Translating clinical judgment into legal proof
Medical malpractice litigation sits at a unique intersection between law and medicine. Clinical decision-making – often made in moments of urgency, uncertainty, and evolving risk – must later be reconstructed into a narrative that satisfies legal standards of proof.
Medicine is a science, but it can also be an art. Physicians make clinical decisions based on a constellation of data, including a patient’s history, symptoms, test results, scoring tools, and their own experience. This is an inherently human process. It involves judgment, pattern recognition, and intuition – which doctors refer to as “gestalt.” On the other side, there are the courts, where the functioning of a good legal system relies on objective facts and predictable outcomes.
Reconstructing the record
The legal process is designed to produce outcomes based on defined standards, supported by evidence that can be tested and weighed by the court. A medical malpractice case requires the plaintiff to establish that a healthcare provider breached the standard of care and caused harm.
“As plaintiff medical malpractice lawyers, our job is to bridge the gap between law and medicine,” says Alexandria Ruigrok, associate at Bogoroch & Associates LLP. “That often involves building a narrative, to translate gestalt into discrete steps that can be examined against the standard,” she continues. “It needs to be both accurate, which requires knowledge of medicine and science, and legally meaningful, which requires expertise in the law.”
For all medical negligence claims, Bogoroch & Associates relies on expert evidence. If an expert concludes that a decision made by the defendant wasn’t reasonable, it generally signals the plaintiff has a strong claim. The team must integrate expert opinion into the broader theory of the case: it’s not just having an expert explain what should have happened, but helping the court understand what actually happened — and why that difference matters. This is especially critical in cases of delayed diagnosis, surgical complications, or comorbidities where the patient has several different medical conditions at play.
“If you can’t build a coherent narrative, you will have difficulty proving the case because of the uncertainty that already exists in medicine,” Ruigrok explains, adding that lawyers in this practice area contend with thousands of pages of medical records, often with multiple practitioners involved in a single episode of care, to reconstruct what led to the plaintiff’s harm.
Importantly, none of the decisions made by healthcare providers can be examined with the benefit of hindsight; they must be reviewed based on what was known at the time.
What diagnoses were considered? How did timing affect the patient's outcome? When did the doctor request labs, and when did they become aware of the results? Once they had the tests back, did they review them and act on them appropriately? What did they order next, or not order, and why?
This may sound like splitting hairs, Ruigrok explains, but “these inquiries help establish what actually happened in such a way that you can understand the defendant’s decision-making, and where they may have gone wrong.”
The firm’s deep expertise in medical malpractice litigation allows its lawyers to synthesize complex information and frame issues in a way that’s “precise and persuasive,” says Ruigrok. “We review thousands of pages of medical records — which are often incomplete and, in some instances, filled with illegible handwriting — to understand what information and resources were available to the practitioner at the time, and determine if their decision was reasonable in light of those factors.”
From pre-med to med mal
Medical malpractice is a rigorous practice area — and one Ruigrok is well-suited to. Her undergraduate degree was in biomedical science, covering areas like biology, chemistry, anatomy, and physiology. In her last year, she took business law as an elective and loved it so much, she reconsidered her options following graduation. Ruigrok ultimately decided to pivot, writing the LSAT and applying to law school.
In her first year of law at Queen’s University, she discovered medical malpractice. Ruigrok participated in a moot “and I was just obsessed with it,” she recalls. She was drawn to the medical research aspect, something she continues to enjoy about her work, and considers herself lucky to have landed at Bogoroch & Associates.
Ruigrok enjoys the challenge of the practice area because she’s able to apply her science and law knowledge at the same time. Law students often ask if a science background is necessary to succeed and while she wouldn’t go that far, she says familiarity with medical terms may help lessen the learning curve for new recruits.
“Speaking to our medical experts is one of the highlights of building a case,” Ruigrok says. “They’re maintaining an active clinical practice and working on their own academic research, and have insights beyond what the medical records alone can provide.”
Beyond the intellectual challenge, Ruigrok is fuelled by the human stakes. Medical records represent the healthcare system's version of events, written from the perspectives of the doctors and nurses. It’s only by coming to a firm like Bogoroch & Associates that plaintiffs get a voice as well.
Handling complex medical and hospital malpractice cases across the country, the lawyers at Bogoroch & Associates painstakingly create the client’s point of view through the statement of claim and by standing up in court on their behalf. It gives them a chance to have their story heard, which is a dimension of the role that drives Ruigrok.
“Being on the plaintiff side really puts client service first. These cases are about people whose lives have been changed forever. Translating the medicine into a legal narrative is giving our clients a voice: it allows them to have their side of the story reflected in the process, which I really love about this work.”
The standard of excellence
Not every adverse medical outcome is the result of negligence, and distinguishing between the two is at the heart of the work. Careful reconstruction of what was known, what was done, and whether decisions met the standard expected in the circumstances is foundational to these claims.
“Effective advocacy involves careful attention to detail in the medical records, a lot of team analysis of the case and litigation strategy, and time spent with experts to make sure we have all the information,” Ruigrok says. “This work depends on more than just legal knowledge; it requires a disciplined approach and a deep understanding of the facts and the medicine.”
It’s a standard of excellence Bogoroch & Associates holds itself to — and one Ruigrok expects only to build on.
“We pride ourselves on being very good at what we do,” she adds. “And we’ll only continue to get better at it in the future.”
This article was produced in partnership with Bogoroch & Associates LLP
