The High Court has rejected Phillip Leo’s negligence claim against the Health Service Executive, finding that he had not proved either that hospital doctors failed to warn him about combining Warfarin with Difene or that he took Difene close enough to his haemorrhage to have contributed to it.
Mr Justice Ryan delivered judgment on 25 July 2013. The case concerned a cervical haemorrhage Mr Leo suffered on 2 February 2006, leaving him with permanent physical disabilities. He had been prescribed Warfarin after being treated for pulmonary emboli at Merlin Park Hospital in Galway in late 2005. He had also used Difene, an anti-inflammatory drug, for gout. The judgment records that the two drugs should not be taken together because their combined effects can increase the risk of bleeding.
Mr Leo said he had not been properly warned about the interaction, either during his hospital stay or at an outpatient appointment on 16 January 2006. He maintained that he probably took Difene before the haemorrhage, based on his usual pattern of gout attacks, though he could not recall a specific attack or date. The HSE denied the allegations. Consultant rheumatologist Dr Amina Gsel and registrar Dr Khadi Afridi testified that warnings were given, including a specific warning about Difene at the January appointment.
The judge preferred the doctors’ evidence. He relied on Dr Afridi’s detailed clinical note and follow-up letter, which recorded that Mr Leo was using Difene as needed, that he had been seen by Dr Gsel, and that the hazards of Warfarin had been explained. The judge found no sufficient basis to reject their accounts and did not believe the doctors had fabricated the consultation or its record.
On causation, the court found that Mr Leo could not say whether he had taken Difene in the days before the haemorrhage. His estimate of gout attacks—two or three a month on average—did not establish that an attack occurred close enough to 2 February for him to have taken the drug. The judgment also noted the lack of recorded gout attacks during the relevant period and that the haemorrhage occurred at the site of earlier neck surgery.
The court concluded that the plaintiff’s evidence fell short on the balance of probabilities on both issues, and his claim failed. The judgment records no damages award or further order.