A 42-year-old man with a profound brain injury who sued over an alleged delay in the diagnosis of his tuberculosis meningitis has settled a High Court action for €10m.
The marketing executive was only 30 years of age when he had two strokes 12 years ago and as a result of the brain injury can never work again. He now lives in a residential facility.
It was claimed that early diagnosis of the tuberculosis meningitis and prompt treatment with anti-tuberculosis triple or quadruple therapy would have led him to make a full recovery and would have avoided the strokes.
He had sued the HSE for the care he received between October 2009 and about January 2010 at the Connolly Hospital, Blanchardstown, Dublin after he presented with back pain, loss of weight and other symptoms. He claims there was an alleged delay in diagnosing tuberculosis meningitis.
His side contended that when he first presented to Connolly Hospital he did not have neck rigidity which they say suggests his disease was in the early stages and eminently treatable. The settlement against the HSE is without an admission of liability.
His Counsel, Edward Walsh SC instructed by Lucy Boyle of Tormey's Solicitors, told the court the man sustained a profound brain injury after two strokes in April and November 2010.
Counsel said it was a particularly tragic case. The executive, he said, in September 2009 began to develop back pain and feel unwell. By October, he couldn't walk or drive and his mother drove him to the A&E at Connolly Hospital, Blanchardstown, Dublin.
At that time, the provisional diagnosis was thought to be sciatica and he was prescribed painkillers and given a sick note for 10 days off work.
A lumbar MRI scan which was carried out in a private capacity in October, counsel said, was reported back as normal. Counsel said it was their case that the scan in fact showed a 2.5cm mass and if read correctly alarm bells would have been sounded and a tuberculosis meningitis diagnosis would have been made.
The man, counsel said, lost 25kg or four stone over a period of months and at one stage on the way to the cinema with his girlfriend he suffered a blackout and later hallucinations. Counsel said there were indicators of underlying tuberculosis meningitis which should have warranted a multi-disciplinary investigation.
There were, counsel said, “classic signs” and “ alarm bells of significant infection”.
On January 17, 2010, the man went back to Connolly Hospital and a five-day history of fever, headache, nausea and vomiting was recorded. Various tests were carried out and the man's case was reviewed, and on January 20, 2010, he was transferred to Beaumont Hospital, Dublin.
A number of diagnoses were raised including TB. A repeat lumbar puncture was performed the next day and TB meningitis was noted.
In the proceedings, it was claimed there was an alleged failure to have any regard to the fact that the man looked thin and had lost weight over a period of months.
There was also, it was claimed, an alleged failure to have regard to the history of night sweats, malaise, nausea, headache as well as a history of confusion, disorientation and slurring.
By the evening of January 17, 2010, there was an alleged failure to put the pieces of information together to make tuberculosis a principal diagnosis and to start anti-tubercular treatment.
There was, it was claimed, a failure to combine lumbar puncture results which showed a high level of protein with clinical information available which it was claimed clearly pointed to tuberculosis meningitis.
There was an alleged failure, it was claimed, at any stage to work on the basis that tuberculosis was the likely cause of the man’s condition.
As late as January 20, the belief that the pathogen was unidentified persisted when it was claimed the overwhelming balance of probability was that it was mycobacterium tuberculosis and required urgent therapy. All the claims were denied.
Approving the settlement, Mr Justice Paul Coffey said it was fair and reasonable and he noted the praise of the man’s counsel for the HSE in its efforts to bring the matter to a conclusion.