The Ontario Court of Appeal outlined what is required to establish medical malpractice in cases involving multiple health care providers whose cumulative errors contributed to a patient’s injuries.
In a two-part blog series, we will unpack this decision. This week, we will explore the facts that led to the patient’s life-altering injuries in an attempt to understand how many small errors performed by multiple individuals can come together to have a significant impact.
Next week, we will explore how the Court of Appeal addressed this situation using the established “but for” test for negligence.
The patient in question suffered an anastomotic leak following a hemicolectomy (an elective bowel surgery which was intended to correct a narrowing of his bowel brought on by chronic Crohn’s disease). The leak resulted in his bowel contents spilling into his abdominal cavity. Bacteria in bowel contents can be a source of infection that, if not properly treated, could evolve into sepsis or septic shock.
The discovery of this leak was delayed, and the patient went into septic shock, eventually falling into a coma and later requiring amputation of both of his legs below the knee, as well as amputation of all his fingertips.
The Chain of Events Leading to Amputation
During the surgery, the patient was operated on by a surgeon who was assisted by a senior resident and a junior resident. The surgery was uneventful, and the patient exhibited no negative symptoms for the first two days following the procedure.
Abdominal Pain Begins
At 7:50 am on May 16, 2008, two days after surgery, the patient complained to a nurse (Nurse 1) about abdominal distention. At 12:50 pm, the patient began to complain of abdominal pain of about a level 8 (on a scale of 1-10, where 10 was the worst pain).
Nurse 1 recorded the pain level and gave the patient pain medication. At 4:30 pm, Nurse 1 informed the senior resident and the junior resident about the patient’s severe pain. Within ten minutes, the junior resident prescribed morphine and ordered an immediate blood count to check for infection. An anastomotic leak was part of the differential diagnosis performed by the residents.
Nurse 1 went off duty at 7:30 pm and informed the nurse who was coming on duty (Nurse 2) about the order for “stat” (i.e. immediate) bloodwork. The junior resident also went off duty, without checking whether the results of the tests she had ordered had come in but did mention the patient’s pain to the senior resident who would be caring or him overnight.
Later that evening, the patient’s wife became concerned and called the surgeon, who came to the hospital around 8:00 pm to examine the patient. While there, the surgeon spoke to the senior resident but did not recall checking the chart, speaking to Nurse 2, or checking the results of the blood test.
Nurse 2 examined the patient after the surgeon met with the patient and noted that he was tachycardic (i.e. had a rapid heart rate) and his blood pressure was lower than the normal range. She did not report this to the surgeon or any other doctor. She administered more morphine.
Delayed Blood Test Results
The results from the bloodwork ordered by the junior resident were entered into the hospital computer 4.5 hours after they were first ordered (in violation of hospital policy under which any stat bloodwork should have been returned within one hour). The results showed an abnormally low white blood cell count and were marked as “Critical”. These findings were not reported by the lab to either the ward or to the ordering physician.
Neither the senior resident nor Nurse 2, who were both on overnight duty, followed up on the results that night.
On the morning of May 17, the patient complained of back pain for the first time. Nurse 2 called another junior resident (Junior Resident 2) to assess the patient. Junior Resident 2 thought that the back pain might be attributable to the fact that the patient had been immobile in a hospital bed. He prescribed a muscle relaxant and sedative. Junior Resident 2 did not speak to the senior resident or become aware of the bloodwork results.
Another Shift Change
As the morning of May 17 unfolded, the surgeon returned to the hospital before 9:00 am for his morning rounds. The senior resident went off duty and turned the patient’s care over to the surgeon.
Around this time, both the senior resident and the surgeon learned about the bloodwork results. The surgeon was concerned that the patient had an infection and ordered more “stat” bloodwork, which came back within the hour and confirmed the low white blood cell count.
Instead of concluding that the patient was septic due to an anastomotic leak and ordering an operating room (which, as an expert who testified at trial explained, was the only possible conclusion to draw in the situation), the surgeon ordered a “stat” CT scan to identify the source of the infection. The CT scan was not performed until 3:00 pm due to delays stemming from reduced staff and one CT scanner being non-functional.
At 5:05 pm, the patient was taken to the operating room to have the leak repaired. By that time, he was in septic shock and had gross contamination in the belly. His wife was told that he might not make it through the night.
The patient eventually went into kidney failure and was in a medically induced coma for three months. Some of his tissues became necrotic and he developed compartment syndrome which eventually resulted in the amputations.
The patient’s wife sued four of his treating doctors and three of the nurses arising from the treatment he received over the two days in question.
How Can a Medical Malpractice Lawyer Help?
As seen in the facts outlined above, a situation involving an injury stemming from medical error is rarely straightforward. Instead, it can involve a complicated timeline with many moving parts, a mountain of medical records and other documentation, and a lot of medical professionals that step in and out as the circumstances leading to the injury unfold.
Medical malpractice lawsuits not only have to try to get to the bottom of what exactly happened that led to an injury but they almost always also involve complex questions of medicine and law, including very technical arguments about causation.
In some circumstances, medical errors are covered up, medical records are falsified, or patients seeking answers are not given a straight answer about what happened.
All of this can be overwhelming and extremely stressful for an injured patient and their family.
If you have been injured and you believe it is the result of negligence or error on the part of a doctor, surgeon, nurse, or any other healthcare professional (or believe it was the cumulative result or error or negligence on the part of several medical professionals), contact Sommers Roth & Elmaleh.
Unlike most other personal injury firms, medical malpractice is virtually all we do. While every case is different, we have been successful in cases that other law firms refuse to take or believed will be unsuccessful. Having 40+ years of trial experience, when we are retained by clients we are ready to go with them all the way. We leave no stone unturned in our investigation and resolutely represent our clients in the most difficult circumstances. Our team of exceptional lawyers takes care of families in some of the darkest times of their life, so that families can take care of themselves and begin to move forward.
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