The patient had a relatively high risk of splenic rupture compared to the average person
The Ontario Court of Appeal has upheld the dismissal of a medical malpractice lawsuit that stemmed from the treatment of a fatal spleen injury.
The dispute in Willick v. Willard, 2023 ONCA 792 centered on medical malpractice allegations against Dr. Peter Willard and Dr. Michael Csanadi regarding their treatment of Brian Willick following a fall that ultimately resulted in his death.
Willick was doing renovation work at his late father's house when a temporary staircase collapsed beneath him, and he fell into the basement. He was admitted to the emergency room of Welland County Hospital, where Dr. Willard attended to him before discharging him for follow-up with his family doctor, Dr. Csanadi.
Willick passed away a few days later due to loss of blood resulting from a ruptured subcapsular hematoma in his spleen. Willick's family initiated legal proceedings against the doctors, alleging medical negligence in the care provided.
The trial judge dismissed the case, citing the absence of detectable injury to Willick's spleen when Dr. Willard treated him. The judge also found that Dr. Csanadi's decision to clear Willick for a return to work was appropriate. The Willick family has appealed the decision to the Ontario Court of Appeal, which ultimately upheld the trial judge's decision.
The appeal court found that Willick had pre-existing conditions, including non-alcoholic cirrhosis of the liver, such that his blood did not clot as quickly as the average person. He also suffered from splenic hypertension and an enlarged spleen. As a result, Willick had a relatively high risk of splenic rupture compared to the average person.
The factual context of the case revealed that Dr. Willard reviewed multiple CT scans and consulted with radiologists before concluding that Willick had not suffered a splenic injury during the fall. Dr. Willard instructed Willick to rest for a week and follow up with his family doctor.
Dr. Csanadi, during the follow-up, conducted a physical examination, ordered an ultrasound and cleared Willick to return to work with instructions to remain sedentary and seek immediate medical attention if he experienced any symptoms. Despite the medical assessments, Willick returned to work and eventually passed away.
On appeal, Willick’s family argued that the trial judge failed to specify the particularized standards of care for either doctor, which allegedly gave rise to a risk that the judge erroneously applied the same standard to both doctors even though they had different specialties and facts available to them.
However, the appeal court found that the trial judge engaged with the standard of care applicable to each doctor. The trial judge summarized the testimony of the competing experts, revealing the standard of care owed to Willick by each doctor.
Willick’s family also characterized the trial judge's credibility findings as amounting to legal error. However, the appeal court recognized the particular advantage of trial judges in assessing the credibility of witnesses and deferred to credibility finding in the absence of palpable and overriding error. The court said it had no basis for rejecting the trial judge's credibility findings because each finding was open to the trial judge on the evidence before him.
Ultimately, the court ruled that the appellants, Willick’s family, failed to meet their burden of showing that the trial judge made an actual error or that his reasons frustrated appellate review. While the appeal court acknowledged that the trial judge's reasons were not perfect, they were adequate for appellate review.
The appeal court also noted that the focus of the appeal was on the trial judge's speculation about whether an intervening event caused Willick's death. However, the appeal court said that once the trial judge determined that the doctors had not breached their respective standards of care, no act or omission on anyone's part could have caused Willick's tragic death.
The court ruled that the alleged flaw in the trial judge's reasons did not render his chain of reasoning or the case's outcome doubtful. The court ultimately dismissed the appeal.
