Eoin Dunne (infant) –v– The Coombe Hospital
On 1 February 2013 Ms Justice Irvine delivered her Judgment in the case following a lengthy 45 day Trial taken on behalf of a child (now 10 years old) who sustained catastrophic brain damage resulting in Dyskinetic Cerebral Palsy by reason of the failure of the nursing and paediatric staff to ensure that he was adequately resuscitated during the first 23 minutes of his life. The Plaintiff, Eoin Dunne was born at 6:35am in the Coombe Hospital on 30 July 2002. His mother, Dr Fiona Murphy was a consultant anaesthetist. He was born at full term following a normal pregnancy but in the last few minutes before birth suffered some degree of asphyxia as he passed through the birth canal which meant he had to be resuscitated by bag and mask ventilation immediately following birth.
It was the Plaintiff’s case that the bag and mask resuscitation which was provided to him by the midwifery nursing staff was inadequate and ineffective. It was also claimed that there was a delay in the midwifery staff calling for the help of the paediatric staff to assist in the resuscitation and to provide intubation if necessary. The Plaintiff claimed that the paediatrician did not arrive until approximately 13 or 14 minutes of age and that it was not until approximately 18 minutes of age that any adequate, effective resuscitation took place by the Paediatric staff, such that by that stage Eoin had suffered catastrophic brain injury.
The Defendant, at all times, claimed that it was not responsible for Eoin’s injuries and led that his injuries had nothing whatsoever to do with a failed or delayed resuscitation. The Defendant sought to maintain over a 45 day Trial that Eoin was born unexpectedly flat and that it immediately provided competent and timely resuscitation from one minute of age right up until 23 minutes of age when his heart beat was eventually restored. It maintained that Eoin was intubated by five minutes of age but that he failed to respond adequately to proper resuscitative and intubation attempts.
The Defendants initially sought to argue that the reason he did not respond to proper resuscitation was that he had sustained an hypoxic ischaemic event in the hours or days before delivery which prevented his timely response to resuscitation attempts. Subsequently, during the Trial the Defendant changed its position and claimed that Eoin was probably born with an underlying mitochondrial disease, muscular or neuromuscular disorder or some other type of complex genetic defect. In consequence they claimed he did not breathe spontaneously at birth or respond normally to the Defendant’s timely resuscitative efforts and as a consequence suffered a period of hypoxia in the first 20 minutes or so of life.
The Plaintiff’s parents had always maintained that the resuscitation attempts being performed by the midwifery staff were inadequate and were not achieving any oxygenation such that the Plaintiff’s mother, an anaesthetist and skilled in resuscitation techniques made a vain attempt to get up from her bed to assist. The parents also maintained that the paediatrician did not arrive to assist with the resuscitation until approximately 14 minutes of age.
After hearing all of the evidence the Learned Trial Judge accepted the Plaintiff’s factual and expert evidence and found that the initial resuscitative attempts by bag and mask ventilation by the midwives was ineffective, that the paediatrician did not arrive until approximately 15 minutes of age and that as a consequence effective resuscitation did not begin until approximately 18 minutes of age and it therefore took until approximately 23 minutes of age until the Plaintiff’s heart rate was adequately restored.
The Learned Trial Judge accepted the expert evidence from the Plaintiff’s eminent paediatric witnesses to the effect that the Plaintiff was born in moderate condition with no prior genetic or acquired injuries. The Court held that the hospital were negligent:
The Judge stated:
“because positive pressure ventilation is fraught with difficulties it is incumbent upon a maternity hospital to have its midwifery staff sufficiently trained to identify a baby’s potential need for intubation and to have a system in place such that it can ensure that within 5 minutes of a baby developing respiratory distress that a senior member of the medical staff, capable of intubation will be in attendance. On the balance of probabilities I believe that for whatever reason, be it delay in the summoning of Dr Ramish, a delay in his receipt or response to such a call or a combination of any of these circumstances, he did not arrive to assist in Eoin’s resuscitation until he was something approaching 15 minutes of age.”
The Learned Trial Judge found:
“If the Defendants had acted with reasonable care for Eoin’s welfare there is no reason why he should not have been effectively ventilated by the time he was nine minutes of age and had this occurred he would not have gone on to develop the injuries which now afflict him.”
The Court therefore found the Defendant negligent in their failure to ensure that Eoin received the type of intubation and ventilation which was mandated within the first 10 minutes of his life and which would have prevented his brain injuries.
The Court will now go on shortly to assess the damages that Eoin should be awarded for his catastrophic injuries and these are likely to run into many millions of Euro.
If you have any further queries, please contact any of the following from our medical negligence group:
Joice Carthy, Managing Partner
09 February 2013