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Archives for December 2019

Paul McGivern Appointed Queen’s Counsel

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Pacific Medical Law is proud to announce that Paul McGivern has been appointed Queen’s Counsel (QC). 

This prestigious recognition is bestowed on lawyers for their excellence in the practice of law, their leadership and their dedication to the legal system. Recommendations for QC appointments are made by a committee of esteemed panelists, including the Chief Justices of the BC Supreme Court and Provincial Court, the presidents of the Law Society of BC and the Canadian Bar Association British Columbia Branch, among others. 

Paul is dedicated to protecting the rights of patients who have been injured as a result of medical malpractice.  He is a founding member of the Birth Injury Lawyers Alliance of Canada, a national alliance of lawyers dedicated to helping families of children with cerebral palsy and other preventable birth injuries.  He has been counsel on over 120 trial or appellant cases and is a frequent invited lecturer at medical and legal conferences nationally.

Join us in congratulating Paul on this well-deserved achievement!

Was your baby cooled immediately after birth?

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Babies are cooled immediately after birth if they have hypoxic ischemic encephalopathy (HIE). HIE is a condition that occurs when an infant’s brain is deprived of oxygen. It is a significant cause of death and long-term disability in infants. The severity of the infant’s HIE determines his or her risk of cognitive impairment and disability.

Oxygen deprivation resulting in HIE typically occurs in the perinatal period – that is, just before, during or shortly after delivery. Potential causes of oxygen deprivation leading to HIE include problems with the umbilical cord, placental abruption, or uterine rupture.

Cooling Treatment for HIE

Cooling treatment – known as neonatal therapeutic hypothermia – is a relatively new option for treating HIE. It involves reducing the infant’s total body temperature by 2-3 degrees Celsius, resulting in modest hypothermia. The treatment works by reducing the brain’s use of energy, which slows disease progression and reduces the chances of the infant suffering from severe brain damage. Research suggests that therapeutic hypothermia is safe and provides long-term protection for the brain.

To meet the criteria for this treatment, infants must be at least 36 weeks’ gestation. The infant must be less than 6 hours old to start cooling treatment. After 6 hours of age, cooling does not provide the same level of protection. Infants may not be eligible for the treatment if they have certain congenital abnormalities or if they have a very low birth weight. Cooling is only used in very specific situations – the infant must have severe acidosis demonstrated by a low umbilical cord pH, abnormal blood gases or base deficit, and a complicated delivery and low Apgar scores, or have needed at least 10 minutes of help breathing. The infant must also show evidence of moderate to severe encephalopathy, demonstrated by a combination of signs and symptoms such as seizures, lethargy or coma, decreased or no activity, abnormal posture, decreased muscle tone, weak or absent reflexes and abnormal heart rate, pupils or breathing.

Because it can be difficult to assess some infants’ injuries, consultation with a neonatologist is sometimes necessary.

There are two main methods of cooling the infant – whole body cooling and selective head cooling. The type of cooling used depends on the hospital, but both methods have been shown to be safe and effective in bringing core body temperature down to therapeutic levels. Rewarming begins after 72 hours of cooling, and serial monitoring of the infant’s core temperature is important to prevent overheating.

Follow-Up for Cooled Infants

Cerebral palsy or other severe disability occurs in more than 30% of newborns affected by HIE and is most common in those who suffer severe encephalopathy. Because of the broad spectrum of developmental impairments found in infants who suffer from HIE, following affected infants throughout their development is important. Specialists such as neonatologists, physiotherapists, neurologists, occupational therapists, pediatricians, ophthalmologists, and audiologists working together to assess long-term outcomes is an important component of care for infants who have received therapeutic hypothermia.

Cerebral palsy may or may not be due to negligence on the part of the medical team attending the delivery. Our cerebral palsy attorney at Pacific Medical Law has a lengthy and established record of determining the cause of the infant’s cerebral palsy and, in appropriate cases, obtaining judgments and settlements on the child’s behalf.

HIE has Severe Consequences

HIE is a condition that can have severe consequences. Over the past decades, therapeutic hypothermia has emerged as an effective treatment option and has been shown to decrease severe long-term disability and death in infants with moderate to severe HIE. Further research is still needed to increase understanding of the progression of HIE, identify additional treatments, and develop more precise ways of predicting long-term outcomes. The use of therapeutic hypothermia can be expected to be more widely used as the process is perfected, with more infants benefiting from its use.

If your child received therapeutic hypothermia treatment and you have unanswered questions about what caused your baby’s HIE, contact our pediatric injury lawyers in Vancouver. We would be happy to discuss your concerns and outline the options available for your child.

Here is an infographic which shows the cooling process:


BILA Canada

Canada Misses the Mark on Patient Safety Goals

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The Canadian Institute for Health Information (CIHI) recently published a report indicating that Canada is falling behind the international average when it comes to patient safety.[1] The recent report analyzes health care statistics from the 36 member countries of the Organization for Economic Co-operation and Development (OECD).[2]

Canada compares well in the area of non-medical determinants of health such as obesity, alcohol consumption, smoking, and fruit and vegetable consumption. Canada also does well, compared to the OECD average, in quality of care. In addition, health status in Canada is positive: Canada has a lower mortality rate for heart disease, stroke and cancer – in fact, our survival rates for breast and colon cancer are among the highest in the world.

But there are areas of concern. While life expectancy in Canada is higher than the OECD average, Canada underperforms in infant mortality. On average in OECD countries, 3.5 infants die for every 1000 live births. In Canada, the average is 4.5 infant deaths for every 1000 live births. In addition, although Canada does well in minimizing wait times for surgeries, wait times for specialists are longer than the OECD average. Equally concerning is that the provision of poor care outside normal business hours occurs more frequently in Canada than the OECD average.

Also concerning is that Canada fell below the international average in four out of five indicators of patient safety. Canada is close to the average in the number of patients who develop sepsis after abdominal surgeries, but we fall behind in the other four indicators of patient safety. Canadian women are twice as likely to suffer a vaginal tear during childbirth, either with or without instruments. When Canadians undergo hip or knee surgeries, they are twice as likely to develop a clot in their lungs. Instruments or sponges left in patients during surgery happens twice as often as the average of the reporting countries, and the rate of instruments or sponges being left in surgical patients has increased by 14% in Canada over the last five years. In the past two years alone, 553 sponges or instruments were accidentally left in patients during surgery.

There has been no overall improvement in the incidence of preventable patient harm over the last five years – the rate has been consistently at about 5.3 preventable incidents for every 100 patients during a hospital stay.  There has been improvement in some areas – for example, the incidence of birth trauma has steadily declined since 2014, but other incidents of avoidable harm have either fluctuated or increased. For example, events of electrolyte and fluid imbalance have continued to increase since 2014, as has the number of incidents of procedure-associated shock, which has more than doubled since 2014. Similarly, the number of women who suffered a hemorrhage during childbirth also seems to be increasing.

All in all, the CIHI data indicates that Canada has room for improvement in meeting national patient safety standards. This is not just about statistics. Each number in the data set represents a real person, with a real life and real people who care about them. The human cost of avoidable hospital errors and gaps in patient safety protocols will always be too high. As a nation we must make every effort to minimize this cost and meet, if not exceed, the OECD averages.  

[1] https://www.cihi.ca/en/canadas-patient-safety-performance-below-oecd-average

[2] https://www.cihi.ca/en/oecd-interactive-tool-international-comparisons-quality-of-care

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