Case Summaries: Williams v Rosenstock, 2020 ABQB 303

Associated Lawyers: Shelagh McGregor, Luke Young, Iman Jomha

The plaintiff, Ms. Williams, attended the Royal Alexandra Hospital emergency room on November 15, 2009 with severe lower back and abdominal pain and a history of blood in her stool. She was examined by the Defendant Dr. Barer, an emergency physician, who examined her and ordered a back x-ray and gastroscopy. She continued to have abdominal, lower back, and leg pain throughout the night and into the next morning and reported urinary frequency and urgency to a GI specialist and the nursing staff. The gastroscopy was negative.

The next morning Dr. Barer transferred care of Ms. Williams to Dr. Bly. Dr. Bly interviewed Ms. Williams and then discharged her approximately 18 hours after she first attended the ER. He did not re-examine her prior to discharge and advised her to follow up with her family doctor.

The next morning Ms. Williams saw her family doctor with complaints of back pain, perianal numbness, and bowel and bladder difficulties. He referred her to the University of Alberta Hospital (“UAH”) emergency room. At the UAH Ms. Williams had an MRI which showed likely cauda equine syndrome (“CES”). She was admitted under Dr. Nataraj, a neurosurgeon, who was on call at home. Dr. Nataraj performed a phone consultation and determined that surgery could wait until the next morning. Ms. Williams was admitted for observation over night.

Ms. Williams underwent a successful disc replacement surgery approximately 12 hours after being admitted to the UAH but was left with significant permanent injuries including motor weakness, numbness, neurogenic bowel and bladder changes, and chronic back pain. She brought a claim in negligence against Dr. Barer, Dr. Bly, Dr. Nataraj, and both hospitals. Justice Friesen found that both Dr. Bly and Dr. Nataraj breached the standard of care, but Dr. Nataraj’s conduct in delaying the surgery did not cause or contribute to Ms. Williams’s injuries. The claim was dismissed against Dr. Barer, Dr. Nataraj, and both hospitals but allowed against Dr. Bly.

Justice Friesen found that Dr. Bly breached the standard of care by discharging Ms. Williams without taking adequate diagnostic steps, including conducting a thorough back pain focussed physical exam, to rule out CES in a patient suffering from yellow flag or precursor CES symptoms. She also found that had Dr. Bly met the standard of care, and conducted an appropriate physical exam, he would have been unable to rule out CES and would have kept Ms. Williams in the hospital until he could conduct further tests or consult a specialist. This would have resulted either in surgery occurring at an earlier time, due to Ms. Williams being in the hospital when her sudden deterioration occurred, or at a later time, due to Ms. Williams being put on bed rest and stabilized as she awaited the results of testing. In either scenario, Ms. Williams’s injuries would have been substantially reduced.