The Ontario Superior Court of Justice ("ONSC") recently dealt with the issue of discoverability relating to three related malpractice actions in Loy-English v. Fournier. The actions had been commenced over time as the plaintiff and her lawyers continued their investigations into the cause of, and responsibility for, her injuries. This case review deals with the judge's analysis of discoverability in such circumstances.
The patient underwent an ERCP or Endoscopic Retrograde Cholangio-Pancreatography in January 2013 as an out-patient as a result of ongoing abdominal pain. Unfortunately, the procedure resulted in a perforation of her duodenum. This injury was not detected or known at the time of her discharge from the clinic.
The patient began to suffer extreme pain and as a result and went to the Emergency Department ("ED"). A series of tests were performed, but all were negative for infection, septic shock and adverse medication reactions. Shortly thereafter she became extremely ill and was admitted to intensive care where she almost died. She remained in hospital until late October 2013.
The impacts on her health were severe and included both physical and cognitive impairments.
The patient retained counsel in July 2014. An action was commenced within the two year limitation period. The gastroenterologist whom the plaintiff thought had performed the ERCP was named. He defended in September 2015 and pleaded that the procedure had been performed by a gastroenterologist "fellow" under his supervision. Further, the x-ray review made before discharge had also been undertaken by that "fellow."
The plaintiff commenced a second action in May 2016 and now made the "fellow" a defendant along with other health care professionals found in her medical chart.
The patient's counsel obtained expert reports. One of them suggested that the ED physician may have played a critical role in the outcome because of a six (6) hour delay in the administration of antibiotics. As a result, a third action was commenced days after the reports receipt naming the ED doctor in December 2016.
The physicians in actions two and three pleaded the Limitations Act and brought motions for summary judgement seeking to dismiss those two actions. Their position was that these proceedings had been commenced more than two years after the surgery of January 2013 which was the presumptive start for the running of the two year limitation period. For these actions to have been timely, the limitation period would have to have started running on or after May 20, 2014, for the second, and on or after December 13, 2014, for the third action.
The resolution of the timeliness of the two actions depended on the subject of discoverability which is the legal determination of when the limitation period begins to run in a particular matter. The ONCA made it clear that this was not an exercise in extending the limitation period but rather one of determining when it began to run. As the defendants were bringing the motions to dismiss, they had to demonstrate that the expiry of the limitation periods was sufficiently evident that the issue could be determined without a trial.
The Limitations Actpresumes that the date of discovery is the date of the act or omission giving rise to the claim unless the contrary is proven. The time of discovery triggers the running of the limitation period. The date of discovery is otherwise the earliest day when the plaintiff first knew, or when a reasonable person with the abilities and in the circumstances of the plaintiff, ought to have known the following:
It is easy to determine the date a medical treatment or error occurred. It is also easy to provide evidence of the time the decision was made to sue a defendant and why it was then felt appropriate to commence an action. These two dates however only give a range of when the limitation may have expired. The determination of the precise time of discoverability is resolved by the Limitations Act which lays out a test with both objective and subjective elements.
The subjective element involves an analysis of the plaintiff's circumstances throughout the time range. The objective element requires an analysis of what a reasonable person should have known through an examination of their efforts to discover, or what they could (should) have found, through reasonable diligence. As the ONCA made clear, it is a standard of reasonableness, not one of perfection.
The ONCA dismissed the defendant's motions for summary judgement in both actions. It did so on the basis that the plaintiff had met her onus and established that there was a genuine issue for trial as to when the material facts to allow her to discover her claims had occurred. The ONCA felt that there were good reasons to leave the final determination on the question of due diligence to the trial judge. This is because an analysis of what capacity the plaintiff had, what records she could have accessed and her cognitive state while in the hospital and afterwards is an analysis intimately related to questions of causation and assessment of damages.
At Wise Health Law, our health law lawyers rely on their significant trial and civil litigation experience to provide our clients with exceptional guidance and representation in medical malpractice claims. To find out more about how we can help, contact us online, or at 416-915-4234to schedule a consultation.
The Chief Medical Officer of Health for Ontario has issued an updated Directive #2 (dated May 26, 2020) for Regulated Health Professionals in the province.
Pursuant to the updated Directive #2, all deferred non-essential and elective services by health care providers may be gradually restarted – subject to the rest of the requirements set out in the Directive.
The updated Directive #2 does not provide particularly detailed guidance to health professionals on how to proceed, likely because it applies to such a broad spectrum of health care and health professionals. It does, however, provide some principles to assist health care providers in making decisions as we enter this transitional period.
In addition to the mask and hand sanitizer shortages, Ontario’s response to COVID-19 highlights the need for more frontline health care workers. Each regulated health profession’s college responded differently, and we have discussed some of those changes in other posts to keep you apprised.
Today, we focus on the College of Physicians and Surgeons of Ontario (CPSO), who set out to increase the number of available and licenced physicians out on the frontlines through certificates of registration that authorize supervised practice of short duration. The temporary licences authorize practice for 30 days.
Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.
On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).