The High Court has dismissed Margaret O’Dea’s clinical negligence claim against the Governors and Guardians for the Relief of Poor Lying Women in Dublin, finding she had not proved that negligence caused or contributed to a vesico-vaginal fistula after her hysterectomy at the Rotunda Hospital.
Mr Justice Michael Hanna delivered the judgment on 15 October 2021. The court accepted that Ms O’Dea suffered the fistula and continuing symptoms after surgery in October 2013. She underwent a five-hour repair operation in Galway in January 2014. The repair was successful, though she continued to report urinary symptoms.
The disputed issue was whether the fistula resulted from negligent injury during the hysterectomy performed by Professor Ronan Gleeson. The plaintiff’s experts proposed possible causes including bladder trauma, suturing or diathermy damage. The defence argued that an infected haematoma, together with vulnerability associated with Ms O’Dea’s previous caesarean section, could explain the injury without negligent care.
The judge found Professor Gleeson to be an impressive and forthright witness and accepted his account of the operation. The only complication was troublesome bleeding at the left vaginal angle, which the judge found was repaired with sutures that did not damage the bladder or ureter. The court was not satisfied that Professor Gleeson used diathermy during the operation or that there was any partial or full penetration or tear of the bladder.
The judgment described the cause as lacking direct physical evidence and said the court had to assess the contrasting expert opinions. It found the plaintiff’s expert, Mr Richard Porter, the least persuasive, citing the late introduction of diathermy and partial-thickness injury in his reports. The judge considered an infected haematoma the most likely cause, with the prior caesarean section having compromised the integrity of the bladder surface. That was the court’s assessment of the likely cause; it did not find negligence by the defendants.
The court concluded it was not satisfied that any act or omission by Professor Gleeson caused or contributed to the fistula. As the plaintiff had not established negligence on the balance of probabilities, the judge dismissed the claim. The judgment records no damages award.