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RDJ's Healthcare Department were involved in successfully resisting an appeal where the Court of Appeal has upheld a modular trial Order confirming strategic case management is appropriate in complex clinical negligence litigation.
Jenny Foley and Linda Ryan review the recent Court of Appeal decision of Mr. Justice Binchy 1 .
On 22 December 2025, the Court of Appeal delivered Judgment in IT v Health Service Executive, dismissing the Plaintiff's appeal from the High Court Order directing a modular trial.
The High Court had ordered 2 that two specific questions of fact be tried before any other issues: (i) whether the Defendant failed to identify that cardiotocography (CTG) was recording the maternal heart rate rather than the foetal heart rate on 18 February 2013; and (ii) whether the Defendant breached its duty by not intubating the Plaintiff from a certain time on that date.
Background to the Dispute
The Appellant was born on 18 February 2013 and was initially diagnosed with hypoxic ischaemic encephalopathy (HIE), and subsequently diagnosed with other conditions to include neurodevelopmental impairment and Autism Spectrum Disorder. An amended Personal Injuries Summons significantly altered the initial case, with the Appellant claiming that the CTG was erroneously monitoring the maternal heart rate rather than the foetal heart rate, thereby concealing the Appellant's condition and the need for intervention.
The Central Issue: Breach of Duty v Causation
The Appellant's central contention was that it would be unsafe for a Court to decide the CTG monitoring question without simultaneously determining causation, because the issues of breach of duty and causation are intertwined. The Appellant argued that evidence of the child's hypoxic state at birth and thereafter is reflective of foetal wellbeing in utero, including oxygen levels during labour and likely heart rate, and, therefore, the Court would need to hear from "an array" of causation experts.
The Respondent countered that the Appellant had conflated allegations of breach of duty with allegations of causation, arguing that whether the maternal heart rate was being negligently misread as a foetal heart rate falls to be determined by reference to circumstances at the time of reading the CTG, not by reference to matters arising thereafter.
The Court of Appeal's Analysis
The Court accepted that the Appellant's case regarding breach of duty during labour falls away if the Appellant cannot satisfy the Court that the Respondent was erroneously monitoring the maternal heart rate rather than the foetal heart rate. Applying the principles from McCann v Desmond 3, the Court held that this is manifestly an issue readily capable of determination in isolation from other issues, and Counsel for the Appellant had fairly conceded that if the Appellant fails on this point, the case must fail.
The Court found there would undoubtedly be a saving in Court time and costs, notwithstanding some uncertainty as to the precise savings. Estimates ranged from a modular trial taking 4 to 5 weeks compared to a unitary trial of 16 weeks or a split liability trial of 11 weeks.
The "Safety Net" Principle
Crucially, the Court emphasised the principle from Weavering 4 that if, whilst hearing a module, the Court comes to the view that it cannot safely reach a final conclusion without entering into evidence relevant to some issue originally intended to be tried at a later stage, then the Court can act in an appropriate way to ensure that no injustice is caused. The Court held that the Trial Judge would have broad discretion in managing the trial to ensure no prejudice to the parties, and could address issues by way of preliminary hearing if appropriate.
Conclusion: A Pragmatic Approach to Complex Medical Negligence Litigation
The Court of Appeal's decision represents a significant endorsement of judicial case management powers in complex clinical negligence cases. By upholding the modular trial order, the Court has sent a clear message that where preliminary issues are genuinely dispositive and capable of determination in isolation, the Courts will not hesitate to deploy modular trials as a case management tool.
The Judgment provides important reassurance that the "safety net" principle from Weavering remains firmly in place. This flexibility should alleviate concerns about potential prejudice whilst preserving the efficiency gains that modular trials offer.
The case also underscores the importance of clear pleadings and the importance of ensuring that a case clearly distinguishes between breach of duty and causation, particularly when facing the prospect of modular trial.
Ultimately, this decision affirms that appellate courts will afford considerable deference to Trial Judges' case management decisions, intervening only where there is a real risk of injustice. In an era of increasing pressure on Court resources and growing concern about the cost and duration of clinical negligence litigation, the Court of Appeal's pragmatic approach to modular trials may well encourage greater use of this procedure in appropriate cases, with the potential for significant savings in time, costs, and judicial resources.
Footnotes
1. Court of Appeal Record No.: 2025/85
2. High Court Record No.: 2022/1444 P
3. High Court Record No.: [2010] 4 I.R. 554
4. Supreme Court [2012] 4 I.R. 681
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