The High Court found the Western Health Board liable for negligent care by maternity staff before Olivia Pyne’s birth, but found no negligence or breach of duty by the doctor who cared for her. The judgment does not state a damages award against the Board.
Mr Justice de Valera said Olivia’s severe physical and mental disabilities resulted from oxygen deprivation during labour immediately before her birth on 4 June 1998. He accepted that an earlier delivery would probably have prevented the hypoxia.
The court found that nursing staff, including midwives, fell below the proper standard of care. It identified failures to monitor the foetal heart before 10.27pm on 3 June; record the duration or frequency of contractions before Mary Pyne was moved to the labour ward; and tell Dr Declan Egan about a delay in that transfer. Staff also failed to recognise the significance of the cardiotocograph (CTG) reading, including tachycardia, and to continuously monitor Mary before 10.27pm and after monitoring stopped at 10.47pm.
The judgment also identified a failure to conduct a vaginal examination before an epidural, or delay the procedure until an examination had taken place, and a failure to summon Dr Egan or another doctor when foetal distress was, or should have been, detected. The judge said these failures meant distress was not identified early enough and delayed remedial action beyond the point when it could have succeeded. The Board was liable for the negligence of the staff involved.
The case began in 2003 against the Board and Dr Egan. A settlement with the Board was ruled on the fourth day of trial, after which the matter continued between the defendants for a further 11 days, with ancillary procedural orders. The judgment does not explain the settlement’s terms or its relationship to the court’s findings about the Board’s liability.
The remaining dispute included an allegation that Dr Egan negligently administered repeat doses of prostaglandin at four-hour intervals. The manufacturer’s recommendation, the judgment said, was to give a second dose if required six to eight hours after the first. The judge found no sufficiently accepted medical practice against which to conclude that Dr Egan’s method was negligent, and no sufficient evidence that the four-hour practice had obvious inherent defects. He also was not satisfied that the second dose caused the abrupt and intense labour. He therefore found no negligence by Dr Egan.