The rapid shift toward digital healthcare has transformed how medical advice is delivered across Ireland. While remote consultations offer convenience, they also introduce unique risks when the safeguards of a physical examination are removed. Patients often feel vulnerable and confused when a diagnosis is missed over a video call or when critical symptoms are overlooked during a telephone triage.
At Michael Boylan LLP, we understand the distress caused when standards of care are not met in a virtual setting. We provide expert legal guidance to individuals and families seeking to investigate lapses in remote medical care.
Telemedicine and virtual care in Ireland: What it includes
Virtual care, often referred to as telemedicine or telehealth, involves the delivery of medical services and clinical advice without the patient and the doctor being in the same room. It is not a separate branch of medicine but rather a different method of delivery. In Ireland, this has become increasingly common for General Practitioner (GP) appointments, out-of-hours triage services, and even some specialist consultant reviews.
The most common formats include video consultations via secure apps, telephone assessments where visual cues are absent, and online triage platforms where patients submit symptoms via text or web forms to receive a callback. While these tools are efficient for administrative tasks, they rely heavily on the clinician’s ability to gather information accurately without the benefit of touch or direct observation.
Where virtual care standards can fail
The absence of physical contact creates a specific set of risks that clinicians must actively manage. In a traditional setting, a doctor might notice subtle signs,a smell on the breath, a clammy handshake, or a specific gait,that trigger a diagnosis. In virtual care, these safeguards are removed. Negligence often arises not because the technology failed, but because the clinician failed to adapt their practice to the limitations of that technology.
Missed or delayed diagnosis in remote consultations
In the absence of a physical exam, the standard of care requires a doctor to take an exceptionally thorough history. Claims often arise when there is:
- Incomplete history-taking, where the clinician fails to ask probing questions that would substitute for the lack of visual checks.
- Over-reliance on assumptions, such as assuming a child’s cough is viral without visually assessing their work of breathing.
- A failure to explore red flags,critical indicators of serious illness,can lead to dangerous delays.
If a doctor cannot confidently rule out a serious condition remotely, the standard of care mandates that they convert the consultation to an in-person visit immediately.
Failure to escalate and “safety-netting” gaps
"Safety-netting" is the medical term for telling a patient exactly what to look out for and when to seek help if things do not improve. In virtual care, this is the most vital safeguard. Negligence issues often centre on vague or missing instructions. When advice is not clearly given or recorded, and a patient's condition deteriorates, it may represent a breach of duty.
Remote prescribing and medication errors
Prescribing medication without seeing a patient carries inherent risks. Clinicians must ensure they have access to the patient's full medical record.
Common failures in this area include:
- Inadequate review of contraindications, where a drug prescribed remotely reacts badly with existing medication the doctor failed to ask about.
- Failure to verify allergies, particularly when dealing with patients not previously known to the service (e.g., out-of-hours services).
- Safeguarding failures on repeat prescriptions, such as issuing antibiotics or painkillers repeatedly without an in-person review to check for side effects or dependency.
- Dosage errors caused by relying on a patient’s estimated weight (especially in paediatrics) rather than a verified measurement.
Triage and administrative failures
Telemedicine is often delivered via a chain of communication involving non-clinical staff. It is important to treat telemedicine as a system of care.
Risks include:
- Delayed callbacks, where a patient with urgent symptoms is left waiting hours for a doctor’s assessment due to poor prioritisation.
- Misdirected messages, where details of symptoms sent via an app are not passed correctly to the prescribing clinician.
- Failures by non-clinical staff, such as receptionists actively blocking access to care or misinterpreting the urgency of a "chest pain" call as a routine query.
- Algorithm errors, where online triage forms fail to trigger an urgent alert for a combination of symptoms that a human doctor would immediately recognise as dangerous.
Communication barriers and technical record gaps
Clear communication is the bedrock of safe medicine. In virtual settings, technical issues can compromise this.
We frequently see cases involving:
- Poor audio or video quality, leading to misunderstandings about symptoms (e.g., a doctor mishearing "chest tightness" as "chest tiredness").
- Language barriers that are harder to overcome without non-verbal cues or professional interpreters.
- Dropped calls that are not immediately reconnected, leaving the patient assuming the consultation is finished.
- Incomplete documentation, where the specific limitations of the call (e.g., "video quality poor") are not recorded in the notes, making it difficult to audit the quality of care later.
Risks with remote monitoring and health apps
Remote patient monitoring involves using devices (like blood pressure monitors or pulse oximeters) at home and sending data to a clinical team. Negligence can occur through:
- Misinterpretation of data, where a device gives a false reading that a clinician relies on without verification.
- Delayed review of alerts; for instance, if a patient’s heart rate spikes over the weekend, but the system is only monitored Monday to Friday, and the patient was not informed of this gap.
- Unclear responsibility for monitoring, which often leads to patients assuming a doctor is watching their data in real-time when they are not.
The standard of care in a virtual setting
The core principle: professional duties still apply
It is a fundamental legal and medical principle that the standard of care does not drop simply because the consultation is remote. A doctor seeing a patient via video link owes the exact same duty of care as a doctor seeing a patient in a surgery.
The Medical Council of Ireland is clear on this: clinicians must ensure that the care provided is safe and effective. If a physical examination is necessary to make a safe diagnosis, the doctor must decline to treat remotely and arrange for the patient to be seen in person. Proceeding with a remote diagnosis when it is clinically unsafe to do so can be considered negligence. Additionally, requirements regarding patient consent and data privacy remain strictly in force.
Ireland’s direction of travel on telehealth
While the HSE has published a Telehealth Roadmap aiming to integrate digital solutions into the public system, the legislative framework specifically for telemedicine remains limited. However, this does not mean it is an unregulated "wild west." The common law principles of negligence and the ethical guidelines of the Medical Council apply rigorously. While the technology is modern, the professional obligations to be competent, thorough, and safe remain traditional and strict.
Who is responsible in these cases?
Determining liability in virtual care claims can be complex as multiple parties are often involved in the delivery of the service.
Potential liable parties include:
- Clinicians: The individual GP, consultant, or nurse practitioner who provided the advice or prescription.
- Platforms and Systems: The private company providing the digital triage app or the out-of-hours call handling service, particularly if their protocols or algorithms were flawed.
- Public vs Private Bodies:
- If the care was provided through the public system (e.g., a public hospital outpatient video call), the State Claims Agency (HSE) typically handles the liability.
- If the care was provided by a private GP or a commercial online doctor service, the claim is usually against the clinician’s private indemnity insurer (such as the Medical Protection Society or Medisec).
Cross-border providers and jurisdiction issues
A growing complexity in telemedicine involves services where the doctor or the platform is based outside of Ireland. If you use an app that connects you to a doctor based in the UK or the EU, jurisdiction issues arise.
Questions may be raised regarding:
- Licensing: Was the doctor registered with the Medical Council of Ireland?
- Prescribing laws: Was the prescription valid in Irish pharmacies?
- Legal Jurisdiction: Can the case be heard in Irish courts?
These cross-border elements require specialist legal analysis to ensure the correct defendant is identified and that the claim is brought in the correct jurisdiction.
Evidence to preserve in virtual care disputes
In traditional medical negligence, the medical file is the primary evidence. In virtual care cases, the digital footprint of the interaction is equally vital.
If you are concerned about the quality of remote care, you should preserve:
- Call logs and timestamps: Proof of when calls were made, how long they lasted, and if calls were dropped.
- App screenshots: Images of the interface, the advice given on screen, or the triage questions asked.
- Emails and text messages: Any digital correspondence regarding appointments, prescriptions, or follow-up instructions.
- Digital prescriptions: Copies of the barcode or email sent to the pharmacy.
- Your own notes: A contemporaneous diary of what was said during the call, particularly regarding safety-netting advice.
- Medical notes: We will assist in requesting the clinician’s official record of the remote consultation to compare it against your recollection.
How these claims are typically assessed
The core legal questions (Duty, breach, causation)
To succeed in a medical negligence claim regarding virtual care, three main elements must be proven:
- Duty of Care: Establishing that a doctor-patient relationship existed (usually straightforward in telemedicine).
- Breach of Duty: Proving that the care provided fell below the standard expected of a reasonably competent doctor. In virtual care, the question is typically: “Would a competent doctor have insisted on seeing this patient in person?”
- Causation: Proving that the breach of duty directly caused the injury. We must show that if the patient had been seen in person, the outcome would have been different (e.g., the diagnosis would have been made earlier, preventing the harm).
Expert evidence and why it is necessary
Judges are not doctors. Therefore, these cases rely heavily on independent expert evidence. We engage leading medical experts (often from the UK to ensure independence) to review your records. They will provide an opinion on whether the remote care met the required standard and whether the virtual format contributed to the error. Without this objective expert support, a claim cannot proceed.
Time limits for legal action
It is crucial to be aware of the strict time limits that apply to medical negligence claims in Ireland.
- The Two-Year Rule: Generally, you have two years from the date of the injury to issue legal proceedings.
- Date of Knowledge: In some cases, you may not realise negligence occurred until later. The two-year clock may start from the date of knowledge,the date you first realised (or should have realised) that your injury was significant and potentially caused by medical error.
- Exceptions: Different rules apply for children (time limits generally start from their 18th birthday) and those without mental capacity.
Given the complexity of investigating virtual care records, it is advisable to seek advice well before the two-year limit approaches.
Why Michael Boylan LLP?
Specialist focus on medical and professional negligence
Medical negligence is not just a part of what we do; it is our core specialism. Michael Boylan LLP is recognised as one of Ireland’s leading firms in this complex area of law. We understand the nuances of clinical risk, particularly in emerging fields like telemedicine.
An evidence-led approach to complex records
Virtual care cases often involve fragmented records,part digital, part paper, part audio. Our team is skilled in forensic analysis of medical files. We know how to identify gaps in the audit trail and how to interpret digital triage logs. We build our cases on hard evidence and authoritative expert opinion, ensuring that when we advise you, it is based on a realistic assessment of the facts.
Supporting clients through the process
We recognise that investigating a medical mistake is stressful and emotional. Our approach is supportive and client-focused. We aim to take the burden of the investigation off your shoulders, allowing you to focus on recovery. We explain every step of the legal journey in plain English, ensuring you feel empowered and informed, never overwhelmed.
FAQs
Are phone and video consultations held to the same professional standard as in-person appointments?
Yes. The standard of care remains the same regardless of the format. Doctors must ensure they can safely assess you. If they cannot make a safe diagnosis remotely, they are professionally obligated to arrange an in-person examination.
What should I do if my symptoms worsened after an online consultation?
If your symptoms have worsened, you should seek immediate medical attention, ideally in person (e.g., at a GP surgery or A&E). Do not wait for a callback if your condition is deteriorating. The safety-netting advice given during the call may have been insufficient, but your immediate health is the priority.
What information should I keep from a telemedicine appointment?
Retain everything. Save screenshots of the booking, the call duration log on your phone, any emails or texts received, and digital prescriptions. Write down a timeline of what was discussed, focusing on what advice you were given about follow-up care.
Can triage or reception errors matter in a virtual-care negligence case?
Yes. If a receptionist or triage algorithm incorrectly filters your request,for example, marking "chest pain" as routine rather than urgent,and this leads to a delay in care that harms you, the provider may be liable for that system failure.
What if the online doctor service was based outside Ireland?
This complicates the legal process but does not necessarily prevent a claim. It raises questions about jurisdiction and which country's laws apply. It is vital to seek legal advice early to determine if the provider can be pursued through the Irish courts.
Does making a complaint affect a later legal case?
Generally, no. Making a complaint via the HSE’s "Your Service Your Say" or to the practice directly does not bar you from taking legal action later. In fact, the written response to your complaint can often provide valuable evidence regarding what went wrong.
How long do I have to take advice about a potential clinical negligence claim?
The general rule is two years from the date of the injury or the date you became aware of the injury. However, investigating these claims takes time. It is best to seek advice as soon as you suspect something went wrong to ensure evidence is preserved.
Can I claim for a prescription error made by an online pharmacy?
Yes. Pharmacists and online prescribing services have a duty of care to check for contraindications and appropriateness. If they dispense the wrong medication or fail to spot a dangerous interaction that causes you harm, a claim may be possible.
Contact Our Specialist Team
If you or a loved one has suffered due to a missed diagnosis, medication error, or failure of care during a remote medical consultation, it is important to understand your rights.
At Michael Boylan LLP, we offer a confidential and expert assessment of your situation. We will help you determine if you have grounds for a claim.
Contact us today to discuss your experience in confidence.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
