Mary Healy v Brendan Buckley and the Bon Secours Hospital and the Bon Secours Health System

• Jurisdiction: Ireland
• Court: High Court
• Judge: O'NEILL J.
• Judgment Date: 20 May 2010
• Neutral Citation: [2010] IEHC 191
• Docket Number: [No. 8001 P/2004]
• Date: 20 May 2010

Healy v Buckley & Bon Secours Hospital

BETWEEN

MARY HEALY

PLAINTIFF

AND

BRENDAN BUCKLEY

AND

THE BON SECOURS HOSPITAL, BON SECOURS HEALTH SYSTEM

DEFENDANTS

[2010] IEHC 191

[No. 8001 P/2004]

THE HIGH COURT

NEGLIGENCE

Medical negligence

Duty of care - Standard of care - Breach of duty - Consent - Lack of information - Material risk - Misrepresentation - Whether valid informed consent - Whether defendant misrepresented plaintiff's condition - Whether treatment appropriate for plaintiff's condition - Whether recommended monitoring carried out within appropriate time frame -Whether plaintiff adequately informed and advised - Whether plaintiff informed of harmful risks and side effects of medication - Whether plaintiff misinformed as to state of tumour - Dunne v National Maternity Hospital [1989] IR 91 followed - Chester v Afshar [2004] UKHL 41 [2005] 1 AC 134 approved - Geoghegan v Harris [2000] IR 536 and Fitzpatrick v White [2008] 3 IR 551 considered - Claim dismissed (2004/ 8001P - O'Neill J - 20/5/2010) [2010] IEHC 191

Healy v Buckley

Facts: The plaintiff sued the defendants for damages for negligence and breach of duty in the treatment of the plaintiff with a drug know as Sandostatin LAR. The plaintiff had a large pituitary tumor, which was rare and complex to treat. The plaintiff was not told by the treating doctor that her tumor was growing and he had sought to present a positive case to her. The issue arose as to whether the drug was an appropriate treatment for her and whether she had given informed and meaningful consent in law to the treatment and whether the side effects had been advised to her of which she had suffered from.

Held by O'Neill J. that the Court accepted the evidence of the first named defendant that at the time the drug was administered, hyopothryroidism was not a known side effect of the drug and could not have been warned prior to the plaintiff's treatment. There was no failure on the part of the first named defendant to give appropriate advice or warnings to the plaintiff concerning harmful risks or side effects. The plaintiff came to believe that the first named defendant was experimenting on her with a drug as a guinea pig and she lost confidence in him. There was no negligence on the part of the defendant as to the treatment of the plaintiff and her consent to the treatment was a valid informed consent.

Reporter: E.F.

DUNNE (AN INFANT) v NATIONAL MATERNITY HOSPITAL & JACKSON 1989 IR 91 1989 ILRM 735 1989/1/165

GEOGHEGAN v HARRIS 2000 3 IR 536 2000/9/3504

FITZPATRICK v ROYAL VICTORIA EYE & EAR HOSPITAL (WHITE) 2008 3 IR 551 2008 2 ILRM 99 2007/23/4814 2007 IESC 51

CHESTER v AFSHAR 2005 1 AC 134 2004 3 WLR 927 2004 4 AER 587

O'NEILL J.

2 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.

3 1.2 The first named defendant is a consultant Endocrinologist at the second named defendant's hospital.

4 1.3 The plaintiff was born in 1946, and is a married woman with three adult children.

5 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.

6 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.

7 1.6 On 29^th 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.

8 1.7 The plaintiff improved following her surgery and was continued on the medication she was on before the surgeryi.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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 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.

15 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.

16 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."

17 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.

18 1.17 The plaintiff was next reviewed by the first named defendant on 22^nd 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 16^th 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.

19 1.18 In November 1998, the plaintiff had an Endocrine review. A chest X-ray of 10^th November, 1998, showed minor cardio megaly. Her routine biochemistry and haematology done then were...