Establishing a Modular Trial Framework in Complex Medical Negligence Litigation

Introduction

The case of Thompson [A Minor] v Health Service Executive (Approved) ([2025] IEHC 156) represents a significant development in the administration of complex medical negligence proceedings in Ireland. In this case, the High Court was called upon to decide on the appropriate method of conducting the trial—a modular trial focusing on discrete factual issues rather than a unitary trial covering all aspects at once.

The litigation arises from claims of medical negligence in the context of ante-natal and post-natal care, where the plaintiff, a minor, is alleged to have suffered severe personal injuries including hypoxic ischemic encephalopathy, developmental delay, and autism spectrum disorder. At the core of the dispute is whether a misinterpretation of a Cardiotocography (CTG) reading—specifically, recording a maternal heart rate instead of a foetal heart rate—led to a delayed intervention and subsequent injury. The defendant (the Health Service Executive) seeks to isolate and resolve two distinct issues of fact in a modular trial setting, thereby hoping to reduce trial duration and cost.

Summary of the Judgment

In the judgment delivered by Ms Justice Reynolds on 5 March 2025, the Court granted the defendant’s application for a modular trial of two separate factual issues:

Whether the CTG was recording the maternal rather than the foetal heart rate on 18 February 2013;
Whether the defendant breached its duty by failing to intubate the plaintiff at 13.33 on the same day.

The Court recognized that resolving these discrete issues independently could lead to significant savings in both time and resources, contrasting with the estimated 16-week duration of a unitary trial. Importantly, the judgment underscored that the success or failure of establishing these specific points would directly impact the overall negligence claim.

Analysis

Precedents Cited

The judgment refers to several key precedents that have shaped the legal landscape for modular trials:

Weavering Macro Fixed Income Fund Limited v PNC Global Investment Servicing (Europe) Limited [2012] 4 IR 681: Clarke J. in this case confirmed the inherent jurisdiction of the court to regulate trials and the permissibility of deciding certain factual issues separately if they are central to the dispute.
Cork Plastics (Manufacturing) v Ineos Compound U.K. Limited [2008] IEHC 93: This decision reiterated that the default position is in favour of a unitary trial. However, it identified factors such as trial complexity, costs, and potential tactical prejudice which could justify a modular approach.
McCann v Desmond [2010] 4 IR 554: In this case, similar considerations regarding time and cost savings, prejudice implications, and the ability to determine issues in isolation were recognized. These principles underpin the decision to adopt a modular trial framework.

These precedents influenced the Court’s decision by establishing that while a unitary trial is generally preferred, the inherent discretion of the court allows for modular trials when doing so promotes efficiency and minimizes undue prejudice.

Legal Reasoning

The Court’s reasoning was grounded in both statutory authority and inherent judicial powers. Relying on O.36, r.9(1) of the Superior Court rules along with its inherent jurisdiction, the Court emphasized the following points:

Efficiency and Resource Allocation: The evidence was clear that a unitary trial would be considerably more time-consuming (estimated at 16 weeks) compared to a modular trial (4-5 weeks). This efficiency in adjudication was paramount in the Court’s decision.
Discrete and Independent Issues: The Court was convinced that the issues concerning the CTG’s interpretation and the timing of intubation were capable of being determined independently. Resolving the CTG issue would potentially render the negligence claims moot if it was established that the CTG was mistakenly recording the maternal heart rate.
Preventing Delay Tactics: The defendant assured that even if an appeal arose from the modular trial decision, it would not be deployable as a delay tactic for the remaining aspects of the case.

The decision also highlights the Court's readiness to adjust its approach should the modular trial framework, in practice, prove to be inadequate in delivering justice.

Impact on Future Cases and Legal Framework

This judgment sets an important precedent for future medical negligence and other complex litigation cases by:

Encouraging the use of modular trials in instances where issues of fact are isolated and can be independently resolved—thereby streamlining proceedings.
Reinforcing the judicial discretion available to courts for trial management, emphasizing the balance between efficiency and fairness.
Potentially influencing broader litigation strategies, as parties may now consider amending pleadings to carve out discrete issues that benefit from a modular approach.

Overall, this decision is likely to be cited in future cases where time, cost, and efficient issue resolution are of paramount importance, thus contributing to a more pragmatic judicial process.

Complex Concepts Simplified

Several legal concepts are central to understanding this judgment:

Modular Trial: Instead of trying all issues at once (a unitary trial), the court agrees to try certain factual issues in separate modules. This means that if one module (e.g., the CTG recording issue) is resolved in a particular way, it could automatically resolve linked claims, such as alleged breaches of duty.
CTG Misinterpretation: The dispute revolves around whether a CTG reading was erroneously interpreted by recording the maternal heart rate instead of the foetal heart rate. The determination of this fact is crucial as it underpins the negligence allegations regarding delayed intervention.
Inherent Jurisdiction: This refers to the court’s authority to manage its processes and make orders (such as directing a modular trial) even if these specific methods are not explicitly outlined in statutory law.

By breaking down these concepts, the judgment becomes more accessible to non-specialists and highlights how procedural efficiency can lead to a more effective administration of justice.

Conclusion

The judgment in Thompson [A Minor] v Health Service Executive (Approved) marks a significant moment in Irish legal procedure by affirming the court’s discretion in ordering a modular trial in complex medical negligence cases. The decision is based on established precedents and careful legal reasoning emphasizing efficiency, resource management, and fairness.

Key takeaways include:

The validation of modular trials as an effective tool in isolating and resolving discrete factual issues.
The reinforcement of judicial discretion in managing the complexity and duration of litigation.
An emphasis on preventing undue delays in the trial process, thereby safeguarding the interests of both parties.

By balancing these considerations, the judgment not only resolves the specific dispute in the case at hand but also sets a new legal precedent that will likely influence the conduct of complex litigation in the future.

Overall, the decision represents a thoughtful integration of judicial efficiency with the commitment to ensuring that justice is both served and seen to be served.