happened might be a natural result of that act or omission.15 The Court also considered the “worst first principle”, the idea that the differential diagnosis process ought to eliminate the most serious, rather than the most probable diagnoses first, and that failure to do so is a breach of the standard of care.16 The admitting doctor’s evidence was that his practice was to address the most common or most likely diagnosis first. The Court found that this practice conflicts with the law and that the principle that possibilities with a higher risk of mortality must be addressed first is clearly established in both law and medicine.17 Furthermore, the Court held that “common sense dictates that when a life-threatening condition has been brought to the attention of a physician, they cannot ignore precautions in the face of those signs, symptoms, and information.”18
By the afternoon of February 21, the Court found that KB was showing symptoms of bacterial infection and she was not getting better as expected from an RSV infection alone. The Court found that it was increasingly difficult to rule out a bacterial infection and the blood test results should have raised alarm for Dr. Guhle. The Court found that Dr. Guhle should have taken further steps, recognizing the increased risk that KB had a bacterial infection at that time; these steps included starting antibiotics while other follow-up testing was done. By failing to do so, Dr. Guhle breached the standard of care.
The on-call physician was found to have breached the standard of care after KB’s symptoms worsened and he determined that a bacterial infection was much more likely to be present and charted a “suggestion” of IV antibiotics but failed to communicate to Dr. Guhle directly, did not perform further assessments, did not order testing, and did not order the antibiotics he suggested in his charting. The Court found that a potentially serious complication and risk to KB’s health was clearly identified to him and he breached the standard of care by failing to take sufficient steps to respond to such risks.
The Ewashko v. Hugo case also serves as an example of a case where the role of risk and foreseeability in the assessment of the standard of care led to a decision in favour of the plaintiff.19 Ms. Ewashko was admitted to hospital in the early stages of labour. Her baby was in breech position, and at the time, the hospital did not perform vaginal breech deliveries, which meant that caesarean section was her only option if she was to deliver there. An attempted rotation of the fetus was not possible due to the onset of labour. Fetal heart rate monitoring was commenced at 4:10am. Between 4:13am and 4:19am, there was a marked deceleration of the fetal heart rate which classified the fetal heart rate tracing as “abnormal”, requiring “prompt” delivery according to the Society of Obstetricians and Gynecologists of Canada. Ms. Ewashko was assessed by Dr. Groenewald between approximately 4:30am and 4:35am. He concluded that an urgent caesarean section was required. He required the presence of Dr. Hugo, an obstetrician with the requisite training to perform the caesarean section. Dr. Hugo was on call at home and had to come to the hospital. Before calling Dr. Hugo, Dr. Groenewald was called away to attend to another patient having a heart attack. He contacted Dr. Hugo at 5:08am, after dealing with the heart attack patient. Dr. Hugo attended to the hospital and examined Ms. Ewashko around 5:25-5:30am. The operating room team was called after the examination and arrived at 5:45am. While the operating room team was setting up the operating room, and before the birth at 6:08am, Baby Ewashko suffered a significant heart rate deceleration which deprived him of oxygen and caused a permanent brain injury. The litigation revolved around the timing of the caesarean section and whether negligent delays caused Baby Ewashko’s injuries.
