The Alberta Court of King’s Bench opened its reasons in Ewashko v Hugo, 2025 ABKB 295 with a single question: did an urgent Caesarean section meet the standard of care when delivery came 101 minutes after the first physician recognized it was needed? “The answer is no.” Justice Lema found that two physicians fell below the standard of care, that their combined delay of about 50 minutes was not defensible, and that the delay caused the brain injury suffered by a baby who is now a child living with severe cerebral palsy. The court held the two physicians jointly liable.
This is an Alberta trial decision. In Ontario it is persuasive only, not binding. It is worth a close read here for two reasons: the underlying clinical guidance is national, and the court’s reasoning on the timeliness of an urgent C-section and on causation tracks issues that arise in Ontario birth-injury cases.
What happened
In the early hours of June 8, 2013, Julie Ewashko arrived at a hospital in Camrose, Alberta in early labour. Her fetus was in a complete breech position, and the hospital did not handle vaginal breech deliveries. Fetal heart monitoring began around 4:10 am and showed a marked, abnormal deceleration between 4:13 and 4:19 am.
Dr. Etienne Groenewald examined her at about 4:35 am and, by roughly 4:38 am, had concluded that an urgent C-section was required. Every expert agreed with that assessment, which reflected the Society of Obstetricians and Gynaecologists of Canada’s guidance on fetal heart rate monitoring, and with the plan to move “promptly” to a C-section. The difficulty was that the guideline does not define how quickly a “prompt” C-section must be done, leaving the standard to be worked out in the circumstances.
Two gaps followed. Dr. Groenewald, who was not authorized to perform C-sections at that hospital, was called away to a newly arrived heart-attack patient and did not call the on-call obstetrician, Dr. Wouter Hugo, until about 5:08 am. When Dr. Hugo was reached, he chose to drive in and examine the patient himself before summoning the operating-room team, rather than calling the team in immediately. He examined her around 5:25 to 5:30 am and called the team then. At 5:53 am, with the patient still on the labour-and-delivery unit and the operating room still being set up, a second major fetal heart deceleration began. A stat C-section was called at 5:57 am, the operation began around 6:10 am, and Aidan Ewashko was delivered at 6:19 am, not breathing. Resuscitation succeeded, but the oxygen deprivation that began around 5:53 am left him with mixed quadriplegic cerebral palsy. He is non-verbal, has a seizure disorder, is legally blind, and is completely dependent on his mother’s care.
The standard of care
The case turned on what “prompt” required. The court declined to adopt a rigid rule, and in particular rejected the idea of a fixed 30-minute “decision-to-incision” maximum for every urgent C-section. It found support for that in Gilmore v Love, 2023 BCSC 1380, a British Columbia decision (also persuasive only in Ontario) holding that hospital resources can sometimes make an hour or more acceptable. But the court was equally clear that a standard still exists even without a number attached to it: the standard was a genuinely prompt delivery, measured from the 4:38 am decision point, and on the evidence a prompt C-section in these circumstances should have taken no more than about 53 minutes.
Against that benchmark, the court identified two breaches, both established through the competing expert evidence the court had to weigh. Dr. Groenewald breached the standard by not calling Dr. Hugo immediately after his examination, which added about 30 minutes; the court accepted that the call could have been made without delaying his attention to the heart-attack patient, and that nothing justified pausing the C-section for half an hour. Dr. Hugo breached the standard by examining the patient before calling in the operating-room team rather than summoning the team at once, which added about 20 minutes for an examination that could not change the trajectory of an operation that was already required.
The court rejected the defence framing of these as defensible judgment calls. On the facts, there was no real judgment to exercise: once an urgent C-section was required, the only options at each step were to move toward it without delay or to delay it, and choosing delay added time for no benefit.
Causation
Causation succeeded on a straightforward “but for” footing, supported by foreseeability. Had the C-section been performed to the timeliness standard, Aidan would have been delivered well before the 5:53 am deceleration and would not have suffered the injury; even on more generous time estimates, he would still have been born before it. There was no evidence that a deceleration would have happened earlier if the surgery had been done on time. And the risk that the abnormal heart pattern would recur was, the court found, not just reasonably foreseeable but actually foreseen by both physicians, consistent with the SOGC guidance.
Because two separate omissions combined to produce a single injury, the court applied the principle that where negligent acts or omissions affect a plaintiff at the same time, both are treated as causing the injury, and held the two physicians jointly liable. Damages had been agreed in advance, so the judgment did not set a figure.
Why it matters in Ontario
To be clear about its weight: as an Alberta trial decision, Ewashko does not bind an Ontario court. Its value here is as persuasive authority and as a clear worked example. Three points carry over.
First, the timeliness analysis. The SOGC guidance the court relied on is national, and the refusal to reduce “prompt” to a single magic number, while still insisting that an enforceable standard exists, is the kind of reasoning an Ontario court could find persuasive in a delayed-delivery case. The standard is promptness in the actual circumstances, proven through expert evidence, not a stopwatch rule.
Second, the treatment of “judgment call” defences. Where the indicated course is obvious and the only choice is to act now or to delay, framing the delay as the exercise of clinical judgment will not necessarily insulate it. That is a recurring battleground in obstetric cases.
Third, causation across multiple providers. Birth-injury cases often involve more than one clinician and more than one missed opportunity. Ewashko is a useful illustration of how combined delays can be tied to a single, avoidable outcome, and of the principle that simultaneous or successive negligent omissions affecting the patient together can each be a cause.
For families, the human point is the one the court returned to: when fetal monitoring signals distress and an urgent delivery is called for, time is the treatment, and minutes lost to avoidable delay can be the difference between a healthy birth and a lifelong injury. Whether a particular delay fell below the standard, and whether it caused the harm, are questions that require expert evidence specific to obstetric care, but this decision shows how that case can be built.
The full decision is available on CanLII: Ewashko v Hugo, 2025 ABKB 295.
Ewashko v Hugo: A Delayed C-Section and a Preventable Birth Injury
An Alberta court found that an urgent C-section taking 101 minutes fell below the standard of care, that two physicians' combined 50 minutes of unnecessary delay was not a defensible judgment call, and that the delay caused a child's cerebral palsy. A look at the timeliness standard, the causation reasoning, and why this Alberta decision is persuasive, not binding, in Ontario.
The Alberta Court of King’s Bench opened its reasons in Ewashko v Hugo, 2025 ABKB 295 with a single question: did an urgent Caesarean section meet the standard of care when delivery came 101 minutes after the first physician recognized it was needed? “The answer is no.” Justice Lema found that two physicians fell below the standard of care, that their combined delay of about 50 minutes was not defensible, and that the delay caused the brain injury suffered by a baby who is now a child living with severe cerebral palsy. The court held the two physicians jointly liable.
This is an Alberta trial decision. In Ontario it is persuasive only, not binding. It is worth a close read here for two reasons: the underlying clinical guidance is national, and the court’s reasoning on the timeliness of an urgent C-section and on causation tracks issues that arise in Ontario birth-injury cases.
What happened
In the early hours of June 8, 2013, Julie Ewashko arrived at a hospital in Camrose, Alberta in early labour. Her fetus was in a complete breech position, and the hospital did not handle vaginal breech deliveries. Fetal heart monitoring began around 4:10 am and showed a marked, abnormal deceleration between 4:13 and 4:19 am.
Dr. Etienne Groenewald examined her at about 4:35 am and, by roughly 4:38 am, had concluded that an urgent C-section was required. Every expert agreed with that assessment, which reflected the Society of Obstetricians and Gynaecologists of Canada’s guidance on fetal heart rate monitoring, and with the plan to move “promptly” to a C-section. The difficulty was that the guideline does not define how quickly a “prompt” C-section must be done, leaving the standard to be worked out in the circumstances.
Two gaps followed. Dr. Groenewald, who was not authorized to perform C-sections at that hospital, was called away to a newly arrived heart-attack patient and did not call the on-call obstetrician, Dr. Wouter Hugo, until about 5:08 am. When Dr. Hugo was reached, he chose to drive in and examine the patient himself before summoning the operating-room team, rather than calling the team in immediately. He examined her around 5:25 to 5:30 am and called the team then. At 5:53 am, with the patient still on the labour-and-delivery unit and the operating room still being set up, a second major fetal heart deceleration began. A stat C-section was called at 5:57 am, the operation began around 6:10 am, and Aidan Ewashko was delivered at 6:19 am, not breathing. Resuscitation succeeded, but the oxygen deprivation that began around 5:53 am left him with mixed quadriplegic cerebral palsy. He is non-verbal, has a seizure disorder, is legally blind, and is completely dependent on his mother’s care.
The standard of care
The case turned on what “prompt” required. The court declined to adopt a rigid rule, and in particular rejected the idea of a fixed 30-minute “decision-to-incision” maximum for every urgent C-section. It found support for that in Gilmore v Love, 2023 BCSC 1380, a British Columbia decision (also persuasive only in Ontario) holding that hospital resources can sometimes make an hour or more acceptable. But the court was equally clear that a standard still exists even without a number attached to it: the standard was a genuinely prompt delivery, measured from the 4:38 am decision point, and on the evidence a prompt C-section in these circumstances should have taken no more than about 53 minutes.
Against that benchmark, the court identified two breaches, both established through the competing expert evidence the court had to weigh. Dr. Groenewald breached the standard by not calling Dr. Hugo immediately after his examination, which added about 30 minutes; the court accepted that the call could have been made without delaying his attention to the heart-attack patient, and that nothing justified pausing the C-section for half an hour. Dr. Hugo breached the standard by examining the patient before calling in the operating-room team rather than summoning the team at once, which added about 20 minutes for an examination that could not change the trajectory of an operation that was already required.
The court rejected the defence framing of these as defensible judgment calls. On the facts, there was no real judgment to exercise: once an urgent C-section was required, the only options at each step were to move toward it without delay or to delay it, and choosing delay added time for no benefit.
Causation
Causation succeeded on a straightforward “but for” footing, supported by foreseeability. Had the C-section been performed to the timeliness standard, Aidan would have been delivered well before the 5:53 am deceleration and would not have suffered the injury; even on more generous time estimates, he would still have been born before it. There was no evidence that a deceleration would have happened earlier if the surgery had been done on time. And the risk that the abnormal heart pattern would recur was, the court found, not just reasonably foreseeable but actually foreseen by both physicians, consistent with the SOGC guidance.
Because two separate omissions combined to produce a single injury, the court applied the principle that where negligent acts or omissions affect a plaintiff at the same time, both are treated as causing the injury, and held the two physicians jointly liable. Damages had been agreed in advance, so the judgment did not set a figure.
Why it matters in Ontario
To be clear about its weight: as an Alberta trial decision, Ewashko does not bind an Ontario court. Its value here is as persuasive authority and as a clear worked example. Three points carry over.
First, the timeliness analysis. The SOGC guidance the court relied on is national, and the refusal to reduce “prompt” to a single magic number, while still insisting that an enforceable standard exists, is the kind of reasoning an Ontario court could find persuasive in a delayed-delivery case. The standard is promptness in the actual circumstances, proven through expert evidence, not a stopwatch rule.
Second, the treatment of “judgment call” defences. Where the indicated course is obvious and the only choice is to act now or to delay, framing the delay as the exercise of clinical judgment will not necessarily insulate it. That is a recurring battleground in obstetric cases.
Third, causation across multiple providers. Birth-injury cases often involve more than one clinician and more than one missed opportunity. Ewashko is a useful illustration of how combined delays can be tied to a single, avoidable outcome, and of the principle that simultaneous or successive negligent omissions affecting the patient together can each be a cause.
For families, the human point is the one the court returned to: when fetal monitoring signals distress and an urgent delivery is called for, time is the treatment, and minutes lost to avoidable delay can be the difference between a healthy birth and a lifelong injury. Whether a particular delay fell below the standard, and whether it caused the harm, are questions that require expert evidence specific to obstetric care, but this decision shows how that case can be built.
The full decision is available on CanLII: Ewashko v Hugo, 2025 ABKB 295.
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.
Veran v Derbyshire: A Late Defence Motion for a Neuropsychological Examination
A defence motion for a neuropsychological assessment was refused eight years after the statement of defence in a complex pediatric malpractice case.
Woods v Jackiewicz: A Trial Victory on the Standard of Care in a High-Risk Twin Pregnancy
Paul Cahill won an $11.5 million jury verdict against an obstetrician whose failure to refer to a perinatologist caused a catastrophic cerebral palsy birth injury.
JB v Bailey: Admitted Negligence Is Not Proof of Causation in a Birth Injury Case
Dr. Bailey admitted that her management of labour was negligent and that it caused a hypoxic brain injury at birth. The plaintiffs still lost, because they could not prove that the brain injury caused the child’s lasting impairments. JB v Bailey is an Alberta decision, persuasive only in Ontario, but it is a clear reminder that admitted negligence and admitted injury are not the same as proven causation.