PAUL HEALY (A MINOR) SUING BY HIS MOTHER AND NEXT FRIEND, MICHELLE HEALY –v - THE HEALTH SERVICE EXECUTIVE AND ROBERT FITZSIMONS

Irish Medical Negligence Judgement - PAUL HEALY (A MINOR) SUING BY HIS MOTHER AND NEXT FRIEND, MICHELLE HEALY –v - THE HEALTH SERVICE EXECUTIVE AND ROBERT FITZSIMONS

In these proceedings, it was claimed on his behalf that he suffered serious personal injuries a short time after his birth by reason of negligence and breach of duty on the part of the defendants. He sought damages from the defendants to compensate him for the injuries which he suffered and for the loss and damage which he has sustained and will sustain as a result of those injuries.

The first named defendant is the Health Service Executive which is the corporate body established by law with responsibility for the provision of health services within the State. Its responsibilities include the management, control and administration of Tralee General Hospital (hereafter “the hospital”), and the provision of paediatric, antenatal and post-natal care and services to patients, (including the plaintiff), who attend the hospital.

The second named defendant, Dr. Robert Fitzsimons, is a consultant paediatrician who, at all times material to these proceedings, practised his profession at the hospital and provided paediatric care to the plaintiff before, during and after his birth.

The plaintiff was born by normal vaginal delivery. Although he appeared to be in excellent condition at birth, there had been a natural interference with the return of his foetal intestine from his physiological hernia to his abdominal cavity. During a normal process of orderly return, the intestine undergoes systematic rotation and fixation. There was an interference with that process for the plaintiff and he was born with a malrotation, which is the term used to denote such an interference.

It was not claimed that malrotation could or ought to have been detected at or immediately after birth in the absence of symptoms indicating its existence. 55% of malrotations present within the first week of life and 80% within the first month.

Although malrotation may exist undetected for significant periods, it is generally accepted that once the diagnosis of malrotation has been established, surgical correction should be carried out in order to avoid the occurrence of what is known as a volvulus.

A volvulus is a twist or twisting of the intestine because it is not or is inadequately secured to the abdominal wall. The resultant knotting or corkscrew twisting of the intestine develops over time and involves an obstruction to the path of nutrients through the intestinal tract. It also results in intestinal obstruction and ischaemia consequent upon interruption of the blood supply to the intestine.

Intestinal obstruction causes bile to pour into the intestine and this causes bile-stained vomit. Consequently, bile-stained vomit is known by experienced and competent practitioners to be a highly characteristic symptom of volvulus.

Ischemia is the consequence of deprivation of blood and oxygen to the intestine, which, consequently, results in necrosis of the affected part of the bowel which becomes gangrenous. The resulting condition is called necrotising enterocolitis.

In these proceedings, it was claimed on behalf of the plaintiff, that, whilst he was relying upon the medical care and treatment provided by the defendants during the first four days of his life, he exhibited the classic symptoms of malrotation which should have been treated by the defendants as a surgical emergency.

It was contended that the defendants failed to recognise those symptoms and discharged the plaintiff from the hospital in the early afternoon of 17th February, 2000.

The plaintiff was brought back to the hospital by his parents and readmitted on the evening of 18th February, 2000, where an acute bowel obstruction was diagnosed and he was transferred by ambulance to Our Lady’s Hospital in Crumlin ( hereafter “Crumlin”) in Dublin where surgery disclosed a malrotation and a small bowel volvulus. Thereafter, the medical and nursing treatment which he received was exemplary.

The surgical and medical staff in Crumlin did not expect him to survive during the first three or four days after his admission, but he did so. He remained in Crumlin for more than seven months during which time he required repeated extensive and extremely serious surgical treatment including five surgical laparotomies. He had repeated small bowel resections. Less than 1% of his small bowel remains.

The consequences of his injury have been permanent and catastrophic. Upon returning to his home, he required constant intensive care, including intravenous feeding in a totally sterile environment artificially created within his home. His parents have both abandoned fulltime gainful employment in order to provide him with necessary care.

He will require ongoing medical care and treatment. The remainder of his life will be permanently blighted. He will suffer permanent distressing and embarrassing symptoms which will cause him to be socially isolated and will greatly diminish his capacity to obtain any kind of remunerative employment.

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