A Saskatoon man stood outside St. Paul’s Hospital on August 5, 2026 and described what happened to his 88-year-old father. Jerry Shyluk, who is in the early stages of Alzheimer’s disease, arrived by ambulance on July 27 after an injury and waited more than two hours to be seen. He was placed in an emergency department pod, then moved into a corridor when another patient needed the space. He stayed in that corridor for roughly five days. There was no call button. The fluorescent lights were on around the clock. Stretchers, equipment and visitors moved past him continuously. His son Mark told reporters that his father said he felt like he was in storage and in the way. The Saskatchewan Health Authority responded that Saskatoon hospitals had been running above average capacity at the start of the summer and that the pressure had since eased.
That story is from Saskatchewan, and nothing in it is governed by Ontario law. It is worth writing about here anyway, because a week earlier CTV reported that a 94-year-old cancer patient in Sault Ste. Marie had spent more than three days in a hallway at Sault Area Hospital. The conditions are not regional. What is regional is the legal framework that applies when those conditions produce an injury, and in Ontario that framework is more demanding of hospitals than most families assume, and harder to satisfy than most headlines suggest.
The question this post takes up is narrower than the political one. It is not whether hallway care is acceptable. It is what Ontario law asks of a hospital when the patient parked in the corridor cannot orient himself, cannot reliably summon help, and cannot tell anyone that something has changed.
Why a hallway is a different problem for a patient with dementia
Delirium and dementia are not the same thing. Dementia is a chronic, progressive loss of cognition. Delirium is an acute disturbance of attention and awareness that develops over hours or days and fluctuates. The two interact badly: pre-existing cognitive impairment is among the strongest predisposing factors for delirium, and an episode of delirium in a person with dementia is associated with worse outcomes.
The precipitants of delirium described in the geriatric and emergency medicine literature read like an inventory of a hospital corridor. Sleep deprivation. Continuous ambient noise. Absence of natural light and of any day and night cue. Immobility. Unfamiliar and constantly changing surroundings. Pain, infection and dehydration layered on top. A hallway supplies most of these at once, and it supplies them to the patient least equipped to tolerate them.
The published evidence is largely American and largely observational, which limits what can be drawn from it in any individual case, but the direction is consistent. A retrospective cohort study of Mass General Brigham emergency departments covering 2018 to 2022 found that emergency department boarding duration was associated with inpatient delirium or severe agitation, and that the association was stronger in patients with dementia. An analysis published in Annals of Emergency Medicine in 2023, using American state administrative data, reported that longer emergency department stays for people living with dementia are associated with death, delirium and medication errors, and that people with dementia are more likely than others to experience a prolonged stay. The same paper cites research on older adults presenting with behavioural concerns, about half of whom had dementia, in which each additional ten hours in the department was associated with roughly a twenty per cent increase in the risk of an adverse event such as a fall or a medication error. A systematic review has estimated that emergency clinicians miss delirium in somewhere between 57 and 83 per cent of cases where no structured screening tool is used.
None of that establishes a standard of care. In litigation the standard is set by expert evidence about what a reasonably competent nurse, physician or institution would have done in the circumstances, not by a literature summary. What the literature does establish is that the risk is foreseeable and well documented, and foreseeability is where a negligence analysis starts.
The downstream harms are concrete rather than abstract: unwitnessed falls, fractures and head injuries in a patient with no call bell and no line of sight to staff; aspiration; pressure injury; unrecognized clinical deterioration; and the use of physical or chemical restraint to manage agitation that the environment itself produced. We have written separately about hospital falls and liability for serious injury, which is the most common way a hallway stay turns into a claim.
The structural driver is not a mystery. The Canadian Association of Emergency Physicians has put the figure at roughly fifteen per cent of acute care beds occupied by patients designated alternate level of care, the large majority of them older adults, with the resulting backlog pushing admitted patients into stretchers and corridors for hours or days without privacy, sleep or reliable washroom access.
The standard of care does not fall with the occupancy rate
Ontario law measures a clinician against what a reasonably competent professional would have done in the same circumstances, and compliance with general and approved practice is normally, though not invariably, a defence: ter Neuzen v Korn, [1995] 3 SCR 674. Circumstances include the operational reality of a full department. They do not include a discount for it.
The clearest Canadian statement of that principle comes from British Columbia. In Law Estate v Simice, a 1994 decision of the Supreme Court of British Columbia involving a physician who did not order a CT scan partly because of cost, the court held that where the choice is between a physician’s responsibility to the individual patient and responsibility to the health care system as a whole, the former prevails. That decision is persuasive only in Ontario and has never been binding here, but it reflects the way Ontario courts have approached resource pressure: as context for the assessment, not as a defence to it.
Against a hospital there are two distinct routes, and they are often pleaded together.
The first is vicarious liability. A hospital answers for the negligence of its employees. In an emergency department that means nurses above all, and in practice the nursing role is where hallway cases live: the triage assessment, the reassessment intervals, the delirium screening if any was done, the recognition of a change in status, and the escalation to a physician.
The second is direct liability for the hospital’s own systems. This is the institution’s own duty, independent of any individual employee’s conduct, and it covers staffing ratios set against actual volume and acuity, policies for monitoring patients boarded in unconventional spaces, protocols for reassessing a confused patient, the availability of call bells and monitoring equipment in the spaces the hospital is actually using for care, and escalation procedures when occupancy exceeds what the department can safely absorb.
Physicians sit outside both routes. In Ontario, emergency physicians and consultants are generally not hospital employees, so the hospital is generally not vicariously liable for them. They owe their own duty, are sued personally, and are defended by the Canadian Medical Protective Association. The broader analysis of these claims is set out in our post on hallway medicine and overcrowded emergency rooms.
Where the claim actually gets hard
Three things defeat most of these cases, and they are worth stating plainly.
Indignity is not a cause of action. Ontario tort law compensates injury. It does not compensate the experience of being warehoused, however degrading that experience was. A hallway stay that was humiliating, frightening and sleepless but that ended with the patient in the same condition he arrived in will not support a claim. Emotional upset must rise to the level of a recognizable psychiatric injury, a serious and prolonged disturbance beyond ordinary annoyance and fear: Mustapha v Culligan of Canada Ltd, 2008 SCC 27, [2008] 2 SCR 114, and Saadati v Moorhead, 2017 SCC 28, [2017] 1 SCR 543. The Ontario Superior Court applied that threshold in Bothwell v London Health Sciences Centre, where psychological upset following a medication error fell short.
Causation is the real battleground. Delirium is multifactorial. The patient came in with an acute injury or illness, often with infection, often on multiple medications, often with baseline cognitive impairment. The defence position writes itself: the delirium was driven by the underlying illness and would have occurred wherever the patient was lying. Proving on a balance of probabilities that the corridor conditions made the difference, under the but for test in Clements v Clements, 2012 SCC 32, [2012] 2 SCR 181, requires expert evidence that can separate the environmental contribution from everything else. That evidence exists in some cases and not in others. Where the negligence is proven and the defendant is better positioned than the plaintiff to know what happened, Snell v Farrell, [1990] 2 SCR 311, permits a robust and pragmatic inference, but it is not a substitute for a theory of causation.
Courts will not run the hospital’s budget. A claim framed as “there should have been more beds” invites a court to review allocative decisions made by a board and a ministry, and courts are properly reluctant to do that. The claim that survives is framed differently: given the beds this hospital actually had, and the corridor it was actually using as a care space, its own systems for monitoring and reassessing a confused patient fell below what a reasonable hospital would have run. That is an operational question, not a fiscal one, and it is answerable on evidence.
What families should record while it is happening
The hospital chart will eventually be produced. It will not contain most of what matters. Families who write things down contemporaneously are frequently the only source of the detail that decides the case, and the record they keep is worth more than a recollection reconstructed a year later. Where you can, note:
- Time of arrival, time of triage, and the time the patient was moved into the hallway or other unconventional space
- Every occasion a nurse or physician actually attended the patient, and what was done
- Whether a call bell was within reach, and whether anyone responded to it
- Whether the patient’s cognitive baseline was recorded on arrival, and whether anyone screened for delirium at any point during the stay
- Whether the substitute decision-maker was identified and consulted. Under the Health Care Consent Act, 1996, treatment decisions for an incapable patient fall to the substitute decision-maker in the statutory hierarchy, and that person’s identity should appear in the chart
- Any fall or near fall, and whether it was witnessed
- Any physical restraint, bed rail, or sedating medication given for agitation, and who ordered it
- Toileting, hydration and meals, and whether the patient could manage any of these without help
- Names of treating clinicians, and the condition of the department generally
Photographs and dated notes made the same day carry far more weight than a later account. A patient, or a substitute decision-maker acting for an incapable patient, can request the hospital record under the Personal Health Information Protection Act, 2004. Requesting it early is worth doing, because it fixes the hospital’s own version of events before anyone is in a dispute about them.
The complaint routes, and what each can deliver
Every Ontario hospital is required to maintain a patient relations process under the Excellent Care for All Act, 2010, and that is the first stop. Where it does not resolve the concern, the Patient Ombudsman, established under the same statute, takes complaints about the patient experience in public hospitals, long-term care homes and home and community care. The office reported 4,886 new complaints in 2024/25, roughly a ten per cent increase over the prior year, with close to sixty per cent of them about hospitals. It has real investigative powers. It cannot award compensation, and it does not take complaints about the conduct of individual regulated professionals.
Those go to the colleges: the College of Physicians and Surgeons of Ontario for physicians, the College of Nurses of Ontario for nurses. A discipline finding protects the public and can be useful evidence, but it is not a finding of civil liability and it produces nothing for the patient. Where a patient has died, a coroner’s investigation may follow, and the coroner’s file is often the first detailed account a family receives. We set out how these processes fit together in our guide to making a formal complaint about hospital care in Ontario.
A civil claim runs on its own clock. The general limitation period in Ontario is two years from discovery under the Limitations Act, 2002. Where the patient has died, section 38(3) of the Trustee Act imposes a hard two years from the date of death, and it is unforgiving. In cases involving elderly patients with cognitive impairment, families often spend the first year seeking answers through complaint channels and only then turn to a lawyer. That sequence can be costly.
A closing thought
Hallway care is a policy failure, and policy failures are not usually torts. Most of the families whose stories make the news do not have a claim, and it is more honest to say so than to imply otherwise.
But the cases that do exist share a feature worth naming. They are almost never about the hallway itself. They are about what the hospital stopped doing once the patient was in it: the reassessment that did not happen, the deterioration nobody saw, the fall in an unmonitored corridor, the delirium that went unscreened and untreated for four days. A hospital that decides to use a corridor as a care space takes on the obligation to make that space safe for the patient it puts there. Where the patient cannot call for help, that obligation gets heavier, not lighter.
If your family member suffered a serious injury after being held in an emergency department hallway or another unconventional space in an Ontario hospital, contact our office for a free consultation. We will tell you honestly whether it is a case we can take.
