The High Court found the Health Service Executive negligent after a surgeon failed to notice a significant tear in a patient’s ureter during a post-operative check following kidney-stone removal. The judgment assessed damages at €701,288.66, while reserving an issue about possible recoverable benefits for further argument.
The plaintiff, Thomas Hill, was treated at the defendant’s hospital in Portlaoise in October 1998. After a stone was removed from his left ureter, he was readmitted with abdominal pain and fever. Imaging later showed a perforation and urine leakage. He was transferred to Tallaght, where treatment included a stent and, ultimately, a permanent Boari flap procedure in February 1999.
Hill alleged negligence in the consent process, during the stone-removal operation, in the surgeon’s subsequent check of the ureter, and in the hospital’s response when he returned in pain. The HSE denied the allegations and disputed how much of Hill’s later pain, disability and loss of work was connected to the treatment.
Justice Cross found Hill had not established a failure to obtain informed consent. The court also found he had not proved that the surgeon should have realised during stone removal that the ureter had been damaged. The judge accepted that the surgeon re-entered the ureter to check for another stone or fragments, despite the check not being recorded in the notes. Given the tear’s significant size, the judge found it should have been visible and that failing to notice it fell below the required standard of care. The court said prompt treatment with a stent would probably have allowed it to heal.
The judge did not determine liability for the care provided after Hill’s readmission, because the finding of negligence in the post-operative check was sufficient. The judgment nevertheless stated that a prompt diagnosis would probably have avoided the ultimate damage, but found Hill had not established liability on that separate ground. The court also recorded that treatment in Tallaght was not criticised.
On injury, the judge found that Hill suffered nerve damage, continuing chronic abdominal and referred testicular pain, and psychological harm associated with the events and the delayed diagnosis. The judgment also attributed a substantial portion of his more recent complaints to unrelated degenerative back problems. It found that the treatment-related injuries left him unable to work, while recognising that his back condition would also have affected his future working life.
The damages assessment comprised €8,500 in agreed special damages, €312,788.66 for past loss of earnings, €130,000 for future loss of earnings, and €250,000 in general damages. The judge said a further recoverable-benefits sum might have to be deducted from the earnings awards, but had not been given the amount or told whether any sum was payable and would await argument. The judgment’s stated total was €701,288.66.