Introduction

Heffernan v Mater Private Hospital (Approved) ([2022] IEHC 260) is a landmark case adjudicated by the High Court of Ireland on May 6, 2022, by Ms. Justice Egan. The case centers on the plaintiff, Dr. Gregory Heffernan, an orthopedic surgeon, and his dispute with Mater Private Hospital ("the Mater") regarding the termination of his practising privileges. The crux of the matter lies in whether the Mater's withdrawal of Dr. Heffernan's theatre and clinic privileges constitutes a breach of contract and violates provisions of the 2020 Constitution.

The High Court's judgment addresses two primary issues: firstly, the appropriate form and nature of the interlocutory order following the initial decision to restrain the termination of practising privileges; and secondly, the allocation of costs arising from the interlocutory application.

Summary of the Judgment

In the interlocutory judgment delivered on December 15, 2021, Ms. Justice Egan restrained the Mater from terminating Dr. Heffernan's practising privileges, finding that the withdrawal could potentially breach contractual obligations and the 2020 Constitution. The subsequent judgment on May 6, 2022, refined the scope of this restraint, determining that Dr. Heffernan was entitled to continue using operating theatres but not necessarily to conduct clinics within the Mater.

The court considered whether Dr. Heffernan's right to hold clinics was inherently part of his practising privileges. It concluded that although theatres were essential to his practice, the clinics were not, especially given that Dr. Heffernan had ceased holding clinics at the Mater prior to the termination notice and had established clinics elsewhere. Consequently, the court maintained the restriction to theatre privileges, thereby refining the initial interlocutory order.

Regarding costs, the court analyzed the applicability of Order 99 rules and the Legal Services Regulation Act 2015. It ultimately decided not to fix the Mater with the costs of the interlocutory application, instead treating Dr. Heffernan's costs as costs in the cause, balancing the potential for future proceedings and the current evidence presented.

Analysis

Precedents Cited

The judgment references several key precedents that influenced the court's decision-making process:

• ACC v. Hanrahan [2014] IESC 40: This case established principles regarding the awarding of costs in interlocutory injunctions, particularly distinguishing between final determinations and matters to be revisited at trial.
• Mason v. ILTB Ltd trading as Gillen Markets and Dermot Browne [2021] IEHC 539: Affirmed the approach to costs in interlocutory applications, emphasizing that costs follow the event unless justly adjudicated otherwise.
• Maha Lingham v Health Services Executive [2006] 17 Employment Law Reports 140: Provided a standard for determining whether a fair issue exists to be tried, a key consideration in granting interlocutory relief.
• Glaxo Group Ltd v. Rowex Ltd [2015] IEHC 467: Clarified the distinction between interlocutory applications that hinge on issues to be fully resolved at trial versus those based on conclusory matters like damages and balance of convenience.
• Allied Irish Banks v Diamond [2011] IEHC 505 and Tekenable Limited v Morrissey [2012] IEHC 391: These cases were instrumental in shaping the court’s understanding of when it is just to determine costs at the interlocutory stage, especially when factual disputes are likely to be re-examined at trial.

Legal Reasoning

Ms. Justice Egan navigated the intricate balance between contractual rights and constitutional provisions. The key aspects of her legal reasoning include:

• Definition of Practising Privileges: The court acknowledged that neither the 2020 Constitution nor the Shanakiel Agreement explicitly defined "practising privileges." Consequently, the court focused on maintaining the status quo rather than strictly defining these privileges.
• Status Quo Maintenance: Given that Dr. Heffernan had already ceased holding clinics at the Mater prior to the termination notice and had established alternate clinic facilities, the court deemed it sufficient to restrain only the withdrawal of theatre privileges to preserve the contractual and professional balance.
• Balance of Convenience: While theatre privileges were deemed essential to Dr. Heffernan’s practice, clinics were not, especially since alternative arrangements were already in place.
• Cost Adjudication: The court meticulously analyzed whether determining costs at the interlocutory stage was just. Considering the core issues, particularly the applicability of the 2020 Constitution—a largely factual question—the court refrained from awarding costs to the Mater, instead treating the plaintiff’s costs as costs in the cause.

Impact

This judgment has significant implications for:

• Medical Professionals: Clarifies the extent of practising privileges and the conditions under which they can be curtailed.
• Contracts Governed by Constitutional Provisions: Highlights the complexities when contractual relationships intersect with constitutional mandates, emphasizing the need for clear definitions within contractual agreements.
• Interlocutory Costs: Reinforces the precedent that costs in interlocutory applications should be carefully adjudicated, particularly when core issues remain unresolved and are to be examined in detail at trial.
• Future Litigation: Sets a precedent for how similar cases involving the preservation of professional privileges and the intersection of contract and constitutional law may be approached.

Complex Concepts Simplified

• Interlocutory Judgment: A temporary court order issued before the final decision, intended to preserve the status quo until the case can be fully heard and decided.
• Balance of Convenience: A legal principle used to determine which party would suffer more harm from a particular court order, guiding the court in deciding whether to grant interim relief.
• Costs in the Cause: Legal costs that are related to the entire litigation process, rather than a specific stage or application within the proceedings.
• Practising Privileges: Permissions granted to a medical professional allowing them to perform certain medical activities within a hospital, such as surgeries in operating theatres or conducting clinics.
• 2020 Constitution: Refers to constitutional provisions or agreements that may impact contractual relationships, although in this context, it appears to be a specific agreement or constitutional framework relevant to the case.

Conclusion

The High Court's judgment in Heffernan v Mater Private Hospital underscores the nuanced interplay between contractual obligations and constitutional provisions within professional settings. By carefully delineating the extent of Dr. Heffernan’s practising privileges, particularly distinguishing between theatre and clinic access, the court has provided a clearer framework for similar disputes. Furthermore, the thoughtful adjudication of costs in interlocutory applications sets a balanced precedent, ensuring that neither party is unjustly burdened while recognizing the unresolved factual and legal questions that warrant comprehensive examination at trial. This case serves as a pivotal reference point for future litigations involving professional privileges, contractual definitions, and the procedural nuances of interlocutory relief.