The High Court found that St James’s Hospital was negligent in the postoperative care of a patient who fainted and struck her head after her pacemaker was removed. The court awarded her €63,112.48, including damages for her injuries and agreed special damages.
Mr Justice Barr ruled that the decision by cardiologist Dr Caroline Daly and cardiac surgeon Michael Tolan not to insert a temporary pacing wire was not negligent. He said they had faced a choice between the risk of infection from the wire and the risk of the patient fainting without a pacemaker. The court accepted that their decision was consistent with careful medical practice.
The patient had been admitted to St James’s Hospital in May 2014 for replacement of a pacemaker. After her permanent device and leads were removed on 17 May, she was placed on telemetry in the Robert Adams Ward because no bed was available in the Coronary Care Unit. She fainted in her en-suite toilet the following night, hit her head against the sink and suffered a laceration. A temporary wire was inserted, and a new permanent pacemaker was fitted on 20 May.
The court found that the patient was not told to remain in bed or to use her call bell before getting up or going to the toilet. She had been allowed to move freely around the ward, with the only restriction being that she stay within range of the telemetry monitor. The judge accepted that her doctors knew she had previously suffered fainting episodes and falls before receiving a pacemaker, but found that the nursing staff had not been told of that history.
Mr Justice Barr found that Dr Daly should have given the nursing staff a clear written instruction that the patient was at risk of falling and should be confined to bed, with any movement supervised. He also found that the patient should have been told to use the call bell and to have assistance when going to the toilet. Telemetry monitored her heart rhythm but did not prevent a faint.
The judge rejected the hospital’s argument that supervision would not have prevented the fall. He found there was a good chance a nurse could have supported the patient if she had fainted while walking. He concluded that the failure to provide clear instructions led to her moving about unsupervised and suffering injury.
The court assessed the patient’s injuries as a moderate head injury, with a permanent forehead scar and altered sensation, as well as anxiety and sleep disturbance from which she had recovered. It awarded €40,000 for general damages to date, €20,000 for future general damages and €3,112.48 in agreed special damages.