The Complexities of Informed Consent & Causation in Medical Malpractice.


In 1997, Victoria Anderson suffered a stroke that left her with “locked-in” syndrome, only able to move her eyes voluntarily. She believes the stroke was caused by the negligent actions of doctors while attempting a procedure. The doctors deny negligence and argue that the stroke could have been caused by other factors, such as hypercoagulability. The main point of contention is the cause of the stroke, with both parties presenting different theories. The doctors claim that the evidence doesn’t support their actions as the most likely cause, suggesting other factors instead.


When the case was taken to trial, the trial judge considered if the defendant physicians’ actions were below the standard of care, if they caused the stroke, and whether or not there was informed consent. 

The judge found that one of the defendant physicians, Dr. Sharma, did not fall below the requisite standard of care in this case. However, he did find that the other physician, Dr. Gee, did fail to meet the standard of care by failing to ensure the procedure was properly undertaken and failing to recognize the importance of the patient’s head placement. The plaintiff was able to prove her head had been significantly rotated during the insertion through expert evidence. 

Had the defendant employed the proper head placement at the time of the procedure, the stroke would not have occurred. To determine causation, the Court had to apply the “but for” test, considering all of the evidence presented. Due to the lack of decisive medical evidence regarding causation, the Court had to rely on inferences from the evidence. 

The trial judge found that it was likely that if the arterial punctures had not occurred, the plaintiff would likely not have suffered a stroke. It was also found that the artery probably punctured the vertebral artery, prompting a clot to develop and become lodged at the base of the brain. This resulted in the plaintiff not having adequate blood flow to minimize the damage done to her brain. All evidence considered, the court found that the doctors’ actions caused the plaintiff’s suffering. 

As for informed consent, the trial judge found that neither of the defendant doctors had warned the plaintiff of the potential risk associated with the insertion of a central line into the jugular vein. By failing to properly warn her of such risks, they failed to obtain informed consent. The 

Court found that Dr. Gee, has breached the requirements of causation and a breach of standard of care and that the plaintiff established a lack of informed consent. Regarding the other doctor, Dr. Sharma, the claim was dismissed. 

Read the full case here or find the case summary at Wagners.

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From CanLII