An expert witness's practice should not be taken as evidence of the standard of care
In a recent medical malpractice case, the Superior Court of Justice for Ontario gave more weight to the testimony of a community rheumatologist, than an academic rheumatologist whose approach was “academic, theoretical, and often contradictory.”
In Leckie v. Chaiton, 2021 ONSC 7770, Dr. Chaiton diagnosed Leckie with gout and prescribed Allopurinol. Leckie developed rashes due to the medication, which was later found to have been brought about by Allopurinol-induced Stephens-Johnson Syndrome. Leckie sued Chaiton for medical malpractice for having allegedly breached the standard of care in treating Leckie, who advanced the theory that she did not need Allopurinol because she did not have gout.
Both sides presented conflicting testimonies of expert witnesses, but it was evident to the trial judge that the testimony of Leckie’s expert witness came from the perspective of an academic rather than community practice.
Leckie’s expert witness held Chaiton to a standard of care that is considerably higher than what he applies to himself or other physicians, said the court. His response to questions consisted mostly of elaborating what he would have done, but it is well established that an expert’s practice should not be taken as evidence of the standard of care, said the court.
Most notably, the opinion of Leckie’s expert witness was not that the diagnosis was wrong, but that further investigation should have been done before arriving at the same conclusion. In his testimony, he was critical of Chaiton for “failing to perform a joint aspiration even though ‘over 90%’ of gout cases in Ontario are diagnosed without a joint aspiration.”
The court concluded that Chaiton’s decision to start Allopurinol therapy was a reasonable exercise of clinical judgment that met the standard of care. Contrary to Leckie’s causation theory, all her doctors diagnosed her with gout and even her expert witness also does not take the position that Allopurinol should never have been prescribed, said the court.
Lastly, as to the dispute of when Allopurinol therapy should have started, the court found that because of Leckie’s genetic haplotype, “it was inevitable that she would develop Stevens-Johnson Syndrome once she received Allopurinol – regardless of when she started it.”