Allen v. Bishop of Victoria
- Citation
- 2016 BCSC 1078
- Status
- Judgment
- Jurisdiction
- Canada
- Court
- Supreme Court of British Columbia
- Decision
- 13 June 2016
- Posture
- Medical Negligence / Personal Injury (obstetrics) / Trial — Reasons for Judgment Following Trial (judgment Dated June 13, 2016)
- Language
- English
More details
- Court
- Supreme Court of British Columbia
- Decision
- 13 June 2016
- Posture
- Medical Negligence / Personal Injury (obstetrics) / Trial — Reasons for Judgment Following Trial (judgment Dated June 13, 2016)
- Language
- English
On this page
Professional case brief
Research organized from the available case record
01
Holding and result
On the evidence the court found the nurse monitored in accordance with the applicable standard for a low‑risk pregnancy, that the intermittent auscultation performed was not shown to be negligent, and that plaintiffs failed to prove on a balance of probabilities that any alleged departure caused the infant's hypoxic ischemic injury; accordingly the claims failed for want of causation and breach.
Court disposition
Plaintiffs' claims dismissed
Orders
- Statement of claim dismissed against all defendants
- Court retains materials and submissions relevant to damages for potential future assessment
02
Material facts
Parties
Brenna Allen (infant)
Plaintiff Counsel: D. J. Renaud; I. R. CampbellMelissa Allen (litigation guardian)
Plaintiff Counsel: D. J. Renaud; I. R. CampbellThe Bishop of Victoria (operator of St. Joseph's General Hospital)
Defendant Counsel: C. L. Woods, Q.C.; D. HwangDr. B. Mathew Bagdan
Defendant Counsel: J. M. Lepp, Q.C.; K. J. JakemanDr. Donald G. Wilson
Defendant Counsel: J. M. Lepp, Q.C.; K. J. JakemanDr. Dennis L. Hartman
Defendant Counsel: J. M. Lepp, Q.C.; K. J. JakemanDr. Natalie J. Aird
Defendant Counsel: J. M. Lepp, Q.C.; K. J. JakemanLisa Bradley, RN
Defendant Counsel: C. L. Woods, Q.C.; D. HwangLeah McCarthy, RN
Defendant Counsel: C. L. Woods, Q.C.; D. HwangRobyn Clarke, RN
Defendant Counsel: C. L. Woods, Q.C.; D. HwangT. Norris, RN
Defendant Counsel: C. L. Woods, Q.C.; D. HwangJ. Hall, RN
Defendant Counsel: C. L. Woods, Q.C.; D. HwangMary Robertson
Defendant Counsel: C. L. Woods, Q.C.; D. HwangAmounts and remedies
- Umbilical Cord P H: 6.92
- Umbilical Cord Base Excess: -20
- One Minute Apgar Score: 4
- Five Minute Apgar Score: 8
- Recorded Fetal Heart Rate Baseline (bpm): 140
03
Procedural history
Posture
Medical Negligence / Personal Injury (obstetrics) / Trial — Reasons for Judgment Following Trial (judgment Dated June 13, 2016)
04
Questions and positions
Legal issues
- 01
Whether nurse breached standard of care in monitoring fetal heart rate
- 02
Whether discontinuation of electronic fetal monitoring and switch to intermittent auscultation was negligent
- 03
Whether any breach caused the infant's hypoxic ischemic brain injury
- 04
Whether hospital and nurse manager were liable for training/supervision failures
Party arguments
- Applicant
- Plaintiffs contend the attending nurse negligently discontinued or failed to re-establish electronic fetal monitoring when the tracing became uninterpretable, failed to escalate or notify the physician of recurrent decelerations/bradycardias, and that adherence to guidelines or reapplication of EFM would have detected deterioration and permitted timely intervention to prevent intrapartum hypoxic ischemic injury.
- Respondent
- Defendants contend the patient was low risk, intermittent auscultation was appropriate and was conscientiously applied, the nurse's assessments comported with accepted guidelines and practice, the recorded readings were not indicative of sustained fetal distress, experts disagree on interpretation, and plaintiffs fail to prove on balance of probabilities that any conduct caused the injury.
05
Court’s reasoning
Legal principles
- 01
Crits v. Sylvester; ter Neuzen v. Korn
A medical professional must exercise the degree of care and skill of a prudent practitioner of similar experience; standards judged by contemporaneous professional knowledge
- 02
Pacard & Robertson, Legal Liability of Doctors and Hospitals in Canada
Duty of care extends to both mother and fetus in obstetrical practice
- 03
Hanke v. Resurfice Corp.; Athey v. Leonati; Snell v. Farrell
Causation is assessed by the 'but for' test and requires plaintiff to prove on balance of probabilities that defendant's negligence caused the harm; inference permitted only where evidence allows
- 04
SOGC / JOGC 2007 guidelines; Vuong v. Morton
Clinical guidelines inform standard of care but do not dictate an exclusive course of treatment; departure must be justified
- 05
Picard & Robertson; Ediger v. Johnston (cited)
In obstetrics urgency, anticipation and communication are key factors in standard of care
06
Ratio, limits and disposition
Ratio decidendi
On the evidence the court found the nurse monitored in accordance with the applicable standard for a low‑risk pregnancy, that the intermittent auscultation performed was not shown to be negligent, and that plaintiffs failed to prove on a balance of probabilities that any alleged departure caused the infant's hypoxic ischemic injury; accordingly the claims failed for want of causation and breach.
Obiter and limits
- Expert opinion in fetal monitoring is divided and inter-observer variability is significant
- Guidelines are important but not slavishly binding; clinical judgment in context remains relevant
- Obstetrics retains inherent uncertainties; not all catastrophic outcomes are attributable to negligent care
- Court will retain materials on damages in case circumstances change
Court disposition
Plaintiffs' claims dismissed
- Statement of claim dismissed against all defendants
- Court retains materials and submissions relevant to damages for potential future assessment
Source and reliance status
Supreme Court of British Columbia · 13 June 2016
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