Fussy, pernickety and “hopefully thorough”. That is how breast and general surgeon Michael Sugrue describes his approach to clinical practice.
While HSE colleagues often talked of their concerns about the potential to be sued, legal issues that can arise out of surgical work were not really on the former Letterkenny University Hospital consultant’s radar. He was focused on maintaining standards and believes he ran a “very tight ship” at the Donegal breast unit.
“I always thought if you looked after the patient then you didn’t have to worry about the lawyers,” Sugrue says. “We do occasionally make mistakes and we inform the patient. It is their right to potentially sue you, but it never really worried me as such.”
But in mid-2022, after about 30 years working as a consultant and just a few years before he was due to retire from the HSE, Sugrue became the subject of a claim that would see him travel to Dublin’s Four Courts more than 40 times.
Very few medical negligence cases make it to trial. Data from the State Claims Agency, which manages actions against public bodies such as the HSE, shows just 2 per cent of all injury claims (including non-clinical claims) are the subject of a court judgment, with about half of these resulting in an award of damages.
Nearly 60 per cent of actions are resolved before court proceedings are issued, while 38.5 per cent conclude after proceedings are brought but before any court judgment.
Sugrue says he was warned by colleagues it would be unwise to defend a High Court claim and that settling would be better. This was because a judgment against him could potentially harm or close the breast unit, while the case would take a “tremendous toll” on him personally, he says.
But he felt sure he had not made a mistake or been negligent, and he believed he had a duty to “take a stance” and stand over his work. He was “determined that the truth would come out”.
After a 23-day hearing, the High Court in March 2023 dismissed the case brought against the HSE alleging there was a delay in diagnosing a patient’s breast cancer.
Judge Mary Rose Gearty found the woman did not establish there was a 15mm cancer on her breast when she saw Sugrue at the Letterkenny hospital in the summer of 2017.
There was no doubt that the plaintiff’s evidence was sincere, but if there was cancer present when she visited the unit, it was likely undetectable at that point, the judge said. The damage to the woman, who recovered after undergoing invasive treatment, was “caused by cancer and not by medical negligence”, the court found. Gearty said Sugrue had been meticulous in his approach to clinical assessment.
Eighteen months later the Court of Appeal rejected the woman’s appeal and refused to grant a retrial of the claim. The three-judge court said the case “failed at the first causation hurdle”.
After the verdicts, Sugrue felt relief for himself, his wife and the staff at the Letterkenny hospital.
Other doctors have retired following negative judgments or settlements due to the stress involved, and many consultants reached out to him to say he had provided a “beacon of hope”, he says.
“I was actually surprised there were so few cases that go to the High Court. After my experience, however, I am not that surprised … I had no idea the toll it would take on me, my family and the unit.”
But he found the High Court and Court of Appeal examined the issues fairly and objectively. “I’m glad to say that I do have confidence in the justice system.”
Would he advise other doctors to defend their work in court if they believe it did not contain errors?
“Definitely,” he replies. “It is your honour, your unit’s credibility and it is the service that we believe in. If you believe you are right I think you should, but if there is any ambiguity in your own mind then I certainly would not recommend the court.”
But defending a claim requires a “huge personal commitment”, he adds. Sugrue estimates he spent about 200 hours driving between his home in Ramelton, Co Donegal, and Dublin’s Four Courts. A further 160 hours or so were taken up by court time.
Although he could have attended only for his three days of testimony, he felt there was “a lot at stake” and decided to be present for nearly all of the hearings in the High Court and Court of Appeal.
Michael Sugrue says he travelled from his home in Co Donegal to Dublin’s Four Courts about 40 times. Photograph: Enda O’Dowd
Over further countless hours he and his wife Pauline pored over notes and transcripts from the proceedings.
“We rechristened our kitchen the Law Library … It took a huge personal toll on my ability to go to work because of the time commitment required.”
He missed some operating lists, cancelled clinics and shelved his research programme that would normally take place each summer, he says. “I actually received a Mass card from one of the nurses in theatre who thought I might have been ill.”
Sugrue knows he probably takes his job “too seriously” and would have found it “very hard to live with” being found guilty of negligence.
“To me surgery is a vocation. You give your life to helping people, and that is something I really enjoy doing … There are times when we do make mistakes, and I have made many mistakes, and you inform the patient about that,” he says.
Having been through the court process, Sugrue feels there is scope for significant improvements, particularly in efficiency.
He believes some claims should be capped so they become affordable but still “appropriate for the patient, because doctors do make mistakes and patients do deserve to be compensated where mistakes are made”.
The State Claims Agency was last year managing more than 4,000 claims alleging clinical negligence, with an estimated outstanding liability of €4.43 billion. Although clinical claims represented just 38 per cent of the 10,600 claims involving the agency, they take up 81 per cent of the overall estimated outstanding liability due primarily to higher levels of settlements and awards, according to a recent report by the agency’s parent organisation, the National Treasury Management Association.
Data from the Courts Service shows there were 130 clinical negligence awards made in the High Court last year, with a total value of €141.9 million. This was up from 99 awards valued at €93.4 million in 2024. Last year’s awards included 48 with values of more than €500,000.
Sugrue says medical legal claims have an effect right across the health service, including in primary care, GP clinics and hospitals.
“It is becoming a really major problem in Irish medicine. People are becoming afraid of being sued.”
A case, with accompanying negative publicity, stress and anxiety, “can be the end of your career”, he says.
Although the result of his case was reported on by this newspaper and a few others, Sugrue found the lack of wider coverage to be “remarkable”.
“Had I lost the case I felt I would have been on the six o’clock news,” he says.
Sugrue, who is soon to take up a professorship at Irish-backed RUMC medical school in Malaysia, recently retired from practice in the HSE and is relieved he did not bow out with a negative judgment against him.
“I didn’t think this was going to be a fair end to my surgical career. There is a concept of natural justice.”