Gough v Neary

JurisdictionIreland
JudgeMr. Justice Johnson
Judgment Date15 November 2002
Neutral Citation2002 WJSC-HC 2916
Docket NumberNo. 13660P/1998
CourtHigh Court
Date15 November 2002

2002 WJSC-HC 2916

THE HIGH COURT

No. 13660P/1998
GOUGH v. NEARY & CRONIN

BETWEEN

ALISON GOUGH
PLAINTIFF

AND

MICHAEL NEARY AND BASIL CRONIN
DEFENDANT

Citations:

DUNNE V NATIONAL MATERNITY HOSPITAL 1989 IR 91

Synopsis:

NEGLIGENCE

Medical Negligence

Liability - Personal injuries - Causation - Evidence - Findings of fact - Whether appropriate medical procedures and practices followed - Whether failure to use more conservative medical treatment negligent (1998/13660P - Johnson J - 15/11/02)

Gough v Neary

Facts: the plaintiff sued for damages for personal injuries caused by a hysterectomy performed by the first defendant to stop haemorrhaging which she alleged could have been arrested by more conservative treatment. She claimed to have suffered emotional trauma as a result of the operation.

Held by Johnson J in awarding the plaintiff EUR250,000 general damages, including EUR150,000 for the 10 years to date and EUR100,000 into the future, with special damages of EUR23,223.27 that the defendant was negligent in that no obstetrician of his qualifications should have done what he did and on the balance of probabilities the haemorrhaging of the plaintiff could have been arrested by more conservative treatment and the operation would have been unnecessary.

1

In this case the plaintiff, who is a married woman, resides at 5 Market House Lane Ardee Co. Louth.

2

The first named defendant, who is an Obstetrician Gynaecologist, resides at 23 Fair Street Drogheda in the County of Louth.

3

The second named defendant is sued in his capacity as a trustee of the International Training Hospital, known as Our Lady of Lourdes Hospital Drogheda, in the County of Louth and employer of the first named defendant.

4

The defendants are sued for their negligence in or about the services, provided at the said hospital, by the first named defendant and the other servants and agents of the said hospital, to the plaintiff.

5

The facts of the case are as follows. The plaintiff, who in October 1992, the time when incidents complained of occurred, was a 27 year old married woman. She had become pregnant and had an expected delivery date of the 15th of October 1992. She was not delivered on that date and on the 25th of October 1992 was admitted to Our Lady of Lourdes Hospital in Drogheda for the purpose of being induced.

1

On the morning of the 26th of October she met with the first named defendant who was an Obstetrician Gynaecologist attached to the said hospital, for the purposes of having his care in the course of her delivery.

2

The defendant first of all ruptured her membranes for the purposes of commencing the process of delivery. She was put on a syntocinon infusion in the early afternoon and her contractions started at 3pm in the afternoon. She was given an epidural anaesthetic at 7.45pm, but the delivery did not progress satisfactorily and in the early hours of the morning of the 27th of October 1992 it was decided that she should have a caesarean section. This decision was taken at approximately 1.27am and a request was made for four units of blood to the pathology department.

3

The process of cross matching the bloods commenced at 1.40am and it appears that by 1.55am the bloods were cross matched and that two packs of blood namely pack number 139858 and 139971 were ready at 1.55am.

4

These units of blood were removed from the laboratory at 2.10am, subsequently a request was made for two further units of blood which cross matched and the third of these was removed at 3.35am to the theatre, that was unit number 139884, which was in actual fact the fourth unit in sequence the third unit 139878 was not removed from the laboratory and was recycled by the laboratory. Further it appears that the following morning at 9.30am two further units of blood were set up for Mrs. Gough but were never removed from the laboratory so that out of six units of blood which were requested three were used and three were not used.

5

The caesarean section would appear to have been completed at 1.44am, and having been commenced at 1. 25 or 1.30am and the placenta having been removed, the plaintiff commenced to bleed.

1

The plaintiff according to the first named defendant lost some 1,500 to 1,750 mls of blood and was still bleeding and he stated that she had a totally atonic uterus.

2

As here before stated blood was collected from the laboratory at 2.10 and therefore transfusion of blood cannot have commenced before 10 minutes past 2.

3

At approximately 2.25 the first named defendant decided that the plaintiff required a sub total hysterectomy, and the first named defendant commenced to carry out that procedure which was completed at approximately 3.05am. After the operation the plaintiff received a further unit of blood in the recovery room. The plaintiff, who was at that time primagravida, in other words expecting her first child claims that the first named defendant was negligent in carrying out that operation, and in failing to take sufficient and proper steps to stop the hemorrhage from which she was suffering. Alternatively the first named defendant embarked on the said procedure without having given proper sufficient time to the conservative methods of stemming the blood.

4

For a caesarean section to be performed on a young woman of this nature without having complicating conditions such as either cancer or placenta praevia is practically, unheard of and occurs something in the region of 1 in every 100,000 cases.

5

In this instance the birth was at 1.44 am as stated, and the plaintiff bled for 12 minutes after the delivery of the placenta which took place for 2 to 3 minutes after the birth and at 2am the bleeding was considered abnormal. Dr. Neary indicates that this was the crisis point, but the blood did not arrive from the laboratory until 2.10, there does not appear to have been emergency alerted to the laboratory, no emergency appears on the notes of the operation. There is nothing on the notes of the operation, to indicate what conservative methods if any, were taken by the first named defendant between the commencement of the bleeding, and the commencement of the hysterectomy at 2.25. It is quite clear only 15 minutes can have elapsed between the arrival of the bloods from the laboratory and the commencement of the hysterectomy.

1

The plaintiff, in the course of her evidence, gave a history of having worked as a domestic in the hospital in Ardee, of having become pregnant, with a normal pregnancy with an expectation date in October. She then gave a description of the proceedings prior to the operation and, then dealt with the situation after the operation when she said she had two conversations with the first named defendant. She describes how she woke up without the baby and was terribly distressed. Key pieces of conversation took place with Dr. Neary and I accept absolutely the plaintiff's version of them.

2

She said to him that she didn't sleep, to which he replied that if she did not sleep how did she think he slept.

3

Some days later the plaintiff spoke to the nurses and said to them that that if she was going to have another child she would prefer to cut out the labour, and go straight to have a section. She said that it would be grand. They said to her to ask the doctor.

4

Then Dr. Neary came to visit her in a public ward. The curtains were pulled around her and she asked the same question to him that if she were going to have any more children she would like to have them by section, which he replied no. She asked him what do you mean by no?

He said he had to remove her womb and that she had had a hysterectomy. He further said that he had saved her life and that he could have sent her son home without a mammy. He further said that she had lost so much blood he had never witnessed anything like it. He further said that he used all the top drugs.

5

When at the sixth week check up she met Dr. Neary again she said to him she could not sleep, and could not come to terms with what had happened to her. He told her she said, that if he told her what had happened on that night that she would never sleep again, and she was better off not knowing. He told her to go home and get on with her life.

1

On behalf of the plaintiff Professor Dr. John Bonner was called an extremely prominent obstetrician and gynaecologist.

2

He said that in his experience the concept of a caesarean hysterectomy for a primagravida case was extremely rare. Primgravida meant of course a woman who was having her first baby.

3

So rare in fact, in his experience he had only come across 1 in 100,000 births, and in that case the patient had suffered from placenta previa. He had also heard of one who had suffered from cancer.

4

Quite clearly his evidence indicated and he stated that this was a uniquely rare occurrence.

5

The professor also went on to say that in his opinion, looking at the records of the plaintiff, they indicated that there was no danger to life from exanginsation whatsoever.

6

This is supported by among other things the total absence of any reference to an emergency in the anaesthetic notes. Also in the rate of transfusion which was used by the anaesthetist namely transfusing a pint in an hour, Dr. Bonner's opinion was that in the case of a massive hemorrhage a unit would be put in in five minutes. And he points out that the reason for the slow blood transfusion was because the patient was in no danger.

7

Professor Bonner also points out that the plaintiff had an excellent urine output which substantiates the fact that there was no danger to the plaintiff's life and I quote "the patient was putting out plenty of urine so it meant that the circulation and blood supply of vital organs were working perfectly normally."

1

Dr. Bonner also pointed out that you don't get involved in doing a laboratory tests if the patient has normal blood pressure and pulse. However if the plaintiff...

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