This is another recent case where an ER doctor was found negligent for providing poor medical treatment: in this case for a stroke patient arriving at the ER (see my prior post entitled “ER Doctor Negligent for Giving Wrist Fracture Patient Bad Follow-up Advice,” for another example).
In this recent case, the plaintiff felt dizzy, nauseous, and began to vomit. He felt unsteady and needed to hold somebody’s hand for fear of falling. His initial visit to the ER of a local hospital led to a quick discharge with the diagnosis of “probable peripheral vertigo”. But with the symptoms just getting worse, the plaintiff visited his family doctor later that day, and he left with a referral note containing the express request for the hospital to “rule out organic cause (brain lesion or stroke).” Important in the result was that the Plaintiff was referred to Trillium Health Partners – Mississauga Hospital (“Trillium”), a designated Regional Stroke Centre.
The ER doctor at Trillium ordered some tests, but none that would assess whether the Plaintiff had a embolic stroke. As such, the Plaintiff was sent home with some pills to address his diagnosis of dizziness – Bell’s Palsy – Peripheral Vertigo. In the wee early-hours the following day, the plaintiff returned to the Trillium ER with worsening symptoms, and once again was seen by the same ER doctor who ran some more tests – however, by noon, the Plaintiff’s condition deteriorated to such a point that he had to be intubated and admitted to the intensive care unit (“ICU”). The Plaintiff suffered a stroke with devastating and severe long-term disabilities.
The court concluded that on a balance of probabilities the ER doctor breached the standard of care for an emergency physician. Tests could have, and should have, been ordered that would have detected the embolic stroke early, and allowed ample time for it to be treated successfully, leading to a full recovery.
One of the major problems for the ER doctor was that he failed to take a good history of the Plaintiff’s symptoms and conditions leading to his attendance at the hospital. The ER doctor, for example, was unaware that the Plaintiff was seen by his family doctor prior to attending at Trillium, who recorded ataxia among the Plaintiff’s symptoms and who specifically sent the Plaintiff to Trillium because it was a Regional Stroke Centre and the family doctor was worried that the Plaintiff was having a stroke, and the ER doctor was unaware that the Plaintiff had difficulty walking prior to his attendance at Trillium and required the support of his friends and a wheelchair. Although many things could cause these issues, the doctor’s job was to rule-out (or rule-in) the most life-threatening conditions first, and the ER doctor simply did not do this. In this case, the court concluded that the standard of care in this case required the ER doctor to conduct a gait assessment, which he did not do. The court considered that once all the hallmarks of a stroke were present, a neurologist should have been called to assess the Plaintiff. As the court noted, being at a Regional Stroke Centre, the ER doctor had easy access to a neurologist and could have consulted them to address any uncertainties. This is a classic case where the location of the medical treatment appears to have played a significant role in the outcome. I submit that the outcome may have been different if the Plaintiff were being treated at a small regional hospital that lacked the technical support that was so readily available to this ER doctor.
The ER doctor did order a CT scan, but such a scan could not rule-out an embolic stroke. The court concluded that if the diagnosis was central vertigo and the CT scan was negative, as in this case, the emergency room physician should then consult with a neurologist, or order a CT angiogram (both of which were readily available to the ER doctor at this facility); it was not an option to do neither as the ER doctor did.
Hasan v. Trillium Health Centre Mississauga, 2022 ONSC 3988
https://www.canlii.org/en/on/onsc/doc/2022/2022onsc3988/2022onsc3988.html