Mr. Borthwick

A medical malpractice action arising from the failure of three emergency physicians to diagnose previable, prelabour, preterm rupture of membranes (pPPROM) at 17 weeks gestation and to refer the plaintiff to an obstetrician.

The plaintiff presented to three different emergency departments over four days with a "gush of fluid" and other symptoms consistent with ruptured membranes.

All three physicians diagnosed threatened miscarriage or second trimester bleeding instead.

The failure to diagnose and refer resulted in a delay of approximately one day before the plaintiff reached a tertiary hospital.

During that delay, the plaintiff developed septic shock, leading to amputation of her left leg below the knee, partial amputation of her right foot, kidney failure requiring transplant, stroke, compromised right arm function, and seizures.

The trial judge found that all three defendants breached the standard of care by failing to diagnose the rupture of membranes and failing to immediately refer to an obstetrician.

However, only the first defendant (Dr. Cavanagh) was found liable for damages, as the evidence established that if the plaintiff had been referred on May 4, she would have been seen by an obstetrician, counselled regarding the grave risks, and would have elected to terminate the pregnancy.

Antibiotics and termination by May 5 would have prevented the septic shock and resulting injuries.

The subsequent physicians' breaches occurred too late to prevent the harm.

The applicant, who was left with partial quadriplegia following two motor vehicle accidents, sought statutory accident benefits for the purchase and renovation of a new home to accommodate his needs.

The insurers had advanced $135,000 based on the estimated cost of renovating his previous townhouse, arguing they were not responsible for the capital cost of a new home.

The arbitrator found that while the applicant reasonably required extensive home modifications, including an additional bedroom, an accessible bathroom, and an elevator, the insurers were not obligated to fund the purchase price of the freehold home itself.

The arbitrator ordered the insurers to pay $153,410 for renovations and the capital cost of an additional bedroom, plus a project management fee, but dismissed the claim for a special award, finding the insurers had not unreasonably withheld payments.