In Perez v Coombe Women and Infants University Hospital and the HSE1, the plaintiff alleged that the Coombe Women and University Hospital ("the Coombe") failed to properly diagnose and treat the plaintiff's primary post-partum haemorrhage after the birth of her second child.
Separately, the plaintiff alleged that the Midland Regional Hospital, Portlaoise, ("MRH") also failed to make a timely diagnosis of secondary post-partum haemorrhage due to retained products of conception. The plaintiff argued that she suffered from prolonged bleeding for six weeks after her delivery until a surgical evacuation was eventually performed, alleging failures in diagnosis, management, escalation, consent, and record-keeping.
High Court rejects plaintiff's claim
In dismissing the plaintiff's case, the High Court emphasised that the long-standing Dunne Principles remain the governing standard for clinical negligence in Ireland. The Judge found that the hospitals' management fell within the range of acceptable professional practice. The judgment reaffirmed that courts must rely on expert evidence to determine what a reasonably competent practitioner would have done under similar conditions. Ultimately, the Judge found that, overall, the care given met the professional standard, even though there were minor deviations from guidelines and some shortcomings in documentation.
Clinical guidelines
Importantly, the Judge considered the application of clinical guidelines, ultimately concluding that they serve as guidance tools rather than mandatory regulations. Although these guidelines can help shape best practice, they do not define the legal standard of care. The Judge held that, in reality, healthcare professionals, especially those in obstetrics and midwifery, must rely on their clinical judgment and experience to determine the most suitable course of care tailored to the specific clinical situation.
The Judge highlighted that although there were some minor record-keeping issues and small departures from guidelines, these did not amount to negligence. The Judge pointed out that such documentation gaps can be common in acute medical scenarios and do not automatically lead to liability.
"Two schools of thought"
The defendant clinicians argued that their conservative management, rather than a surgical approach, was appropriate, whereas the plaintiff’s experts contended that a more proactive surgical approach was the only reasonable option. The Court accepted both approaches.
In doing so, the Court found that where competent experts genuinely disagree on the proper course of treatment, and each approach is supported by a reasonable body of medical opinion, the Court will not prefer one school of thought over another.
The Court concluded that there was no evidence to suggest that providing treatment sooner or taking a different approach would have avoided the harm, nor would the Plaintiff have opted for an alternative course of care if it had been presented to her. Specifically, the Court determined that if negligence had been established on the part of the Coombe or MRH, which was not the case, the plaintiff’s adjustment disorder arose from the necessary surgical intervention rather than from any negligent act.
The High Court’s ruling implies that such cases can be successfully defended when a patient’s care falls within an acceptable professional range, is aligned with expert opinion, and any harm caused did not arise from deviations from professional standards.
Insurers can expect courts to continue to ask whether the defendant’s conduct was one that no reasonable practitioner of equal status would have taken. Insurers should also note that establishing clinical negligence under the Dunne Principles sets a high threshold for plaintiffs. The plaintiff must demonstrate that the care provided fell outside the bounds of acceptable professional practice and constituted actual negligence.
