Judgment delivered by O'Hanlon J., the 20th day of January, 1989.
The Plaintiff in this case is Catherine Edwards, a child-care worker living in Cork, unmarried, and now 31 years of age. She is the mother of a child born in July 1984, and now four and a half years of age. She lives with her child in her parental home in Cork with her widowed father and her brother.
The action arises out of the events surrounding the birth of her baby in the Erinville Maternity Hospital, Western Road, Cork, and the post-natal care given to her by the medical staff of that Hospital, for which the Southern Health Board accepts full responsibility.
By reason of certain prenatal complications, a decision was taken by Professor Jenkins, the consultant gynaecologist who had been looking after the Plaintiff during her pregnancy, that a Caesarean Section should be performed. The Plaintiff was made aware of this decision and agreed that the delivery of the baby should take place in this manner. She was admitted to the hospital on the 20th July, 1984, and the baby was delivered successfully by Caesarean Section on the 25th.
Professor Jenkins had advised that the operation should take place on the 27th July, 1984, on which date he himself was due to leave Cork on holidays, and the carrying out of the operation was delegated to his Registrar, Dr. Mattar. For some reason the date was brought forward to the 25th. The delivery appears to have been uneventful and no complications ensued until after the baby was born.
In the normal course of events the incision made when carrying out the delivery by Caesarean Section should have healed quickly, leaving an operation scar of no real significance, but that did not happen in the case of the Plaintiff. Infection set in, as happens in a very small percentage of such cases and in the days which followed the birth the Plaintiff's four-hourly temperature chart showed what was described as "spiking" on a daily basis, with sharp rises and falls in her temperature - a clear indication that all was not well.
Professor Jenkins did not return from holidays until late in August and next saw the Plaintiff on the 25th of that month. In the intervening period she remained under the general care of his Registrar, Dr. Mattar, with one intervention by the Senior Registrar, Dr. Curtin, and - at a later stage - by Dr. McGuinness, Consultant Obstetrician, and ultimately by Dr. Fenton, another Consultant attached to the Hospital.
The Plaintiff herself said that she was in extreme pain during the three or four days after the delivery; that she could not stand or walk; that she could not sleep. She said that on the 29th July she was asked to take a shower, preparatory to the removal of the bandages from the operation wound. She was upset by this request as there was a lot of blood coming through the dressing and on going to the shower she was bleeding quite heavily. She said she called the nurse, who in turn sent for Dr. Curtin. Her recollection of what then happened was that Dr. Curtin said it was an emergency situation; that there was a clot which he had to get rid of immediately; that he did so manually, - a very painful procedure carried out without anaesthetic, and the wound was then packed. She said she continued in extreme pain - that she was in despair; that the wound was cleaned and packed twice a day thereafter with "wicks".
She said that Dr. Mattar came and looked at the wound every day, and on the 1st August she was kept fasting from midnight apparently by way of preparation for an operation under general anaesthetic the following morning. In fact, no operation took place.
She said that she continued in extreme pain, feeling desperate, unable to hold or feed her baby. On the 6th August she was seen by a Consultant, Dr. McGuinness, and told she was quite well and that she could go home, on the basis that she was to come back to the hospital twice daily for dressings. She said she was glad to go home. She said she was not examined by Dr. McGuinness, but that he consulted her chart. She went home that day - her home being located within a short distance from the hospital. At that stage she said the wicks were still in the wound, covered over by a baby's nappie for a day or two before her discharge, and that at cleaning time the dressings were saturated, mostly with pus.
She said that she was in extreme pain at home and had to change the baby's nappie covering the wound three times during the night. She reported back to the hospital the following morning and was re-admitted. She said she noticed an unpleasant smell from the discharge while she was at home and that this persisted after her re-admission to hospital. Dr. Mattar continued to see her on a daily basis.
On the 10th she was taken to the theatre and the wound was dealt with under general anaesthetic by Dr. Mattar. It was opened up, a drain was inserted and left in situ until the 16th, and the wound was re-stitched. On the 17th she said that she was again told by Dr. McGuinness that she could go home. She became upset. She wanted to remain in the hospital until the infection had cleared. She was told that this could take "an awful long time". Dr. Mattar intervened and said she would not have to leave.
On the 17th she was seen by another Consultant attached to the hospital - Dr. Fenton - who directed that the wound should be opened up by removal of the stitches, and the wound should be left open and cleaned and packed with wicks, impregnated with an antiseptic solution. The wound was cleaned and re-packed twice a day. She suffered a lot of pain, and painkilling tablets were not effective. She said that when Professor Jenkins saw her on his return from holidays, he commented: "What a mess!" This was the 27th August. She was allowed home on the basis that she would come back twice daily to out-patients and she did so.
She said that on one occasion the nurse attending her in Out-Patients was unable to find a sterile dressing and wanted to put back the soiled pack in position until she, the Plaintiff, objected to this procedure. She said that on the 13th September Dr. Mattar expressed pus manually from the wound, which was very painful, and that prior to that date her temperature had risen again and she was hot and unwell. She said that the wound eventually healed up around the end of October, 1984.
Photographs of the operation scar which were put in evidence and which were taken recently, show a large, deep scar extending across the base of the abdomen. The Plaintiff was studying for a Diploma in Child Care when she became pregnant, and should have commenced a work expieience session in October, 1984, but was unable to do so. She did, however, resume her studies on a part-time basis at College from about the 10th October, while the wound was still not fully-healed. She was unable to complete an examination which she would normally have taken in December, 1984. She resumed work with young children in January 1985, and has been able to continue as before from that time forward. She did, however, complain that the wound bled again on one occasion and that she continues to experience a stabbing pain at the site of the wound if she lifts anything heavy or has to get up suddenly from the flat of her back. She also finds the sensation unpleasant when she has to clean the area of the scar. She said she was conscious of it as a disfigurement and was depressed by it.
She is able to do her full work, and has been promoted to a higher grade in her sphere of employment. The complaint made on behalf of the Plaintiff in these proceedings is that the post-operative procedures adopted after the birth were faulty and that as a result a wound which became infected but which should have healed up with a good result within a short period was instead allowed to deteriorate, occasioning prolonged pain and suffering to the Plaintiff and a final result which is cosmetically far from satisfacCory.
While the Plaintiff has recovered her health and strength, she undoubtedly had a very bad time for a long period after the birth of her baby, particularly during the weeks while she was detained in hospital and later while attending as an out-patient, and some permanent after-effects of that traumatic experience will remain with her for the rest of her life.
The case is one of major importance for all the parties concerned, since a decision against the Plaintiff would deprive her of any compensation for all the pain and suffering she endured and for the continuing after-effects of this episode, while a decision in her favour would involve a grave reflection on the competence of the medical staff who looked after her in the Erinville Hospital.
Evidence in support of the Plaintiff's claim for damages was given by Mr. Scurr, a Consultant Surgeon attached to Middlesex Hospital, and a University Lecturer with very considerable experience in wound treatment. He described the procedure of delivery by Caesarean Section as a "clean operation" with a very low rate of infection occurrence, which he put within a range of 1% to 4%. His conclusion, from the account given by the Plaintiff and from his reading of the hospital records, was that infection had occurred in the wound; that once pus had collected in the wound and discharge from the wound commenced that there had been a manual expression of pus from the wound by Dr. Curtin, but that this had not been enough to cause the wound to settle down; that the Plaintiff's temperature which had been going up and down immediately after the birth had continued to swing, indicating that inadequate draining of the wound was taking place.
The records indicated that the Plaintiff was prepared for operation on the 1st August, which would have involved re-opening the wound, and he did not know why that did not go ahead. He said: "I would have operated on the 1st, or a few days before". He considered that the treatment at that stage, and from that time forward was inadequate. It was reasonable to try antibiotics on the third and fourth day but that there was no sense in continuing to rely (solely) on this form of treatment when it was not proving successful. The wound was getting worse. Surgical drainage of the wound should have taken place then instead of much later.
He said the first choice should have been to remove the sutures and the drainage would then settle within 24 hours. If this did not happen, a more formal exploration under general anaesthetic would have been necessary.
On the 10th August, he said the drain was inserted and closed over, whereas the wound should have been left open for a few days, followed by suturing, if the wound was then found on examination to be clean. He said that what was done involved taking an unnecessary chance - "they might have got away with it". He said that what was done under Dr. Fenton's direction on the 17th August, involving removal of the sutures, cleaning out of all foreign material from the wound, and leaving it open to allow natural healing, should have been done on the 1st August. If this had taken place, the Plaintiff's recovery would not have been delayed; she should have been out of hospital in a few days and should have recovered quickly thereafter.
He said the procedure followed on the 10th August did not help - it was correct to open up the wound, but not to bring it together again. The end-result of the Plaintiff's treatment was a wide scar, tethered to the underlying tissues, and still causing occasional pain. He said that an infection, even if correctly treated, would not produce as good a result as a conventional Caesarean Section, but would not be too dissimilar.
In cross-examination, Mr. Scurr said the wound should have been examined from the second day after the birth, in view of the Plaintiff's "spiking" temperature. With reference to the procedure followed by Dr. Curtin on the 29th July, as appearing from the medical records, Mr. Scurr accepted that the insertion of "wicks" in the wound on and from that date could be regarded as one way of draining the wound. He continued: "If it works - fine. You have to see what happens in the next 24 hours. Next day her temperature was still up and the wound should have been opened and the sutures removed."
He concluded that what was done amounted to an attempt to try to preserve the original scar, which he described as "fundamentally wrong", and as "only a half-hearted attempt to drain the wound". He said there was a very strong body of medical opinion to support his conclusion that there was no other appropriate treatment than to open the wound fully. He criticised the use of "wick" drainage, which he said was not effective. He said the procedure followed by Dr. Mattar on the 10th August was different from exposing the wound; it should not have been closed in again. He himself would not have put a drain in on the 10th. The treatment ultimately adopted was correct.
Evidence on the issue of liability was given on behalf of the Defence by members of the nursing staff at the hospital; by the medical staff, and by Mr. Harold Browne, a Consultant Surgeon practising in Dublin.
The Plaintiff's temperature charts which were put in evidence showed that from the time of the performance of the Caesarean Section on the 25th July her temperature rose to above normal on the 25th, 26th, 28th, 29th and 30th July. It had been normal during the week preceding the birth. It is referred to in the Record of Puerperium as "still spiking" on the 31st July (although I am unable to discern this on the accompanying graph), and thereafter was generally normal throughout the remainder of her stay in hospital.
The relevant entries in the hospital records, in so far as they are concerned with the treatment of the wound which remained following upon the Caesarean Section, are obviously important and I propose to refer to them in some detail. The following are what appear to me to be the significant entries from the 25th July, 1984, to the 17th August, 1984:-
As there is no complaint relevant to her cause of action concerning the treatment of the Plaintiff from that time forward, I do not consider it necessary to refer in any detail to the later entries in the hospital records. They indicate that the wound improved gradually, with some discharge of pus continuing from time to time. The Plaintiff was described in the notes of the 27th August as "very anxious to go home", and on the 28th, "Home today. To come back for dressings." The wound, on that date, was described as "still improving - very mild tenderness" (accompanied by a diagram showing the area involved).
I will now endeavour to summarise the evidence on the question of liability given by a number of medical witnesses called on behalf of the Defendants. Professor Jenkins was the Consultant Obstetrician in charge of the Plaintiff until he left to go on holidays on the 27th July. He gave evidence about the general arrangements for consultant cover which obtained in the hospital throughout the year and also during periods when some of the consultant staff were on holidays. There were four consultants attached to the hospital at the time, Drs. Fenton, Richie and McGuinness as well as himself. In his own case he would usually be on call one week-end in four and on one night per week and by this means cross-cover was provided between the consultants as there was no full-time locum available. During holiday periods some consultant would remain on call at all stages, and a Registrar left in charge of a patient while his Consultant was on holidays could refer to whichever Consultant was on duty from time to time for advice as might be considered necessary. Dr. Mattar was his Registrar at the time and had been left in charge of the Plaintiff while he, Professor Jenkins, was absent on holidays. At that time the Plaintiff's condition was giving no cause for concern, her baby having been delivered with no complications. Were this not the case he said he would have briefed one of the other Consultants to take charge of the case.
He went on to say that Dr. Mattar, to whom the care of the Plaintiff was primarily entrusted in his absence was a Registrar with very considerable experience who had already performed over 2,000 Caesarean Sections in the course of his medical practice; that the Senior Registrar on the team, Dr. Curtin, was virtually of Consultant status though still in training, and that at all stages some Consultant was on call to whom Dr. Mattar could resort in case of unusual difficulty.
Dr. Curtin, now a Consultant Surgeon, who was the Senior Registrar on Professor Jenkin's team in 1984, said in evidence that he had no recollection of his own intervention in the treatment of the Plaintiff which occurred, apparently, on the 30th July, 1984, and that he had to rely on the hospital notes of what happened. He said, however, that in a situation such as existed on that date he had an invariable practice which he had followed at all times before and after that date, and that he was quite sure he had followed it on the occasion in question.
This was to open up the incision, clean out any material, and insert an antiseptic pad. The pack would normally consist of "wicks" which would keep the edges of the wound apart and serve as a drain. He agreed with what was put to him in cross-examination, that to enclose a wound containing pus, without drainage, would be bad practice. He was quite sure that he did not manually express pus. He said: "It was not my practice. One doesn't do that. It would be very painful." He said he would open up by inserting a very fine scissors into the wound; opening up gently, not necessarily cutting any stitches; then clean out pus using a forceps with cotton wool or gauze and some antiseptic material. He considered that the Plaintiff's temperature would have continued to fluctuate if he had not conducted the procedure properly, whereas this had not happened.
Dr. Mattar, who was the Registrar primarily responsible for the care of the Plaintiff from the time he delivered her baby by Caesarean Section on the 25th July until the return of Professor Jenkins from holidays on or about the 25th August, gave evidence that he had qualified
in medicine in the University of Baghdad in 1973. He had served as a doctor while on military service in Iraq and had considerable experience of wound treatment. He later obtained a qualification in Obstetrics and had performed upwards of 2,000 Caesarean Sections during his period in Baghdad, with further similar experience later in Limerick and Cork.
He said that he attended on the Plaintiff every day, save when he was off duty at week-ends. He was told by the nursing staff or the House Officer that the wound was oozing on or about the 29th July. He found no evidence of a collection of pus, but the wound was inflamed, and her condition was the same on the following day. He said that wicks were used and the drainage was effective. He contemplated opening the wound and directed that she should be kept fasting from midnight. However, she had no temperature for 48 hours; the wound was draining through wicks, and there was clinical improvement. He said he discussed the case at the time with Dr. McGuinness, a Consultant. There was no collection of pus anywhere. The antibiotics were controlling the infection. He was very satisfed with the drainage through the wicks. He felt there was nothing to be achieved by opening the wound.
He said she was discharged home on the 6th on the advice of Dr. McGuinness, Consultant. She was re-admitted on the 7th. The wound was still improving. His impression was that she could not cope with the baby at home, was unable to sleep, and that there was no medical reason for re-admission. On the 10th, under general anaesthetic, he probed the wound with a needle, the wound being already open. He removed any infected or necrotic material, but found no sign of any pus. He put in a new nylon suture to appose the edges of the wound, and inserted a corrugated drain as a precaution in case of infection. There was no reason to open the wound up fully. He agreed with the course taken by Dr. Fenton on the 17th, in the circumstances obtaining on that date.
He was not prepared to accept that the hospital records were correct in describing the wound as oozing pus in the days leading up to the 10th August. Dr. Fenton never saw the Plaintiff until the 17th August, 1984. On that date he found the wound partly open and partly closed - probably over half open. The drain had been removed. He asked to have it opened fully and cleaned with an antiseptic solution. The wound was cleaned daily from then on. He thought it should heal up quite quickly - within a week or so. The purulent material under the skin ridges would not drain (through the corrugated drain which had been inserted) and it was ineffective for that purpose up to that time. He agreed that if there was pus in a wound, the wound should not be closed over - it would be unacceptable practice. He said he would only open as far as necessary for a localised abscess. Generally it was not necessary to go any further - it would mean administering a general anaesthetic. "It is not necessary in my experience. I don't do it."
On re-examination he explained that when he spoke of "closing a wound" he meant closing it completely with no drainage by drain or wick.
Dr. Richie, who was also one of the four Consultant Obstetricians attached to the Erinville Hospital in 1984, was not involved at any stage in the care of the Plaintiff, but was asked to comment on the course taken in the wound treatment from what he had heard of the evidence and from what was disclosed by the hospital records.
So also was Mr. Harold Browne, a General Consultant Surgeon, with very extensive surgical experience in Ireland and overseas, who was also called as a witness for the Defence.
The over-all view expressed by the medical witnesses called for the Defence, other than those immediately concerned with the treatment of the Plaintiff prior to the 17th August, was that they would not quarrel with the.course taken by that treatment from day to day and from week to week. They disagreed with the opinion expressed by Mr. Scurr, that the complete opening up of the wound, which had taken place by direction of Dr. Fenton on the 17th August, should have been carried out on the 29th July, when Dr. Curtin intervened, or indeed at any stage prior to the date when it was in fact effected.
The general tenor of their evidence was that in a case of wound infection, the better course normally is to treat it conservatively by administering antibiotics and by opening up the wound only to such extent as might be necessary to enable any pus contained in the wound to drain away, either by use of wicks, or a drain of some approved kind. If this course of treatment proved successful, it would speed up the recovery of the patient; obviate the necessity to bring the patient to the operating theatre and administer a general anaesthetic (with the element of risk always inherent in this procedure), and ultimately leave the patient with a scar which was cosmetically more satisfactory
They further stated that infection of the operation wound only occurred in a small percentage of Caesarean Section cases, and that it was extremely rare for the favoured course of treatment to fail to produce a good result within a short time. The Plaintiff was merely one of the rare and unfortunate exceptions to the rule. They said that the wound had not been closed up over pus at any time from the date of the first intervention of Dr. Curtin on the 29th July, and that at all times thereafter it was kept open and draining, first by the presence of wicks in ,.J the wound, and later by the use of a large corrugated drainfrom the 10th August until the 16th. This, coupled with the concurrent use of antibiotics, they regarded as being in accordance with recognised and correct practice.
Mr. Condon, a Consultant Plastic Surgeon who is also Administrative Director of Accident and Emergency Services in a Cork Hospital referred to a modern English medical text-book, Hardy on the Treatment of Accidents and Emergencies, in which the author described a method known as the Ellis Method as having virtually superseded all other forms of treatment of serious wound infection. This involved opening up the wound under general anaesthetic, cleaning it out thoroughly, using antiseptics and antibiotic cover; then closing up the wound by suturing. This method was clearly very much out of line with the course put forward by Mr. Scurr, and was also dissimilar to the course adopted in the treatment of the Plaintiff. The author of the text-book accepted that "traditionalists sometimes cavil" at this method.
The legal principles applicable in a case where negligence is alleged against a medical practitioner in the course of his duty were considered by the Supreme Court in the case of O'Donovan v. Cork Co. Council and Others, (1967) IR 173. The following passage appears in the judgment of Mr. Justice Walsh, which appears at p. 193 of the Report:
"A medical practitioner cannot be held negligent if he follows general and approved practice in the situation with which he is faced; see Daniels .v. Heskin, (1954) IR 73. That proposition is not, however, without qualification. If there is a common practice which has inherent defects, which ought to be obvious to the person-giving the matter due consideration, the fact that it is shown to have been widely and generally adopted over a period of time does not make the practice any the less negligent. Neglect of duty does not cease by repetition to be neglect of duty. Furthermore, if there be a dispute of fact as to whether or not a particular practice is a general and approved practice, it is a matter far the jury to determine whether or not the impugned treatment is general and approved practice. In such circumstances a jury would be told that if they find that there is such a general and approved practice they must acquit the practitioner where there is not the qualification which I have referred to above. If some witnesses say that a particular practice is a general and approved one and other medical witnesses deny that, then it is an issue of fact to be determined as any other issue of fact."
Applying these principles to the circumstances of the present case, I make the following findings of fact:1. I find that the method of treatment of cases of serious wound infection advocated by Mr. Scurr, while it obviously has much to recommend it, has not been shown to have obtained anything like universal acceptance in the medical profession as the only method, or the best method which can be adopted for the treatment of such cases.
Mr. Scurr said that there was a considerable body of medical opinion to support his view, but he stopped short of saying that what was done in the Plaintiff's case represented a complete departure from approved or standard practice. He considered it "inappropriate", but only because it did not conform with his own best judgment, supported as he said, by a considerable body of medical opinion, that the very different method of treatment advocated by him should have been adopted.
The only text-book evidence introduced (Hardy) stated that a method which seemed to be very much at odds with the method advocated by Mr. Scurr was now generally favoured - except, perhaps among traditionalists. Conversely, the substantial body of medical evidence called on behalf of the Defence, was to the effect that the procedure followed in the Plaintiff's case was correct and standard procedure and would produce the best results in all save a tiny minority of cases. I found this evidence quite convincing and I find that Dr. Curtin and Dr. Mattar followed general and approved practice in the situation with which they were faced when they respectively dealt with the Plaintiff's wound treatment between the 25th July and 17th August, 1984.
If the evidence established that the wound was closed up at any time during the relevant period, in the sense of being sealed up by stitching while there was pus detectable within the wound, I feel I would be constrained to find that this was a departure from normal and approved practice and also clearly indicated a method of treatment inherently defective. However, I find that the evidence establishes as a matter of fact that from the time Dr. Curtin made a sufficient opening in the wound on the 29th July, 1984, to permit drainage of pus from the wound by means of insertion of wicks to take place, some form of drainage was maintained at all times up to the 17th when the intervention on the part of Dr. Fenton took place. In the light of the medical evidence for the Defence, that this course of treatment, when combined with the administration of antibiotics, brings about good healing within a relatively short period in all but the most exceptional cases, (which evidence I am prepared to accept), I cannot find that it was inherently defective in any way. I am of opinion that no critical situation arose in the treatment of the Plaintiff at any time prior to the 17th August, which demanded the adoption of the more radical course which was ultimately directed to be taken by Dr. Fenton.
I confess to having great difficulty in accepting as accurate the view expressed by Dr. Mattar that the wound was "clean and dry" on the 9th and 10th August, having regard to the entries in the hospital records clearly indicating the presence of pus on those two days. I cannot believe that the nursing staff or House Officer responsible for making those entries were unable to recognise pus oozing from the wound if they saw it. Similarly, Dr. Mattar's recollection of the Plaintiff's condition when re-admitted to hospital on the 7th August is very much at variance with the written records which refer to "wound break-down" and "Problem - wound infection with central debriscence, pus +, induration ++."
However, the fact that I do not find his evidence on these details of the case convincing does not undermine my over-all view of the case that appropriate treatment was given to the Plaintiff at all relevant times having regard to the decisions which had to be made by her medical advisers from day to day and from week to week. The fact that, with hindsight, a different course of treatment might have produced a better result is not sufficient to justify a finding of negligence against the Defendants.
I think that anyone reading the hospital records cannot but be impressed by the meticulous care given to the monitoring and treatment of the Plaintiff's condition throughout the long period which she, unfortunately, had to spend in the hospital, and she herself spoke in general, very favourably about the care and attention she received from the nursing staff and from Dr. Mattar during that period.
In addition to the matters touching on the question of liability which have already been dealt with in the course of this judgment, Counsel for the Plaintiff also relied strongly on the alleged absence of adequate Consultant cover to ensure that the Plaintiff's treatment was correct at all relevant stages. It is correct to say that with the departure of Professor Jenkins on holidays no individual Consultant was given special responsibility for the care of the Plaintiff in his absence.
It does not appear to me, however, that the system of Consultant cover was inadequate. No complications had emerged in the Plaintiff's condition prior to the departure of Professor Jenkins which should have alerted Professor Jenkins to the need to make any special arrangements for entrusting her to the care of a nominated Consultant in his absence. She was left in the general care of Dr. Mattar, whose experience in dealing with similar cases could hardly be called into question. On the same team was the Senior Registrar, Dr. Curtin, who is now a Consultant in his own right, and he was available to assist and advise in dealing with the Plaintiff's problems. Finally, Professor Jenkins said that a Consultant was available on call at all times if Dr. Mattar felt that any situation was arising which was outside his own range of skill and expertise to deal with.
I do not consider that the question of continuous Consultant cover gave rise to any real problem in this case, particularly having regard to the fact that the Consultants who gave evidence in the case - with the exception of Mr. Scurr - appeared to be unanimous in saying that the course of treatment adopted would have been the same had they been in charge of the case during the period when it was being dealt with by Dr. Curtin and Dr. Mattar.
In these circumstances I am of opinion that a case of negligence has not been made out against the-Southern Health Board or any of its officers, and I have no option but to dismiss the Plaintiff's claim.
20th January, 1989.
Counsel for the Plaintiff:- Dermot Gleeson SC B. Tynan SC
John O'Donovan BL (instructed by Dunlea, Murray & Co., Solicitors).
Counsel for the Defendants:- Ralph Sutton SC Henry Hickey SC Michael Gleeson BL (instructed by Hayes & Sons, Solicitors).
Cases and Materials cited:
O'Donovan v. Cork Co. Council & Ors, (1967) IR 173
Roche v. Peilow, (1986) ILRM 189
Hunter v. Hanley, (1955)SC 200
Daniels v. Heskin, 194) IR 73
Bolam v. Friern Hospital Management Committee, (1957) 2 AER 118
Gold v. Haringey Health Authority, (1987) 2 AER 888
R.H. Hardy, Accidents and Emergencies, Oxford Medical Publications, Third Edition.