

Mr Birthistle denied any negligence on the part of the medical or nursing staff in St. James’s Hospital, either as alleged or at all.

The temporary wire issue

Having heard evidence from experts for Ms Anderson and for the defendant, who all agreed that the Consultants treating Ms Anderson had to carry out a balancing exercise of the risk of infection against the risk of syncope when considering whether it was appropriate to insert a temporary wire, Mr Justice Barr concluded that in deciding not to insert a temporary wire, the consultants were not negligent in their care of Ms Anderson.

Although there were two schools of thought as to the appropriate course of treatment, the course taken was not negligent.

Post-operative care given history of syncope

On the issue of the management and care of Ms Anderson after her permanent pacemaker was removed on 17^th of May 2014, Mr Justice Barr was satisfied that she had not been instructed to stay in bed after her pacemaker was extracted, and was allowed to ambulate freely around her room and around the ward. Mr Justice Barr was satisfied that the only instruction Ms Anderson had been given was that she was not to go out of range of the telemetry monitor.

Having chosen to run the risk of Ms Anderson suffering a syncope episode, and having regard to the fact that she had a history of falls and injury prior to implantation of the pacemaker and that she would revert to this condition with the removal of the pacemaker, Mr Justice Barr said it was incumbent on the Consultant Cardiologist who was responsible for Ms Anderson’s care to minimise the consequence of the risk of falling and injury.

Mr Justice Barr found that the Consultant Cardiologist was negligent in not ensuring that clear instructions were given to the nursing staff that Ms Anderson was a falls risk having regard to her previous history and therefore that she should be confined to bed and should only ambulate under supervision. The consequence of this was that no instructions were given to Ms Anderson to stay in bed, she was allowed to ambulate freely within the range of the telemetry monitor, exposing herself to a risk of serious injury.

In these circumstances, Mr Justice Barr was satisfied that Ms Anderson established negligence in respect of the post-operative care given to her in St. James’s Hospital. Due to that breach of duty, Ms Anderson suffered injury when she had a fall on 18 May 2014.

Mr Justice Barr rejected the argument that there was negligence on the part of the doctors or hospital staff in placing Ms Anderson in a coronary step down ward, considering that it was a specialised ward and Ms Anderson was given her own room around 5m from the nurse’s station.

Damages

As a result of the fall, Ms Anderson suffered a blow to the head which caused a laceration – leaving her with a permanent scar on her forehead. Ms Anderson also suffered psychiatric injury in the form of anxiety and sleep disturbance, which are symptoms of acute stress disorder. This required treatment in the form of medication for approximately three and a half years after the accident.

Mr Justice Barr accepted Ms Anderson’s evidence regarding the impact of her injuries, including the effect of the visible scar on her forehead.

Taking everything into account, Ms Anderson was awarded €63,112.48:

• €40,000 for general damages to date;
• €20,000 for general damages into the future;
• €3,112.48 agreed for special damages.

• by Seosamh Gráinséir for Irish Legal News