In reaffirming the application of the Dunne Principles, this case reminds healthcare providers that the legal test for negligence is not perfection, but the lack of reasonable care.
Background
In the recent judgment of AMS v Birthistle[1], Judge Egan addressed a complex case of diagnostic delay involving cross-jurisdictional healthcare. The plaintiff was a young Spanish national who fell ill and was admitted to St James's Hospital Dublin ("SJH") on 19 February 2014. He was diagnosed with HIV and HLH (a rare but serious immune system problem) after having persistent fever, weight loss, and gastrointestinal discomfort. Despite aggressive treatment, his condition continued to deteriorate and upon his request, the plaintiff was transferred to a hospital in Spain on 1 April 2014. The Court heard that within three days of being admitted, he was diagnosed and treated for Visceral Leishmaniasis ("VL").
Finding of negligence/standard of care
The Court determined that, while an immediate diagnosis of the rare but treatable condition of VL upon the plaintiff’s admission to SJH was not reasonably expected, by mid-March 2014 (almost four weeks later), sufficient clinical indicators had emerged justifying suspicion of VL. The High Court found that the delay in treating the plaintiff appropriately should have commenced by 14 March at the latest; however, the treatment did not begin until over three weeks later.
In her judgment, Judge Egan applied the first Dunne Principle – the true test for establishing negligence in diagnosis or treatment on the part of a medical practitioner is whether he has been proved to be guilty of such failure as no medical practitioner of equal specialist or general status and skill would be guilty of if acting with ordinary care.
In applying this principle, Judge Egan asked whether the consultants at SJH had committed a failure so significant that no other reasonable practitioner in their position would have acted similarly. With the evidence presented in Court, the answer was yes, they had – particularly given the plaintiff’s lack of improvement and the clear clinical signs.
Court's reasoning and compensation
In assessing whether negligence occurred, the High Court looked at the conduct of the medical team at SJH over the course of the plaintiff’s 42-day admission. The Court acknowledged that, at the outset, the treating team’s working diagnosis of HLH was reasonable. However, this justification weakened as the plaintiff’s condition failed to improve in response to treatment. Between 10–14 March 2014, it was evident that the initial diagnosis was incomplete or incorrect.
Judge Egan concluded that the failure to initiate the appropriate treatment during that critical mid-March window constituted a deviation from the standard of care. The Court emphasised that clinicians are not expected to be infallible or to diagnose rare conditions instantly. However, they are required to act with reasonable diligence, adapt their clinical reasoning as evidence evolves, and remain open to alternative diagnoses when a patient is not responding to standard treatments.
Conclusion
The High Court ultimately awarded the plaintiff €26,000 in general damages. Judge Egan found against SJH stating that the hospital failed in its duty of care by not diagnosing a rare but treatable condition during the plaintiff's 42-day admission at SJH.
