BAILII is celebrating 24 years of free online access to the law! Would you
consider making a contribution?
No donation is too small. If every visitor before 31 December gives just £1, it
will have a significant impact on BAILII's ability to continue providing free
access to the law.
Thank you very much for your support!
[New search]
[Printable RTF version]
[Help]
Cooke v. Cronin [1999] IESC 54 (14th July, 1999)
THE
SUPREME COURT
No.
239/98
Denham
J.
Keane
J.
Lynch
J.
BETWEEN
EILEEN
COOKE
PLAINTIFF/APPELLANT
AND
BASIL
CRONIN AND MICHAEL NEARY
DEFENDANTS/RESPONDENTS
[Judgments
delivered by all 3 judges]
Judgment
of The Hon. Mrs. Justice Denham delivered the 14th day of July, 1999.
-2-
1. I
am in complete agreement with the judgment of Lynch J. on this appeal. I wish
to add a few observations.
2. The
appeal in this case was dismissed on 23rd June, 1999 after oral submissions had
been made. In view of certain matters which concerned the Court it was decided
that a written judgment would be given at a later stage.
Communication
3. The
professions provide a service to the public and appropriate information should
be given and made available at all times. This may cast a heavier onus on a
professional in certain situations as the person receiving the professional
care may be in a vulnerable, situation and may be unable, because of illness,
trauma or stress, to absorb information offered. It is often necessary to
repeat and explain information more than once.
4. There
is no suggestion that the Appellant was other than a truthful witness. It is
accepted that she suffered symptoms. The Learned Trial Judge held at page 12:
“Ms.
Cooke has clearly suffered for some years from painful and stressful symptoms.
It is clear that she is quite satisfied, on her own account, that these very
painful and unpleasant symptoms were caused by this particular incident.”
5. Many
of the symptoms of which the Appellant complained when the Statement of Claim
was delivered in 1994 were not proceeded with in the High Court. The sole issue
in the High Court and on this appeal was the suturing of four of the stitches
in the episiotomy. Whilst this is an important matter it is less important than
some of the matters set out in the Statement of Claim and which were not
proceeded with.
-3-
6. It
is unfortunate that the Appellant was not in a position to take appropriate
medical action previously. The Learned Trial Judge stated at page 14:
“I
cannot explain Ms. Cooke’s symptoms and I hope that she recovers from
them. I think that she -- it is not for me to give advice, but she might be
better advised to seek remedy with a medical authority and it might have been
helpful if she had pursued that option from the outset.”
7. Communication
between hospitals and patients aid and protect the public. Such communication
should be maintained and information should be given and available to patients
and not excluded for unreasonable reasons founded on commercial considerations.
There are a wide variety of reasons why professionals, hospitals or insurance
companies may be reluctant to provide information. However, it is in the public
interest that information be provided to patients and not impeded.
Legal
Professional duty
8. Counsel
for the Respondents submitted that this case was run on a wing and a prayer. He
informed this Court that he had brought to the attention of the Learned High
Court Judge the statement of Barr J. in
Reidy
v. The National Maternity Hospital,
unreported
judgment delivered on 31st July, 1997, where he stated at page
15:
“It
is irresponsible and an abuse of the process of the court to launch a
professional negligence action against institutions such as hospitals and
professional personnel without first ascertaining that there are reasonable
grounds for so doing. Initiation and prosecution of an action
-4-
in
negligence on behalf of the plaintiff against the hospital necessarily required
appropriate expert advice to support it.”
9. He
pointed out that this had been endorsed by Kelly J. in
Connolly
v. James A. Casey and Laura Murphy (Trading under the style and title of Casey
and Murphy) and Michael Fitzgibbon
,
unreported, High Court, Kelly J., 12th June, 1998. That was an action where the
Defendants, who were solicitors, were sued for damages for professional
negligence. Kelly J. stated at page 19:
“I
have no difficulty in endorsing the views of Barr J. that the commencement of
proceedings alleging professional negligence is irresponsible and an abuse of
the process of the Court unless the persons advising such proceedings have
reasonable grounds for so doing.”
10. While
bearing in mind the important right of access to the Courts I am satisfied that
these statements of law are correct. To issue proceedings alleging professional
negligence puts an individual in a situation where for professional or practice
reasons to have the case proceed in open Court may be perceived and feared by
that professional as being detrimental to his professional reputation and
practice. This fear should not be utilized by unprofessional conduct.
Party
11. The
claim against the second named Defendant in the case was dismissed by the
Leamed High Court Judge during the hearing of the action. He stated in his
judgment at page
5:
-5-
“Dr.
Neary first encountered Ms. Cooke some five days after the birth after he was
consulted by Dr. Morris about the fact that one suture had come loose. In the
light of that, it is clear, and acknowledged on behalf of Ms. Cooke, that the
claim against Dr. Neary should be dismissed, and I have already dismissed that
claim without objection, and quite rightly so.”
12. Yet,
the second named Defendant’s name remained in the appeal and on the
appeal papers. It was in oral submissions in Reply that Counsel for the
Appellant said that it was through inadvertence that Dr. Neary’s name was
still on the heading of the appeal and he apologised to Dr. Neary. This
approach to legal proceedings, which challenge the professional competence upon
which a defendant’s reputation and career is based, is, to say the least,
inappropriate.
Medical
Evidence
13. Lynch
J. in his judgment sets out the circumstances in this case where shortly before
the case commenced the Appellant’s solicitor introduced the Appellant to
his personal medical advisor. This doctor, a General Practitioner, then agreed
to become the medical witness for the Appellant in this case.
14. There
may be difficulties in obtaining professional evidence; for example, a siege
mentality may be encountered, which is inappropriate professional behaviour.
The need for evidence should be met by appropriate professionals who are
willing to give evidence of standards of care, whether the witness be from this
jurisdiction or elsewhere.
-6-
Practice
and Procedure
15. The
event giving rise to the action occurred in 1990. Legal proceedings were
commenced in 1993, the Statement of Claim was delivered on 4th May, 1994, the
defence for the first named Defendant was delivered on 9th September, 1994 and
for the second named Defendant on 19th July, 1994. The Notice of Trial was
dated 23rd September, 1994. The trial was held in the High Court on 8th and 9th
July, 1998 and judgment given on 10th July, 1998. A Notice of Appeal was dated
6th August, 1998 and a Notice to Dismiss for Want of Prosecution was filed
dated 16th November, 1998. Whatever the reasons for the delay in this case it
has served no one; not the Appellant and certainly not the Respondents. Whilst
professional negligence cases are often complex, modern case management
procedures would help to eliminate delays, identify issues, confirm parties and
promote justice. Similar problems have evoked responses in other jurisdictions.
In England and Wales Lord Woolf, Master of the Rolls, advised the Lord
Chancellor on practices and procedures in relation to medical negligence cases
and made twelve specific recommendations. (“Access to Justice, Final
Report” by The Right Honourable The Lord Woolf, Master of the Rolls,
London, 1996, Chapter 15 at pp. 195-196)
16. There
has been a move in this jurisdiction towards developing modern practices as to
reports of expert witnesses. However, this case illustrates the need to
consider developing a modern case management process for professional
negligence cases.
THE
SUPREME COURT
Denham;
J.
Keane,
J.
Lynch,
J.
BETWEEN
EILEEN
COOKE
Plaintiff/Appellant
AND
BASIL
CRONIN & MICHAEL NEARY
Defendants/Respondents
JUDGMENT
delivered the 14th day of July, 1999 by Keane, J.
17. I
agree that this appeal should be dismissed for the reasons set out in the
judgment of Lynch J.
18. I
also agree with the observations of Denham J. and Lynch J. as to the serious
responsibility which rests on both branches of the legal profession in the
institution and conduct of proceedings for negligence against professional
persons. It is most regrettable that those standards were not met in the
present case.
THE
SUPREME COURT
DENHAM
J
KEANE
J
LYNCH
J
‘
BETWEEN:
EILEEN
COOKE
APPELLANT/PLAINTIFF
AND
BASIL
CRONIN AND MICHAEL NEARY
RESPONDENTS/DEFENDANTS
JUDGMENT
DELIVERED THE 14th DAY OF JULY 1999 BY LYNCH J
19. This
is an appeal by the Plaintiff against an Order of the High Court (Quirke J)
made on the 10th July 1998 dismissing her claim for damages for personal
injuries allegedly due to the professional negligence of medical practitioners
in Our Lady of Lourdes Hospital Drogheda, County Louth who are sued through
their nominee, the first Defendant.
20. The
Plaintiff was born on the 9th September 1967. She was admitted to the hospital
on the 12th February 1990 then aged approximately twenty-two and a half years
in the expectation of the imminent birth of her first child. A healthy child
was born to the Plaintiff on the 13th February 1990 during the course of which
an episiotomy cut was required. Following the birth, the episiotomy cut needed
as usual to be stitched. Eight catgut soluble stitches were inserted in the
internal muscular parts of the vagina and four nylon non-soluble.n stitches
were inserted in the outer skin. One of the nylon stitches fell out on the
fifth day after the
birth:
two fell out on the sixth day after the birth and the fourth was removed on the
seventh day when the nylon stitches were scheduled to be removed in any event.
It is in relation to the fact that three of the four nylon stitches fell out as
aforesaid that the Plaintiff alleged negligence against the medical
practitioners in the hospital. She had also complained in her Statement of
Claim of difficulties in inducing labour: of difficulties in inserting a drip
after labour was induced: and of difficulties in administering an effective
local anaesthetic for the purpose of stitching the episiotomy cut but none of
those complaints was pursued at the trial in the High Court. The sole issue in
the High Court and on this appeal was an allegation that the four nylon
stitches had been sewn too tightly and as a result fell out leaving the outer
aspect of the episiotomy cut to heal by secondary intention and thus allegedly
causing a tenderness, discomfort and a lack of elasticity in the vagina.
21. For
the defence it was accepted that if the nylon stitches had been sewn too
tightly and as a result thereof had fallen out and had caused to the Plaintiff
the tenderness, discomfort and disability complained of, that would amount to
actionable negligence. It was however vehemently denied that the stitches had
been sewn in too tightly and further denied that the Plaintiff suffered the
alleged tenderness, discomfort or lack of elasticity in the vagina.
22. The
Plaintiff’s case was sought to be established by calling as witnesses
only the Plaintiff herself and a general medical practitioner namely Dr Dermot
Halpin. Dr Halpin was the Plaintiff’s solicitor’s own personal
general practitioner. He was not the Plaintiffs general practitioner. He saw
the Plaintiff for the first and only time on the 15th June 1998 and reported on
the 16th June 1998 the case being then scheduled to commence on the 17th June
1998. It was explained on behalf of the Plaintiff that her usual general
medical practitioner was unavailable because he was on holidays and hence the
referral to Dr Halpin. However
-2-
the
case did not go on the 17th June. It was adjourned for three weeks to the 8th
July and it went on on that day and the following day and judgment was reserved
overnight and delivered on the 10th July 1998. Presumably by the 8th July the
Plaintiff’s own general medical practitioner was available, but if he
was, he was not called as a witness.
23. The
Plaintiff said that she was told by Dr Neary that the stitches fell out because
they must have been sewn in too tightly. Dr Halpin said that the only reason
why the stitches would have fallen out in the case of the Plaintiff was because
they were sewn in too tightly in the first place.
24. Dr
Pauline Morris who had done the stitching gave evidence on the 9th July 1998 as
follows:
“170
Q Would
you use any instruments when you are suturing?
A Yes
you would. You would have the needle and the material and you would have the
forceps to hold those. You would stitch the two pieces of muscle or vaginal
wall together with the suture and you would tie the knot. After completing that
you would hold up the knot and with closed scissors you insert them between the
skin and the knot to ensure that there was adequate space.
171 Q When
you finish you hold up the knot to slide the scissors under?
A The
closed scissors underneath.
-3-
172 Q
Closed
scissors?
A
Yes.
173
Q
Whydoyoudothat?
A To
ensure that the stitches are not pulling too tightly.”
25. And
again at questions 199 to 204:
“199
Q In
your experience from putting in sutures and in your time in the hospital was it
unusual for sutures to fall out?
A They
do fall out on occasions yes.
200
Q So
it is not an unusual occurrence?
A It
is not an unusual occurrence no.
201
Q You
heard the evidence I think of the plaintiff that she alleged that Dr Neary had
told her that the sutures were put in too tightly?
A Yes.
-4-
202
Q From
your experience in the hospital and dealing with Dr Neary if that had happened
would you have heard anything from Dr Neary?
A
Of
course. Yes. He would have said it back to me.
203 Q What
would he have done?
A He
would have indicated that the stitches were incorrectly put in and would have
shown me and instructed me how to do them correctly if that was the case.
204
Q
Would
he have in a sense had you back for retraining?
A
He
would yes.”
26. Dr
Neary gave evidence of being asked to examine the Plaintiff after the first
stitch had fallen out and of doing so and he continued as follows:
“335
Q
You
had to examine Ms Cooke, obviously, on this occasion?
A Idid,
yes.
336
Q Would
you have had an opportunity of observing the three stitches which were still in
position?
-5-
A Oh
I did.
They
appeared perfectly normal.
337 Q If
there
had
been anything abnormal about them such as they were too tight or were biting
into the skin or something of that sort would you have recorded it?
A I
would yes.
338 Q Would
you have done anything about it?
A I
would have removed them.
339 Q That
is what this case is about, the suggestion being that these stitches had been
put in too tightly. As far as your records go, did you see anything of that sort?
A I
saw no evidence of that at all
370 Q Had
you at any stage mentioned anything to Ms Cooke about the stitches having been
put in too tightly?
A No.
-6-
371 Q Had
you found anything to suggest that they had been put in too tightly?
A No.
441 Q Is
there any particular reason why that particular stitch would be the first to
give?
A Not
really. Any of the. sutures can fall out at any time and indeed do. We do not
have a particular reason for it. It is not something that we particularly worry
about.
442 Q When
that stitch had fallen out you had no reason to suspect that the other stitches
were suspect or liable to –
A No.
The other stitches looked to be perfectly well inserted and looked entirely
normal.
443 Q Can
you give an explanation to the Court how those stitches fell out within the
next eighteen hours of you inspecting the wound, how they would have fallen out
and why they had fallen out?
-7-
A I
have no idea. Absolutely not. Stitches sometimes fall out. Five/Six days after
delivery it is not something we particularly worry about, because the majority
of healing has taken place at that time. We would have taken the sutures out on
the following day anyway.
449 Q Would
you agree or disagree with that?
A We
never really know why sutures sometimes fall out. Even if I put in sutures,
they can fall out and they wouldn’t be too tight or too loose. It is just
that individual bodies vary and stitches just can fall out.”
27. Finally
Dr Dermot MacDonald who was called on behalf of the Defendants as an
independent medical expert gave evidence at page 121 and 122 of the transcript
of the 9th July 1998 as follows:
“A That
would negative all the research that is going on currently into healing, not
just healing of scalp wounds and hand wounds, but healing of episiotomies as
well. Because I would go the other way and say maybe we do not know why they
break down or separation or why they don’t heal. I would say at present
we don’t know why thirty per cent of that happens. We know some of it is
related to haematoma formation, bleeding. We know some of it is due to
-8-
qualities
in the tissues that impede the healing process. We know some of it is due to
infection. We know some of it is due to bowel stool distension and pressure.
But there is an enormous amount of work going on to find why all the others
don’t heal. Is it a particular suturing matter, is it techniques, is it
tissue problems? There is a lot of work going on.
Mr
Justice Quirke
Why
do sutures actually come out as it were?
A Fall
out?
Mr
Justice Quirke
Yes.
A That
is the same thing. There is a lot of work going on as to why that happens. We
do not know is the honest answer.
Mr
Justice Quirke
Are
you saying that, in fact, it is not that uncommon for stitches to come out in
the absence of any plausible explanation?
A Yes
I would say it is.
Mr
Justice Quirke
Because
Dr Halpin seems to think it should not happen at all unless
A Oh
no it can happen quite frequently. Certainly in my experience in the National
Maternity it is not something that would be brought to my notice. It would be
dealt with by somebody else, probably. It is no big
-9-
deal,
it is a common event and you would wonder why. There is work going on.”
28. I
now turn to the judgment of the leamed trial Judge which is recorded in the
transcript of the 10th July 1998 and I quote from page 9 and pages 11,12, 13
and 14:
“There
are conflicts of evidence in the case and the following matters were in issue.
Dr Ha/pin stated in evidence that sutures in circumstances like this may fall
out for five separate and distinct reasons. Four of those reasons are unrelated
to the circumstances which have given rise
tQ
this
claim and the remaining reason,
it
is
relevant, given by Dr Ha/pin for sutures falling out, is that they are inserted
either too tightly or too loosely. Dr Halpin gave the view that in this
instance having regard to the history recounted to him and to the
plaintiff’s complaints and condition he felt that they had been inserted
too tightly at the time when they were administered by Dr Morris.
Dr
Neary, and in particular Dr MacDonald, agreed that five reasons advanced by Dr
Ha/pin as potential causes for sutures falling out and thus added that there
was a sixth reason. Dr MacDonald in particular was adamant that sutures can
fall out for reasons which are totally unexplained. He says that this is not
uncommon and can relate to the character of individual anatomy.
-10-
The
onus is on the Plaintif to prove on the balance ofprobabilities that she or he
has sustained damage or loss as a result of negligence. In this case, the onus
rests with Ms Cooke to prove that on the balance of probabilities the Hospital
Authorities through the agency of Dr Morris were negligent in the manner which
the sutures were inserted on the 14th February 1990 that they were inserted in
a negligent fashion because they were inserted too tightly.
It
was claimed firstly that the only plausible explanation to why they fell out
was that they were inserted too tightly: and secondly that Ms Cooke ‘s
present condition and her symptoms are inconsistent with the proper
administration of the sutures and with careful and diligent treatment. The
Hospital Authorities say that it is not uncommon
for
sutures to fall out: and ~they do so that
it
is
not necessarily consistent with negligence. They also say that Dr Morris was
carefully trained, very competent and more than sufficiently experienced in
what she was doing. They say the Plaintif’s condition and her symptoms
are consistent with the proper administration of these sutures and the careful
and diligent treatment.
Ms
Cooke has clearly suffered for some years from painful and stressful symptoms.
It is clear that she is quite satisfied, on her own account, that these very
painful and unpleasant symptoms were caused by this particular incident. It is
not unusual regrettably,
it
is
not unheard of certainly for patients to receive less than polite treatment in
hospitals. There is no evidence of that in this case, but sometimes that can
occur and it can give rise to a sense of grievance, which lam sure Ms Cooke
feels aggrieved in this case, and I can understand that that would be the case.
-11-
It
is also clear that when the Statement of Claim was delivered on her beha lf in
May 1994 she clearly attributed her symptoms to the inappropriate suturing of
her episiotomy wound. The symptoms of which she complained then at that time
were that the wound was unsightly and cosmetically unacceptable, that there was
dificulty and pain with sexual intercourse and she complained of bladder and
urinary d~fflculties and menstrual problems arising out of the suturing. It has
now been accepted by Ms Cooke that what I would have thought were perhaps the
more serious aspects the urinary dificulties and the menstrual difficulties
that they are entirely unrelated to the suturing. It is clear also that Ms
Cooke felt when the Statement of Claim was delivered that they were caused by
that, that those matters are unrelated and accepted to be completely unrelated
to the suturing in this instance. I do not think that any serious case has been
advanced as to the cosmetic aspect of the scar.
There
is a clear conflict between the testimony of Dr Halpin and the testimony
adduced by Dr MacDonald and by Dr Neary. Dr MacDonald is a consultant
gynaecologist with some 35 years standing. He has had the opportunity to
examine Ms Cooke both in 1995 and 1997. Dr Halpin only saw Ms Cooke on one
occasion and that was in less than desirable circumstances it seems to me. I
accept the evidence of Dr MacDonald to intent that sutures may and do on
occasion fall out for reasons which are unexplained and that it is not uncommon
for that to occur and it can be explained by anatomy in individual cases. I
also accept the evidence of Dr MacDonald that when he examined Ms Cooke in 1995
and 1997 that there was no evidence of the raised scar and that the area was as
he found it. I cannot explain Ms
Cooke
‘s symptoms and I hope that she recovers from them. I think that she - it
is not
-12-
for
me to give advice but she might be better advised to seek remedy with a medical
authority and
it
might
have been helpful Wshe had pursued that option from the outset. In any event in
the circumstances of the case Ifind that the onus ofproof has not been
discharged in this and that
it
must
be dismissed.”
29. The
foregoing findings of the learned trial Judge are manifestly supported by the
evidence in this case including the few brief extracts from the transcripts
which I have quoted. Indeed if the learned trial Judge had found against the
Defendants, the circumstances of this case and its manner of presentation,
including quite unnecessarily interposing Dr Halpin before the Plaintiff had
given any really relevant evidence, are such that I have no doubt that his
decision would be reversed if appealed by the.Defendants to this Court in that
event.
30. I
regard this appeal as unstateable and I would emphatically dismiss it. In doing
so I endorse Counsel for the Defendants criticisms of the manner in which
medical evidence for the Plaintiff was procured in this case.
31. Whatever
about suing the hospital there never was any conceivable basis for suing the
second Defendant personally. He had nothing to do with the Plaintiffs
ante-natal care, nor with her confinement or delivery or episiotomy, nor with
the stitching. The first time he saw the Plaintiff was five days after the
birth when he was asked by Dr Pauline Morris to examine the Plaintiff after the
first stitch had fallen out. He was dismissed from the case by consent at the
latter stages of the High Court trial and nevertheless the Notice of Appeal was
directed to both Defendants. The joinder of the second Defendant as a personal
defendant was at all times wholly unwarranted and his apparent inclusion as a
Respondent to the appeal was
-13-
deplorable
and is in no way excused or even explained by the apology that his inclusion as
a Respondent to the appeal was due to an oversight in drafting the Notice of
Appeal.
32. In
all cases of alleged negligence on the part of a qualified professional person
in carrying out his professional duties there should be some credible evidence
to support the plaintiffs case before such an action is commenced.
33. As
I have said I would dismiss this appeal.
-14-
© 1999 Irish Supreme Court
BAILII:
Copyright Policy |
Disclaimers |
Privacy Policy |
Feedback |
Donate to BAILII
URL: http://www.bailii.org/ie/cases/IESC/1999/54.html