The Court of Appeal has dismissed Linda Farrell’s appeal against the rejection of her negligence claim over a symphysiotomy performed at the Coombe Hospital in 1963, finding that the High Court had credible evidence to support its decision.
The appeal concerned a narrow, reformulated claim: that there was no justification in any circumstances for performing an antenatal symphysiotomy on Ms Farrell when it was done. The Court of Appeal did not rehear the case as a fresh trial. Applying the appellate approach in Hay v O’Grady, it considered whether the High Court’s findings were supported by credible evidence and concluded that they were.
Ms Farrell underwent the procedure under general anaesthetic on 25 September 1963, before labour had begun. Her first child was delivered by forceps 12 days later. The medical notes recorded a contracted pelvis, a narrow sub-pubic arch and that the baby’s head could not be made to engage during an examination under anaesthetic. The experts agreed that the findings suggested mild to moderate disproportion, rather than absolute disproportion.
At trial, Ms Farrell’s experts argued that suspected mild or moderate disproportion could not justify a symphysiotomy before labour, and that a Caesarean section was the appropriate intervention if labour was not attempted. The hospital’s experts said the measurements and examination indicated a strong risk of obstructed labour. They told the court that, by 1963 standards, a symphysiotomy could be considered in selected cases where it might allow vaginal delivery and avoid the risks of Caesarean section. The appeal judgment recorded evidence that experts considered it 90% likely Ms Farrell would have needed surgical intervention during labour.
The appeal court held there was credible evidence for the High Court’s conclusions that the procedure was clinically justified in the circumstances and that prophylactic symphysiotomy was a general and approved practice among comparable clinicians in Dublin in 1963. It also concluded that Ms Farrell had not discharged the heavy burden of showing that the practice had an inherent defect that should have been obvious at the time. The judge expressed reservations about parts of the High Court’s reasoning on that issue but found no basis to overturn its conclusion.
The court distinguished Ms Farrell’s case from Kearney v McQuillan, where the symphysiotomy was performed after the baby had been delivered and the evidence showed no relevant pelvic abnormality or clinical indication. It stressed that negligence cases depend on their individual facts. The judgment also said the practice has since been abandoned and that, assessed by present-day standards, it would likely be considered inherently defective.
The Court of Appeal dismissed Ms Farrell’s appeal. This judgment addressed the liability appeal; the defendant’s cross-appeal on the limitation issue was dealt with in a separate judgment by another judge.