The High Court dismissed a negligence claim brought by a woman who suffered a severe shoulder injury in a fall while an inpatient at Roscommon County Hospital. The judge found that the care provided between 1 and 3 December 2005 did not fall below the appropriate standard. She also concluded that the claim would fail on causation, even if the care had been negligent.
The woman was admitted voluntarily to the hospital’s psychiatric unit in November 2005. Her claim focused on the Health Service Executive’s decision not to continue one-to-one nursing care from 1 December. She argued that her symptoms and history of falls required continuous one-to-one supervision, or alternatively two-to-one or “open door” nursing. Her psychiatrist’s expert evidence was that the one-to-one care should have continued.
The HSE said a care plan was reviewed by medical and nursing staff, with increased observation and short periods of one-to-one care when staff considered them necessary. Its witnesses said close intervention could worsen the woman’s agitation and increase risks to her and staff. The court accepted that she was disturbed, paranoid and at times aggressive, and that nursing intervention could aggravate her behaviour.
The judge found that the woman had become unsteady during the first days of her admission because of fluctuating blood pressure, but that this was brought under control. The court did not accept family evidence that dizziness continued throughout the admission. It found that her fall at issue occurred shortly before 4pm on 3 December, based on the medical and nursing records and staff evidence. The woman’s husband had been visiting when she got up to go to the toilet, took a few steps and fell, striking her head against a gas cylinder before landing on her left shoulder.
The injury was a severe fracture dislocation. She underwent surgery on 8 December and later had continuing pain, restricted movement and difficulty with personal care and household tasks.
The judge found that the HSE had considered the risks, reviewed the woman’s condition and increased observation. The court was not persuaded that continuous one-to-one, two-to-one or open-door nursing was required under the legal test for medical negligence. It also found that one-to-one care had not been shown to reduce her risk of falling; she fell on two other occasions that evening while nursing staff were present.
On causation, the judge said the nurse would have moved away to give the couple privacy and that the evidence did not establish that advice to rise more slowly would have prevented the fall. The court therefore dismissed the claim on both the standard-of-care and causation grounds.