The High Court awarded a woman €425,000 plus any agreed special damages after finding that negligence during a hysterectomy probably caused a bladder injury and lasting psychological harm.
In a judgment delivered on 7 December 2012, Mr Justice O’Neill found that a suture placed while closing the vaginal vault had probably caught tissue in the woman’s bladder. The court concluded that the surgeon failed to take adequate care to move and protect the bladder during the procedure.
The woman underwent a total abdominal hysterectomy at Mount Carmel Hospital on 7 April 2008. She began leaking urine through her vagina about three to four weeks later. Tests showed a vesicovaginal fistula, an opening between the bladder and vagina. A urologist repaired it in July 2008, and the court said the repair completely stopped the leakage.
The surgeon denied placing a suture into the bladder. The judgment records competing expert evidence about how fistulas develop and when symptoms would appear. The judge accepted the woman’s experts’ explanation that a misplaced suture could cause tissue damage that took several weeks to produce a leak. He rejected infection and erosion from contact with a suture knot as probable causes, and said bloodstained urine recorded after the operation did not resolve the question.
The judge found that the bladder had been too close to the area being sutured. He said it was not possible to determine whether this resulted from inadequate dissection or from failing to move and hold the bladder safely out of the way. He concluded that the fistula was caused by the surgeon’s failure to meet the standard of care expected of a consultant gynaecologist.
The court also found that the fistula and its treatment caused a severe anxiety disorder with a depressive component. It considered the woman unlikely to return to paid work in the foreseeable future and found that workplace tensions raised by the defence did not cause her condition.
The award comprised €100,000 for pain and suffering to date, €100,000 for future pain and suffering, and €225,000 for past and future loss of earning capacity, including consequential pension loss. The court entered judgment for the plaintiff for €425,000, plus any agreed special damages.