The role of frustration in medical malpractice cases and determining compensability for unexpected outcomes in mental injury claims.

What is Frustration?

Frustration, in a legal context, refers to an unforeseen event or circumstance that significantly alters the purpose or nature of a contract or legal relationship, rendering it impossible to fulfill the original intent. This principle applies not only to contractual matters but also to areas like medical malpractice.

Frustration in Medical Malpractice Cases

A recent article by Siskinds LLP, titled examines the role of frustration in medical malpractice cases and how the frustration doctrine can be invoked to assess the compensability of medical errors or unexpected outcomes.

When determining compensability, various factors come into play. Traditionally, medical malpractice cases required the presence of negligence or a breach of the standard of care. However, frustration introduces an additional element that considers whether the outcome was unforeseeable, making it impossible to achieve the original objective of the treatment or care.

Medical treatments are inherently complex and involve uncertainties. In some instances, despite healthcare professionals providing competent care, unforeseen complications or outcomes may arise. The doctrine of frustration recognizes that healthcare providers cannot be held liable for outcomes that were beyond their control and not reasonably foreseeable.

Determining Compensation

Expert testimony can play a crucial role in medical malpractice cases involving frustration. Plaintiffs must prove that the mental injury is serious, prolonged, and greater than ordinary annoyances. A psychiatric diagnosis or expert evidence may help the plaintiff to prove that a mental injury has occurred. 

To distinguish whether the mental injury is compensable or if the plaintiff is not entitled to compensation and has only experienced psychological upset, the following will be considered:

  • Impairment of cognitive functioning
  • Interference with participation in daily activities
  • Treatment sought and taken in relation to the psychological upset (and the nature and effect of the treatment)

A recent appeal case from Ontario, Bothwell v. London Health Science Centre, re-affirms these considerations. In this particular case, the trial judge concluded that the Defendants had deviated from the expected standard of care by administering Heparin, a blood thinner, instead of Voluven, a blood volumizer, during the plaintiff’s surgery. Although the medication error did not cause any physical injuries to the plaintiff, the judge recognized the plaintiff’s emotional distress, including feelings of frustration and anger, as a compensable mental injury.

The defendants lodged an appeal arguing that the plaintiff had not provided sufficient evidence to establish that his feelings of frustration and anger amounted to a compensable mental injury.

Upon review, the Court of Appeal determined that the trial judge had made a legal error by neglecting to consider the Saadati factors. They concluded that the plaintiff’s frustration and anger did not result in impairment to his cognitive functions or hinder his daily life participation. During the trial, the plaintiff himself acknowledged that it did not impact his job performance, and there was no indication that he sought any form of treatment. The Court of Appeal held that 

“feelings of anger and frustration, without additional evidence, indicate psychological distress rather than an injury.” 

The appeal was successful, and the lawsuit was dismissed.


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From Siskinds LLP