Healy -v- Buckley & Anor, [2010] IEHC 191 (2010)

Docket Number:2004 8001 P
Party Name:Healy, Buckley & Anor
Judge:O''Neill J.







JUDGMENT of O'NEILL J. delivered on the 20th day of May, 2010

  1. Factual Background

    1.1 The plaintiff, in this case, sues the defendants for damages for negligence and breach of duty in the treatment of the plaintiff between September 2000, and March 2001, with the drug known as Sandostatin LAR.

    1.2 The first named defendant is a consultant Endocrinologist at the second named defendant's hospital.

    1.3 The plaintiff was born in 1946, and is a married woman with three adult children.

    1.4 In February 1982, the plaintiff was found to have a large pituitary tumour. Initially, she declined surgery for this. Later on in the year in September 1982, she was admitted to hospital, quite distressed, with severe pain, headache and photophobia. A neurological examination revealed complete left-sided opthalmoplegia with absence left corneal reflex. Fundoscopy showed early papilloedema, with early evidence of optic atrophy.

    1.5 The plaintiff was pregnant at the time. A CT scan showed an enlarged pituitary intrasellar tumour extending to the left side with evidence of haemorrhage in this area. A carotid angiogram showed a large central mass effect with distortion of the internal carotid and middle cerebral arteries. Initially, the plaintiff was given drug therapy. Her condition deteriorated and it was decided to remove as much of the tumour as possible.

    1.6 On 29th September, 1982, a left frontal temporal craniotomy with biopsy of the pituitary tumour was performed. Because of the vascularity of the tumour, only a very limited biopsy was taken. This showed a small amount of infarcted tissue. Following surgery, she developed a left ptosis.

    1.7 The plaintiff improved following her surgery and was continued on the medication she was on before the surgery i.e. Bromocryptine, and she was also prescribed Carbamazepine for temporal lobe seizures which had developed as a result of the pressure of the tumour on the left temporal lobe.

    1.8 In 1984, the plaintiff's treating surgeon, Mr. Feely, thought the tumour was slightly larger in spite of the Bromocryptine. The plaintiff continued on Bromocryptine and has done so ever since. The plaintiff continued under the care of Mr. Feely until he left his post in 1992, and thereafter, she came under the care of Mr. Charles Marks, a neurosurgeon, and also a little later, Dr. Teresa Mitchell, a consultant Endocrinologist.

    1.9 By the early 1990s, it was clear that the plaintiff had an extremely rare tumour which was hyper-secreting three hormones, namely, Thyroid Stimulating Hormone (TSH), Growth Hormone (TH) and Prolactin. This is not only an extremely rare condition, but in the experience of all of the experts who have given evidence in this case, unique.

    1.10 From an early stage, the excessive secretion of Prolactin was successfully suppressed by the Bromocriptine. Much greater difficulty was encountered in dealing with the excess secretion of TSH and GH. Dr. Mitchell treated the excess secretion of TSH and the consequent Thyrotoxicos with Propranol and Carbimazole and her seizures were treated with Carbamazepine.

    1.11 In 1994, various treatments were considered for the plaintiff. Primary of these was radiotherapy, but it takes many years, frequently up to ten or more years for the beneficial effects of this treatment to take hold. The drug type Somatostatin or its analogue, Octreotide, was considered. Sandostatin, the drug at issue in this case, is that type of drug.

    1.12 In 1994, it was available, but in a different format to the one at issue in this case. Then, the drug had to be administered by three daily injections into the abdomen. The treatment given to the plaintiff in these proceedings, in September 2000, was a long-acting version of the drug which became available in the late 1990s, and is given by means of a single injection every four weeks into the gluteal muscle.

    1.13 The Cork University Hospital notes indicate that around February 1994, the Somatostatin type drug was considered but the plaintiff was not keen on it. Also, at the time considered was radiotherapy and the plaintiff opted for this treatment which was carried out that year. In the meantime, the plaintiff continued on quite high levels of Bromocriptine and anticonvulsant medication.

    1.14 Pending the effects of the radiotherapy on the plaintiff's Growth Hormone levels and her Thyroxine, Dr. Mitchell increased her Bromocriptine to 10mg. per dose. In the spring of 1994, the plaintiff had a radical course of radiation of her tumour over a period of six weeks. As of January, 1995, Dr. Mitchell found that a CAT scan demonstrated no further growth of the tumour and that her Growth Hormone levels had stabilised but her serum Thyroxine, though much lower, was still abnormally high. She also found that her serum cortisol had fallen either due to the tumour or to the radiotherapy.

    1.15 During 1995, the plaintiff decided to leave the care of Dr. Mitchell and her

    GP referred the plaintiff to the first named defendant who saw her first in

    September 1995. The first named defendant admitted the plaintiff to the

    second named defendant's hospital for a full workup to establish her pituitary

    status. In addition, he referred her to the Radiological Department of St.

    Vincent's Hospital in Dublin for a MRI scan of the tumour. The report of this

    MRI scan stated its findings as follows: "A large multi-lobulated enhancing mass lesion is present within the pituitary fossa with extensive spread outside of the pituitary fossa. This lesion measures 4cms x 3 cms x 3cms. The lesion has grown through the floor of the pituitary fossa into the left side of the sphenoid sinus and demonstrates extensive left-sided parasellar and suprasella extension. The lesion is immediately adjacent to the medial aspect of the left temporal lobe which it has compressed. Anteriorally, the lesion has encased the left internal carotid artery. There is no apparent compression of the optic chiasm or hypothalamus. The pituitary stalk is displaced towards the right side. There is no evidence of hydrocephalus."1.16 As a result of biochemical review, the first named defendant put the plaintiff on a cortisol replacement and continued her on other medications. The first named defendant reviewed the plaintiff in October 1996, and found her to be doing well. Her biochemistry, as of this time, was satisfactory, so no alteration was made in her medication.

    1.17 The plaintiff was next reviewed by the first named defendant on 22nd July, 1997. At that time, she was symptomatically well. The plaintiff was troubled by her left eye ptosis and thereafter, the first named defendant referred her to Dr. Ger O'Connor, an ophthalmic surgeon. Her biochemical tests were satisfactory. She was seen again by the first named defendant on 16th February, 1998. She appeared to have been well then, although reported having 'flu over Christmas. She complained of early morning wakening. Her hormonal situation was as before.

    1.18 In November 1998, the plaintiff had an Endocrine review. A chest X-ray of 10th November, 1998, showed minor cardio megaly. Her routine biochemistry and haematology done then were unremarkable. She was, however, excreting excess TSH, causing her to be slightly hyperthyroid. The plaintiff was next reviewed by the first named defendant on 2nd March, 1999, when there appears to be no change in her condition.

    1.19 In April 1999, she had surgery on her left eye to deal with the ptosis. The outcome of this surgery appears to have been good.

    1.20 The plaintiff was next reviewed by the first named defendant on 29th November, 1999. Nothing remarkable appears to have transpired from this review.

    1.21 The plaintiff next encountered the first named defendant on 24th July, 2000. The first named defendant was of the view, that as it had been some time since the plaintiff had had a full review, he proposed bringing her into hospital for a couple of days to do this, including getting an MRI scan done.

    1.22 It would appear that a consultation took place between the plaintiff and the first named defendant on 24th July, 2000, at which or after which, the first named defendant filled out a booking form for the second named defendant's hospital with an admission date of 14th August, 2000. The plaintiff was admitted to the second named defendant's hospital on that date and had a series of tests carried out to assess the status of her pituitary tumour.

    1.23 On 15th August, 2000, she had an MRI scan carried out in Cork University Hospital. The report of the radiologist on this MRI, in its findings and conclusion, reads as follows: "Findings: previous left craniotomy. There is a very large enhancing pituitary mass measuring about 4cms in maximum diameter, displacing the pituitary stalk to the right. The mass involves the residual part of the pituitary gland and extends into and lateral to the left cavernous sinus, completely surrounding the internal carotid artery. The mass extends inferiorly into the sphenoid sinus and laterally compresses the left temporal lobe, its most posterior portion extends along the left petrous apex.

    Conclusion: very large enhancing pituitary mass involving the left cavernous sinus. Appearances are consistence with recurrence of the patient's pituitary tumour."1.24 The radiologist who carried out the MRI, Dr. A. Brady had not been furnished with the radiologist's report from the previous MRI in 1995 and hence, could not compare one with the other. It is accepted by all of the expert witnesses in the case and also the first defendant that the August 2000 that the MRI did not show any significant change to the 1995 MRI. As Dr Brady did not have sight of the earlier MRI to compare he naturally concluded that there had been a reoccurrence of the plaintiff's pituitary tumour.

    1.25 Amongst the tests carried out on the plaintiff in...

To continue reading