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Hemmings v. Peng – Trial Decision Upheld in $12m Malpractice Case

July 15, 2024
Case Law

Facts

On April 20, 2009, Sophia Hemmings (“Ms. Hemmings”) suffered a cardiac arrest during a caesarean section (C-section) at Scarborough General Hospital, leading to severe brain injury. Ms. Hemmings, who was 29 years old, was represented in a lawsuit by her mother, sister, daughter, and son. They alleged negligence by several healthcare practitioners, resulting in a $12 million damages award.

The primary dispute in this Court of Appeal case centers around whether the cardiac arrest was caused by an anesthetic accident or complication, as found by the trial judge, or by an amniotic fluid embolism (AFE), as argued by the defendant physicians, including Dr. Jamensky who was the attending anesthesiologist during the C-section.

Sequence of Events (para. 213)

Ms. Hemmings was given spinal anesthesia, which typically alleviates pain.
Following the administration of spinal anesthesia and the initial surgical incision, Ms. Hemmings became agitated.
Due to her agitation, the decision was made to convert from spinal to general anesthesia. Expert testimony says that general anesthesia should be a last resort in C-section procedures.
During the process of administering the general anesthetic, Dr. Jamensky encountered difficulties in intubating Ms. Hemmings. The first attempt to intubate failed. A second attempt with a larger blade succeeded, but significant time had passed, leading to a drop in oxygen levels and blood pressure.
After the administration of general anesthesia and the difficult intubation, Ms. Hemmings suffered a cardiac arrest. Resuscitation efforts were made, but Ms. Hemmings sustained a profound anoxic brain injury.

Trial Level Decision and Appeal

At trial, the judge determined that Ms. Hemmings’ cardiac arrest was caused by an “anesthetic accident or complication” rather than an amniotic fluid embolism (AFE), as argued by the appellant physicians. Specifically, the trial judge concluded that Dr. Jamensky’s negligence, particularly in failing to properly assess Ms. Hemmings’ airway and inappropriately converting to general anesthesia, directly led to the cardiac arrest (para. 200). The judge stated that without the general anesthetic, the cardiac arrest would not have occurred, establishing causation as shown in Clements v. Clements, 2012 SCC 32.

Dr. Jamensky appealed this conclusion on two fronts: First, he appealed the finding that the cardiac arrest was due to an anesthetic accident, not AFE. Second, he argued that the trial judge failed to perform an adequate causation analysis regarding whether his breach of the standard of care caused the cardiac arrest and subsequent brain injury.

Amniotic Fluid Embolism (AFE)

Dr. Jamensky argued that the trial judge erred by rejecting AFE as the probable cause of the cardiac arrest. AFE is recognized as an extraordinarily rare event that can lead to sudden cardiorespiratory collapse when amniotic fluid enters the maternal bloodstream as explained in Clements v Clements, 2012 SCC 32 (para. 201). However, the trial judge found AFE unlikely due to several reasons, including its rarity, how it is used as diagnosis of exclusion, and the usual presence of coagulopathy, which was absent in this case (para. 205).

The trial judge’s reliance on expert testimony from Dr. Barrett, the respondent’s obstetrical expert, who said that AFE was not the cause of the cardiac arrest, was significant to this conclusion. The evidence provided by both plaintiffs’ and defendants’ expert anesthetists supported the exclusion of AFE as the likely cause. The trial judge’s approach was supported by the expert testimony and did not display any palpable and overriding error (para 206). As per Sacks v Ross, 2017 ONCA 773, the court’s primary task in a causation analysis is to ascertain what likely happened, and the trial judge appropriately fulfilled this by evaluating and rejecting the AFE hypothesis based on the presented evidence.

Anesthetic Accident or Complication

Dr. Jamensky also contended that the trial judge failed to adequately explain the anesthetic accident that allegedly caused the cardiac arrest. However, the trial judge explained why a general anesthetic should be a last resort for a C-section due to the associated risks, citing expert advice from Dr. Goldszmidt (para. 213).

Expert testimony also explained how the effects of combining spinal and general anesthesia, along with poor airway management, led to hypotension and hypoxia, causing the cardiac arrest. Dr. Goldszmidt testified about the combined effects of spinal and general anesthesia in lowering blood pressure, which contributed to the cardiac arrest. Dr. Barrett and Dr. Westacott, defence anesthesiology expert, supported this conclusion, attributing the cardiac arrest to the anesthetic management (paras. 214-217).

Conclusion

In conclusion, the trial judge’s finding that the cardiac arrest was caused by an anesthetic accident or complication, rather than AFE, was upheld by the expert evidence in the Court of Appeal. Therefore, the appeal on causation grounds lacked merit, as no palpable and overriding error was evident in the trial judge’s reasoning and findings.

Decision Date: April 30, 2024

Jurisdiction: Court of Appeal for Ontario

Citation: Hemmings v. Peng, 2024 ONCA 318 (CanLII)

Paul Cahill

Paul is a partner at Davidson Cahill Morrison LLP. He has proven himself a fearless advocate by a number of successful trial outcomes over the years, including a $11.5 million judgment for medical malpractice causing cerebral palsy against a negligent doctor as well as a recent judgment against a negligent emergency room physician who caused the death of a 34 year-old mother of 4 young children.