WOMEN make up 80 per cent of the cases that come through the doors of Limerick solicitor Melanie Power. Her practice, Power Solicitors, is a boutique firm of medical negligence solicitors who mainly deal with women who have received inadequate healthcare that has left them with lifelong consequences.
While this isn’t a figure that surprises Melanie anymore, she remains steadfast in her mission to provide answers to women and families. Limerick Post reporter Sarah Coleman sat down with the solicitor to find out more about her work and the challenges she faces on a daily basis.
In simple terms, medical negligence happens when a patient seeks medical treatment but the care they receive falls below the standard of care expected.
There are several legal principles that set out what constitutes as negligence. Firstly, there has to be a breach of duty, meaning something has been done wrong. Secondly, causation, which means that the wrong has caused somebody to suffer, and finally, that this has caused an individual to suffer an injury.
A case is only considered to be potentially negligent if the injury is missed and, as a result, worsens over time. Indicators of this may include the impact an injury has on a person’s overall quality of life, for example, their ability to dress themselves, maintain a good standard of personal hygiene independently, and whether they can remain in full-time employment.
This can range from somebody presenting to hospital with shoulder pain or, in more high-profile cases, involve women who experienced a traumatic childbirth, their child acquiring a brain injury, other maternity care issues, or delays in cancer diagnoses.
In 2018, the late Limerick woman Vicky Phelan was just one of 221 women at the centre of the CervicalCheck scandal diagnosed with terminal cancer having received false-negative smear tests results and not being informed of subsequent audit findings.
Recalling the landmark case, Melanie told the Limerick Post: “You need to be able to show not only that the diagnosis of cancer was missed but, during that period, where there has been a delay, that the cancer has progressed.”
“In some cases, the expert evidence could say that yes, the cancer was missed and it should have been diagnosed earlier, but during this time it didn’t progress, so therefore it’s not actionable. This can be a difficult thing to explain to people.”
‘Nobody comes into the office for money’
Proving a case to be medically negligent is not a straightforward process either, she explains.
“It’s not as simple as somebody calling and saying, ‘I have a case’. There is a lot of investigation that needs to go in before I can say that it is actionable. You also have to be very careful with medical negligence cases because if you progress a case without having the evidence, it’s considered an abuse of process,” Ms Power shares.
“We get expert reports from the UK to make sure they are fully independent who are able to set out medical standards in clear legal terms, which can be a difficult thing for doctors to do to relate things to people in layman’s language. This then needs to be translated into legal terms as well.”
In some cases, this process can take as long as four years to complete, particularly if it is a grieving family seeking answers about the care of their loved one.
“Nobody comes into the office for money because somebody has died, it’s not even a feature of the conversation. They just want to see that somebody is held accountable, that something changes in the system, and that other families don’t have to go through what they have experienced,” Melanie says.
Last October, the Irish Hospital Consultants Association (IHCA) said the rising costs of medical negligence is one of the biggest challenges for the health service. This is something Melanie believes can be curbed for women and their families with increased state involvement.
“It’s a rare occasion that I will have an approach for mediation where I don’t have a trial date and this is where most black and white negligence is evident. It’s still very much defend and deny for as long as they can.”
Melanie maintains a complete cultural overhaul of the health system is needed, particularly for cases involving women. She explains that in cases where a child has acquired a brain injury during early childhood as a result of medical negligence, mothers carry “awful guilt” and believe that “they might have done something wrong in their pregnancy” for such a thing to happen.
Last December, University Maternity Hospital Limerick (UMHL) issued a public apology to the mother of a little boy who died at 16-weeks-old following a breach in the hospital’s duty of care to the baby, which resulted in a delayed diagnosis.
When asked about the standard of healthcare in Limerick, and the overcrowding crisis at University Hospital Limerick (UHL), Melanie says while she doesn’t believe there is one root cause, noting anecdotal experiences of other Irish hospitals from clients.
“The difference can be chalk and cheese and they are in the same country,” she says. “Why is there such a geographical divide when it comes to medical care?”
Concerns around surgery abroad
Stories of women travelling abroad for cosmetic procedures are also becoming more common, with many travelling for procedures such as dental surgery, tummy tucks, and hair transplants. But if complications arise once they arrive back home to Ireland, some women are surprised to learn the law isn’t on their side.
This fact, Melanie says, is not well known amongst people who get these procedures done, and if somebody comes to her with such a claim, there is nothing legally an Irish court can do if the surgery was performed in another jurisdiction.
This can also extend to prescription medication, like Ozempic, she says, which (if taken unprescribed) can pose problems for women.
“Patient information leaflets show you how pills should be taken. Don’t discount them,” she says. “They need to be followed, they’re not just there for fun.”
Next month, Melanie’s years-long advocacy for women’s health will take her to the European Parliament, where she will speak at a conference discussing the importance’s of women’s health.
She founded the Mesh Survivors Ireland eight years ago, calling for the suspension of the use of transvaginal mesh. Although the Chief Medical Officer granted the suspension, there are now concerns over doctors offering the surgery to Irish women abroad.
Once one of the most popular gynaecological procedures carried out in Ireland, it was commonly used for treating stress urinary incontinence in women. However, women were not told at the time that the devices could result in chronic pain, with many unaware that the once it was put in, it could not be fully removed in Ireland, Melanie explained.
“We’ve dealt with women whose bladders no longer function, who struggle to mobilise now because the nerves in their groin down to their legs are totally affected. Most of these women have since lost their jobs and their mental health is massively affected,” she says.
“There’s all sorts of questions as to why cross border directive money appears to be used for a process or procedure that was suspended by the Chief Medical Officer. Some women have spoken out about not being able to get this surgery done in Ireland, but I think the question that needs to be asked is why they aren’t being offered alternatives? This should be the last resort option for women.”
Ultimately, Melanie believes that, at its heart, her job is to provide clients with all the information they need to make an informed decision.
“I think it’s a very important thing to learn as a solicitor that all of our clients come to us with their own life experience and it’s not for us to impose what we feel is best for them. It’s for us to give them the options, the risks, the benefits of each choice, and then to think about it for themselves.”
– Court Reporting Scheme