The Court of Appeal’s decision in Stevenhaagen Estate v. Kingston General Hospitalis a good reminder for physicians practicing in a collaborative setting like a hospital. Even if the physician is not the most responsible physician (“MRP”) for a patient, they may still be liable for supporting the decisions of the MRP or failing to disagree.
Facts
The plaintiff, Julia Stevenhaagen, had a congenital heart condition and underwent an angioplasty procedure when she was 46. During the procedure, her aorta ruptured, causing a serious emergency as she was bleeding to death.
Dr. McLaughlin (interventional cardiologist) and Dr. Sternbach (vascular surgeon) responded to the situation and contained the bleeding by inserting a covered stent instead of consulting a cardiovascular surgeon immediately. The stent was not meant to be used in a thoracic aorta, but Dr. Sternbach obtained permission to use the device in this manner.
A few hours after they had completed the procedure, concerned that she was again unstable, they paged a cardiovascular surgeon. He diagnosed ongoing bleeding and a gathering hematoma in Ms. Stevenhaagen’s chest. He was concerned that Ms. Stevenhaagen had already sustained a neurological injury and immediately rushed her to the operating room.
Although the aortic repair was successful, Ms. Stevenhaagen suffered serious injuries, including paraplegia, paralysis of the left vocal cord, brain ischemia, left arm pain syndrome, and bladder and bowel dysfunction
Trial
The trial judge found both Drs. McLaughlin and Sternbach liable. Both failed to meet the standard of care by failing to consult with a cardiovascular surgeon in a timelier manner, resulting in a lengthy delay in getting Ms. Stevenhaagen to the operating room.
The Three Main Issues on Appeal
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Standard of Care
The Court of Appeal upheld the trial judge’s decision that the standard of care had been breached in this case. When Drs. McLaughlin and Sternbach treated Ms. Stevenhaagen, the “gold standard” at the time was open-heart surgery — not an endovascular repair with a stent.
Consultation with a cardiovascular surgeon should have occurred as soon as the emergency arose during the angioplasty. Although their attempts to stem the bleeding through an endovascular procedure were reasonable, they still had a duty to consult. Ms. Stevenhaagen’s need for cardiovascular surgery was both inevitable and imminent.
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Causation
Although the duty was breached when the doctors failed initially to consult a cardiovascular surgeon, the evidence did not establish that the decision to employ an endovascular repair would have been any different had cardiovascular surgery been consulted at that time.
Consequently, the analysis shifted to the end of the endovascular procedure and whether damage occurred in the hours between then and when the cardiovascular surgery began
The Court of Appeal upheld the trial judge’s finding that Ms. Stevenhaagen’s injuries could have been prevented had the doctors consulted with a cardiovascular surgeon immediately after the stent was in place.
This involved two main findings: (i) that the surgery would have actually occurred had cardiac surgery been consulted earlier; and (ii) had the surgery occurred earlier, Ms. Stevenhaagen would not have suffered the injuries that she did. Ms. Stevenhaagen arrived in the operating room in grave condition and would have died but for the surgery.
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Consultant’s Responsibility for Liability
On appeal, Dr. Sternbach submitted that the trial judge erred in finding him liable for having merely “supported” Dr. McLaughlin’s decision not to arrange for a consultation with a cardiovascular surgeon.
The trial judge found that Dr. Sternbach joined Dr. McLaughlin in the critical decision: once the stent was in place, there was no longer a need to refer to a cardiovascular surgeon. The Court of Appeal noted that it was possible to find Dr. McLaughlin in charge of the situation as the most responsible physician while also determining that Dr. Sternbach was sufficiently involved in the negligent treatment of Ms. Stevenhaagen to warrant a finding of liability. Dr. Sternbach did not disagree with Dr. McLaughlin’s decisions; instead, he played a critical role in facilitating it.
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