The Supreme Court’s ruling in Armstrong v. Ward allows trial judges to assess causation before standard of care, helping plaintiffs more easily prove medical negligence.
A 2021 Supreme Court of Canada decision is reshaping the legal landscape for medical malpractice claims. Armstrong v. Ward established that trial judges can assess causation before evaluating the standard of care, making it easier for plaintiffs to prove negligence in complex cases.
What Happened in Armstrong v. Ward
The plaintiff underwent a laparoscopic colectomy and later suffered complications due to an obstructed ureter. The trial judge found the surgeon negligent for operating outside appropriate margins. Although the Ontario Court of Appeal overturned the decision, the Supreme Court restored the trial ruling by adopting Justice van Rensburg’s dissent.
The key takeaway? Courts can now determine what happened—the factual cause—before assessing whether the defendant met the required standard of care.
Why Armstrong Matters
According to Ryan Marinacci, associate at Bogoroch & Associates LLP, Armstrong is the strongest affirmation in Canadian case law that courts can consider the nature of an injury to help determine if negligence occurred. Marinacci states
“Before this case, it was less clear whether judges could take this approach. Armstrong gives plaintiffs a clearer path to establishing liability.”
Recent Case Applications
The precedent set in Armstrong has already impacted trial decisions:
- In Szeto v. Kives, a bowel perforation occurred during a gynecological procedure. The court first found that the perforation was large enough to be detected during surgery—establishing causation—then determined that failing to find it breached the standard of care.
- In Dallner v. Gladwell, a patient suffered an unusually severe brachial plexus injury during shoulder surgery. Both parties’ experts agreed the injury was rare. The court used the injury’s severity as circumstantial evidence of excessive traction, relying on Armstrong to justify that approach.
Takeaways for Plaintiffs and Counsel
For lawyers representing patients in surgical negligence cases, Armstrong is essential reading. It opens the door for judges to use the outcome of the procedure itself—the “what happened”—to inform whether the medical care met the standard expected. Marinacci advises that
“In any surgical negligence case, plaintiff’s counsel should read Armstrong very, very closely.”
By shifting the sequence of analysis, Armstrong offers a more flexible, fact-driven pathway for holding negligent providers accountable.
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