In Reyes v Marsden10 the BC Supreme Court was asked to determine the standard of care expected of a senior emergency physician in interpreting a plain CT scan. The plaintiff was seen by the defendant emergency physician when attending hospital with complaints of headache, vomiting and fever. The defendant ordered a non-contrast CT scan of the plaintiff’s head, which he read as normal. He then proceeded to perform a lumbar puncture on the patient to rule out bacterial meningitis as the cause of the plaintiff’s symptoms. Unfortunately, the defendant missed a brain tumor on the CT scan. Brain tumor is a contraindication to a lumbar puncture, and the plaintiff became permanently blind from the pressure change caused by the removal of cerebrospinal fluid during the lumbar puncture. Since the CT scan was performed to rule out contraindications to a lumbar puncture, such as a brain tumor, the defendant would not have performed the lumbar puncture had he correctly identified the tumor.
The Court accepted that it was standard and accepted practice among senior emergency physicians to read, interpret and act upon plain head CT scans, on the basis of what they have learned on the job through years of experience, even though they lacked formal training. The court found that while the defendant should not be held to the standard of a radiologist, he was expected to be able to independently assess a non-contrast CT head to a level of expertise that would allow him to exclude significant contraindications to a lumbar puncture. The Court went on to state that if that level of skill was not the standard of care, then the standard practice itself would appear negligent “…as it would expose patients to a risk of significant harm in circumstances where there were no exigencies requiring immediate action, and no downside to consulting a radiologist who was present and available.”11
In finding that the defendant failed to meet the required standard of care in interpreting the CT scan, the Court stated the following:
…I conclude that in missing this tumor, having taken on the responsibility of interpreting and acting upon the CT scan without availing himself of the assistance of a radiologist who was immediately at hand, Dr. Marsden fell below the standard of care reasonably to be expected of an emergency physician in his circumstances. The defence cannot have it both ways. If Dr. Marsden could not reasonably be expected to see a meningioma in this location with this level of visibility, then reasonable care would require him to consult someone who could. The fact that standard and accepted emergency medicine practice was to read the scan and act without consultation emphasizes the high degree of skill reasonably to be expected of an emergency physician in interpreting the scan…12
