Case Review (Med Neg): Ringelstein v Metro North Hospital and Health Service

CLAIM TYPE: Medical Negligence

PLAINTIFF: Cheryl Ann Ringelstein, female, 68 years old, finished year 10 education, no particular qualifications, no prior exposure to legal system, parlous financial situation at all times.

INJURY: Significant complications from total abdominal hysterectomy and posterior repair surgery at Caboolture Hospital on 15 June 2004, requiring multiple subsequent surgeries that have not resolved health issues; ongoing pain, deterioration of physical and mental health; rectovaginal fistula, vesicovaginal fistula, requiring colostomy.

ISSUE: The plaintiff needed to sue the hospital for medical negligence but the three-year deadline expired around mid-2007. She didn't obtain expert medical reports proving negligence until October 2023 - over 16 years after the deadline. She had tried to get lawyers in 2008 and 2010 but couldn't afford the $2,200 fee for expert reports and couldn't find a lawyer to work on "no win, no fee". After the 2010 rejection, she didn't pursue the claim again until 2022.

The question: Could the court extend the deadline when she waited 12 years (2010-2022) after being told about the Queensland Law Society referral service before trying again?

SUMMARY & LEGAL ANALYSIS:

On 15 June 2004, the plaintiff (then 48 years old, married with 4 children) underwent a total abdominal hysterectomy and posterior repair at Caboolture Hospital operated by Metro North Hospital and Health Service. Serious complications arose from the surgery allegedly due to deficiencies in care.

By 8 July 2004 (less than one month post-surgery), she was diagnosed with rectovaginal fistula (faeces appearing in vagina). She underwent multiple emergency surgeries including sigmoidoscopy, colostomy procedures, laparotomy, and psychiatric review. Between 2004-2006 she continued experiencing complications requiring further surgeries and numerous outpatient clinic visits. She suffered significant urinary incontinence and persistent stoma issues.

The plaintiff lodged a complaint with the hospital in 2004 but received no acknowledgment of negligence. Her husband stopped work for about a year to care for her. They lived week to week paying essential bills and mortgage while supporting four children. Her husband stated there were "no circumstances" in which they could have found $2,200 in the years following surgery. Their financial situation was "worse than it was prior" due to his time off work and her ongoing treatment needs and inability to work.

2008 - First Legal Consultation: On 24 September 2008, she approached Clewett Lawyers who agreed to investigate but required $2,200 for an expert's report. She could not afford it. On 20 January 2009, Clewett Lawyers requested $2,200 within four weeks or they would be unable to represent her. She did not have the money.

2010 - Second Legal Consultation: On 4 October 2010, she approached Slater & Gordon. On 17 November 2010, Slater & Gordon advised they were unable to assist her on a no win, no fee arrangement. Their letter referenced the Queensland Law Society Solicitor Referral Service as a resource to find other solicitors.

2010-2022 - The 12-Year Gap: Following the Slater & Gordon rejection, the plaintiff took no steps to progress the matter for 12 years. She explained she "did not think there was any way I would be able to pursue a claim. I had tried to lodge a complaint with Queensland Health and tried two lawyers which got nowhere, so I gave up and didn't pursue it any further and concentrated on my physical and mental health". Her financial situation did not improve. Her physical condition remained poor and her mental state deteriorated. Her medical records showed continuing complications, surgeries, ongoing pain, and health deterioration throughout this period.

2022 - Renewed Action: In May 2022, a friend told her about a television program concerning surgeons and operations at Caboolture Hospital dating back to her surgery. On 27 June 2022, she met with hospital executives who told her it was "terrible what had happened" and "should not have happened". She was offered $10,000 as goodwill payment. On 16 August 2022, the hospital confirmed the care was "below the expected standard".

She approached Slater & Gordon again on 3 March 2023. This time they agreed to represent her without requiring advance payment. The firm obtained expert reports from Dr Geoffrey Reid (gynaecological surgeon) in October 2023 which concluded:

• Lack of due care in conduct of surgery
• Failure to perform cystoscopy after operation constituted lack of due care
• Extraordinary that she was transferred to 21-bed regional hospital on postoperative day 7 with multiple unresolved issues
• Rectovaginal fistula caused by failure to provide appropriate standard of care (on balance of probability)
• Vesicovaginal fistula caused by failure to provide appropriate standard of care (on balance of probability)

On 23 June 2023, she commenced proceedings seeking limitation extension to that date.

TRIAL COURT DECISION ([2025] QSC 75 - Martin SJA):

Application DISMISSED.

The trial judge found:

• The expert reports from October 2023 constituted a material fact of decisive character (conceded)
• She did not have actual knowledge of this fact before receiving the reports (conceded)
• However, she had NOT taken all reasonable steps to find out the fact before June 2022

The judge reasoned:

• She knew as early as 2009 that she needed to act urgently to obtain a medical report
• In 2010, Slater & Gordon told her about the Law Society referral service to find other solicitors
• She was aware of the urgency and importance of making limitation extension applications and the significance of expert reports
• There was "no evidence to satisfactorily explain the lengthy delay" between 2010 and 2022
• While she couldn't afford the $2,200, she could have contacted the Queensland Law Society to seek other lawyers who might work on different terms
• A reasonable step would have been to approach the Law Society referral service

COURT OF APPEAL DECISION

The Court of Appeal held the trial judge's conclusion was in error.

The Court of Appeal ALLOWED the appeal, and REVERSED the trial decision. The Applicant's limitation date was extended to 23 June 2023, enabling her to pursue her medical negligence claim.

Key Holdings:

Standard of Appellate Review: The court clarified that decisions on whether a plaintiff took "all reasonable steps" are findings of fact subject to correctness standard of review, NOT discretionary decisions subject to House v The King review. The statutory test demands one correct answer about whether the prerequisite for discretion has been satisfied.

"All Reasonable Steps" Analysis: The test requires assessment of what reasonable steps could be expected from THIS actual person in HER circumstances - not an idealised reasonable person. The court found she HAD taken all reasonable steps because:

• Financial Circumstances:
• • The applicant's parlous financial situation throughout - living week to week, no savings, no ability to pay $2,200 at any point
  • Both lawyers she approached required payment she could not afford
  • Slater & Gordon (known for no win, no fee work) rejected her for no-fee arrangement
• Health and Mental Condition:
• • Significant ongoing pain and physical deterioration requiring constant medical attention
  • Mental health deteriorating - she was "demoralised"
  • While she retained capacity to act, she can be described as demoralised by failed attempts
  • Medical records showed 11 medical events in June 2022 - March 2023 period alone
• Lack of Legal Sophistication:
• • Finished year 10 education
  • No prior legal system exposure
  • No evidence suggesting sophistication to appreciate that Law Society referral would produce different result
• Absence of Evidence of Negligence:
• • Hospital's 2004 response to her complaint gave no encouragement negligence had occurred
  • She had only physical symptoms-no expert opinion supporting negligence claim
• Why Not Contacting Law Society Was Reasonable:
• • She had already tried TWO law firms (including one known for no-fee work) both rejected her or required payment
  • Slater & Gordon letter didn't advise that Law Society referral offered realistic prospect of finding firm willing to FUND expert report
  • Her understanding was the letter didn't encourage view she could mount successful claim even if expert report obtained
  • Any further approaches would be futile if (as was her only experience) she'd be required to provide funds
  • It was reasonable for demoralised person in physical/mental distress, with no evidence of negligence, who twice failed to get legal help except on terms she could never afford, to have "given up"

Contrast With Grapes v AAI [2025] QCA 60: The court implicitly distinguished this case from Grapes (paramedic PTSD case where limitation extension denied). Grapes presumably had greater means and different circumstances making it reasonable to expect earlier engagement of solicitors.

June 2022 - June 2023 Period: Once hospital confirmed substandard care (August 2022), she took all reasonable steps, as follows:

• Received and considered goodwill offer with lawyers
• Retained solicitors (who this time didn't require advance payment)
• Solicitors acted promptly with PIPA notice, pre-proceedings steps, and June 2023 commencement
• Did all this while continuing to deal with serious medical conditions

KEY PRINCIPLES FOR PRACTITIONERS:

1. "All reasonable steps" is assessed based on plaintiff's ACTUAL circumstances - financial capacity, education, health issues, legal sophistication, prior experiences with legal system.
2. A person of limited means who cannot afford legal fees and has been unable to secure no-fee representation is NOT required to continue approaching lawyers through referral services when they have no capacity to pay.
3. Prior failed attempts to secure legal representation on affordable terms are relevant to whether further attempts would be reasonable.
4. Physical and mental health deterioration, ongoing pain, and need for constant medical attention affect what steps are reasonable.
5. Absence of any evidence supporting negligence (until hospital's 2022 acknowledgment) is relevant to whether further legal pursuit was reasonable.
6. Being "demoralised" by failed attempts and focusing on health recovery instead of continued futile legal approaches can be reasonable in the circumstances.
7. A plaintiff's capacity to undertake certain actions (e.g., could have called Law Society) doesn't determine reasonableness - question is whether it was reasonable NOT to do so given all circumstances.
8. Financial circumstances that remain parlous throughout the limitation period and beyond strongly support finding that approaches requiring payment were not reasonable steps for that plaintiff.
9. Courts must avoid imposing middle-class assumptions about access to legal services on plaintiffs in genuine poverty.

OUTCOME:

• Trial Court: Application DISMISSED.
• Court of Appeal: Appeal ALLOWED, trial decision REVERSED, limitation extended to 23 June 2023, respondent to pay appellant's costs of appeal.

DECISION: Ringelstein v Metro North Hospital and Health Service [2025] QSC 75 (Trial) / [2025] QCA 188 (Appeal)

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.