Ontario Court of Appeal dismisses stroke-related medical malpractice suit against physician

The Ontario Court of Appeal has affirmed the dismissal of a medical malpractice lawsuit against a physician concerning the treatment of a patient who suffered a severe, life-altering stroke.

In Johnson v. Lakeridge Health Corporation, 2024 ONCA 291, the patient, William Johnson, had alleged that Dr. Rose-Anne Vieira’s negligent discharge from the hospital led to his second stroke. William first suffered a stroke in October 2012, diagnosed as resulting from a dissection in the vertebral artery. Following this, he was hospitalized and underwent various tests, including an MR angiogram. Dr. Vieira discharged him with a prescription including Aspirin but did not review the angiogram results, a decision later agreed to be a breach of standard care. However, the central issue at trial was whether this negligence caused William’s subsequent stroke on October 30, 2012.

The trial involved expert testimony from both parties. William’s expert, Dr. Louis Caplan, argued that had William not been discharged and instead treated with Heparin, a second stroke might have been prevented. In contrast, Dr. David Gladstone, representing Dr. Vieira, contested this, suggesting that the outcome would likely have been the same under Aspirin or Heparin, given the arterial occlusion noted in William’s diagnostic imaging.

The trial judge favoured Dr. Vieira, accepting Dr. Gladstone’s evidence over Dr. Caplan’s, particularly noting that medical literature does not favour anticoagulant therapy over antiplatelet therapy for treating artery dissections like William’s. The judge also noted Dr. Caplan’s defence of his opinions despite contrary scientific evidence, which affected his credibility.

On appeal, William challenged the admission of Dr. Gladstone’s testimony regarding the cause of the second stroke, arguing it constituted a "trial by ambush," and claimed that he had established a prima facie case on causation, which Dr. Vieira failed to counter sufficiently. The appellate court disagreed, noting that both potential causes of the stroke were sufficiently explored during the trial. The court found that Dr. Gladstone’s testimony did not introduce new or surprising evidence outside the agreed facts.

The appellate court reiterated that the trial judge's acceptance of Dr. Gladstone's interpretation of the evidence was reasonable and well within the discretionary standards of trial conduct. Furthermore, the court emphasized that the effectiveness of Aspirin compared to Heparin, in this case, showed no significant difference, supporting the decision that William’s second stroke was not likely preventable by different or additional medication at the time of his discharge.

Accordingly, the court affirmed the trial judge's findings and dismissed the appeal, awarding costs to the respondent, Dr. Vieira.