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Cases 1

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imissyou419's version from 2017-11-30 06:59

Section 6

Question Answer
Law Estate v. Simice- judge stated that doctors should not consider cost factors in making treatment decisions
- doctors constrained by BC insurance plan and by BC medical association standards to restrict their requests for CT scans as diagnostic tools
- if it comes to a choice b/w a physician's responsibility to his/her patient and his/her responsibility to the medicare system overall, the former must take precendence
memorize

Section 7

Question Answer
McKinnon v. Grand River Hospital- plaintiff was not informed of the possible risks of nerve and vascular damage, and heart failure or that there was no cardiovascular backup in Kitchener
- defendant was a general surgeon who held himself out to be a thoracic surgeon
- defendant nicked an artery, causing plaintiff nerve and vascular damage
- plaintiff sued defendant for negligence in preparing and performing the surgery, and for failing to obtain an informed consent
- Court said surgeon nick an artery does not necessarily mean he is negligent but the use of inappropriate equipment, poor positioning of patient, poor visibility caused damage to the artery
- defendant held negligent in his pre-surgical preparation and his decision to undertake surgery w/o backup
- defendant failed to inform plaintiff of serious potential risks and she would not have consented if properly informed
Holan Estate v. Stanton Regional Health Board- pyschiatric nurse with 15 years experience assessed the patient before patient was allowed to leave on day pass
- doctor and nurse absolved of liability in negligence b/c both had spoken to patient directly and both had undertaken necessary and appropriate assessments
- court said while risk of suicide existed, its occurrence was not reasonably foreseeable on that day. Even though physician and nurse's decision was incorrect, both exercised reasonable care in making that decision
G.(I.) v. Rusch- patient alleged she had been sexually abused by members of her family
- Counsellor revealed allegation to family and the police
- Family sued counsellor for breaching his fiduciary duty to them and for negligence in counselling the patient
- court dismissed the family's action. 1. counsellor did not owe the patient's family a fiduciary duty. 2. counsellor owed a paramount duty of care in negligent to his patient, which should not be limited or interfered with by extending a duty to the alleged perpetrators
- a counsellor could only owe a duty of care in negligent to a patient's family in cases of misdiagnosing the patient, making public accusations of abuse against a party, or encouraging the patient to do so
Turkington v. Lai- plaintiff sued, claiming the surgeon was negligent in recommending and conducting the surgery and in failing to inform her of the risk of nicking her bowel
- court held surgeon acted reasonably in recommending and performing the operation, given the plaintiff's symptoms
- surgeon informed the plaintiff of the 5 general material risks in any gynaecological operation, including bowel injury; surgeon was not required to disclose specific risk of nicking the bowel b/c it was 1/100,000 chance so not a serious material risk
- surgeon was not required to explain the option of doing nothing b/c it was not an accepted alternative
- court stated a reasonable person with an ovary 10x larger than normal would have had the surgery, even if informed of the 1/100,000 chance of bowel injury
Bollman v. Soenen- plaintiff sued for failure to obtain an informed consent
- defendant told the plaintiff's family doctor that he had reviewed the procedure and its possible risks with plaintiff including risks of bleeding, infection, injury to bowel/bladder/ureter but no notes of this
- judge accepted the plaintiff's testimony that she had only been informed of the risks of bleeding and infection
- judge concluded plaintiff would not have had the surgery if she had been adequately informed and held defendant liable
- defendant appealed on causation
- court of appeal said there was no evidence for the judge's conclusion that she would have forgone hysterectomy had she been informed of this 2% risk of damage to her ureter and judge did not consider what a reasonable person in the plaintiff's position would have done if adequately informed
- court of appeal overturned trial judgement and ordered a new trial
memorize

Section 8

Question Answer
Shackleton v. Knittle- ambulance attendant allowed a patient with paranoid schizophrenia to sit in front seat
- they received no warning about transporting the patient and assured there was no problem
- patient was found not guilty of criminal negligence causing death by reason of mental disorder
- patient sued the attendants in negligence for allowing him to sit in front seat
- court held attendant had not been negligent b/c not warned by doctors, common practice to allow patients to sit in front, patient's file indicated he suffered from schizophrenia was not sufficient to require the attendant to take special precautions
Ahmed v. Stefaniu- 2 involuntary admissions in 1995
- Sept 1996 Johannes became increasing threatening to his sister and admitted as involuntary patient
- Dr. Stefaniu assessed Johannes as lacking insight into his mental illness, potentially violent, severely paranoid, incapable of consenting or refusing consent to treatment
- Johannes challenged his involuntary admission and CCB upheld the commital
- In mid-October, Dr. Stefaniu recorded Johannes' mental state had deteriorated further with potential for self-harm and/or harrassing others
- Dec 2, Johannes remain delusional and paranoid but evidence that Johannes had become less threatening over the course of his hospitalization
- Dec 3, nurses' notes described Johannes as angry, loud and intrusive
- Dec 4, Johannes threatened a nurse, Dr. Stefaniu assessed Johannes and found he no longer met criteria for involuntary admission
- Dec 5, Dr. Stefaniu informed Johannes he would be voluntary patient, Johannes left hospital. Dr Stefaniu's notes indicated Johannes showed no signs of delusions, paranoid thinking or psychosis, no suicidal or homicidal ideas, but Johannes remained provocative, macho, angry and fragile
- Johannes returned to hospital to visit a female patient but those visits were disruptive
- Dr. Weinstein and Dr. Lee both said he did not meet criteria for involuntary admission in January
- On January 24, Johannes murdered his sister in delusional rage
- Sister's husband sued Dr. Stefaniu in negligence for changing Johannes' status to that of a voluntary patient on Dec 5
- 2 expert witnesses said Dr. Stefaniu's decision fell below the requisite standard of care, 2 expert witnesses testified she acted in an honest and reasonable manner that met the standard of care
- jury found that Dr. Stefaniu breached the standard of care
- Stefaniu argued that she had acted in "honest and intelligent" fashion, she could not be held liable, argued trial judge failed to adequately instruct the jury on causation - Johannes would have been released in any event prior to Jan 24 as Dr. Weinstein and Dr. Lee both concluded he did not meet criteria for involuntary admission
- Court of Appeal rejected Stefaniu's argument on the basis the jury could find the fine line b/w error in judgement and breach of standard of care had been crossed, trial judge had adequately explained to the jury that Dr. Stefaniu could not be held to breached standard of care if her decision was consistent with a "reputable body of opinions within the profession"; jury was entitled to reject this argument of not finding causation and conclude Johannes' status would not have been changed before Jan 24, it was open to the jury to conclude that but for Dr. Stefaniu's decision, he would not have murdered his sister (Stefaniu treated him from Sept - Dec and knew his history, those hospitals of the other Drs did not have the knowledge)
Brown (Next Friend of) v. University of Alberta Hospital- radiologist reported the abnormal CT scan to the infant's paediatrician and stated it was not of clinical significance
- a year later, infant brought back to hospital and infant was unconscious and CT scan revealed massive brain damage
- mother sued various parties on infant's behalf, other doctors and hospital staff were absolved of liability, radiologist was held liable in negligence, he had obligation to report not just clinical findings but also the fact they raised a reasonable suspicion of child abuse to paediatrician who would have contacted Children's Aid
- thus radiologist's negligence was a cause of infant's subsequent massive brain damage
Young v. Bella- Professor Bella speculated that a case study that Young had included as an appendix was a personal confession to having sexually abused children as a result of missing footnote + suspected paper was plagiarized
- Bella took her concerns to Acting Director of School of Social Work who instructed her to confront Young but Bella only spoke to Young about the plagiarism and not suspected child abuse
- Bella contacted Child Protection Services for advice that told her absent info on a specific child there was nothing CPS can do, told her to seek clarification from Young
- Bella went to Dr. Rowe, the new Director of School of Social Work
- Dr. Rowe forwarded a carefully worded letter to CPS suggested they might want to investigate Young
- CPS decided to place Young's name in Child Abuse Registry
- suspicion that Young was a child abuser was communicated with 3 professors, RCMP, at least 10 social workers
- 2 years later, CPS investigated Young and found appendix not a confession
- Young sued Bella, Dr. Rowe, Memorial University in negligence and defamation
- Judge said no evidence for defamation but liable in negligence
- Court of Appeal overturned trial decision, held that defendant were immune from liability under section 38 of Child Welfare Act (no one can be held liable for reporting suspected abuse, unless they acted maliciously or WITHOUT REASONABLE CAUSE)
- SCC said defendant could not rely on immunity provisions because no reasonable cause to make report, could not invoke section 38 as defendant had failed to seek an explanation from Young
- jury conclude that they had breached the standard of care expected of university professors in respect to their students
D.(M.) (Guardian at litem of) v. British Columbia- Staff of Ministry of Children and Families placed Molly, 2 month old infant born addicted to methadone in foster care with Ms. Kierkegaard
- Ministry refused application of Molly's aunt for custody, stating Molly required medical supervision with foster parents who had experience
- The staff who placed Molly with Ms. Kierkegaard was never fully informed of Molly's special needs and failed to make adequate inquiries, he knew she was not an ideal candidate but made no effort to find someone better (she was a single parent w/ 7 year old son, already caring for special needs foster infant, no significant income outside of foster care, recovering from broken leg so she had neither the capacity nor experience to meet the special needs)
- Molly admitted to hospital with injuries 4 days later
- Ms. Kierkegaard plead guilty to criminal negligence causing bodily harm
- Molly's aunt and uncle bought civil suit on her behalf against Ms. Kierkegaard and the Ministry
- Judge found Ministry negligent for its bureaucratic bungling, failure to ensure effective communication among staff, and its decision to place Molly in Ms. K despite obvious unsuitability
- Ministry unable to raise a defence b/c staff's conduct not in good faith of their duty
- Court also found Ministry vicariously liable for Ms. K's assaultive behaviour b/c it had direct, day-to-day control over her conduct
T. (a minor) v. Surrey County Council- Advisor went on to state that there was no reason why infant could not be safely entrusted to Mrs. W's care even though advisor knew that another infant had been seriously injured 3 months earlier
- authority had not deregistered Mrs. W b/c not conclusive that she had caused the injury
- Based on advisor's recommendation, infant was placed with Mrs. W and caused the infant serious brain damage
- Action brought on infant's behalf against adviser and local authority
- Court held the adviser knew or ought to have known that there were considerable risks in placing any infant in Mrs. W's care, adviser and local authority were held liable for their negligent misstatements concerning Mrs. W's suitability
McInerney v. MacDonald- Dr. McInerney refused to release copies of consultation reports and docs prepared by other Drs. arguing she had ethical duty to keep them confidental, she gave a copy of the material she personally prepared only
- SCC rejected and ordered her to release the entire file b/c given the fiduciary nature of the relationship, physicians are required to act in the patient's best interest so patient is entitled to look and obtain a copy of whole record
- SCC said physician can apply to have court deny the patient access in limited circumstances but onus is on physician to prove that granting the patient access would likely endanger the patient or a third party
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