The High Court has found the Health Service Executive liable for failures by a public health nurse in the care of a child who suffered permanent neurological damage from hydrocephalus. The ruling followed a trial on liability; the question of compensation was left for a separate stage.
Mr Justice Cross found that the nurse was negligent at examinations on 24 April and 8 September 2008. He concluded that failures at the April visit were materially causative of the child’s condition and that negligence in September also caused legally significant damage by delaying diagnosis and treatment.
At the April examination, the nurse first recorded the child’s head circumference as 46.5cm, then changed it to 46cm. The judge found the correct measurement was 46.5cm and said the alteration and its reasons were not properly recorded. The child’s mother also raised concern that the child could not hold her bottle and needed it propped up. That concern was not recorded.
The judge accepted evidence that the 46.5cm measurement was outside the normal range on a relevant chart and should have prompted further monitoring. He found that a recall within about four weeks would probably have shown continued head growth, led to referral and scans, and detected the hydrocephalus before significant damage. He concluded that timely treatment would probably have prevented the serious neurological damage.
The court separately considered the September visit, when the nurse recorded a head circumference of 46.5cm. The HSE admitted that the measurement was wrong and that the nurse failed to address serious developmental concerns raised by the mother, instead attributing the problems to the child’s weight and discouraging further medical advice. The judge rejected the HSE’s argument that this caused only a one-week delay. He found that correct measurement and referral would probably have brought diagnosis forward by at least two weeks, and likely about two and a half weeks, causing legally significant damage.
The judge did not find negligence at the three-month examination. He concluded that the 41cm measurement did not then warrant further action under the guidance available to the nurse, and that a referral at that point would not have led to tests.
The judgment records that the child’s hydrocephalus was congenital and that significant permanent neurological damage had occurred by the time a shunt was inserted. It determines liability only; the amount of damages was not decided in this judgment.