Anyone who has spent a long night in an Ontario emergency department in the last few years recognizes the pattern. The waiting room is full. Stretchers line the corridors outside the treatment area. Patients who should be in monitored beds are instead in hallways, behind curtains, or on chairs in the ambulance bay. Triage nurses are overwhelmed. Physicians are running between patients with incomplete information. Vital signs are not reassessed for hours. People who arrive with chest pain, severe abdominal pain, neurological symptoms, or sepsis are sometimes sent home with a diagnosis that does not match the seriousness of what is actually happening.
This is what is known as hallway medicine, and it is no longer an exception. It has become a routine feature of how care is delivered across Ontario hospitals. From a medical-legal perspective, the question that increasingly arises is straightforward: when an overcrowded emergency department contributes to a delayed diagnosis, a missed condition, a premature discharge, or a death, who is legally responsible?
The short answer is that the legal standard of care does not change because the system is in crisis. Patients who are harmed by negligent emergency care still have rights, and physicians and hospitals can still be held accountable.
What “Hallway Medicine” Actually Means
The term refers to patients receiving care — including admitted, post-operative, and acutely ill patients — in spaces never designed for it: hallways, conference rooms, family lounges, and unmonitored alcoves. The Office of the Auditor General of Ontario has documented the scale of the problem in detail. In its 2023 value-for-money audit of Ontario emergency departments, the Auditor General found that the average wait to be assessed by a physician had grown to roughly two hours, and that patients who needed to be admitted were often waiting more than 24 hours for an inpatient bed. There were over 200 unplanned, temporary ED closures across 23 hospitals — most of them rural or northern — in a single twelve-month period, driven largely by nursing and physician shortages.
A 2025 follow-up audit found that, while progress has been made on some recommendations, hospital occupancy continues to hover above 95% and serious adverse events remain a recurring feature of return ED visits — including missed diagnoses, delayed diagnoses, and unsafe discharges.
Ontario’s “left without being seen” rate — the percentage of patients who give up and leave the emergency department before being assessed — has more than doubled in recent years. At some hospitals, more than one in ten patients walks out before seeing a physician. Each of those patients is a person whose condition was never assessed, never diagnosed, and never treated. Some are fine. Some are not.
The downstream consequences are significant. A recent analysis published in Healthy Debate cited research estimating that as many as 15,000 Canadians die each year as a result of hospital overcrowding. That is not a failure of any one nurse, physician, or hospital. But it does set the stage for a real and growing volume of preventable harm.
The Standard of Care Does Not Bend to System Pressure
In Ontario, the legal standard of care for a physician or nurse is what a reasonably competent professional would have done in the same circumstances. That standard is not waived because the department is busy, because there is a nursing shortage, or because the patient was being seen in a hallway rather than a treatment bay.
This principle was applied directly in Ibrahimova v. Cavanagh, where the Ontario Superior Court of Justice found an emergency medicine physician negligent for failing to refer a pregnant patient with ruptured membranes to an obstetrician. The patient went on to develop septic shock and required multiple amputations. The decision confirms what plaintiffs’ counsel have long argued: emergency physicians are not relieved of their duty to recognize red flags, escalate appropriately, and arrange specialist input simply because the department around them is under strain.
Put bluntly, an overcrowded ER is the context for the analysis, not a defence to it. Triage decisions, reassessment intervals, the decision to admit or discharge, the decision to order or repeat a test, the decision to consult — each of these is still measured against what a competent emergency physician or nurse should have done.
Where Liability Most Often Arises
In our experience litigating these claims, the patterns are remarkably consistent. The most common categories of negligence in overcrowded Ontario emergency departments include:
- Triage errors. A patient is undertriaged at the front door — assigned a less urgent CTAS level than their presentation warrants — and is then left in the waiting room while their condition deteriorates. Sepsis, stroke, and acute coronary syndromes are particularly vulnerable to this failure.
- Failure to reassess. A patient is triaged, vitals are taken once, and they are then effectively forgotten in a hallway for several hours. By the time someone returns, the clinical picture has changed dramatically.
- Premature discharge. A patient is sent home before pending test results are reviewed, before symptoms have meaningfully resolved, or with safety-net instructions that are inadequate to the actual diagnosis on the differential.
- Missed sepsis, missed stroke, missed cardiac events. These are time-sensitive diagnoses where every hour of delay materially worsens outcomes. They account for a disproportionate share of catastrophic ED claims in this province.
- Failure to escalate or refer. A patient with red-flag symptoms is managed entirely by the emergency physician without consultation to the appropriate specialist — obstetrics, neurology, general surgery, cardiology — when the standard of care required that consultation.
- Communication breakdowns. Critical results come back hours after the patient has been moved or discharged, and the loop is never closed. Abnormal imaging and abnormal labs that require urgent action sit in the chart unread.
For a more detailed discussion of the specific diagnoses that are most often missed in this setting, see our earlier post on the top five most dangerous misdiagnoses in the emergency room.
Hospital Liability Versus Physician Liability
When a person is harmed in an overcrowded emergency department, the legal analysis usually involves more than one defendant.
Individual physicians — emergency physicians, consulting specialists, and any residents involved — owe a personal duty of care to their patients and may be sued directly. Most are defended by the Canadian Medical Protective Association, which is well resourced and aggressive in defending claims.
Hospitals, in turn, can be liable on two distinct theories. First, they are vicariously liable for the negligence of their employees — most importantly nurses, but also residents, technologists, and clerical staff who play a role in patient flow. Second, hospitals can be directly liable for systemic or institutional failures: inadequate staffing, the absence of policies for reassessment of waiting patients, failure to implement reasonable triage protocols, failure to ensure that critical results are communicated to the responsible clinician, and failure to provide an adequate physical environment for safe care.
The interplay between these theories matters. In a hallway-medicine case, the question is rarely whether something went wrong — it is whose failure caused the harm, and whether more than one defendant should answer for it. A careful pleading typically names both the individual clinicians and the hospital, and the defence positions of those parties often diverge as the case progresses.
What Patients and Families Should Document
If you or a loved one have a serious adverse outcome after an emergency department visit, the contemporaneous record is often the most important piece of evidence. The hospital’s chart will eventually be obtained through formal disclosure, but families are often in a better position to capture details that the chart will not contain. Where possible, write down:
- The date and time of arrival, and the time triage was completed.
- The triage level assigned and what the nurse said about expected wait.
- Each time a clinician — nurse or physician — actually assessed the patient, and what they said.
- Each set of vital signs taken, and the times.
- What was said at the time of any discharge, and what written instructions were provided.
- The names of treating clinicians, where known.
- Any complaints made by the patient or family during the visit, and to whom.
These details are routinely missing or thin in hospital charts and can become decisive in establishing what actually happened during a hallway-medicine encounter.
When to Speak With a Medical Malpractice Lawyer
Not every bad outcome in an Ontario emergency department is the result of negligence. Emergency medicine is genuinely difficult, and even excellent clinicians make decisions in conditions of irreducible uncertainty. We have written separately about why many medical malpractice cases are declined in Ontario, and the analysis there applies fully to ED cases.
That said, a serious harm following an emergency department visit — a stroke that was missed, a sepsis that was sent home, a perforated viscus that was not investigated, a baby who was harmed because a transfer or consult never happened — deserves a careful legal review. There is a two-year limitation period in Ontario, and important evidence can be lost quickly.
If you or a family member have suffered serious injury or lost a loved one following an emergency department visit in Ontario, please contact our office for a free consultation. We will tell you honestly whether your case is one we can help with.
