In February 2025, the High Court delivered its decision in Tynan v Bon Secours Health System CLG & Dr Heiko Kindler[1]. The case arose from a pacemaker implantation and loop recorder removal which was performed under local anaesthetic at Bon Secours Hospital, Cork, in July 2018.
The plaintiff alleged she endured severe pain throughout the 54-minute procedure and suffered subsequent psychiatric injury. She also claimed that the defendants failed to provide her with adequate anaesthesia and neglected to monitor her properly. She also claimed that she was not told before her operation that sedation with midazolam was an option which could have potentially eased the pain.
Plaintiff's allegations
The plaintiff described the procedure as "excruciating from the outset". The plaintiff claimed that she asked Dr Kindler on numerous occasions to stop the procedure whilst crying with pain, feeling ignored by not only Dr Kindler but by the rest of the team. The plaintiff had stated that the administration of fentanyl she received had little to no effect. The overall experience left her traumatised with symptoms consistent with PTSD.
Defendant's position
Both Bon Secours Hospital Cork and Dr Kindler denied any negligence and maintained that the procedure was straightforward and conducted in line with recognised standards. They stated that the plaintiff did not display any signs of severe pain or distress during the operation. The plaintiff's heart rate and behaviour remained consistent with a patient tolerating the procedure well. Furthermore, any discomfort was brief and addressed by additional local anaesthetic and a small dose of fentanyl, the Court was told. Expert witnesses for the defendants argued that physiological readings in relation to her stable heart rate did not align with her claims of being in extreme pain.
Evidence before the Court and Judge's findings
Expert witnesses on both sides all agreed that pacemaker implantation can involve moments of discomfort but is generally well tolerated under local anaesthetic. Furthermore, sedation with midazolam is not mandatory and is typically used at the clinician’s discretion.
The Court found that the treating team was not aware of her history of anxiety prior to the operation, as she did not relay this to the staff. The plaintiff had referred to an earlier incident where a junior doctor attempted a cannulation, which she argued should have alerted the medical team to her anxiety and prompted pre-procedural sedation. The Court considered the expert evidence and found that it was not a breach of duty that the treating team did not provide the patient with information about preoperative sedation. The Court also found that the patient had failed to give any evidence that she would likely have opted for sedation had it been offered.
Judge Coffey ultimately preferred Dr Kindler’s account, finding it more consistent with the objective evidence and other witness testimony. He determined:
- The failure to discuss midazolam did not breach the duty of care or vitiate consent.
- There was no reliable evidence that the plaintiff would have chosen sedation had it been offered.
- The defendants were not aware, nor should they reasonably have been aware, of any heightened anxiety requiring sedation.
- The plaintiff’s description of extreme pain throughout was not supported by the evidence, and her psychiatric claim lacked a factual foundation.
The Court also noted that while intraoperative pain documentation could be improved, its absence was not, in this case, a causative breach of duty. The case was dismissed.
