The High Court has dismissed a woman’s medical negligence claim against the consultant obstetrician who performed a radical hysterectomy, finding she had not proved that no obstetrician of comparable skill, acting with ordinary care, would have carried out the operation.
The judgment, delivered by Mr Justice Barry White on 2 March 2006, concerned treatment between 1986 and 1996. The woman alleged negligence by four defendants: the obstetrician, a consultant radiologist, a general practitioner and the Western Health Board, which was responsible for University Hospital Galway.
During the trial, the judge granted applications to nonsuit the general practitioner and the Health Board at the close of the woman’s case. After hearing evidence from the obstetrician, he also nonsuited the radiologist on a renewed application. The only issue left for decision was whether the obstetrician was negligent in deciding to perform the radical hysterectomy.
The judgment recounts a history of abnormal cervical smear results, including a 1986 result recommending colposcopy and biopsy. It says earlier results were not made known to the woman and were not followed up. In 1995, a smear raised concern about possible glandular cancer. Biopsies in February 1996 showed severe pre-cancerous changes but no invasive carcinoma. The obstetrician nevertheless planned an extended hysterectomy, citing the clinical and cytological picture and concern about invasive disease.
A CT scan shortly before the operation reported enlarged right internal iliac lymph nodes and a cervix measuring 5cm. The obstetrician had received a verbal report but not the written report before surgery. Neither report mentioned a tumour. The judge said the obstetrician mistakenly formed the impression that the scan had shown one, but accepted his evidence that this belief did not influence his choice of surgery.
The woman’s experts considered the operation unnecessary and said further investigations should have been done. Experts for the obstetrician considered that they would have performed the same operation. The judge found both groups of consultants honest and accepted their evidence, concluding that there were two genuine schools of thought. He was satisfied that a number of reputable obstetricians would have acted as the defendant did.
The judge said the legal question was not whether further investigations would have been preferable, but whether the woman had proved that no obstetrician of like skill, acting with ordinary care, would have performed the operation. He also found that informed consent was not an issue for decision. The claim against the obstetrician was dismissed.