The High Court awarded Anne English €75,000 after finding that negligent care during her treatment for an ectopic pregnancy caused additional pain and psychological distress. It apportioned the contribution to the award 60% to the South Eastern Health Board and 40% to consultant obstetrician and gynaecologist Raymond Howard.
In a judgment delivered on 28 July 2011, Mr Justice Ryan found Dr Howard negligent in failing to exclude ectopic pregnancy before transferring Ms English from St Joseph’s Hospital in Clonmel to Our Lady’s Hospital in Cashel on 9 October 1996. The judge said the doctor had continued with a suspected diagnosis of molar pregnancy, although the medical records did not mention ectopic pregnancy as a possibility. Dr Howard’s decision to transfer her for a surgical opinion was also negligent, the court found.
Ms English had been admitted to St Joseph’s on 7 October. After developing severe abdominal pain and other symptoms, she was transferred to Cashel. The following day, as her condition deteriorated and internal bleeding was suspected, Cashel doctors sent her back to Clonmel by ambulance. At St Joseph’s, Dr Howard operated and found a ruptured fallopian tube. The judgment records that about three litres of blood were removed from her abdominal cavity.
The judge found Cashel Hospital negligent for returning Ms English to Clonmel while she was critically ill. He rejected Dr Howard’s argument that the Cashel transfer broke the causal connection between his negligence and the harm. The trauma of the first transfer and the night in Cashel flowed from Dr Howard’s failures, the judge said; the return transfer worsened it. The defendants were found to be concurrent wrongdoers.
The damages award was limited to the additional physical and psychological harm attributable to the negligent care. The judge said Ms English had serious psychological problems before the pregnancy and that only a smaller part of her overall difficulties resulted from the defendants’ negligence. The impact of the negligent care was more than marginal but transient, while the loss of the pregnancy continued to affect her. The operation would have been necessary in any event, but the judge said its severity would likely have been less, with a different incision and without large-scale blood transfusion.
In apportioning responsibility, the judge described Cashel’s decision to transfer Ms English back in her critical condition as grossly negligent. He assessed the South Eastern Health Board’s contribution at 60% and Dr Howard’s at 40%.