INTERIM DAMAGES OF €3 MILLION AWARDED FOR BIRTH INJURY AZ (AN INFANT) V XY HOSPITAL
The plaintiffs mother, at term, was assessed at a rural maternity unit at a General Hospital on March 8th and 9th, 2014 because of some concerns. She was not in labour at the time. The CTGs at that time were considered reassuring. For this reason, she was sent home. However according to the expert obstetric and midwifery advice commissioned by this firm the mother should not have been discharged from hospital on the 9th march because of the presence of green staining (possible evidence of meconium) on sanitary pads and because of severe abdominal pain. She presented again to Hospital on March 11th, 2014 because of abdominal pain and decreased fetal movement. There was some suggestion that she had had pain and concern about decreased fetal movements prior to this time. It is the mother’s opinion, she arrived at the hospital at around noon on March 11th. She was assessed at 1440 hours and examined by a doctor at 1505 hours, who, on the basis of the CTG findings suggested an urgent caesarean section.
There was an initial delay in performance of the caesarean section because both of the operating theatres were in use. The infant boy was delivered by caesarean section at 1546 hours on March 11th, 2014 in a severely compromised state. He required vigorous resuscitation, and he was described as being pale and floppy and covered in meconium. He was intubated at which time meconium was found below the vocal chords. The heart rate at one minute of age was 60 bpm.
Apgar scores were assigned as 3, 5 and 6 at one, five and ten minutes respectively and the infant was then placed on the therapeutic hypothermia protocol for the management of hypoxic ischemic encephalopathy. The birth weight was 3280 grams and the head circumference at birth was 36.3 centimetres. The cord blood gas measurements showed pH 6.87 and base excess -16.2. The lactate level on the cord blood was 12.3 (normal <2). These values demonstrate a severe metabolic acidosis. Following resuscitation, the infant was hypotensive and was treated with dopamine and adrenaline to increase the blood pressure. He was transferred to the Neonatal Intensive Care Unit (NICU) for ongoing management.
Ventilation continued for several days. Cardiological assessment revealed cardiac dysfunction related, in part to, hypoxic ischemic insult. . He was transferred to the National Maternity Hospital (NMH) in Dublin for ongoing management. At around the time of admission to the NMH, he had a 2nd seizure that was associated with desaturations of the blood oxygen content.
The working differential diagnosis, at this stage, was meconium aspiration syndrome, hypoxic ischemic encephalopathy, and sepsis? He remained intubated and was ventilated for several days.
At age 3 years, the plaintiff was assessed by a consultant paediatric neurologist at Crumlin Hospital. At this time, it is noted that he had been admitted to Crumlin on October 16th for the insertion of a gastrostomy tube. He was still having seizures and a major problem was dystonia. He had little social awareness and was considered microcephalic. When assessed in subsequent years continued to suffer from the complications of his hypoxic brain injury with severe cognitive impairment, severe cerebral palsy and a severe seizure disorder
In summary, the plaintiff was born at term following a late intrapartum hypoxic ischemic insult and brain injury. He had a neonatal encephalopathy and evidence of hypoxic ischemic injury to organs other than brain in the neonatal. He was subsequently severely delayed with cerebral palsy, dystonia, epilepsy, and microcephaly.
Legal proceedings were brought by this firm on the basis of the supportive expert evidence we had gathered both on the issue of breach of duty/negligence and causation, The action was fully defended by the hospital/HSE who delivered at full defence denying all liability.
Exchange of expert evidence between the parties shortly before trial demonstrated the extent of the dispute between the parties respective experts and crucially the likely dispute on the mothers condition upon discharge from hospital on the 9th of March 2014.
In these circumstances the plaintiffs legal team believed that it was justified and prudent to settle the claim on the basis that the plaintiff would receive 80% of his full damages. The agreement to allow for a 20% discount on damages would reflect the litigation risks that the plaintiff might lose the action, should the court prefer the evidence on disputed fact tendered by the defendants. As the infant plaintiff was only 8 years old at the time of settlement (October 2023) , the future prognosis remained uncertain and thus the parties agreed to an interim settlement for the next 5 years, until the plaintiff is 13 years old. The agreed damages to cover the next 5 years net of the 20% discount were approved by the court at €3,037,000 and judgement was entered against the defendants for this amount. The case will return to court in 5years for further assessment of damages to cover the plaintiffs future needs.
If you require further information or advice on any issues arising from this report contact Gillian O'Connor, Managing Partner, Michael Boylan Partner or Ciara McPhillips Partner at 01-9017418