An Ontario court has ruled that an internist’s delayed actions and poor record-keeping during an acute asthma case caused a patient’s brain injury, breaching the standard of care.
In a recent medical malpractice case, the Superior Court of Justice of Ontario found that an internal medicine specialist breached the standard of care, leading to a patient’s brain injury during an asthma attack.
The case, Gumbley v. Vasiliou, 2024 ONSC 4858, centered on events that took place in October 2014 at Toronto East General Hospital, where a patient arrived at 4:30 p.m. with an acute asthma attack. While initial treatment was administered by an emergency physician, the internist on duty—who was the defendant—took over the case after 6:00 p.m.
Despite her experience with respiratory conditions, the internist was not regularly involved in intubating patients with severe asthma. Her decisions and actions during the patient’s critical hours were found by the court to be negligent and causative of the patient’s permanent brain injury.
Timeline of Events and Court Findings
- 7:00 PM: The internist admitted the patient to the intensive care unit (ICU).
- 9:00 PM: Additional treatments, including epinephrine, were ordered.
- 9:40 PM: The patient was transferred to the ICU.
- 11:00 PM: The internist decided to prepare for intubation.
- 12:00 AM: Intubation was performed by a respiratory therapist on the third attempt. Post-intubation, the patient was difficult to ventilate.
- 1:10 AM: The internist paged the on-call intensivist, who arrived at 1:50 a.m.
- After intervention, ventilation improved, but a later MRI revealed significant brain damage.
Multiple Breaches of the Standard of Care
The court identified several key failures by the internist:
- Inadequate Medical Record-Keeping
- The internist’s notes contained “troubling omissions”, including missing details about arterial blood gas tests and arterial line timing.
- The court rejected claims that IT issues due to system maintenance justified these omissions.
- Unreasonable Delay in Consulting the Intensivist
- The internist waited until 1:10 a.m. to contact the intensivist, despite the patient’s deteriorating condition.
- The court found this delay unreasonable, stating: “A reasonable internist would have called the intensivist by 10:00 p.m.”
- Delayed Decision to Intubate
- The decision to intubate was made too late. The court noted it should have occurred before or shortly after the ICU transfer.
- Even after making the decision, the internist failed to ensure prompt execution by the most experienced clinician available.
Causation and Judgment
The court determined that the internist’s negligent actions—including delays in contacting the intensivist, delays in intubation, and failure to involve the most experienced staff—were cumulatively the most likely cause of the patient’s brain injury.
The court concluded that
“Multiple chances of a better outcome were lost because of the several breaches of the standard of care that occurred… which, viewed together, more likely than not resulted in the plaintiff’s brain injury.”
The court ruled in favor of the plaintiffs, granting judgment subject to approval of the agreed damages under Ontario’s Family Law Act, 1990.
Legal and Medical Implications
This case underscores the critical importance of timely intervention in emergency care, especially in acute respiratory conditions. It also highlights how delays and inadequate record-keeping can lead to devastating outcomes and legal liability.
For families impacted by medical negligence, cases like Gumbley v. Vasiliou serve as a reminder of the importance of seeking legal support to understand what went wrong—and to pursue justice for avoidable harm.
MedMalDoctors has a nation network of medical experts that provides lawyers with opinions on Causation and Standard of Care regarding potential medical malpractice.
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From the Law Times