Spinal injuries occur in many ways including accidents at work, road traffic accidents, assaults and sporting injuries.  Spinal injuries can also arise as a result of medical negligence, with medical misadventure either casing the injury or worsening an existing injury or condition through a failure to act in a timely or appropriate manner. Spinal Injuries Ireland estimates that an average of 2 people per week in Ireland suffer a spinal cord injury, with almost 2,000 people in Ireland currently living with spinal cord injury.

What is medical negligence?

In Ireland, the true test for establishing negligence in diagnosis or treatment on the part of a medical practitioner is whether he has been proved to be guilty of such failures as no medical practitioner of equal specialist or general status and skill would be guilty of if acting with ordinary care.

How can medical negligence contribute to a spinal injury?

There are three ways in which medical negligence can lead or contribute to a spinal injury, namely:

1. Delayed treatment
2. Failures in diagnosis or treatment
3. Not providing patients with accurate information, or not involving them properly in decision-making around their own care

Frequently, cases involving medical negligence and spinal injury involve more than one of these factors.

Delayed treatment and spinal injury

Cauda Equina syndrome (CES) is an obvious example of where delayed treatment and/or failure to diagnose can have devastating consequences.

CES occurs when the bundle of nerve roots (the cauda equina) in the lumbar spine is compressed, disrupting sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.  It can lead to permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems if left untreated. Even with immediate treatment, some patients may not recover complete function.

CES is a medical and surgical emergency requiring immediate intervention.  If the symptoms of CES are ignored or misdiagnosed, the neurological effects can be permanent and life-changing.

Failures in treatment or diagnosis and spinal injury

Due to the sensitivity of the spinal cord, failures in treatment and diagnosis can lead to life-changing disabilities. CES is one such example.

Spinal surgeries can lead to paralysis if negligently performed or if performed without the requisite monitoring and/or imaging.

In other situations, there may be a failure to properly manage a pre-existing condition or injury resulting in permanent damage being done to the spinal cord.

Informed consent to medical treatment and spinal injuries

To give effective consent to treatment, a patient should be warned of all material risks.  A material risk is one which the patient, not the doctor, would be likely to consider significant.

The Supreme Court case of Geoghegan v Harris established, as a general principle that:

“the patient has the right to know, and the practitioner a duty to advise of, all material risks associated with a proposed form of treatment. The Court must ultimately decide what is material. ‘Materiality’ includes consideration of both (a) severity of the consequence and (b) statistical frequency of the risk…”

In any case alleging negligence of the grounds of a lack of informed consent, it will be necessary to establish, on the balance of probabilities, that:

1. Proper consent was absent, that is to say that the injured party did not truly consent and was not fully informed of the risks/benefits of the treatment.
2. The injured party must prove that had he/she known of the material risk, he/she would not have consented to the treatment.
3. The damage must be a consequence of the negligently obtained consent.  The action of the clinician must result in the very risk/injury about which the injured party was entitled to be warned.

The examples above set out some possible mechanisms as to how spinal injury may occur as a result of medical negligence.