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Medical negligence – Medical procedure – Credible evidence – Appellant seeking to make a claim for negligence – Whether the appellant had established that there was no justification for the performance of an antenatal symphysiotomy at the time it was perf

Posted 3/11/2016

Medical negligence – Medical procedure – Credible evidence – Appellant seeking to make a claim for negligence – Whether the appellant had established that there was no justification for the performance of an antenatal symphysiotomy at the time it was performed 

Facts: The appellant, Mrs Farrell, sought to make a claim for negligence against the Coombe Hospital. That claim concerned a procedure known as a symphysiotomy which was carried out on the appellant on 25th September, 1963, by the then Master of the hospital, Dr Stuart, some 12 days prior to the birth of her first child. On 1st May, 2015, the High Court (Cross J) rejected the appellant’s claim for negligence. The appellant appealed to the Court of Appeal against the judgment of the High Court, submitting that: 1) there was no credible evidence to support the trial judge’s conclusions that the plaintiff had clinical features or signs of disproportion such as would have justified a prophylactic symphysiotomy in 1963; 2) even if there were clinical signs to suggest disproportion, there was no credible evidence to support a conclusion that prophylactic symphysiotomy was a general and approved practice to be adopted in such circumstances i.e. in the case of a patient suffering from mild or moderate Cephalopelvic Disproportion; 3) even if the High Court judge was entitled on the evidence and as a matter of law to conclude that prophylactic symphysiotomy could be considered to have been a general and approved practice within the meaning of the principles in Dunne (an infant) v National Maternity Hospital [1989] IR 91, on the evidence before him he was mandated to conclude that the practice had inherent defects which ought to have been obvious to any person giving the matter due consideration. The respondent, Mr Ryan, submitted that: 1) there was credible evidence to support the findings of the trial judge that, in the circumstances as they related to Mrs Farrell, prophylactic symphysiotomy was medically justified; 2) there was credible evidence to support the conclusions of the trial judge that the carrying out of a prophylactic symphysiotomy on Mrs Farrell in 1963, having regard to the clinical findings, was in accordance with a general and approved practice among clinicians of equivalent experience to Dr Stuart; 3) there was more than sufficient evidence to support the trial judge’s conclusion that prophylactic symphysiotomy was not a procedure which at that time could have been considered inherently defective.
Held by Irvine J that by the standards of 1963, and in the very particular circumstances of Mrs Farrell’s case, it could not be said that there was not credible evidence to support the conclusion of the trial judge that she had failed to establish that the prophylactic symphysiotomy to which she was subjected could never, in any circumstances, have been justified. Irvine J was quite satisfied that the trial judge was entitled to conclude that a reasonable and respectable body of clinicians of like expertise to that enjoyed by Dr Stuart would have approved of the use of prophylactic symphysiotomy in the circumstances of her case in 1963, and that the practice was not one which, judged by the then prevailing standards, could be considered to have been inherently defective within the meaning of the Dunne principles. Irvine J held that she would dismiss the appeal. Appeal dismissed.
Farrell, Linda v Ryan, John
14/10/2016 No. 2015/311 [2016] IECA 281

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