On July 19, 2023, a trial judge of the Ontario Superior Court of Justice dismissed a medical malpractice lawsuit against two emergency medicine physicians, Drs. Sellers and Laidley.

The case involved a 26 year-old woman, Ashly Coville (“Ashly”) who died on December 26, 2012 as a result of complications of bacterial pneumonia.

Pneumonia a common lung infection caused by germs, such as bacteria, viruses, and fungi. It can be a complication of the flu, but other viruses, bacteria and even fungi can cause pneumonia. Pneumonia and its symptoms can vary from mild to severe.

Just two days prior to her death, on December 24, 2012, Ashly had attended the Hamilton General Hospital (“the Hospital)” emergency department where she came under the care of the Defendant physicians. 

Ashly had presented to the Hospital with a history of cough, fever and vomiting for one week. She was a smoker. She had aches and pains. Her heart rate and blood pressure were elevated. The emergency room physicians felt that she was dehydrated with a viral illness. She was given intravenous saline along with Tylenol and Gravol. She was reassessed, noted to have improved and was discharged home.

She returned to hospital 24 hours with worsening symptoms. She was admitted to hospital but died of bacterial pneumonia a short time later. 

The patient’s family brought a claim in medical malpractice alleging that the emergency medicine physicians failed to order bloodwork and a chest x-ray at the initial visit which would have resulted in an earlier diagnosis of pneumonia, treatment for same and the prevention of her death. 

ISSUES

At issue were standard of care and causation. Damages were settled prior to trial for an unknown amount.

FACTS

In coming to a decision in this case, the trial judge made the following important factual determinations regarding the initial visit to the emergency room:

• Ashly did not have an observable cough while being treated by the Defendant physicians, even though the Plaintiff complained of a history of a cough for one week, there was no notation in the hospital records of her being observed to have a cough by hospital staff.
• Ashly did not tell the emergency medicine physicians that she had congestion.
• Ashly did not have a measurable fever while in the emergency department.
• Ashly did not have “persisting” vomiting despite providing a history of vomiting in the three days prior to the emergency room visit.
• The Defendant emergency room physician, Dr. Laidley did perform a respiratory examination of Ashly despite not documenting the results of same.
• Ashly was not in respiratory distress in the emergency room.
• Ashly’s condition improved after treatment and her heart rate was within the normal range.
• Ashly’s condition remained improved after discharge for approximately 24 hours at which time she quickly worsened prompting a return to the emergency department.

DECISION

The Plaintiff’s position was that the clinical constellation of symptoms and signs exhibit by Ashly on December 24, 2012 required bloodwork and a chest X-ray to be performed. Furthermore, the Plaintiff argued that that physical examination of the chest/lungs alone is not sufficiently accurate to confirm or exclude the diagnosis of pneumonia.

The trial judge was not, however, persuaded by the Plaintiff’s expert opinion that the standard of care was not met by Drs. Laidley and Sellens. Instead, the trial judge found find that Ashly’s vital signs, appearance, and existing physical conditions on December 24, 2012 were more compatible with a diagnosis of a viral illness, and that her presentation did not raise a concern for pneumonia, and so a chest X-ray and bloodwork were not clinically required. 

I find that Dr. Laidley and Dr. Sellens were not faced with any indications that pneumonia was a real possibility on December 24, 2012. In combination with her vital signs, Ms. Coville’s bilateral air entry with no adventitious sounds, her non-distressed presentation, her normal respiratory rate, her normal oxygen saturation, and her lack of cough and fever all pointed away from pneumonia infection. There was no change in Ms. Coville’s condition during the time she was in the Emergency Department on December 24th that one can point to and say that the Defendants should have revisited their working diagnosis of viral illness (at para. 268)

The trial judge was furthermore not persuaded that the Plaintiff had proven on a balance of probabilities that earlier blood work and a chest x-ray would have saved Ashly’s life. With respect to causation, the trial judge made the following findings:

• Ashly did not present with bacterial pneumonia at the emergency room on December 24, 2012 but instead she developed a rapid fulminant bacterial pneumonia the next day.
• An earlier chest X-ray and bloodwork would not have revealed bacterial pneumonia therefore would not have resulted in treatment for pneumonia.
• It was not established that Ashly’s death would have been prevented with earlier treatment.

EXPERT LIABILITY WITNESSES

Plaintiff’s Experts

Dr. John Bonn was qualified as an expert in emergency medicine and to provide an opinion on the standard of care of emergency medicine physicians, and whether the care provided by Drs. Laidley and Sellens met the applicable standard. 

Dr. Ignatius Fong was qualified as an expert in infectious diseases to provide an opinion on the cause of Ashly’s death and to opine on the care of emergency physicians from the perspective of an infectious disease specialist.

Defence Experts

Dr. Eric Letovsky was qualified as an expert in emergency medicine and to give opinion evidence on the standard of care that is expected of an emergency medicine physician in Ontario and whether the Defendants met that standard of care.

Dr. Ole Hammerberg was qualified as an expert in infectious diseases to provide an opinion on the cause of Ashly’s death and to opine on the care of emergency physicians from the perspective of an infectious disease specialist. 

Decision Date: July 19, 2023

Jurisdiction: Ontario Superior Court of Justice

Citation: The Estate of Ashly Mickey Lynn Coville v. Hamilton Health Sciences Corporation, 2023 ONSC 4245 (CanLII)