This point was recently affirmed by the British Columbia Court of Appeal in Briante v. Vancouver Island Health Authority,12 which addressed the injuries suffered by a plaintiff who sustained permanent brain damage from a suicide attempt six days after being discharged from the emergency room. The trial judge in that case found that the registered psychiatric nurse had failed to collect adequate information about the patient and discuss the patient’s situation fully with the emergency physician. The emergency physician herself failed to personally obtain information, communicate diligently with the nurse, and refer the patient for a psychiatric consultation before discharging him.13 Although the action at large was dismissed because causation had not been made out, the trial judge highlighted the role that this miscommunication played in his finding that both the physician and the nurse had breached the standard of care:
Where the patient is seen by a treatment team … there is also a duty on each person in the team to communicate diligently with the other medical professionals. The treatment team must take care in comparing notes and make certain that things do not slip through the cracks; elements of treatment or assessment should not be overlooked because each member of the team thinks the other has completed the task.14
The Court of Appeal, however, determined that the emergency physician had not breached the standard of care, as she was entitled to rely on the nurse to competently perform her initial psychiatric assessment and inform her of any relevant information. In rendering its decision, and relying on Granger, the Court of Appeal reiterated that, unless they detect a “red flag” that may trigger the need to personally seek out additional information, “medical professionals must, to a certain extent, rely on information supplied to them by other healthcare providers on the understanding that upstream providers of information have acted within the scope of their professional obligations.”15
It is no longer the case, then, that fault will fall solely, or even primarily, on the most responsible physician in the event of a patient injury. In naming defendants and building a theory of the case, counsel for the plaintiff should assess whether the miscommunication from one professional triggered the inappropriate actions of another.
Gilmore v. Love
Gilmore v. Love,16 a recent decision of the B.C. Supreme Court, addressed an obstetrical malpractice claim that arose during the labour and delivery of the infant plaintiff. The reasons for judgment highlighted a host of communication errors between members of the care team which contributed, through a ripple effect, to the catastrophic brain injury sustained by the plaintiff during her birth. This section will address the miscommunications that occurred between the obstetrician and the two primary obstetrical nurses; the obstetrician and the plaintiff’s mother; and the obstetrician and the operating room team.
Background and Law
The plaintiff’s mother attended to Lion’s Gate Hospital on June 3, 2014, when she went into spontaneous labour. At 2:30 pm, the obstetrician performed an initial examination and noted that the mother was six centimeters dilated and the fetus was presenting head-down at 0 station. Crucially, there was a broad misunderstanding from this moment through to just before the birth as to whether the fetal head was in occiput anterior (OA) position — that is, facing towards the mother’s back — or occiput transverse (OT) position — that is, facing sideways.17 This was a critical finding to have made: while a fetal head in OT position is “not necessarily an obstacle to a vaginal birth in and of itself,” the court found that it “would raise a red flag for a more difficult labour and the need to more closely monitor progress for both rotation and descent.”18
