The High Court has allowed a doctor’s appeal and quashed a finding of poor professional performance over his failure to order blood, urine and kidney-function tests for a patient admitted to University Hospital Limerick in November 2012.
Mr Justice Mícheál O’Higgins found that the tests were necessary in the circumstances. But he was not satisfied beyond reasonable doubt that the doctor’s single omission crossed the seriousness threshold required for a poor professional performance finding.
The patient, identified in the judgment as B.K., was transferred from Bon Secours Hospital in Tralee with severe abdominal pain and suspected widespread lymphoma. The doctor, an oncology registrar on call, examined him on the evening of 6 November. He did not order the tests or write up examination notes. The doctor later said he had been called away to another seriously ill patient.
The judgment records that tests had been taken at the referring hospital the previous afternoon and were reported as normal. The doctor prescribed pain relief, including morphine. The patient suffered no injury or other consequence from the failure to order fresh tests.
The Medical Council’s expert, Professor Ray McDermott, said current results were needed to assess a patient with suspected advanced cancer and inform prescribing. The doctor’s expert, Dr Ernest Allan, considered the tests unnecessary that evening. The judge preferred Professor McDermott’s evidence on whether the tests were warranted, while also finding Dr Allan’s evidence useful in assessing the seriousness of the omission.
The court treated the allegation as one omission, despite its division into three parts. It said the failure was an error, but considered its seriousness in light of mitigating circumstances: the previous day’s results, the after-hours admission, the lack of evidence of a handover or instruction to order tests, the absence of harm, and the limited scope of the charge. The allegation concerned tests on admission, not an indefinite delay in testing.
The judge also declined to rely on material suggesting the doctor may have thought the existing tests were a week old. The issue had been raised only at the submissions stage, after evidence had concluded. He found it unfair to introduce it then and, in any event, had reasonable doubt about the doctor’s understanding.
The court held that the Council had not proved the required seriousness beyond reasonable doubt. It allowed the appeal and quashed the poor professional performance finding and resulting sanction of advice. The judge reserved costs and the terms of the order for further submissions.