The court found the defendant physician negligent in failing to take an adequate history from Ms. Pinch which would have revealed a history of high blood pressure three weeks earlier, failing to elicit that her neck pain radiated into her head, and failing to note that the nurse had not documented the patient’s blood pressure. The court found that the ER physician’s failure to make use of all the information that was available to him combined with his failure to take an adequate history brought his failure to diagnose pre-eclampsia beyond a mere error of judgement. In order to meet the standard of care, clinical judgement must be based on information that is as complete as reasonably available and possible in the circumstances, including tests that should have been carried out but were not.4 The court found that the defendant too quickly took the patient’s pregnancy out of the equation and focussed instead on the most likely explanation for her presentation, namely her neck pain.
In many delayed diagnosis cases, physicians have been found negligent for focussing on the more likely cause of a patient’s complaints instead of ruling out the most serious or time sensitive potential causes first. Physicians have been found negligent for delays of days, hours or even minutes in the diagnosis of serious and time-sensitive conditions if this delay caused or contributed to the patient’s injury or death. In Law Estate v. Simice5, the defendant physician was found liable for a five-day delay in the diagnosis of a ruptured aneurism. In Dillon v. Leroux 6, the defendant family physician was found liable for a three and a half hour delay in diagnosing and treating a heart attack in a 35- year- old[JK1] patient, and instead relying on a working diagnosis of heartburn. In Brodeur v. Provincial Health Services Authority 7 the defendant resident was found negligent in failing to immediately call the obstetrician when her patient, who was attempting a vaginal birth after caesarean section (VBAC), was showing signs of a possible uterine rupture, a potentially life-threatening complication for mother and baby. Although the delay attributable to the resident was a matter of minutes, the court found her liable as her actions contributed to the delay in delivering the infant plaintiff, which caused the infant plaintiff’s brain injury.
While a doctor may not be liable for an initial misdiagnosis, they may be found negligent if they fail to reconsider the diagnosis in the face of new information. In Williams v Bowler 8, the plaintiff suffered a serious brain injury caused by the delayed diagnosis of a ruptured aneurism. The plaintiff attended the office of her family physician with complaints of headaches after hitting her head during a bar room brawl. Following repeated visits with worsening headaches and nausea, vomiting and blurred vision, the defendant physician admitted the plaintiff to hospital.
During the plaintiff’s hospital stay, the defendant performed a lumbar puncture which revealed blood in the plaintiff’s cerebral spinal fluid (CSF), diagnostic of a subarachnoid hemorrhage (SAH). Most cases of SAH are due to trauma, are self-limiting and do not require treatment. In about 30% of cases, however, SAH is caused by a spontaneous and life-threatening condition, most commonly a leaking or ruptured aneurism. The plaintiff was discharged from hospital after the defendant attributed her complaints to resolving viral meningitis and the blood in her CSF to her head injury. Approximately three weeks later, the plaintiff suffered a ruptured aneurysm resulting in a serious brain injury.
