Clarifying Causation

A medical malpractice plaintiff must show that the defendant’s actions caused their injury; in a negligence action this is known as ‘causation’. At times, causation may be difficult to establish as medical procedures can be complicated and may be challenging to comprehend for those outside the medical profession. The Supreme Court of Canada decision in Ediger v Johnston, 2013 SCC 18 provides assistance to medical malpractice plaintiffs with the task of proving causation.  

In this case, unanticipated complications arose during the birth of baby “C”. The doctor conducting the delivery attempted to deliver the baby using mid-level forceps but failed to inform the delivering mother of the dangers this procedure carried. Mid-procedure the doctor abandoned the forceps and decided to deliver the baby via C- section. With this decision the doctor left the room for approximately twenty minutes to make preparations for the C-section procedure. Baby C succumbed to the dangers surrounding her delivery and now suffers from spastic quadriplegia and cerebral palsy.

The mother sued the doctor who delivered baby C for negligence. At trial, the judge found the doctor liable for failing to adequately prepare for a C- section and concluded that the doctor caused the child’s injury when he attempted to deliver using forceps. The British Columbia Court of Appeal overturned this decision concluding the plaintiff could not prove that the doctor actually caused the injury. The Supreme Court of Canada reinstated the trial judge’s decision.

On the sole issue of causation, the Supreme Court endorsed the analysis of the trial judge. The trial judge relied on a historic Supreme Court of Canada case called Snell v Farrell, [1990] 2 SCR 311, which states that proving causation does not always require scientific certainty; a trial judge may draw an inference of causation if a defendant does not introduce sufficient evidence to defend their actions. The BC Court of Appeal concluded the trial judge improperly relied on the above reasoning in Snell. In short, the BC Court of Appeal believed causation required a more narrow approach to causation; the Supreme Court of Canada disagreed.

This decision aligns with the wider interpretation of causation as found in Snell. It confirms that a medical malpractice litigant does not need to prove causation with 100% certainty and drawing an inference of causation upon weighing all the appropriate evidence may be sufficient when establishing causation in a medical malpractice claim.

If you believe that you have received improper or negligent medical treatment, contact of the members of the Patterson Law Personal Injury Team for advice. Please note that this article is meant to provide information only and is not intended to confer legal advice or opinion. If you have any further questions please consult a lawyer. Please note as well that many of the statements are general principles which may vary on a case by case basis.