Standard of Care for Nursing Students in Nova Scotia medical malpractice claims – McIntosh v. Isaac Walton Killam-Grace Health Centre

by John McKiggan

Justice Muise of the Supreme Court of Nova Scotia recently released his reasons in McIntosh v. Isaac Walton Killam – Grace Health Centre.

The Facts

Ms. McIntoshs’ baby was delivered at the IWK by C-section after a period of pushing in an attempt to deliver vaginally. Ten days after the delivery she became aware of pain in her left hip. She had not had any prior problems with her hip before her delivery.

Approximately one year later, x-rays showed Ms. McIntosh had bone fragments in her hip. She had to undergo surgery and a subsequent hip replacement. Ms. McIntosh sued the IWK claiming the student nurse that was supporting her legs during the delivery caused the damage to her hip joint.

Standards for Students?

One of the issues that Justice Muise had to determine was whether a student nurse should be held to the same standard as a registered nurse.

Standard of Care for Student Doctors

I have previously discussed the issue of the standard of care for medical students. See for example Medical Malpractice Claims in Canada: Standard of Care for Medical Students – Anderson v. Greene

Standard of Care for Nursing Students

Justice Muise had this to say about the issue:

[9] The nursing student is to be held to the standard of care expected of a registered nurse of average competence and ordinary skill facing the circumstances in question. Judicial comments to that effect have been made in Tekano (Guardian ad litem of) v. Lions Gate Hospital, 1999 CarswellBC 1709 (B.C.S.C.), at paragraph 109, and in Dixon v. Calgary Health Region, 2006 CarswellAlta 378 (A.B.Q.B.), at paragraph 73.

[10] The standard of care expected of nurses is dealt with in the same way as the standard of care expected of other health professionals. Useful comments, in relation to the standard of care of health professionals generally, are contained in paragraph 6.26 of the Canadian Health Law Practice Manual (Markham: LexisNexis Canada Inc., 2000) where it is stated:

“The conduct of the institution and its health professionals will be judged on whether the care provided met a reasonable standard in the particular circumstances of the case. The health practitioner is not held to a standard of perfection. The test is not whether the patient received the best care possible from the health practitioner in question. Rather, the Court will look at what the reasonable health professional in a comparable setting would have done in like circumstances.”

After an examination of the case law and considering the evidence by both parties, Justice Muise concluded:

“Based on the forgoing, I find that the plaintiff has not established, on the balance of probabilities, that the student nurse, Cynthia Mann, breached the applicable standard of care.”

Why is this important?

This case is important to Nova Scotians, and Haligonians in particular because the IWK-Grace Health Centre and the Halifax Infirmary are both teaching hospitals. Much of the primary medical care provided to patients in these hospitals is provided by students (both medical and nursing) obtaining further training in their profession.

However, patients in these hospital are usually not told that the person that is treating them is a student and whether it is their first day in the hospital or whether they have been training for years.

Increase in Medical Errors

There is a significant increase in mortality rates (death) for patients who are admitted to teaching hospitals in July: Beware the July Effect.

Researchers have concluded that in fact the spike in mortality rates is usually due to the fact that July is when medical students begin their training in their new specialties.

Be an Advocate

As patients, we all have certain rights. One of those rights is to be provided with competent medical care. Most of the health care professionals who treat patients here in Nova Scotia are capable and dedicated professionals. However, everyone makes mistakes and lack of experience can lead to medical errors.

If you have a concern about the lack of training or experience of anyone that is providing you with medical care you have the right to ask that a more experienced professional provide your treatment.

Now more than ever effective medical and hospital care often depends on patients, or their familt members, being their own advocates.

What Do You Think? Leave a comment and let me know.

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