By Bronwyn Ackland, Partner and Poppy Scaife, Paralegal

Hartfield v Calvary Healthcare ACT Ltd (No 4) [2025] examines the duty of care owed to a patient presenting with a suspected ectopic pregnancy and highlights the consequences of discharge, in the context of deteriorating symptoms.

Despite the Plaintiff’s reproductive history and ongoing pain, she was discharged without adequately ruling out the likelihood of an ectopic pregnancy or warning her of the associated risks.

The Court found that this constituted a breach of duty, causing physical and psychological harm. However, the Court held the Plaintiff had failed to establish that earlier intervention would have preserved her fertility.

This decision illustrates the importance of appropriate clinical management in early pregnancy presentations and the challenges associated with proving causation in medical negligence claims.

Factual Background

The Plaintiff’s medical history included, a miscarriage and a previous ectopic pregnancy (occurring when a fertilised egg grows outside of the uterus) which had resulted in the prior removal of the Plaintiff’s right fallopian tube.

On 31 July 2019, the Plaintiff presented to the former Calvary Hospital in North Canberra (“Calvary”), five weeks pregnant, concerned that she may be suffering from another ectopic pregnancy.

The Plaintiff was admitted to the Calvary, and discharged the following day. At discharge, the diagnosis was a pregnancy of unknown location. Neither identified as a miscarriage or a tubal ectopic pregnancy.

The Plaintiff re-presented to the emergency department at Calvary that same evening as her condition had deteriorated and was subsequently diagnosed with an ectopic pregnancy.

The Plaintiff then, underwent an emergency laparoscopic left salpingectomy, for the removal of her remaining fallopian tube.

Issue

The Plaintiff sought damages against the Calvary for negligence.

The Plaintiff contended that a laparoscopy (a keyhole surgery of the abdomen and pelvis) would have revealed the ectopic pregnancy at her first admission. If discovered at that time, this would have presented an opportunity for a salpingostomy to remove the ectopic pregnancy from the fallopian tube, without removing the fallopian tube itself, and preserving her fertility.

The Plaintiff claimed that the Calvary breached its duty of care owed to her, by discharging her following her first admission when the likelihood of an ectopic pregnancy had not yet been ruled out. The Plaintiff was still experiencing pain and there was a failure, by the Calvary to provide adequate advice concerning the seriousness of her condition.

The Plaintiff believed that, in the event she had not been discharged following her first admission, she would have been at the Calvary, when her condition deteriorated later that evening and a salpingostomy could have been performed then to remove the ectopic pregnancy from the fallopian tube.

Further, the Plaintiff claimed that, should the salpingostomy been performed at this time, she would not have sustained psychological injury, caused by the distress and fear, which was suffered as a result of the emergency laparoscopic left salpingostomy.

Decision

The Court found the Calvary breached its duty of care by discharging the Plaintiff following her first admission, and had failed to provide appropriate care and management regarding the danger of her condition. The Court accepted that it was this breach which caused the Plaintiff to suffer both physical and psychological harm.

However, the Court found that the Plaintiff had failed to establish that a salpingostomy would have followed the laparoscopy during her first admission.

Further, the Plaintiff had not shown on the balance of probabilities that a salpingostomy, performed during the first admission, or performed after, would have saved the Plaintiff’s left fallopian tube.

The Court dismissed the Calvary’s claim that the Plaintiff was contributorily negligent, in that she failed to return to the Calvary more immediately when her condition deteriorated. The Court found that the injuries would not have occurred but for the Calvary failing to provide appropriate care and management, and advice concerning the danger of her condition.

Judgement was entered for the Plaintiff in the sum of $118,306 for general damages, economic loss and psychological treatment.

The Plaintiff was not awarded damages in relation to her post-operative physical symptoms and her fertility, as they did not arise on the basis of the liability which the Court found.