Endometriosis delayed diagnosis can have serious consequences when the condition is identified years later, and the delay causes further harm.
In these circumstances, a medical negligence claim may be possible.
Endometriosis is a common condition, affecting around one in seven women according to the HSE’s first National Endometriosis Framework, yet it remains one of the most consistently late-diagnosed conditions in women’s healthcare.
A long wait for a diagnosis is not, on its own, negligence.
However, where an avoidable delay fell below the standard of care expected from a competent doctor, and that delay allowed the condition to progress or caused additional harm, it may form the basis of a claim.
What Is endometriosis, and why is it diagnosed so late?
Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the womb grows outside the uterus.
It can affect the ovaries, the bladder, the bowel and other organs, and it causes symptoms that range from severe pelvic pain and heavy periods to fatigue and, in many cases, difficulty conceiving.
In its first National Endometriosis Framework, the HSE states that around one in seven women may have the condition, which makes it one of the most common conditions in women’s health.
Despite how common it is, endometriosis is diagnosed late far too often.
There are no official figures for how long diagnosis takes in Ireland, but international research points to a delay of around eight years between a woman first raising her symptoms and receiving a diagnosis, and a recent United Kingdom study put the figure at about nine years.
A large part of the reason is that severe pelvic pain is dismissed as ordinary period pain, or attributed to other conditions, so that women make repeated visits to their GP and to hospital before the condition is recognised.
The HSE Framework now recommends that women and girls with symptoms be treated on the presumption that they have endometriosis, which is an acknowledgement at a national level that women have been diagnosed too late for too long.
When is a delayed diagnosis of endometriosis medical negligence?
It is important to be clear that an endometriosis delayed diagnosis is not, by itself, medical negligence.
Endometriosis is genuinely difficult to diagnose, the symptoms vary from woman to woman, and part of the delay is a systemic problem rather than the fault of any individual doctor.
A claim depends on two questions being answered.
The first is whether the care fell below the accepted standard. In Ireland, the standard of care in medical negligence is set by the Supreme Court’s decision in Dunne v National Maternity Hospital [1989].
In broad terms, a doctor is negligent where they did something that no medical practitioner of equal specialism and skill, acting with ordinary care, would have done, or failed to act on symptoms or findings that clearly called for further investigation or a referral.
The key question in an endometriosis case is whether a reasonably competent doctor, presented with the same symptoms, should have suspected the condition and investigated or referred the patient sooner.
The second question is causation. It must be shown that the delay caused harm that earlier diagnosis and treatment would, on the balance of probabilities, have avoided or reduced.
In an endometriosis case, this might mean that a woman who should have been diagnosed at an earlier stage progressed, because of the delay, to a more advanced stage, needed more extensive surgery, or suffered a loss of fertility that timely treatment could have preserved.
Both questions are decided on the specific facts of each case, with the benefit of independent expert evidence, usually from a consultant gynaecologist.
Coleman Legal’s Diane Treanor has acted for a client in a case against the HSE arising from a delayed diagnosis of endometriosis, which was resolved by settlement.
How to make an endometriosis delayed diagnosis claim
For a woman who believes her endometriosis delayed diagnosis happened late, the first step is not a court case but advice.
A claim generally follows a recognisable path. It begins with a confidential consultation to understand what happened.
The medical records are then gathered and reviewed by an independent consultant gynaecologist, who can say whether the care fell below the standard expected and whether an earlier diagnosis would have made a material difference.
Only then is a view taken on whether there is a claim.
If a claim proceeds, proceedings are issued in the courts.
Claims of this kind are not dealt with by the Injuries Resolution Board and are instead pursued directly through the courts because they arise from alleged negligence in medical care.
Many claims are resolved by a settlement, while some proceed to a hearing.
Because an endometriosis delayed diagnosis is one form of delayed diagnosis claim, you may also find our broader delayed diagnosis claim page helpful, and our article on the recent endometriosis cases explains the developments that have brought this issue to public attention.
Time limits for an endometriosis delayed diagnosis claim
Time limits apply, and they matter.
A medical negligence claim in Ireland is generally subject to a two-year period.
In a delayed diagnosis case, that period does not necessarily run from the date of the missed opportunity, but from the date of knowledge, which is the date on which a person knew, or ought reasonably to have known, that their injury was connected to the care they received.
For a condition that is diagnosed years after the symptoms began, that date is often later than people expect.
Where the person affected was under 18 at the relevant time, the two-year period does not begin to run until they reach the age of 18, and different rules can apply for a person who lacks the capacity to bring a claim.
Because these rules are fact-specific, a woman should not assume that a claim is out of time without first taking advice on her individual position.
What compensation can an endometriosis claim cover?
Compensation in an endometriosis delayed diagnosis claim is intended to reflect the harm the delay has caused. It is generally considered under two headings.
General damages compensate for the pain, suffering and effect on quality of life caused by the avoidable delay and its consequences, which in an endometriosis case can include the effect on fertility.
Special damages cover measurable financial losses, both past and future, such as the cost of additional treatment and surgery, loss of earnings, and, where relevant, the cost of treatment abroad.
The value of any individual claim depends on its particular facts and is assessed having regard to the Personal Injuries Guidelines.
A solicitor can explain how compensation is assessed in the context of a specific case.
Frequently Asked Questions
Q: Can I make a claim if my endometriosis symptoms were dismissed as normal period pain?
A: In Ireland, the symptoms of endometriosis, and severe pelvic pain in particular, are too often put down to ordinary period pain, and this can contribute to an endometriosis delayed diagnosis.
Whether that gives rise to a claim depends on whether a reasonably competent doctor, faced with the same symptoms, should have suspected endometriosis and investigated or referred sooner, and on whether the delay caused further harm.
Each case is assessed on its own facts with the help of independent medical evidence.
Q: Does the stage my endometriosis had reached affect a delayed diagnosis claim?
A: In Ireland, the stage the condition had reached can be relevant both to whether the endometriosis delayed diagnosis caused harm and to the value of any claim.
Where a woman who should have been diagnosed at an earlier stage progressed, because of the delay, to a more advanced stage that required more extensive surgery, the delay is more likely to have made a material difference.
The effect of the delay is assessed on the medical evidence in each individual case.
Q: Can I make an endometriosis claim if the delay affected my fertility?
A: In Ireland, a loss of fertility, or a reduced chance of fertility, that earlier diagnosis and treatment could have prevented is one of the most serious consequences of an endometriosis delayed diagnosis, and it can form an important part of a claim.
Establishing this requires independent expert evidence on whether timely treatment would, on the balance of probabilities, have preserved fertility.
A solicitor can advise on how this is assessed in a particular case.
Q: How do I prove my endometriosis should have been diagnosed sooner?
A: In Ireland, an endometriosis delayed diagnosis claim is built on the medical records and on independent expert evidence, usually from a consultant gynaecologist.
The records show which symptoms were reported and what was done about them, and the independent expert provides an opinion on whether the care fell below the expected standard and whether an earlier diagnosis would have changed the outcome.
A solicitor arranges for the records to be gathered and reviewed before any view is taken on whether there is a claim.
Q: Can I claim against my GP or against the HSE for a delayed endometriosis diagnosis?
A: In Ireland, an endometriosis delayed diagnosis claim can be brought against whoever was responsible for the failure in care, which may be a GP, a hospital consultant, or the HSE, depending on where the opportunity to diagnose was missed.
Claims involving the HSE and other public bodies are defended by the State Claims Agency.
A solicitor can identify the correct party to bring the claim against once the records have been reviewed.
