Evidence failed to show the patient would have been treated in time to prevent the fatal outcome
In a recent decision, the Saskatchewan Court of Appeal upheld a ruling that a physician’s failure to refer a patient to a cardiologist breached the standard of care but did not cause the patient’s fatal heart attack.
In late 2004, the patient sought medical attention after experiencing symptoms including anxiety, night sweats, and other distressing signs. He initially consulted a different physician, who diagnosed an anxiety disorder and prescribed medication. Two follow-up appointments with another physician took place in November and December of that year. During these visits, the physician noted ongoing pain and diagnosed severe anxiety and moderate depression, prescribing alternative medication and requesting further psychological assessments. However, the physician did not explore potential cardiac causes or make a referral to a specialist.
In January 2005, the patient suffered a heart attack. Although he was revived in the hospital, he sustained significant brain and organ damage. Life support was withdrawn days later, and he passed away.
The family of the deceased alleged that negligence by the attending physician contributed to his death, asserting that a timely referral to a cardiologist could have uncovered the heart condition and enabled lifesaving treatment.
The trial judge determined that the physician breached the standard of care by not investigating potential cardiac issues or referring the patient to a specialist. However, the court concluded that the negligence did not causally contribute to the death. Evidence presented suggested that even if a referral had been made, the time required for diagnosis and treatment would likely have exceeded the period before the heart attack occurred.
The family appealed, arguing that the trial judge erred in applying the legal test for causation and in interpreting evidence regarding the potential timeline for medical intervention.
The Court of Appeal upheld the trial judge’s findings. It confirmed that the correct legal test for causation, the "but for" test, had been applied. The court noted that the family had to prove, on a balance of probabilities, that the patient would have survived if the physician had acted within the standard of care.
The court agreed with the trial judge’s assessment that the available evidence did not establish that the patient would have been referred, diagnosed, and treated in time to prevent the fatal cardiac event. It also rejected arguments that the trial judge misinterpreted or overlooked evidence, emphasizing that the decision was based on the absence of sufficient proof rather than speculation. Ultimately, the court dismissed the appeal.
