Ontario Court of Appeal upholds medical negligence finding in septic pregnancy loss case

In a medical malpractice proceeding involving a septic pregnancy loss, the Ontario Court of Appeal saw no reversible error in the trial judge’s conclusion that the patient’s catastrophic injuries would not have occurred but for the appellant doctor’s negligence. 

The medical malpractice suit sought damages for the patient’s serious injuries, including a partial amputation of her right foot, the amputation of her left leg below the knee, kidney failure, a stroke, seizures, and difficulties using her right arm. 

The action asserted that three doctors who saw the patient in the emergency department on different dates – including the appellant in Ibrahimova v. Cavanagh, 2026 ONCA 573, who met the patient from May 3–4, 2019 – were negligent in failing to diagnose the previable, prelabour, preterm rupture of membranes (pPPROM) resulting in infection and other injuries. 

Production order denied

The three doctors moved for the production of video/audio recordings from the in-home camera of the patient and her husband. On Feb. 20, 2025, Justice M.J. Lucille Shaw of the Ontario Superior Court of Justice dismissed this motion for a production order. 

Superior Court finds appellant negligent

On Aug. 22, 2025, Justice John R. Sproat of the Superior Court determined that: 

• The appellant breached the standard of care of an emergency room physician on May 4, 2019 
• The appellant negligently failed to recognize the patient’s pPPROM 
• But for the appellant’s negligence, the patient would have avoided the damages from her catastrophic injuries flowing from the septic shock due to the delayed treatment for pPPROM 

The trial judge acknowledged that the two other doctors – who met the patient separately on May 5 and May 6, 2019 – were also negligent in their care of the patient. 

However, the trial judge dismissed the medical malpractice action against these two doctors because the patient would have developed a severe infection and sepsis even without their negligence. 

While the appellant accepted the negligence finding, she argued that her negligence did not cause the patient’s damages. The appellant added that the trial judge based his causation findings on speculation, misconstrued and ignored evidence, and relied on inadmissible evidence. 

Ontario Court of Appeal denies appeal

The Ontario Court of Appeal dismissed the appeal upon finding that the trial judge had conducted the proper legal analysis to conclude that the appellant’s negligence caused the patient’s damages. 

The appeal court awarded the patient and her spouse all-inclusive costs of $60,000. 

Causation findings upheld

Based on the evidence, the Ontario Court of Appeal ruled that the trial judge was entitled to make the following factual findings in his causation analysis: 

• If the appellant had referred the patient to an obstetrician when he met her on May 4, 2019, then the obstetrician would have advised her of the risk that continuing with her pregnancy could cause potentially life-threatening injury 
• If she had known about the risks associated with pPPROM, the patient would have immediately chosen to terminate the pregnancy 
• The London Hospital’s obstetrical team would have identified and taken steps to address the signs and symptoms of infection 
• The London Hospital would have prioritized scheduling the procedure to terminate the pregnancy on May 5, 2019 
• The London Hospital doctors could have performed a discharge and evacuation (D&E) procedure within two hours of the patient’s decision to terminate the pregnancy 

No error regarding obstetrical care standard

Regarding the argument that the trial judge invented a new standard of obstetrical care, the Ontario Court of Appeal saw no error in his approach in accepting the uncontradicted testimony of a London Hospital obstetrician/gynaecologist. 

According to the testimony, if there were any evidence of infection, the obstetric team would have administered antibiotics and offered the option to terminate the pregnancy. 

No adverse inference error

Regarding the ground of appeal that the trial judge misapplied the law of adverse inference, the Ontario Court of Appeal said he did not need to explain why he did not draw an adverse inference based on the plaintffs’ failure to ask the London Hospital obstetrician for his opinion on whether the patient had chorioamnionitis on May 5, 2019. 

No reversal of onus of proof

Lastly, the Ontario Court of Appeal rejected the argument that the trial judge erred in reversing the burden of proof by requiring the defence to disprove causation. 

Previous disciplinary cases at Ontario Court of Appeal

Here are some other recent decisions from the Court of Appeal for Ontario arising from disciplinary matters involving medical professionals in the province. 

In a medical malpractice action regarding a brain aneurysm, the Ontario Court of Appeal made a May 1 decision quashing an appeal against an order adding defendants upon determining that the appeal lay to the Divisional Court with leave because the order was interlocutory. 

In proceedings arising from a medical malpractice settlement, the Ontario Court of Appeal issued a Mar. 25 order for a law firm to pay the injured party and his mother costs of $37,000 after confirming on Jan. 8 that a contingency fee agreement was unfair and unreasonable. 

In a medical malpractice case asserting a delayed diagnosis, the Ontario Court of Appeal made a Dec. 16, 2025, decision upholding a judge’s determination that a doctor breached the standard of care by failing to call the patient back to the hospital for a consultation. 

Enjoy this story? Read the latest medical malpractice law news on the main page!