GP Defends Professional Negligence Claim About Breast Cancer Diagnosis in High Court

differential costs order

The High Court decision in Rossiter v Donlon is a useful one to look at when it comes to increasing our understanding of professional negligence, and what you need to prove to bring home such a legal action.

Background

The background to the case is that Ms. Rossiter sued Dr. Donlon for professional negligence arising from his advice and care in a consultation in which she presented with a history of an armpit lump.

Ms. Rossiter noticed a lump in her left armpit and after three months she went to Dr. Donlon. She was 32 years old at that stage in 2014. Dr. Donlon examined her left armpit and could not discern any lump. Dr. Donlon reassured her and told her to return to if the lump returned.

Ms. Rossiter attended Dr… Donlon, and other doctors, for approximately two years for the treatment of eczema but there was no further mention of the armpit lump.

In August 2016 she attended another doctor with a lump on her left breast and was diagnosed with terminal breast cancer.

Ms. Rossiter claimed the breast cancer could have been diagnosed earlier if she was referred to a Breast Clinic in 2014 by Dr. Donlon; she further claimed that Dr. Donlon had carried out an inadequate examination and had failed to carry out a breast examination in 2014.

Dr. Donlon’s evidence was that a breast examination was offered but this was declined, and she asserted that Ms. Rossiter agreed with her on the day that there was no lump present. Ms. Rossiter denied Dr. Donlon told her to return if there was a recurrence of the lump and she claimed that the lump persisted after the September 2014 consultation.

It was clear from the evidence of both parties that there were important conflicts of evidence on a number of points as to what was said at the September 2014 consultation. The Court preferred Dr. Donlon’s evidence on most heads, however, because she had made notes at the time of the consultation and these notes were preferred to the memory recall of Ms. Rossiter.

Dr. Donlon’s notes stated, “declined breast exam”. If the Court was to accept Ms. Rossiter’s evidence over the notes of Dr. Donlon it would meant that this note was a lie and added after the fact. This would be an extremely serious finding for the court to arrive at against a doctor and, furthermore, Ms. Rossiter’s legal team did not make this allegation or put this proposition to Dr. Donlon during cross-examination.

Expert medical evidence was produced by both sides as to the rate of tumour growth in an attempt to arrive at the likely size of the tumour in 2014. The evidence of Dr. Donlon’s expert witness was preferred and, on that basis, it was estimated that the size of the tumour in September 2014 would have been .6cm in size which is below the threshold size of 1 cm to have been discoverable on palpation by a GP at that time.

Negligence?

Mr. Justice Barr had to look at two questions when deciding whether Dr. Donlon was negligent or not:

  1. Should Dr. Donlon have insisted more strongly that Ms. Rossiter attend for a breast examination when it was declined?
  2. Should Dr. Donlon have arranged a review appointment at a later date?

It was decided that where both doctor and patient disagreed about the presence of a lump a further consultation should have been scheduled; however, in this case there was agreement that there was no lump and, therefore, no need to arrange a further consultation.

Mr. Justice Barr also found that even if Dr. Donlon was negligent in failing to refer Ms. Rossiter for a breast exam in 2014 this failure did not lead to any loss or injury.

He also held that, having regard to the rate of growth of the tumour from 2014 to 2016 when it was discovered, it would not have been detectable in September 2014 due to its small size.

Read the full decision here: Rossiter v Donlon [2019] IEHC 105

Proof of Negligence-How to Prove Negligence in Irish Civil Law

 

negligence law ireland

If you bring an action for negligence in Ireland, you must prove the defendant was negligent.

The standard of proof is on the balance of probabilities, which is the standard of proof in civil law cases. (The standard of proof in criminal cases is beyond a reasonable doubt).

Essentially, you must establish facts from which negligence can be inferred.

This does not mean you must prove or show how the accident occurred; simply because an event was not foreseen does not mean it cannot be reasonably inferred.

But you must show on the balance of probabilities that the defendant was guilty of negligent conduct which caused the accident.

There is also a principle in the law dealing with negligence-res ipsa loquitur.

Res Ipsa Loquitur

Res ipsa loquitur means “the thing speaks for itself”. There are some cases, where the thing speaks for itself and where there may be no other evidence to prove negligence.

But a presumption of negligence can arise from the fact of an accident. An example would be the case from which this phrase emanates-it involved a barrel of flour falling out the first floor window of a shop and hitting the plaintiff on the head.

The defendant shopowner claimed that there was no evidence of negligence, unless the act itself was evidence of negligence. The Court of Appeal in this case recognised that res ipsa loquitur was appropriate in some cases, and this was one of them.

When will this principle apply?

  1. When “the thing” is under the control of the defendant
  2. When the accident would not have occurred if the defendant who controlled “the thing” used reasonable care

This principle will not apply when there is an explanation of how the accident or event occurred.

If the principle applies in your case it will be up to the defendant to avoid liability by showing that the cause of the accident cannot be attributed to his negligence.

The Supreme Court decision in Hanrahan v Merck Sharp & Dohme (Ireland) limited held:

“in the tort of negligence, where damage has been caused to the plaintiff in circumstances in which such damage would not usually be caused without negligence on the part of the defendant, the rule of res ipsa loquitur will allow the act relied on to be evidence of negligence in the absence of proof by the defendant that it occurred without want of due care on his part”.

Conclusion

Assuming your case has the four essential elements of the tort of negligence you will still need to prove negligence to win your case.

Negligence-An Essential Element of a Successful Personal Injury Claim

negligence

If you have suffered a personal injury, the question of “negligence” is an important one. This piece will explain what negligence is.

Legal actions in Ireland, such as medical negligence or personal injuries actions, are pursued on the basis of negligence which is a tort (a civil wrong).

There are four elements to the tort of negligence:

  1. The wrongdoer had a duty of care to the person who suffered loss or damage-you don’t owe a duty of care to everyone. However, you do owe a duty to those who are proximate, and where the danger is reasonably forseeable;
  2. The defendant failed to conform to the required standard in his/her behaviour/conduct. The required standard is that of the ‘reasonable person’ and Courts will address the question: did the defendant act as a reasonable person would?
  3. Did the plaintiff/victim suffer actual loss or damage? And was the damage or loss forseeable? This is the general principle of “remoteness” of damage.
  4. Was there a sufficiently close connection between the conduct of the defendant and the loss suffered by the plaintiff? This is the idea of “causation”.

Each of these elements must be present to successfully sue for negligence. And each of them has been well canvassed in various Courts in common law jurisdictions around the world.

For example, if a Court decides that a person had indeed a duty of care to the person who suffered loss or damage, it will then turn to the question of the standard of care.

In assessing this aspect of a negligence claim, Courts will look to

  • The seriousness of the threatened injury
  • The likelihood of an  accident
  • The social usefulness of the conduct complained of
  • The cost of eliminating the risk.

The third element above-actual loss suffered-must be proven as negligence on its own is not actually actionable. The general principle of ‘remoteness’ of damage is important here; this means that the loss should have been reasonably foreseeable.

The fourth element above is concerned with a sufficiently close causal relationship between the conduct complained of and the resulting damage.

There are two further aspects of negligence claims which must be considered before bringing any legal proceedings:

1. Assumption of risk

The Civil Liability Act, 1961, section 34(1)(b):

this subsection shall not operate to defeat any defence arising under a contract or the defence that the plaintiff before the act complained of agreed to waive his legal rights in respect of it, whether or not for value; but, subject as aforesaid, the provisions of this subsection shall apply notwithstanding that the defendant might, apart from this subsection, have the defence of voluntary assumption of risk;

This means that if the defendant can show that the plaintiff agreed to waive his/her legal rights before the act complained of, the action will be dismissed.

2. Contributory Negligence

This arises where the ‘victim’ was in some way responsible for the loss/damage suffered. The plaintiff’s compensation, if the claim is successful, will be reduced in proportion to the amount in respect of his/her own fault.

If you have suffered as a result of the negligent conduct of another and want to be compensated you should consider contacting a solicitor.