OD v. VY, TR, IC
The Deceased was a fit and healthy 31 year old man who attended the Accident & Emergency Department of a large Dublin Hospital complaining of acute pain in his upper abdomen and left chest following an incident at his place of employment. A chest x-ray demonstrated a gross herniation of the stomach and bowel into the left chest cavity and the Deceased was admitted to the ICU under the care of a cardiothoracic surgeon. A naso-gastric tube was inserted and the trapped air and secretions decompressed which appeared to improve his condition. A CT scan was taken. The following day it was noted that there was greenish bile present in the naso-gastric tube and the decision was taken after a further two days to perform a thoracotomy which occurred the following day approximately 100 hours after his admission to A & E.
The operative note for the thoracotomy noted that the stomach and bowel were present in the chest coming through a hiatus hernia in the diaphragm and there were also adhesions present. The adhesions were dissected, the stomach and bowel pushed back through the hole in the diaphragm and then this hole was itself repaired. Unfortunately later that day the Deceased was noted to have become very unwell and was acidotic, hypotensive with very low urine output despite receiving a large volume of fluids. He was monitored by the anaesthetic staff who initially queried whether there might have been bowel entrapment resulting from then thoracotomy and the Cardiothoracic Team was called. The next morning the Deceased underwent a laparotomy under the care of a different surgeon who noted a para oesophageal herniation of small intestine into the thorax, ischaemia and necrosis. A reduction of the hernia was carried out and a mesh inserted. Small portions of the bowel were also resected. Tragically the Deceased continued to deteriorate and despite further surgical intervention he passed away a little over two weeks later from multi organ failure.
An Inquest into the death was heard by the Dublin City Coroner Dr Brian Farrell sitting with a jury over 12 separate dates between January 2004 and March 2007. A finding of death by medical misadventure was entered following the deliberations of the jury.
The Deceased’s widow brought proceedings against the Cardiothoracic Surgeon, the Consultant Aneasthetist and the Hospital claiming damages for the wrongful death of her husband, a loss of dependency on her own behalf and on behalf of her son as well as her own psychiatric injuries arising out of the circumstances surrounding her husband’s death. Based on her expert reports the Plaintiff’s case was that the Defendants’ delayed in performing the initial thoracotomy of almost 100 hours contributed to the ongoing necrosis of the bowel. It was also her case that there was a failure on the part of the Surgeon to carry out the repair of the hernia correctly by failing to insert a mesh as opposed to a primary repair and that this led to the re-herniation which the Deceased suffered that contributed to his death. It was further alleged that the Defendants failed to adequately monitor the Deceased in the post operative period and take proper account of his loss of urine output and his potassium and creatine readings (indicative of kidney failure) resulting in a delay in the surgical team being called in to carry out the emergency laparotomy.
Liability was denied by each of the Defendants and a trial date fixed. A settlement meeting was arranged shortly after the Plaintiff secured a trial date and the matter ultimately settled without an admission of liability for €1 million in addition to the Plaintiff’s legal costs. It is the opinion of the Plaintiff’s legal advisers that this figure represents almost full value of the case.
For further details please contact Michael Boylan or Joice Carthy.
31 August 2010