The High Court dismissed a medical negligence claim against the Central Remedial Clinic (CRC) and the Health Service Executive, finding that the care and treatment decisions made for the plaintiff met the applicable standard of care.
The plaintiff alleged that the defendants failed to monitor him adequately for hip problems and did not respond to warning signs that should have prompted X-rays. He argued that earlier imaging could have identified hip dysplasia or the developing hip dislocation. The court rejected the claim after considering the expert evidence and applying the test in *Dunne v National Maternity Hospital*.
The plaintiff had been referred to the CRC at age two. An X-ray then showed normal hips. His case focused on later signs including a shortened right leg and a tilt in his chair. In March 2009, after he slipped while transferring from his chair to his bed and dislocated his knee, an X-ray at Our Lady of Lourdes Hospital in Drogheda showed a dislocated hip that had been present for some time.
The plaintiff’s expert, consultant orthopaedic surgeon Mr Cosgrove, said the shortening should have prompted further investigation with an X-ray. He considered that earlier corrective surgery could have delayed the need for hip replacement. The defence experts disagreed. Professor Damien McCormack said the plaintiff had hereditary spastic paraplegia, a progressive muscle weakness condition, and that surgery carried a serious risk of leaving him unable to walk. He said X-rays would not have changed his treatment plan. Defence expert Mr Jacques Noel considered the decision not to operate reasonable in the circumstances.
The court accepted the defence evidence. It found that the decision not to order further X-rays was supported by clear medical reasoning and that earlier surgery would likely have prevented the plaintiff from benefiting from the later operation. In August 2012, Professor McCormack and Mr Kevin Mulhall performed what the judgment described as pioneering constrained-hip surgery. The court said the operation had left the plaintiff able to transfer, rather than completely non-ambulatory.
The judge also found that the plaintiff and his parents had received appropriate consultation and explanations, and that the multidisciplinary team’s decisions were made in his best interests. The order was to dismiss the claim on liability. The judgment does not set out a separate damages determination.