Standard of Care in Medical Malpractice Claims: Supreme Court of Canada Releases Decision

by John McKiggan

Today the Supreme Court of Canada issued a decision refusing to grant leave (permission) to hear the appeal of a case from Alberta dealing with the issue of standard of care in medical malpractice compensation claims.

The Court of Appeal decision in Nattrass v. Webber reminds us that the practice of medicine is constantly evolving and this may affect the issue of the standard of care.

Four Things You Need to Prove

As I have explained in earlier posts, there are four things that a medical malpractice victim needs to prove in order to succeed with their claim:

Standard of Care: The claimant must prove what the standard of care is with respect to the medical procedure involved in the claim. In other words, what is the standard expected of a reasonably competent doctor (or nurse or other health professional) when conducting the medical procedure that may have caused the claimant’s injury?

Breach of the Standard of Care: The plaintiff must also prove that the defendant failed to meet the standard of care. In other words, that the doctor did something that a reasonably competent doctor would not have done, or the doctor failed to do something that a reasonably competent doctor would have done.

Causation: The plaintiff must also prove that the defendant’s breach is what actually caused the plaintiff’s injuries. Even if the doctor was negligent, if the doctor’s negligence was not the actual cause of the plaintiff’s injuries, the defendant will not be found liable (responsible) for the plaintiff’s injuries.

Damages: Finally, the plaintiff must prove what damages or losses they have suffered as a result of the defendant’s negligence. This would include non-pecuniary damages (what is commonly referred to as “pain and suffering”) as well as the economic losses for things like ongoing medical care or loss of income.

The Facts

In the Nattrass case Mr. Nattrass fell and broke his ankle. He had surgery to repair the fracture. The surgery was performed by the defendant physicians, Dr. Webber and Dr. Harley.

Mr. Nattrass was given a blood thinner, Heparin, to prevent unnecessary clotting after his surgery. Dr. Webber and Dr. Harley did not issue any orders to increase the blood tests that Mr. Nattrass was receiving to ensure that he did not have any unusual reactions to the medication.

Unfortunately, Mr. Nattrass developed deep vein thrombosis which is an unusual (although known) adverse reaction to the medication he was receiving. As a result, he ended up having to have both of his legs amputated.

At trial, the judge found that if the doctors had ordered more frequent testing of Mr. Nattrass’ platelet levels, the adverse reaction would have been discovered in time to save Mr. Nattrass’ legs. The trial judge found the defendants negligent.

However, the Alberta Court of Appeal reversed the decision finding that, on the basis of the evidence led at trial, the standard of care at the time that Mr. Nattrass had his surgery, he did not require more frequent blood tests.

Not Perfect Care-Just Competent Care

In other words, although the defendant doctors could have done more to prevent Mr. Nattrass’ injury, they met the standard that was required of them at the time Mr. Nattrass suffered his injury.

The Supreme Court of Canada denied Mr. Nattrass’ leave to appeal, confirming the decision of the Court of Appeal.

No Rear View Mirror in Medical Malpractice Claims

As the saying goes, hindsight is 20/20. In other words, it is very easy to look back after a patient has been injured or died to figure out what could have been done differently to prevent the patient’s injury or death. However, the courts do not look at medical malpractice claims in the rear view mirror.

Judges and juries are required to look at the evidence to determine what the standard expected of the doctor was at the time the patient was injured. Standards of medical practice change over time and patients must be careful that they lead the appropriate evidence and have supporting opinions that establish the standard of care during the appropriate time frame.

Further reading:

Medical Malpractice Claims: Is Expert Evidence Always Necessary?

Doctor’s “Error in Judgment” is not Negligence

The Top 5 Defences to Medical Malpractice Claims

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