This was an extremely unusual case involving the diagnosis of multiple sclerosis in a young girl in her late teens who had been attending a Consultant Neurologist for a number of years with a variety of non-specific symptoms. MRI scans at the time of the initial diagnosis were inconclusive but the diagnosis of multiple sclerosis was made nonetheless. The Plaintiff attended her local general hospital for treatment of what were considered to be relapses which involved courses of intravenous corticosteroids in the form of methylprednisolone, sometimes with tapering dosages of oral steroids. This treatment continued for a number of years with the medication being administered on regular occasions.
The Plaintiff’s care was taken over by a different Consultant Neurologist at a different hospital who questioned the original diagnosis of multiple sclerosis suggesting that the symptoms that the Plaintiff was experiencing could be more properly explained by a diagnosis of conversion disorder. Concern was also raised by the neurological team about the high dosage of intravenous steroids which the Plaintiff had been receiving from her local general hospital and corresponded with that hospital indicating their concerns and requesting that they desist from prescribing further courses of steroids to the Plaintiff. A side effect of long term corticosteroid use is the development of avascular necrosis in a patient’s joints and the Plaintiff at this stage was showing signs of this condition. The Plaintiff continued to attend her local General hospital and receive course of intravenous corticosteroids until she was advised in 2008 that her most recent MRI scan conclusively demonstrated that she did not have MS.
The Plaintiff contacted Augustus Cullen Law in late 2009 as she wished to investigate whether or not her original diagnosis of multiple sclerosis made when she was in her late teens was negligent. The Plaintiff developed avascular necrosis in each of her knee, hip and shoulder joints and required a double hip replacement as well as a shoulder replacement. She may require further surgery on her remaining joints which have been affected. An expert report from a Consultant Neurologist in England was obtained analysing the standard of care the Plaintiff had received from her Consultant Neurologist who had arrived at her original diagnosis. This report however agreed with the original diagnosis and indicated that it was a reasonable diagnosis and that the Plaintiff did have a degree of demyelination disease. However, this expert pointed out that he felt that the dosage levels and frequency of the course of intravenous corticosteroids were outside of the therapeutic range and that the Plaintiff had grounds to allege negligence against the Defendants on these grounds. Further expert reports were then obtained from expert Physicians and Pharmacologists who supported this view and proceedings were issued against the HSE and a number of General Physicians attached to the Plaintiff’s local hospital where she had been receiving her courses of intravenous steroids. Certain allegations of negligence were admitted by one of the Defendants but the issue of causation was fully defended. The Defendants also claimed that the Plaintiff was statute barred from bringing her case due to the passage of time and further that she was guilty of contributory negligence in continuing to allow her treating clinicians prescribe her intravenous steroids in circumstances where it was alleged she knew them to be detrimental to her. This was an allegation strenuously denied by the Plaintiff.
The proceedings took some time to progress due to the complexity of the Plaintiff’s medical condition and the difficulty in identifying the precise point in time when ceasing the courses of corticosteroids would have prevented the development of avascular necrosis in each joint. A trial date was fixed for January 2016 and a mediation meeting held the week before the case was due to commence. The matter was successfully resolved by way of mediated settlement in the sum of €900,000 and costs in favour of the Plaintiff.
For further information please contact Jamie Hart in our Medical Negligence Department.
15 February 2016