Aleks Mladenovic

The appellants (defendant doctors) appealed a trial judgment finding them liable for failing to obtain informed consent for a multi-step medical treatment plan that resulted in catastrophic brain injury to the plaintiff.

The appeal addressed the nature and extent of a physician's duty to obtain informed consent, on which physicians this duty rests, sufficiency of reasons, evidentiary issues (including expert witness exclusion), and costs.

The Court of Appeal dismissed the appeal, upholding the trial judge's findings that all three appellant doctors failed to provide adequate disclosure regarding the cumulative risks of the treatment plan, and that the plaintiff would not have proceeded had he been properly informed.

Leave to appeal costs was refused.

The plaintiffs sought costs following a successful 25-day medical malpractice trial where they "beat" a Rule 49 offer.

The defendants proposed a lower costs amount.

The court awarded the plaintiffs $3 million in costs, finding their request consistent with similar complex medical malpractice cases and justified by the defendants' conduct, which unnecessarily lengthened the proceeding and increased the plaintiffs' legal work.

The court considered factors under Rule 57.01, including the complexity of the case, the plaintiffs' complete success, and the defendants' late disclosure and attempts to introduce contradictory evidence.

The plaintiff suffered a catastrophic brain bleed and traumatic brain injury during an elective multi-step medical intervention for an asymptomatic brain AVM.

The plaintiff brought a medical negligence action against the treating physicians, alleging a failure to obtain informed consent.

The Superior Court of Justice found that the physicians failed to adequately disclose the cumulative risks of the multi-step procedure, the likelihood of requiring surgical resection, and the risks of conservative management.

The court concluded that a reasonable person in the plaintiff's position would not have proceeded with the intervention had they been properly informed, and held the physicians liable for the plaintiff's injuries.

The plaintiffs in a medical malpractice action brought a motion to exclude the defendants' expert witness, a vascular neurosurgeon and interventional neuroradiologist, on the basis of bias.

The court conducted a voir dire and reviewed the expert's reports, past testimony, and relationship with the defendant physicians.

The court found that the expert was not impartial, acted as an advocate, failed to disclose his professional and personal relationship with one of the defendants, and assumed the defendants' evidence was credible while ignoring the plaintiffs' evidence.

The court concluded that the expert was unable and unwilling to comply with his duty to the court and excluded his evidence in its entirety.

The plaintiff attended the emergency department after suffering multiple stab wounds, including one to his right knee.

The defendant emergency physician assessed the wounds as superficial, sutured them, and discharged the plaintiff.

Weeks later, an MRI revealed a completely transected patellar tendon, requiring complex reconstructive surgery due to the delay.

The court found that the tendon was completely transected at the time of the initial emergency visit.

The defendant breached the standard of care by failing to properly assess the knee's extensor mechanism, failing to detect air in the knee joint on x-rays, and failing to refer the plaintiff to an orthopedic surgeon.

The court concluded that this negligence caused the delayed diagnosis and worsened the plaintiff's outcome.

Judgment was granted in favour of the plaintiff.

The plaintiffs brought a motion for leave to appeal the November 30, 2020 order of Davies J. The Divisional Court dismissed the motion for leave to appeal.

No costs were ordered as neither party filed a bill of costs.

The plaintiffs in a medical malpractice action appealed a Master's decision upholding a defendant doctor's refusal to answer certain hypothetical questions during his examination for discovery.

The Superior Court of Justice dismissed the appeal, finding that the Master correctly ruled that the doctor was not required to answer hypothetical questions based on factual premises he disputed, nor questions that indirectly asked him to opine on the standard of care or decisions of other medical professionals involved in the infant plaintiff's care.

The appellant, a general surgeon, appealed a trial judgment finding him liable for medical negligence in the treatment of an 11-year-old patient who presented with abdominal pain.

The surgeon discharged the patient without ordering imaging or hospital admission, providing discharge instructions that the patient should only return if her condition worsened.

The patient's appendix subsequently ruptured, causing significant bowel damage.

The trial judge found the surgeon breached the standard of care in both his assessment and discharge instructions, and that causation was established.

The Court of Appeal dismissed the appeal, finding no palpable and overriding error in the trial judge's findings on standard of care or causation.

The court also addressed the inordinate delay in releasing reasons but concluded it did not impede fair adjudication.

The defendants sought summary judgment in a medical negligence action, proposing to address causation and standard of care.

The case management judge, applying the Hryniak v. Mauldin framework, assessed whether the proposed motion, requiring a mini-trial with extensive viva voce expert evidence, would be proportionate, timely, and affordable.

Given the complexity of competing medical opinions on delayed diagnosis and the effectiveness of antiviral treatment, the anticipated length of the mini-trial (7-10 days), and the unlikelihood of resolving all triable issues, the judge concluded that the motion would not meet the goals of efficient dispute resolution.

Consequently, the defendants' proposed summary judgment motion was denied, and the scheduled motion dates were vacated, with the judge remaining seized to schedule an early trial.

The plaintiffs' medical negligence action against the defendant physician settled for $400,000 in damages prior to trial, and the parties settled liability on the morning of the trial.

The parties could not agree on costs.

The plaintiffs sought over $264,000 in costs and disbursements, arguing the defendant unreasonably delayed settlement.

The court rejected the argument for elevated costs to sanction the defendant, noting the case involved competing expert opinions.

Applying the principle of proportionality, the court reduced the plaintiffs' claimed fees and significantly reduced an expert witness's disbursement, fixing total costs at $125,000 for fees and $45,000 for disbursements.

The appellant emergency room physician appealed a trial judgment finding him liable in negligence for the death of a patient from bacterial meningitis.

The trial judge found the appellant breached the standard of care by failing to consider meningitis, perform a lumbar puncture, or administer standard treatment when the patient presented with confusion, fever, and a history of decreased consciousness.

The Court of Appeal dismissed the appeal, finding no palpable and overriding error in the trial judge's factual findings regarding the patient's mental status, her reliance on an infectious disease specialist's standard of care evidence, or her causation analysis applying the 'but for' test.

A Sanderson costs order against the appellant was also upheld.

The plaintiff sued her physician for medical malpractice, alleging he negligently managed her right forearm pain by failing to properly assess and investigate a bump that was eventually diagnosed as a rare synovial sarcoma.

The defendant physician had diagnosed repetitive strain injury and reflex sympathetic dystrophy, treating the plaintiff with psychotherapy and medication for nine years before ordering an MRI.

The Superior Court of Justice found that the defendant breached the standard of care of a primary care physician by failing to include a tumour in his differential diagnosis, failing to properly monitor the lump, and failing to order an MRI earlier.

The court also found that this breach caused the plaintiff's damages, as an earlier MRI would have led to earlier surgical removal of the tumour and eliminated years of pain.

Following a successful medical negligence trial, the plaintiffs sought costs after achieving complete success on liability and damages of $190,000.

The plaintiffs had made a Rule 49 offer of $150,000 inclusive of prejudgment interest prior to trial and argued that the judgment exceeded the offer by 31%, entitling them to substantial indemnity costs from the offer date.

The defendant argued the claimed costs were disproportionate to the damages and that agreeing to damages prior to trial prevented a determination that the offer had been beaten.

The court found the plaintiffs had repeatedly attempted settlement and that the defendant displayed intransigence in proceeding to trial despite the standing offer.

Applying the principles of fairness, reasonableness, and the reasonable expectations of the parties, the court awarded the plaintiffs their full claimed costs and disbursements.

The appellants appealed a motion judge's determination on a question of law regarding the applicability of a Florida statutory threshold defence.

The Court of Appeal found that the motion judge erred by failing to consider section 6 of the OPCF 44R-Family Protection Coverage Form, which limits the Ontario insurer's exposure based on the threshold applicable to the underinsured tortfeasor under section 737 of the Florida statute.

The appeal was allowed, and the court held that the Florida threshold applies.

The appellants appealed a trial judge's costs disposition.

Prior to trial, the appellants offered to settle the case for $85,100.

The parties later agreed on damages of $125,000, and the trial proceeded only on liability, resulting in a finding against the respondents.

The trial judge held that the agreement on damages invalidated the prior offer to settle and awarded partial indemnity costs.

The Court of Appeal allowed the appeal, finding that the offer to settle was not withdrawn and Rule 49.10 applied, entitling the appellants to substantial indemnity costs from the date of the offer.

The court remitted the quantum of costs to the trial judge and upheld the refusal to award a risk premium.

Following the dismissal of the plaintiff's appeal in a copyright infringement action, the Court of Appeal received written submissions to fix the respondents' costs on a substantial indemnity basis.

The court declined to refer the costs for assessment, finding it was better positioned to fix them given its knowledge of the complex appeal.

The court applied the new costs rules and Tariff A grid, rejecting the respondents' request to apply the former solicitor and client scale.

After adjusting hourly rates, reducing preparation hours, and setting off the appellant's costs for interlocutory proceedings, the court fixed the respondents' costs at $536,464.42.