The Courts are Struggling with Causation Tests in Some Malpractice Cases - White v. St. Joseph’s Hospital (Hamilton), 2019 ONCA 312

May 23, 2019, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

This decision White v. St. Joseph’s Hospital (Hamilton), 2019 ONCA 312 tackled the allegation of malpractice in a case of delayed diagnosis. The decision upheld a lower court’s decision and included obiter remarks and is one of several cases in which the plaintiff failed to make their case for delayed infection.

Mr. White had routine surgery and suffered a ‘pinhole’ leak in his bowel which was not detected until a nurse noted signs of septic shock - mottled limbs - while bathing him. Mr. White claims he experienced pain, low blood pressure and reduced urine output prior to the mottling being noted. He claims that these were abnormal changes and that the hospital had not met its standard of care in the case in detecting the infection earlier. Mr. White acknowledged that the pin hole leak itself did not arise as a result of anyone’s negligence. His complaint is with the development subsequently of sepsis.

Mr. White also claims that immediately following his surgery he should have been administered certain medication and that the medical records were unclear whether it had been administered correctly. The Sepsis lead to Mr. White requiring a long hospital stay including admission to the ICU and remedial corrective surgery. He also suffered an unrelated perforated bowel. One expert testified that Mr. White’s outcome was mostly unavoidable. Experts testified that if a dose of the specific medication had been missed it would not have contributed to the development of the sepsis as the sepsis was already well underway.

The Court of Appeal for Ontario case highlights the uncertainty that exists surrounding causation in medical malpractices cases of delayed diagnosis allegations. CanadianLawyer.com reported that Paul Harte, principal at Harte Law acting for the appellant said “One of the things that this case demonstrates is the real challenge in establishing causation in a medical negligence case wen there are both negligent and non-negligent causes. In this case, it was alleged that there was a delay in treatment, but of course there was an underlying illness to begin with. And sorting out what materially contributes to a plaintiff’s loss can sometimes be very challenging as this case demonstrates.”

The appeal court upheld the lower court decision that the alleged negligence did not exacerbate Mr. White’s injury, nor cause or contribute to it, and that the award of $20,000 in costs to the respondent as Mr. White had not established the alleged negligence.

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