On November 22, 2024, the Supreme Court for British Columbia dismissed a claim by a patient who alleged that an emergency medicine physician had failed to diagnose appendicitis leading to a ruptured appendix.
On November 30, 2016, Ms. Wray attended the emergency department (“ED”) at Kelowna General Hospital (“KGH”) with abdominal pain. She was attended on by Dr. Balfour. Ms. Wray was assessed and an ultrasound was ordered, which showed a normal appendix. Given her past history with endometriosis, Ms. Wray was advised that her abdominal pain was likely due to a ruptured ovarian cyst. She was discharged later that day. She was given pain medication for seven days and told to follow up with her physician or return to clinic if the pain continued.
Ms. Wray continued to have pain when she returned home. On December 4, 2016, she returned to the ED by ambulance where she was diagnosed with a punctured appendix and underwent surgery. She was discharged on December 11, 2016.
The principal issue was whether the emergency room physician fell below the standard of care by not doing more to rule out a potential appendicitis following an ultrasound that showed a normal appendix.
Dr. Garry Feinstadt (Family Medicine): Dr. Feinstadt was tendered as an expert in family and emergency medicine, qualified to provide opinion evidence on the standard of care of an emergency physician in the assessment, diagnosis, treatment, and discharge of patients with acute abdominal pain and suspected appendicitis.
Dr. Ken Perrier (Family Medicine): Dr. Perrier is an experienced family physician. He had been Ms. Wray’s physician since 2001. Dr. Perrier was tendered as an expert and qualified to provide opinion evidence in family medicine. Dr. Perrier was also tendered as a fact witness.
Dr. William Siu: Dr. William Siu is a practicing radiologist and is on the medical staff at Royal Columbian Hospital and Eagle Ridge Hospital. He also works at a community clinic in Coquitlam. He was tendered as an expert in radiology qualified to provide opinion evidence in the field of radiology and the assessment of pelvic ultrasounds.
Dr. John Ward (Emergency Medicine): Dr. Ward is a specialist in emergency medicine and internal medicine and has been practicing for 27 years. Dr. Ward was tendered as an expert in emergency medicine and is qualified to provide opinion evidence on the standard of care of an emergency physician in the assessment, diagnosis, treatment, and discharge of patients with acute abdominal pain and suspected appendicitis in the ED.
Dr. David Konkin (General Surgery): Dr. Konkin is a general surgeon. He is the Regional Medical Director and Department Head of Surgery for the Fraser Health Authority and a clinical professor in the Department of Surgery, Division of General Surgery, at University of British Columbia.
The Court found that Dr. Balfour had both appendicitis and a ruptured ovarian cyst on the differential diagnosis as it related to Ms. Wray’s abdominal pain. He also charted that her pelvic pain was not yet diagnosed.
It was furthermore accepted that Dr. Balfour arrived at this conclusion based on Ms. Wray’s past medical history including a history of endometriosis, his history taking and physical examination of Ms. Wray, as well as the results of the ultrasound imaging which included an endovaginal ultrasound which showed a normal appendix.
When an ultrasound is negative showing a normal appendix, a diagnosis of appendicitis is extremely unlikely.
In all of the circumstances, the Court found that Dr. Balfour’s conclusion that Ms. Wray did not have appendicitis was reasonable and logical.
The Plaintiff’s claim was dismissed.
Decision Date: November 22, 2024
Jurisdiction: Supreme Court of British Columbia
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