Health Law - SCJ

The plaintiffs in a medical negligence action brought a motion for leave to bring a motion after setting the action down for trial, and for an order compelling the defendant physician to produce his response letter to the College of Physicians and Surgeons of Ontario.

The court found that leave was required under Rule 48.04(1) and declined to grant it, as the plaintiffs had known about the letter for nearly a decade and offered no plausible explanation for the delay.

Even if leave had been granted, the court held the CPSO response letter was inadmissible in civil proceedings under s. 36(3) of the Regulated Health Professions Act, which constitutes an absolute bar to use of documents prepared for College proceedings.

A child protection agency brought a motion under the Child, Youth and Family Services Act, 2017 seeking a declaration that the father was a "special party" within the meaning of Rule 2(2) of the Family Law Rules, and an order appointing the Public Guardian and Trustee as his legal representative under Rule 4(3).

The Public Guardian and Trustee declined to consent, taking the position that the father had not met the legal test for incapacity.

The court applied the presumption of capacity under the Substitute Decisions Act and found that, despite the father's unusual, paranoid, and hostile communications, the agency had not established that the father was mentally incapable of understanding the issues and making decisions in the litigation.

The motion was dismissed.

The respondent psychiatrist brought a motion under s. 19 of the Health Care Consent Act seeking an interim treatment order while an appeal from a Consent and Capacity Board decision remained outstanding.

The appellant had appealed a finding that he was incapable of consenting to treatment but had taken no steps to advance the appeal, resulting in a statutory suspension of treatment.

Evidence from the treating psychiatrist demonstrated that the appellant’s untreated psychotic disorder had significantly deteriorated, leading to aggression toward another patient and heightened risk to himself and others.

The court held that the statutory criteria for interim treatment were satisfied, including that treatment would substantially improve the appellant’s condition and that the benefits outweighed the risks.

An interim treatment order authorizing treatment without consent was granted pending the final disposition of the appeal.

The plaintiffs brought a medical malpractice action alleging negligence and lack of informed consent arising from cosmetic breast augmentation and tummy tuck surgery.

The court excluded the plaintiffs’ expert evidence because the expert lacked familiarity with the Ontario standard of care, leaving no admissible evidence on the negligence claim.

The court therefore dismissed the standard of care allegations but proceeded on the issue of informed consent.

Considering the patient’s limited English proficiency, education, and the circumstances surrounding the consultations and consent forms, the court found that the physician failed to ensure the patient understood the material risks and consequences of the procedures.

The court held that a reasonable person in the patient’s circumstances would not have proceeded had adequate disclosure been made, and awarded damages.

The plaintiff brought a motion seeking default judgment and to strike the defendant’s defence.

The defendant brought a motion under Rules 21 and 25 of the Rules of Civil Procedure to strike the claim without leave to amend.

The court found the plaintiff had filed no evidentiary record and provided no basis for default or summary judgment.

The claim was struck on multiple grounds, including statutory inadmissibility of the plaintiff’s proposed evidence under the Regulated Health Professions Act, absence of allegations overcoming statutory immunity, and failure to plead a duty of care.

The court concluded that the claim was fundamentally inconsistent with settled legal principles and declined to grant leave to amend.

The defendant physicians brought a motion for summary judgment dismissing a medical malpractice claim on the basis that it was statute-barred under the Limitations Act, 2002.

The action alleged negligent delay in diagnosing breast cancer, which later recurred and became terminal.

The court considered the discoverability principle and the requirement that a claim be based on material facts including causation and actionable damage.

It held that although the cancer was diagnosed in 2007, the plaintiff’s condition went into remission and actionable injury only became apparent when the cancer recurred in 2009.

The court concluded that the defendants failed to establish that the limitation period necessarily began earlier, and that the issue required a trial.

The defendant physicians brought a motion for summary judgment arguing that a medical negligence claim arising from treatment that preceded a patient’s death from necrotizing fasciitis was statute-barred under the one‑year limitation period in s. 89 of the Regulated Health Professions Act.

The estate argued that the limitation period did not begin to run until a medical expert later reviewed the records and identified specific errors in treatment.

The court held that discoverability required knowledge of material facts establishing potential negligence, which in complex medical cases may require expert interpretation of medical records.

Because the plaintiff only obtained those material facts after receiving an expert analysis of the records, the action was commenced within the applicable limitation period.

The motion for summary judgment was dismissed.

The applicant sought orders under the Substitute Decisions Act, 1992 appointing it as guardian of the respondent’s property following a capacity assessment concluding the respondent was incapable of managing property due to mental illness and delusional beliefs.

The applicant also requested an order compelling the respondent to undergo an Occupational Health Assessment to enable access to employment disability benefits, along with enforcement provisions including possible police assistance.

The court accepted the capacity assessment and appointed the applicant as guardian of property.

The court further ordered the respondent to attend an Occupational Health Assessment and directed disclosure of health and financial records necessary for the guardianship.

However, the court declined to authorize police apprehension or hospital examination at this stage, finding that the assessment should occur at the respondent’s residence and that enforcement measures could be sought later if necessary.

The moving defendants sought to transfer two related medical negligence actions from Toronto to London, Hamilton, or Milton under Rule 13.1.02(2) of the Rules of Civil Procedure.

The claims arose from alleged latex exposure during medical treatment in London and Ancaster, and the defendants argued that the events and witnesses were primarily located outside Toronto.

Applying the holistic analysis of the enumerated factors under Rule 13.1.02(2), the court considered the location of events, convenience of parties and witnesses, court availability, litigation costs, and other relevant circumstances.

The court concluded that the moving parties failed to demonstrate that any proposed venue was significantly better than the plaintiff’s chosen venue.

The motion to transfer the actions was dismissed.

Licensed pharmacists operating pharmacies within retail stores sought an interlocutory injunction restraining the retailer from selling or transferring pharmacy records to third‑party pharmacy operators following the closure of the stores.

The moving parties argued the records belonged to them under the license agreements and that privacy legislation governing personal health information prevented the transfer.

The court held that the agreements clearly provided that customer records belonged to the retailer, though it acknowledged a low‑threshold serious issue regarding the interaction of contractual terms with health‑information legislation.

The court found no irreparable harm because any business losses could be compensated in damages and patient privacy would not be breached under the statutory regime permitting transfer of records to a successor health information custodian.

The balance of convenience favoured allowing the transfers to ensure continuity of patient care.

The motions for injunction were dismissed.

The appellant appealed two decisions of the Consent and Capacity Board confirming a Community Treatment Order and finding the appellant incapable with respect to a community treatment plan including antipsychotic medication.

The court reviewed the Board’s decisions under a reasonableness standard pursuant to s. 80 of the Health Care Consent Act, 1996.

The appellant raised concerns regarding forced medication, substitute decision-making, and procedural fairness at the Board hearing.

The court held that the Board’s interpretation of the evidence and application of the Mental Health Act and Health Care Consent Act were reasonable and adequately supported by the record.

Alleged procedural issues were not proven to have caused prejudice or constituted significant flaws in the hearing process.

A motion was brought under s. 19 of the Health Care Consent Act, 1996 seeking authorization to administer antipsychotic and mood stabilizing medication to an involuntary psychiatric patient pending the disposition of an appeal from a Consent and Capacity Board decision.

The court accepted evidence that the patient was incapable of consenting to treatment and that several statutory criteria under s. 19(2) were satisfied.

However, the court was not persuaded that the patient's condition required immediate treatment before the appeal could be heard and determined, which was scheduled within several weeks.

Because the urgency requirement under s. 19(2)(d) was not met, the requested interim treatment authorization was refused.

The appellant appealed a decision of the Consent and Capacity Board confirming the renewal of a Community Treatment Order under the Mental Health Act.

The appellant argued that the tribunal failed to determine his capacity to consent to treatment at the time of the mandatory review and that, if he had regained capacity, the substitute decision maker’s prior consent would be invalid.

The court held that the tribunal was required to consider capacity as part of the statutory review criteria and found that it had done so.

The tribunal reasonably concluded that the appellant lacked the ability to understand and appreciate the consequences of refusing treatment, based primarily on medical evidence regarding persistent delusional beliefs and lack of insight into illness.

The tribunal’s reasoning was adequate and entitled to deference as a specialized body.

The appeal was dismissed.

The appellant appealed a decision of the Consent and Capacity Board finding her incapable of consenting to treatment with antipsychotic and thyroid medication under the Health Care Consent Act.

She argued the Board overlooked evidence suggesting she had agreed to treatment shortly before the hearing.

The court held that the Board’s determination of incapacity was a question of mixed fact and law subject to a reasonableness standard.

Reviewing the full evidentiary record, the court found overwhelming evidence that the appellant could neither understand relevant treatment information nor appreciate the consequences of refusing treatment.

The Board’s decision was reasonable and the appeal was dismissed.

In a medical malpractice action involving minor plaintiffs, the moving party sought to set aside an administrative dismissal for delay in order to file a litigation guardian affidavit and involve the Office of the Public Guardian and Trustee.

The court applied the factors governing relief from administrative dismissal and found the delay adequately explained, the motion brought promptly, and no prejudice to the responding party.

However, the court held that a settlement agreement dismissing the action without costs was enforceable against the adult plaintiff personally because clear authority had been given to counsel to settle.

The settlement was not enforceable against the minor plaintiffs because no litigation guardian had properly been appointed and the required affidavit under Rule 7.02 had never been filed.

The action of the adult plaintiff was dismissed without costs and without prejudice to the rights of the minor plaintiffs.

The plaintiff alleged wrongful psychiatric detention and negligence against a hospital and psychiatrist after being held as an involuntary patient for approximately two weeks and reported to the Ministry of Transportation, which led to suspension of his driver's licence and alleged financial losses.

The defendants brought motions for summary judgment, arguing there was no genuine issue requiring a trial because the plaintiff had produced no expert evidence establishing breach of the medical standard of care.

The defendants filed expert reports concluding that the psychiatrist’s clinical decisions and the nursing care met the applicable standards and that the report to the Ministry of Transportation was appropriate.

The court held that medical malpractice claims generally require expert evidence and that without such evidence the plaintiff had no reasonable prospect of success.

Statutory protections under the Health Care Consent Act, 1996 and the Highway Traffic Act also shielded the physician for actions taken in good faith and for mandatory reporting.

Summary judgment was granted dismissing the action against the hospital and physician.

The plaintiffs brought a motion to set aside a registrar’s order dismissing a medical malpractice action as abandoned under Rule 48.15 of the Rules of Civil Procedure and to extend time for service of the statement of claim.

The action alleged negligent misdiagnosis and treatment resulting in severe brain damage following whole brain radiation administered on the basis of an incorrect MRI interpretation.

Applying the contextual analysis and the Reid factors, the court found the delay was attributable to inadvertence arising during a transition between counsel rather than solicitor negligence.

The defendants failed to demonstrate actual prejudice and presumptive prejudice was minimal given the short interval between the limitation expiry and notice of the claim.

The dismissal order was therefore set aside and the time for service extended.

The appellant appealed a decision of the Consent and Capacity Board confirming an involuntary psychiatric admission and finding the appellant incapable of consenting to certain forms of treatment under the Health Care Consent Act.

By the time the appeal was heard, the appellant had been discharged from the treating facility and was under the care of a different physician, with subsequent admissions and new incapacity findings having occurred.

The court concluded there was no longer a live controversy between the parties because the treatment relationship underlying the Board decision had ended.

Applying the mootness principles articulated in Borowski v. Canada (Attorney General), the court declined to exercise its residual discretion to hear the matter.

The appeal was dismissed as moot, leaving the Board’s earlier decision as the final disposition of the application.

In a medical negligence trial arising from a compromised birth, the plaintiffs alleged that labour and delivery nurses failed to meet obstetrical monitoring standards before a severe bradycardic event.

The court found that active labour had begun by at least 18:00, requiring half-hourly auscultation, and held the nursing care fell below the standard by failing to monitor appropriately, verify concerning findings, and escalate monitoring.

On causation, the court preferred expert evidence that a prolonged partial hypoxic-ischemic process likely developed before 21:00 and would probably have been detected with proper surveillance.

The court concluded earlier intervention would likely have prevented or substantially reduced the neurological injury.

The hospital was found liable, with damages previously admitted subject to approval.

The applicant sought habeas corpus with certiorari in aid, arguing that his continued detention as an involuntary psychiatric patient following completion of a criminal sentence was unlawful and violated the Canadian Charter of Rights and Freedoms.

He alleged the practice of “psychiatric gating” and argued that his detention constituted double jeopardy.

The court held that the detention was authorized under the Mental Health Act following lawful execution of a Form 1 and Form 3 and repeated confirmation by the Consent and Capacity Board that the statutory criteria for involuntary admission remained satisfied.

The court also found that civil committal following a completed criminal sentence does not breach Charter protections against arbitrary detention or cruel and unusual punishment.

The proper remedy for disagreement with the board’s decisions was an appeal, not habeas corpus.