Cardiothoracic Surgery Negligence Claims

Overview: Understanding Cardiothoracic Surgery

Cardiothoracic surgery is a specialised field of medicine that focuses on the surgical treatment of organs inside the chest (the thorax). Generally, this discipline covers both heart surgery (cardiac) and surgery on the lungs or chest wall (thoracic).

Cardiac surgery (heart and major vessels)

Cardiac surgery deals specifically with the heart and the major blood vessels connected to it. In simple terms, this involves procedures to repair or replace heart valves, bypass blocked arteries to improve blood flow, or repair damage to the heart muscle itself. These surgeries almost always involve a team of consultants, perfusionists (who manage the heart-lung machine), and specialist nurses.

Thoracic surgery (lungs and chest cavity)

Thoracic surgery focuses on the lungs, the oesophagus (gullet), and the chest wall, excluding the heart itself. This type of surgery is most commonly used to treat diseased lung tissue, such as removing tumours or managing severe infections. The goal is often to remove damaged tissue or repair structural issues that are affecting breathing or swallowing.

Why these cases are clinically complex

Cases involving the chest and heart are among the most complex in medical negligence litigation. This is because multiple medical teams are involved at every stage. A single patient journey involves the surgical team, the anaesthetic team, and the intensive care (ICU) staff. Because the heart and lungs are vital for life, the margin for error is incredibly small. Identifying exactly where a failure occurred requires a forensic level of attention to detail and a deep understanding of hospital protocols.

Common procedures involved in these claims

To understand where issues may arise, it is helpful to look at the specific surgeries most frequently involved in these enquiries.

Cardiac procedures

Cardiac surgeries are high-stakes operations. Negligence enquiries in this area often focus on technical proficiency and the management of blood flow during the operation.

• Coronary Artery Bypass Graft (CABG): Commonly known as a "bypass," this involves taking a healthy blood vessel from another part of the body (like the leg or chest wall) and grafting it onto the heart to bypass a blocked artery. Issues can arise if the graft fails, is attached incorrectly, or if the heart is not adequately protected during the procedure.
• Valve Repair and Replacement: This involves fixing a damaged heart valve or replacing it with an artificial (mechanical) or biological (tissue) valve. Critical errors here can involve incorrect sizing of the valve, damage to surrounding heart tissue during insertion, or failure to secure the valve properly, leading to leaks.
• Aortic Procedures: Surgery on the aorta (the body's main artery) is required for aneurysms or dissections (tears). These are high-risk surgeries where controlling bleeding and blood pressure is paramount. A failure to manage these factors can lead to catastrophic strokes or internal haemorrhage.

Thoracic procedures

Thoracic surgery has evolved significantly with technology, but the risks of infection and organ damage remain.

• Video-Assisted Thoracoscopic Surgery (VATS): This is "keyhole" surgery where small incisions are used to insert a camera and instruments. While less invasive, there is a risk of unnoticed injury to blood vessels or surrounding organs if the surgeon’s view is obstructed or if the conversion to open surgery is delayed when complications arise.
• Open Thoracotomy: This involves making a large incision between the ribs to access the lungs. It is a major procedure used for complex cases. Complications here often relate to pain management errors, nerve damage, or failure to close the chest wall securely, leading to infection or respiratory failure.
• Lung Resections (Lobectomy/Pneumonectomy): This is the removal of a lobe of the lung or an entire lung, usually to treat cancer. The critical issues often involve ensuring the remaining lung tissue is sealed (to prevent air leaks) and that the patient has sufficient lung capacity to survive without the removed tissue.

Where the standard of care may fall short

In medical negligence law, a poor outcome does not automatically mean negligence occurred. To build a case, we must establish that the care provided fell below the standard expected of a reasonably competent professional. We examine the entire timeline of your care to identify these failures.

Before surgery (Pre-operative)

Failures often occur before the patient even reaches the operating theatre. Proper planning is just as critical as the surgery itself.

• Assessment Failures: Doctors must thoroughly assess a patient’s fitness for surgery. This includes cardiac testing (like angiograms) and lung function tests. Missing a red flag in these tests can lead to operating on a patient who is too high-risk for the procedure.
• Medication Management: Patients on blood thinners (anticoagulants) need careful management to prevent excessive bleeding. Failing to stop these medications correctly before surgery is a common source of avoidable harm.
• Infection Risk Planning: Patients must be screened for infections like MRSA. A failure to treat existing infections or provide prophylactic (preventative) antibiotics can lead to devastating deep-seated infections after surgery.

During surgery (Intra-operative)

This is the phase where technical skill and immediate decision-making are scrutinised.

• Surgical Technique Errors: This refers to avoidable physical mistakes, such as nicking a nearby artery, nerve, or organ. While some risk is inherent, a surgeon must demonstrate the dexterity and care expected of a specialist.
• Equipment Checks: The surgical team is responsible for ensuring all equipment, from heart-lung machines to surgical sponges, is accounted for and functioning.
• Decision-Making Under Pressure: If a complication arises, such as unexpected bleeding, the surgeon must react appropriately. A delay in converting from keyhole to open surgery, or a failure to call for senior assistance when out of one's depth, can constitute negligence.

After surgery (Post-operative)

The period immediately following surgery is arguably the most critical for patient survival. This is where the standard of care often relates to vigilance.

• ICU Monitoring Failures: After major chest surgery, patients require intense monitoring of vital signs. A failure to spot dropping blood pressure or oxygen saturation can delay the diagnosis of internal bleeding or heart failure.
• Failure to Escalate Deterioration: Junior doctors or nursing staff may spot signs of trouble but fail to alert the consultant in charge. Delays in returning a patient to theatre for a bleed or a leak can turn a manageable complication into a fatal one.
• Discharge Issues: Sending a patient home too early, without ensuring their wound is healing or their infection markers are stable, is a significant failure. Missing signs of sepsis or deep sternal wound infection before discharge is a frequent area of investigation.

Distinguishing between a "known risk" and negligence

One of the most difficult aspects for patients to understand is that a bad outcome is not always the result of negligence. All surgeries carry inherent risks. For example, there is a known statistical risk of infection or bleeding in any heart operation, even when the surgeon performs the procedure perfectly. If a complication is considered a "known risk" and you were warned about it, and the medical team managed it correctly when it happened, it is unlikely to be considered negligence.

However, an avoidable error is different. Negligence occurs when the care provided fails the "standard of care" test. In Irish law, we must prove that no other reasonably competent medical professional of the same status and skill would have acted in the same way under the same circumstances. If the surgeon cut a vessel they shouldn't have, or the team ignored clear signs of infection that a competent doctor would have treated, that is not a "known risk",that is a failure of care.

Time limits for cardiothoracic claims in Ireland

It is crucial to act quickly when considering legal recourse, as strict time limits apply.

Generally, under the Statute of Limitations, you have two years to initiate legal proceedings. This two-year clock typically starts ticking from the date the negligence occurred. However, in medical cases, the injury is not always immediately obvious.

Therefore, the two-year period may start from the "date of knowledge". This is the date you first realised (or should have reasonably realised) that your injury was significant and that it was potentially caused by a medical error. Determining this date can be legally complex. There are also exceptions for those who lack mental capacity. We strongly advise seeking legal counsel as soon as possible to ensure you do not fall outside these strict time limits.

What an investigation typically focuses on

When you engage Michael Boylan LLP, we initiate a thorough forensic investigation to uncover the truth.

Building the timeline

The first step is establishing a precise, minute-by-minute timeline of events. We need to know exactly what happened and when. Did the drop in blood pressure happen at 10:00 AM? When was the doctor called? When did they arrive? Establishing these facts helps us identify delays and gaps in care that may not be obvious from a casual reading of the notes.

Medical records and independent experts

We will request your full medical file, including handwritten clinical notes, operation reports, anaesthetic charts, and radiology imaging (X-rays/CT scans). Once we have organised these, we send them to independent medical experts,typically senior consultants from the UK or further afield,to ensure an unbiased opinion. These experts will provide a report stating whether, in their professional opinion, the care you received met the required standard or if it was negligent.

Practical steps for patients seeking clarity

If you are concerned about the treatment you received, there are immediate steps you can take to assist any future investigation.

• Keep a written timeline: Write down everything you remember as soon as possible. Dates, times, names of doctors, and conversations are easier to recall now than in a year’s time.
• Keep discharge notes: Retain all letters, discharge summaries, and prescription lists given to you by the hospital.
• Document follow-up: Keep a record of any follow-up appointments, including what was discussed regarding your recovery or complications.
• Request your records: While we will do this formally, you have a right to request a copy of your own medical records from the hospital under Data Protection acts.

Why Michael Boylan LLP?

Choosing the right solicitor is the most critical decision you will make in this process. You need a team that understands both the law and the medicine.

Specialist focus on medical and professional negligence

We do not dabble in other areas of law. Our practice is dedicated to medical negligence. This specialisation means we possess a deep, nuanced understanding of clinical issues. We understand the language of cardiothoracic surgeons and know how to interrogate complex medical evidence.

An evidence-led approach

We pride ourselves on providing honest, realistic advice. We are led entirely by the evidence. If the independent experts conclude that negligence occurred, we will pursue your case with rigour and determination. We believe in managing your expectations from day one.

Supporting clients through complex litigation

We understand that behind every file is a person or a family who has suffered a trauma. Litigation can be stressful, but our role is to shoulder that burden for you. We treat every client with dignity, empathy, and respect, ensuring you are kept informed and supported throughout what can be a lengthy process. We fight to secure the answers and the security you deserve.

FAQs

Can a delay in spotting infection be considered negligence?

Yes, potentially. While getting an infection is a risk of surgery, a failure to diagnose and treat it promptly can be negligence. If there were clear signs (like fever, rising white blood cell count, or wound discharge) that were ignored or not acted upon by the medical team, leading to a worse outcome, this may be grounds for a case.

What if I signed a consent form mentioning risks?

Signing a consent form does not sign away your rights. You consented to the procedure and its unavoidable risks (like a small chance of infection). You did not consent to negligent care. If the surgeon made a mistake that no competent surgeon should make, the consent form does not protect them from liability.

What documents are most important to gather first?

The most critical documents are your medical records. This includes the operation notes, the anaesthetic chart, the fluid balance charts from ICU, and nursing notes. While your solicitor will gather these, keeping your own discharge summary and a diary of events is very helpful.

Does the Injuries Resolution Board handle these claims?

Generally, no. The Injuries Resolution Board (formerly PIAB) usually declines to assess medical negligence claims because they are too complex and require detailed liability investigations. These cases typically proceed through the court system, though many are settled through mediation before reaching trial.

How long do I have to start a claim?

In Ireland, the general rule is two years from the date of the injury or the "date of knowledge" (when you found out the injury was caused by negligence). Because establishing the Date of Knowledge can be tricky, it is safest to seek legal advice immediately to avoid being time-barred.

Will I have to go to court?

Not necessarily. The vast majority of medical negligence cases in Ireland are settled outside of court. We prepare every case as if it will go to trial to ensure the strongest position, but we frequently use mediation and settlement meetings to resolve cases without the stress of a full court hearing.

Can I claim on behalf of a family member?

Yes. If a family member has passed away due to suspected negligence, or if they have suffered a brain injury and lack the capacity to instruct a solicitor, a next of kin or legal representative can bring a claim on their behalf.

Take the next step towards clarity

If you or a loved one has suffered due to complications in cardiothoracic surgery, we are here to help you understand what happened and whether you have a valid case for legal redress.

Contact Michael Boylan LLP today. We will listen to your story, review your situation, and provide the expert guidance you need to move forward.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.