Rian Murphy –v- HSE
On 6th November 2015, Mr Justice Cross in the High Court, approved a settlement reached by Augustus Cullen Law in a claim on behalf of a 5 year old Galway boy who suffered a severe brachial plexus injury at the time of his delivery resulting in very limited use of his right arm. The Plaintiff alleged that said injury, which is a permanent injury, was caused by the Defendant’s negligence. The case was very unusual on its facts insofar as the Plaintiff’s mother suffered a premature pre-labour rupture of membranes at only 22 weeks gestation and remained in the Defendant Hospital on bed rest for approximately 10 weeks. At 32 weeks gestation she went into labour, at which time the Plaintiff only weighed 4lbs 4 ounces. At that time the labour became obstructed by a shoulder dystocia where the child’s right shoulder, which was the anterior shoulder, could not pass below the pubic symphysis. Shoulder dystocia is normally diagnosed when the shoulders fail to deliver shortly after the fetal head. The anterior shoulder refers to the shoulder of the fetus that faces the mother’s pubic symphysis during delivery. The Plaintiff’s mother was also noted to have a fibroid both prior to and during this pregnancy, of which the Defendant Hospital was well aware.
After the Plaintiff’s mother had reached full dilatation, she was becoming exhausted and the CTG trace recording the baby’s heart rate began, it was alleged, to show a pattern of variable decelerations (where the baby’s heart rate dropped) and this was a cause for concern. The decision was then made to proceed to an instrumental delivery using forceps.
The Plaintiff’s head was delivered with three tractions after an episiotomy was carried out. However, after delivery of the head, difficulties were encountered and a right shoulder dystocia was noted in the medical records. In the circumstances, the Defendants attempted to do a McRobert’s manoeuvre, which is recommended to assist delivery in cases of shoulder dystocia and they noted that “abdominal pressure” was applied to deliver the anterior shoulder. It was alleged by the Plaintiff that the obstetric Registrar delivering the baby applied far too much traction on the baby’s head, thereby causing his injuries. Of the five nerves comprising the brachial plexus, four nerves were ruptured i.e. torn in two and the fifth was injured. The Plaintiff pleaded that the fifth nerve had actually been avulsed from the spinal cord, although the Defendants argued that the injury to that nerve may not have been this severe. It was also the Plaintiff’s case that the McRobert’s manoeuvre was not carried out properly and that pressure was applied to the upper part of the mother’s abdomen (fundal pressure), which is contraindicated, rather than suprapubic pressure, the latter being the acceptable and recommended type of pressure to apply in cases of shoulder dystocia.
Despite having undergone a number of surgical procedures, the Plaintiff has, and will continue to have, extremely limited use of his right arm for the rest of his life.
Liability was not admitted in this case and indeed, the Defendants engaged numerous experts including an expert in Biomedical Engineering who alleged that the Plaintiff’s injury was in fact caused by maternal propulsive forces. The Plaintiff’s medical experts felt that this argument was completely without foundation and particularly so in the circumstances of this case. Three of the Defendant’s other experts also queried whether the rupture of membranes 10 weeks earlier and the lack of amniotic fluid may have made the Plaintiff more susceptible to injury and one of the Defendant’s experts specifically stated that the shape of the mother’s uterus and her fibroid, made it very difficult to deliver the Plaintiff, even with all competent manoeuvres being carried out.
The Plaintiff’s experts felt the fibroid had played no role in this injury whatsoever given the position of the fibroid and the location of the Plaintiff when the shoulder dystocia was encountered. The Plaintiff’s obstetric experts felt that the obstetric Registrar had not carried out the forceps delivery competently. The case was therefore atypical on its facts and there was a huge dispute on liability which was not admitted in the case.
The case was specially fixed for 28th October 2015 and was then adjourned for a few days and was due to open on 6th November 2015. At that time, the case was settled for a compromised figure of €650,000 plus legal costs. Most of this sum was comprised of future care, aids and appliances and assistive technology.
If you have any further queries, please contact Joice Carthy, Managing Partner.
07 December 2015