A medical malpractice claim depends on expert evidence to establish the standard of care and to address causation. Without an expert who can give admissible evidence on the relevant questions, the plaintiff has no path to liability, and the claim is vulnerable to summary disposition. The rule applies even where the underlying clinical situation is genuinely complex and the patient is genuinely concerned about the care they received.
Beazley v Johnston et al, 2023 ONSC 4956, is a useful illustration. The plaintiff was self-represented, alleged delayed diagnosis of Lyme disease across multiple physicians and specialties over a two-and-a-half year period, and supported the claim with a single expert. On a defence motion for summary judgment, the motions judge ruled that the plaintiff’s expert was not properly qualified to give the opinion evidence proposed. With no admissible expert evidence on the standard of care from the plaintiff’s side, and seven defence experts on the record, there was no genuine issue requiring trial. The claim was dismissed.
The case is precedent for the disposition of malpractice claims at summary judgment where expert evidence is inadequate, and it engages a current Ontario clinical-legal question about the standard of care for diagnosing Lyme disease.
The Lyme disease context
Lyme disease is a tick-borne bacterial infection caused by Borrelia burgdorferi, transmitted to humans through the bite of an infected blacklegged tick. It is endemic in parts of Ontario and is increasing in geographic range as tick habitats expand. Early Lyme disease is typically diagnosed clinically based on the characteristic erythema migrans rash and a history of possible tick exposure. Where the diagnosis is less clear, serological testing supports the clinical assessment.
The current standard for Lyme disease testing in Ontario, endorsed by Public Health Ontario and consistent with the broader Canadian and American mainstream medical position, is a two-tier serological protocol:
- A first-tier enzyme immunoassay (typically an ELISA) screens for antibodies to Borrelia
- If the first-tier test is positive or equivocal, a confirmatory second-tier Western blot is performed to assess the antibody pattern
The two-tier protocol is intended to balance sensitivity (the ELISA captures most positives) and specificity (the Western blot confirms the diagnosis and reduces false positives). It is the test available through the Ministry of Health and is the test most Ontario physicians rely on.
A separate body of clinical practice, often described as “Lyme-literate” medicine, uses different testing approaches and a broader diagnostic framework. The most common alternative tests are offered by IGeneX, a private laboratory in California, and include direct detection methods such as PCR (which looks for Borrelia DNA) and proprietary serological tests with criteria that differ from the CDC-endorsed standard. Lyme-literate physicians often rely on these tests to support a diagnosis of “chronic Lyme disease,” and they frequently treat that diagnosis with long-term courses of antibiotics. The mainstream medical position is that the chronic Lyme framework is not supported by the available evidence and that long-term antibiotic treatment is not indicated.
The clinical-legal question that arises in cases like Beazley is whether reliance on the Ontario standard (two-tier serology) is adequate when the patient subsequently obtains a positive result through alternative testing. The doctrinal answer in this case is that reliance on the standard is within the standard of care.
The facts
Mr. Beazley alleged that he had been suffering from undiagnosed Lyme disease since late 2015. Between December 2015 and May 2018, he saw multiple physician defendants across a range of specialties, including family medicine, cardiology, emergency medicine, infectious diseases, internal medicine, neurology, and sports medicine. Two of the defendants never saw the plaintiff in person; their involvement was limited to interpreting echocardiograms.
Three rounds of testing in 2016 were central to the claim:
- May 2016. A two-tier Lyme test through the Ontario Ministry of Health, ordered by Mr. Beazley’s then family physician, was negative.
- October 2016. Routine bloodwork ordered by Dr. Jacobson, a Toronto-based family/emergency physician who began treating Mr. Beazley in the fall of 2016 and who was not a defendant in the action.
- November 2016. An IGeneX laboratory test ordered by Dr. Jacobson was positive. The IGeneX test uses a different methodology from the two-tier MOH protocol and is not available through the MOH.
Based on the clinical presentation, the patient’s history, and the IGeneX result, Dr. Jacobson opined that Mr. Beazley was likely experiencing symptoms of a tick-borne disease and prescribed a long-term course of antibiotics.
Mr. Beazley’s case against the defendant physicians was that they should not have relied on the negative MOH two-tier result, should have investigated further, and should have considered Lyme disease as a working diagnosis. Some of the defendant physicians, when they saw Mr. Beazley after the May 2016 negative result, did rely on it (in part) to rule out Lyme as a cause of his symptoms.
Summary judgment in medical malpractice
The defendants brought a motion for summary judgment under Rule 20 of the Rules of Civil Procedure. The test on a summary judgment motion is whether there is a genuine issue requiring trial. Where the moving party can show that the claim has no real chance of success on the available evidence, the court can dispose of the matter without a trial.
In medical malpractice cases, summary judgment is often unsuccessful because the standard of care typically requires expert evidence, the experts on either side will typically disagree, and the resolution of a battle of experts is usually a matter for trial. Where the plaintiff has competent expert evidence, the threshold for surviving summary judgment is low.
The cases in which summary judgment succeeds in this area generally involve one of three scenarios: the plaintiff has no expert evidence at all, the plaintiff’s expert is not properly qualified or not impartial, or the plaintiff’s expert evidence does not support the claim made. Beazley falls into the second category.
The expert evidence ruling
The plaintiff supported the claim with a single expert: Dr. Ben Boucher, a family medicine and emergency medicine physician.
Expert evidence in Ontario is governed by the framework set out by the Supreme Court of Canada in White Burgess Langille Inman v Abbott and Haliburton Co, 2015 SCC 23. The threshold requirements are relevance, necessity in assisting the trier of fact, the absence of an exclusionary rule, and that the expert is properly qualified. There is also a discretionary gatekeeping function at which the court weighs the benefits of admitting the evidence against the costs.
The motions judge ruled that Dr. Boucher should not be permitted to provide the opinion evidence proposed. The detail of the qualification ruling is in the decision; the practical effect was that the plaintiff had no admissible expert evidence to put against the seven defence experts who supported the defendant physicians’ approach.
Without admissible expert evidence on the standard of care, there was no genuine issue requiring trial. The claim was dismissed.
The doctrinal lessons
The case stands for several propositions.
Reliance on the MOH two-tier Lyme test is within the standard of care. The seven defence experts, accepted on the record, supported the proposition that Ontario physicians can reasonably rely on a negative two-tier MOH test in evaluating a patient for Lyme disease. The plaintiff’s argument that the approach itself is negligent was rejected. This is consistent with the position of Public Health Ontario and the broader Canadian and American mainstream medical bodies.
Summary judgment is available against malpractice claims that lack adequate expert evidence. Although summary judgment is rarely granted in malpractice cases where there is a genuine battle of experts, it is available where the plaintiff has no admissible expert evidence at all. Beazley is an example of how summary judgment operates in this category.
Expert qualification is a real gating issue. The dispositive ruling in this case was on the qualification of the plaintiff’s expert. Plaintiffs (and their counsel where they are represented) need to ensure that the expert proposed has the qualifications, the impartiality, and the focus to give admissible evidence on the precise issues in the case. An expert who is qualified in some general area but not the specific discipline relevant to the alleged breach is at risk of exclusion.
Self-representation in complex medical malpractice is a serious obstacle. The motions judge specifically noted Mr. Beazley’s self-represented status. Medical malpractice claims are document-heavy, expert-driven, and procedurally complex. The retention and preparation of expert witnesses, the qualification analysis under White Burgess, and the negotiation of summary judgment motions all benefit substantially from experienced counsel. The case is a difficult illustration of the structural disadvantage faced by self-represented plaintiffs in this area.
The “claims that fail” sub-cluster
Beazley adds to a substantial body of case-comment content on this site dealing with malpractice claims that fail at various stages. The cluster now includes:
- Knight v Lawson: a surgical injury where causation defeated the claim (a case I conducted as plaintiff counsel)
- Johnson v Lakeridge Health: a stroke discharge where causation defeated the claim
- Coville Estate v Sellens: a pneumonia death and an ER that met the standard of care
- Martindale v Bahl: a cancer claim where the standard of care was met
- Beazley v Johnston (this case): a claim dismissed at summary judgment for inadequate expert evidence
Each case illustrates a different way in which a malpractice claim can fail. Knight and Johnson turn on causation. Coville and Martindale turn on the standard of care. Beazley turns on the procedural and evidentiary framework that operates before the substantive analysis. Together, the five cases form a useful reference set on the realistic obstacles that plaintiffs face in malpractice litigation.
Why this case matters
For patients and families considering a malpractice claim. A malpractice claim depends on expert evidence at every stage of the analysis. The expert needs to be qualified in the right specialty, impartial, and prepared to give an opinion that supports the specific allegations. A claim that proceeds without that foundation, or with an expert whose qualifications do not match the issues, is at serious risk of summary disposition. The Beazley outcome is a difficult one for a self-represented plaintiff who genuinely believed his Lyme disease was missed by his doctors, but it reflects the operation of the framework as it applies to all plaintiffs.
For physicians. Reliance on Public Health Ontario’s two-tier Lyme test is within the accepted standard of care. The case is reassuring on the substantive standard but a reminder that Lyme disease litigation continues to occur, often involving patients who have subsequently been told by alternative practitioners that the standard testing missed their condition. Documentation of the clinical reasoning, the basis for excluding Lyme as a working diagnosis, and the symptoms that did and did not align with a Lyme presentation is the most reliable defence in the event of a claim.
For lawyers screening malpractice claims. Expert evidence is foundational. Before retainer, screen for whether the available expert pool includes a properly qualified, available, and willing expert who will give the opinion needed. After retainer, the White Burgess analysis should be part of the working analysis from the outset, not an afterthought. A claim that depends on an expert whose qualification is contestable is at risk of summary disposition before any of the substantive issues are reached.
For more on how malpractice claims are evaluated and prosecuted in Ontario, see Suing for Medical Malpractice in Ontario: What You Need to Know and How to Choose a Medical Malpractice Lawyer in Ontario. For the broader landscape of complaints and reviews available to Ontario patients, see A Patient’s Guide to Making Complaints About Health Care in Ontario.
Decision Date: August 31, 2023
Jurisdiction: Ontario Superior Court of Justice
Citation: Beazley v Johnston et al, 2023 ONSC 4956 (CanLII)
Beazley v Johnston: A Lyme Disease Claim Dismissed at Summary Judgment
A self-represented plaintiff's Lyme disease delayed-diagnosis claim was dismissed at summary judgment after his sole expert witness was disqualified.
A medical malpractice claim depends on expert evidence to establish the standard of care and to address causation. Without an expert who can give admissible evidence on the relevant questions, the plaintiff has no path to liability, and the claim is vulnerable to summary disposition. The rule applies even where the underlying clinical situation is genuinely complex and the patient is genuinely concerned about the care they received.
Beazley v Johnston et al, 2023 ONSC 4956, is a useful illustration. The plaintiff was self-represented, alleged delayed diagnosis of Lyme disease across multiple physicians and specialties over a two-and-a-half year period, and supported the claim with a single expert. On a defence motion for summary judgment, the motions judge ruled that the plaintiff’s expert was not properly qualified to give the opinion evidence proposed. With no admissible expert evidence on the standard of care from the plaintiff’s side, and seven defence experts on the record, there was no genuine issue requiring trial. The claim was dismissed.
The case is precedent for the disposition of malpractice claims at summary judgment where expert evidence is inadequate, and it engages a current Ontario clinical-legal question about the standard of care for diagnosing Lyme disease.
The Lyme disease context
Lyme disease is a tick-borne bacterial infection caused by Borrelia burgdorferi, transmitted to humans through the bite of an infected blacklegged tick. It is endemic in parts of Ontario and is increasing in geographic range as tick habitats expand. Early Lyme disease is typically diagnosed clinically based on the characteristic erythema migrans rash and a history of possible tick exposure. Where the diagnosis is less clear, serological testing supports the clinical assessment.
The current standard for Lyme disease testing in Ontario, endorsed by Public Health Ontario and consistent with the broader Canadian and American mainstream medical position, is a two-tier serological protocol:
The two-tier protocol is intended to balance sensitivity (the ELISA captures most positives) and specificity (the Western blot confirms the diagnosis and reduces false positives). It is the test available through the Ministry of Health and is the test most Ontario physicians rely on.
A separate body of clinical practice, often described as “Lyme-literate” medicine, uses different testing approaches and a broader diagnostic framework. The most common alternative tests are offered by IGeneX, a private laboratory in California, and include direct detection methods such as PCR (which looks for Borrelia DNA) and proprietary serological tests with criteria that differ from the CDC-endorsed standard. Lyme-literate physicians often rely on these tests to support a diagnosis of “chronic Lyme disease,” and they frequently treat that diagnosis with long-term courses of antibiotics. The mainstream medical position is that the chronic Lyme framework is not supported by the available evidence and that long-term antibiotic treatment is not indicated.
The clinical-legal question that arises in cases like Beazley is whether reliance on the Ontario standard (two-tier serology) is adequate when the patient subsequently obtains a positive result through alternative testing. The doctrinal answer in this case is that reliance on the standard is within the standard of care.
The facts
Mr. Beazley alleged that he had been suffering from undiagnosed Lyme disease since late 2015. Between December 2015 and May 2018, he saw multiple physician defendants across a range of specialties, including family medicine, cardiology, emergency medicine, infectious diseases, internal medicine, neurology, and sports medicine. Two of the defendants never saw the plaintiff in person; their involvement was limited to interpreting echocardiograms.
Three rounds of testing in 2016 were central to the claim:
Based on the clinical presentation, the patient’s history, and the IGeneX result, Dr. Jacobson opined that Mr. Beazley was likely experiencing symptoms of a tick-borne disease and prescribed a long-term course of antibiotics.
Mr. Beazley’s case against the defendant physicians was that they should not have relied on the negative MOH two-tier result, should have investigated further, and should have considered Lyme disease as a working diagnosis. Some of the defendant physicians, when they saw Mr. Beazley after the May 2016 negative result, did rely on it (in part) to rule out Lyme as a cause of his symptoms.
Summary judgment in medical malpractice
The defendants brought a motion for summary judgment under Rule 20 of the Rules of Civil Procedure. The test on a summary judgment motion is whether there is a genuine issue requiring trial. Where the moving party can show that the claim has no real chance of success on the available evidence, the court can dispose of the matter without a trial.
In medical malpractice cases, summary judgment is often unsuccessful because the standard of care typically requires expert evidence, the experts on either side will typically disagree, and the resolution of a battle of experts is usually a matter for trial. Where the plaintiff has competent expert evidence, the threshold for surviving summary judgment is low.
The cases in which summary judgment succeeds in this area generally involve one of three scenarios: the plaintiff has no expert evidence at all, the plaintiff’s expert is not properly qualified or not impartial, or the plaintiff’s expert evidence does not support the claim made. Beazley falls into the second category.
The expert evidence ruling
The plaintiff supported the claim with a single expert: Dr. Ben Boucher, a family medicine and emergency medicine physician.
Expert evidence in Ontario is governed by the framework set out by the Supreme Court of Canada in White Burgess Langille Inman v Abbott and Haliburton Co, 2015 SCC 23. The threshold requirements are relevance, necessity in assisting the trier of fact, the absence of an exclusionary rule, and that the expert is properly qualified. There is also a discretionary gatekeeping function at which the court weighs the benefits of admitting the evidence against the costs.
The motions judge ruled that Dr. Boucher should not be permitted to provide the opinion evidence proposed. The detail of the qualification ruling is in the decision; the practical effect was that the plaintiff had no admissible expert evidence to put against the seven defence experts who supported the defendant physicians’ approach.
Without admissible expert evidence on the standard of care, there was no genuine issue requiring trial. The claim was dismissed.
The doctrinal lessons
The case stands for several propositions.
Reliance on the MOH two-tier Lyme test is within the standard of care. The seven defence experts, accepted on the record, supported the proposition that Ontario physicians can reasonably rely on a negative two-tier MOH test in evaluating a patient for Lyme disease. The plaintiff’s argument that the approach itself is negligent was rejected. This is consistent with the position of Public Health Ontario and the broader Canadian and American mainstream medical bodies.
Summary judgment is available against malpractice claims that lack adequate expert evidence. Although summary judgment is rarely granted in malpractice cases where there is a genuine battle of experts, it is available where the plaintiff has no admissible expert evidence at all. Beazley is an example of how summary judgment operates in this category.
Expert qualification is a real gating issue. The dispositive ruling in this case was on the qualification of the plaintiff’s expert. Plaintiffs (and their counsel where they are represented) need to ensure that the expert proposed has the qualifications, the impartiality, and the focus to give admissible evidence on the precise issues in the case. An expert who is qualified in some general area but not the specific discipline relevant to the alleged breach is at risk of exclusion.
Self-representation in complex medical malpractice is a serious obstacle. The motions judge specifically noted Mr. Beazley’s self-represented status. Medical malpractice claims are document-heavy, expert-driven, and procedurally complex. The retention and preparation of expert witnesses, the qualification analysis under White Burgess, and the negotiation of summary judgment motions all benefit substantially from experienced counsel. The case is a difficult illustration of the structural disadvantage faced by self-represented plaintiffs in this area.
The “claims that fail” sub-cluster
Beazley adds to a substantial body of case-comment content on this site dealing with malpractice claims that fail at various stages. The cluster now includes:
Each case illustrates a different way in which a malpractice claim can fail. Knight and Johnson turn on causation. Coville and Martindale turn on the standard of care. Beazley turns on the procedural and evidentiary framework that operates before the substantive analysis. Together, the five cases form a useful reference set on the realistic obstacles that plaintiffs face in malpractice litigation.
Why this case matters
For patients and families considering a malpractice claim. A malpractice claim depends on expert evidence at every stage of the analysis. The expert needs to be qualified in the right specialty, impartial, and prepared to give an opinion that supports the specific allegations. A claim that proceeds without that foundation, or with an expert whose qualifications do not match the issues, is at serious risk of summary disposition. The Beazley outcome is a difficult one for a self-represented plaintiff who genuinely believed his Lyme disease was missed by his doctors, but it reflects the operation of the framework as it applies to all plaintiffs.
For physicians. Reliance on Public Health Ontario’s two-tier Lyme test is within the accepted standard of care. The case is reassuring on the substantive standard but a reminder that Lyme disease litigation continues to occur, often involving patients who have subsequently been told by alternative practitioners that the standard testing missed their condition. Documentation of the clinical reasoning, the basis for excluding Lyme as a working diagnosis, and the symptoms that did and did not align with a Lyme presentation is the most reliable defence in the event of a claim.
For lawyers screening malpractice claims. Expert evidence is foundational. Before retainer, screen for whether the available expert pool includes a properly qualified, available, and willing expert who will give the opinion needed. After retainer, the White Burgess analysis should be part of the working analysis from the outset, not an afterthought. A claim that depends on an expert whose qualification is contestable is at risk of summary disposition before any of the substantive issues are reached.
For more on how malpractice claims are evaluated and prosecuted in Ontario, see Suing for Medical Malpractice in Ontario: What You Need to Know and How to Choose a Medical Malpractice Lawyer in Ontario. For the broader landscape of complaints and reviews available to Ontario patients, see A Patient’s Guide to Making Complaints About Health Care in Ontario.
Decision Date: August 31, 2023
Jurisdiction: Ontario Superior Court of Justice
Citation: Beazley v Johnston et al, 2023 ONSC 4956 (CanLII)
Paul Cahill
Partner, Davidson Cahill Morrison LLP | LSO Certified Specialist in Civil Litigation
Paul represents victims of medical malpractice across Ontario, with trial experience including a $11.5M jury verdict in a birth injury case. He is recognized in Best Lawyers in Canada and serves as trial counsel to other lawyers on complex medical negligence matters.
About PaulMore on medical malpractice in Ontario.
Other articles by Paul exploring the conditions, decisions, and systems behind preventable medical harm.
A Laboratory Susceptibility Testing Failure in Tuberculosis Treatment: Recurrent Disease and a Reconstructive Spinal Surgery
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Finding the Right Expert in a Medical Malpractice Case
Why expert selection drives outcomes in Ontario medical malpractice cases. Paul Cahill on finding the right expert from an OTLA webinar.
The Business of PI: Boosting Success Through Strategy and Partnerships
How plaintiff-side PI practice works as a business: case screening, partnerships, and resourcing. From a 2024 Legal Innovation Forum panel.