This recent decision from the Ontario Supreme Court highlights the difficulties faced by families who want to pursue a medical malpractice claim for the loss of a loved one.
Sharon Mangal was admitted to the William Olser Hospital on February 16, 2004 to give birth to her second child through caesarean section. Although she ultimately gave birth to a healthy baby girl, Sharon did not survive the procedure.
Sudesh Mangal, Sharon’s husband, along with Vincent and Sarina Mangal, her children, sued the hospital and the doctors alleging their negligence caused Sharon’s death.
The defendants in the case were the obstetricians, nurses, and the anesthesiologists who cared for Sharon Mangal during her labour and delivery, and William Osler Health Centre where the surgery took place. Marocco J. meticulously reviewed the evidence put forward against each of the defendants.
Standard of Care
In any medical malpractice claim, the plaintiff has the burden of proving what the expected standard of care was for each of the defendants and that one or more of the defendants breached the standard of care. In other words, the plaintiff has to prove that one or more of the defendants was negligent.
The plaintiffs have the burden of establishing that, but for the negligent act, the injury would not have occurred. Or in this case, Sharon’s family must prove that timely and appropriate treatment from the Hospital and the doctors and nurses involved would, more likely than not, have avoided the Sharon’s death.
The Medical Evidence
Marocco J. noted that Ms. Mangal’s pregnancy was not routine because she had developed high blood pressure and she had an enlarging fibroid in her uterus. This was important because while the existence of a fibroid was not unusual, it did create a higher risk of bleeding after delivery.
The delivery
The delivery proceeded without complications and after delivery of a healthy baby, Sharon Mangal appeared to be doing well. Dr. Chandran, the obstetrician, left directions with the nurse and returned to her office. The judge noted this was the standard practice.
Everything appeared to be fine with Ms. Mangal until about 11:30 a.m. when the nurse on duty noted some bleeding and that Ms. Mangal’s blood pressure readings had dropped.
Justice Marocco determined that although there was a delay in acting on this information, the nurse did notify the relevant professional on or about noon – thereby satisfying the expected standard of care.
Dr. Girvitz saw Sharon at 12:35 p.m. He did not order coagulation studies when he saw Sharon because she was not bleeding at the time, and, according to the doctor, her blood was not watery. Dr. Girvitz thought Sharon was stable at the time of his assessment. The judge found that the failure to order a transfusion at this point did not fall below the standard of care.
Delay in reporting test results
Coagulation tests were eventually ordered. Marocco J. noted there was unacceptable delay in reporting these tests back to the Post-Anesthetic Care Unit, where Sharon was receiving treatment.
However, because coagulation factors were ordered before the test results arrived, the delay in the test results did not delay the administration of coagulation products.
22 minutes
Marocco also assessed the timing of the decision to return Sharon to the operating room. The judge concluded from the evidence that she should have been sent to the operating room around 1:30 p.m. She only arrived in the O.R. at 1:52 p.m.. This 22 minute delay constituted a breach of the standard of care.
Causation
The next step for the Ontario Court was to decide if the breach of the standard of care led to Sharon Mangal’s death: “whether it is more likely than not that failing to decide to operate at 1:30 p.m. contributed to Ms. Mangal’s death”.
The judge determines that Sharon died as a result of Disseminated intravascular coagulation a clotting disorder commonly referred to as DIC that occurred around 2:07 p.m..
The evidence established that in the William Osler health Ceneter, once the decision to operate is made it takes approximately one hour and ten minutes (1:10) to actually commence surgery (the time from decision to incision).
Justice Marocco found that if the decision was made to operate on Sharon at 1:30 p.m., as would have been appropriate, she would not actually have been in surgery until 2:40 p.m.
Unfortunately, the evidence indicated that Sharon was in DIC at 2:07 p.m..
As a result, the court determined that despite the negligence in the care provided to Sharon Mangal, the failure to meet the standard of care did not cause her death.
Conclusion
The judge found there was conduct of the defendants that fell below the standard of care. However, the family was not able to prove that this conduct led to Sharon Mangal’s death. Accordingly the case was dismissed.
This case is an example of the tough road that medical malpractice victims face. Even though Sharon’s family lost their wife/mother, and they could prove that the medical professionals fell short of their standard of care, they could not prove the deficiencies actually led to her death.
As a result, they were unable to recover anything to compensate them for their tremendous loss.
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