The hardest structural problem in a medical malpractice claim is often not proving the negligence. It is knowing who to sue before the clock runs out. A patient who spends three years moving through a large teaching hospital is treated by dozens of physicians, residents, fellows and nurses, and the hospital holds the records that identify them. The plaintiff frequently does not have those records when the limitation period expires.
The accepted workaround is to plead John and Jane Doe placeholders and correct the names later under the doctrine of misnomer. Ramzanali v Sunnybrook, 2026 ONSC 4198, released on July 20, 2026, is a reminder that the workaround only does its job if the original pleading did its job first. Justice Merritt refused to treat the case as misnomer, then allowed the three physicians to be added anyway, with the limitation defence preserved for trial. Both halves of that result are worth reading closely.
The claim and the motion
Mr. Zulfikar Ramzanali received care at Sunnybrook Health Sciences Centre from June 2019 until his death on May 4, 2021. The statement of claim was issued on May 4, 2023, the last day of the two year period under section 38(3) of the Trustee Act, and it named eight physicians, the hospital, and eighty John Doe and Jane Doe defendants.
Sunnybrook produced Mr. Ramzanali’s records in its affidavit of documents in December 2024, under a court ordered timetable. Only then were the plaintiffs able to identify the orthopaedic surgeon who performed an amputation and the two gastroenterologists who performed procedures referred to in the claim. They moved to substitute those three physicians for three of the Jane Doe defendants on the basis of misnomer, and alternatively to add them under the doctrine of special circumstances. The defendants did not oppose the balance of the proposed amendments.
Issue one: the litigation finger has to point somewhere
The parties agreed on the law. Misnomer corrects the misnaming or misdescription of a party already before the court; it does not add anyone: Ormerod v Strathroy Middlesex General Hospital, 2009 ONCA 697, 97 O.R. (3d) 321. The operative question comes from the Loy-English principles: read objectively and generously, would a properly informed physician reading the claim recognize that he or she was the target of the allegation? Where the pleading takes a shotgun approach, the requirement is not met. Urie v Peterborough Regional Health Centre describes the failure case as a litigation finger “quivering over a pool of possible individuals.”
The pleading here did not survive that test. Paragraph 9 alleged wide ranging failures across cardiovascular, gastrointestinal, internal and endocrinal medicine. Paragraph 10 alleged that “repeatedly there was incompetence and malpractice” across a series of admissions. Paragraph 25 attributed to every named and unnamed defendant, collectively, a list that ran from surgeries and amputations through scopes, scans, intubations, medications and dressings. No material facts were pleaded about a negligent amputation or negligent gastroenterological care specifically, which is why the plaintiffs needed extensive amendments to advance those allegations at all.
The plaintiffs’ position on the motion was candid and, in the end, fatal. They conceded that the litigation finger pointed at every person from whom Mr. Ramzanali received care, and argued that this necessarily captured the three proposed defendants. Justice Merritt rejected the argument in a sentence that is likely to be quoted for some time: “Misnomer is not for cases where the Plaintiff does not know who to sue.”
The court added a second, independent reason. Even if references to scopes, gastrointestinal medicine and amputations had been sufficient, the proposed defendants could not realistically have identified themselves. Four gastroenterologists saw Mr. Ramzanali, and he had more than one amputation. The description did not narrow the field to these three physicians.
That analysis is the practical distinction between this case and Estate of Henders v Lakeridge Health Oshawa, where the pleading tied unnamed providers to identifiable roles and time periods and the misnomer amendments succeeded. Doe pleading is not a reservation of rights against an entire institution. It works when the claim says, in substance, “the gastroenterologist who performed the colonoscopy on this date,” and fails when it says “everyone who touched this patient.”
Issue two: an absolute limitation period, and a decision deferred
Section 38(3) of the Trustee Act bars an action brought more than two years after the death. Discoverability does not apply to it: Ryan v Moore, 2005 SCC 38, [2005] 2 S.C.R. 53. That makes it materially harsher than the discoverability based scheme that governs most limitation periods for medical malpractice claims in Ontario, and it is why estate claims are so often issued at the edge of the deadline, as this one was.
The doctrine of special circumstances can still permit an addition after expiry. On the Estate of John Edward Graham v Southlake Regional Health Centre framework, the plaintiff must rebut the presumption of prejudice that arises from the loss of a limitation defence, and then show special circumstances. Several of the Graham factors were apparent on this record: the proposed defendants get the benefit of the investigation already done by their co-defendants, they are represented by the same firm as the other physicians, and no trial date has been set. Justice Merritt noted that the onus rests on the plaintiff, while also observing that the proposed defendants did not assert that the claims against them were untenable or that they had stopped practising in Ontario.
Where the record broke down was diligence. The plaintiff Zakyr Ramzanali deposed that he began seeking the records in May 2021, that a patient experience advisor directed him to MyChart, the family doctor, or a paid formal request, that MyChart was incomplete, that the family doctor was retiring, and that Sunnybrook would not waive the fee or even quote one. He said he submitted a request for information form in the autumn of 2021 and heard nothing. Against that, Sunnybrook’s evidence was that the MyChart registration was never completed, that no department has any record of a request, call or voicemail after July 2021, and that no copy of the form was ever produced despite an undertaking to make best efforts. His explanation, that the records were stolen and the proof sits on a hard drive he cannot safely access, was not tested.
The court declined to resolve that conflict on an interlocutory motion. The amendments were allowed, the proposed defendants may plead the expiry of the limitation period, and the special circumstances question goes to the trial judge on a full record. Costs of $4,000, agreed in advance and payable to the successful party, went to the plaintiffs.
What the result is actually worth
On paper the plaintiffs won: leave granted, costs recovered. In substance the outcome is closer to a draw, and arguably worse than that.
A successful misnomer motion is dispositive of the limitation problem, because correcting a name is not adding a party. What the plaintiffs obtained instead is permission to add three physicians who arrive in the action with a live absolute limitation defence, on a record where the court has already noted conflicting evidence about diligence, gaps in the evidence about what was done after the claim was issued, and no evidence that these physicians knew anything about the claim before the two years expired. The claim was issued on day 730, so even the named defendants had minimal notice. Those are not encouraging findings to carry to trial.
The defence view of the deferral is not unreasonable either. The purpose of an absolute limitation period is finality, and three physicians will now spend years in litigation before a trial judge decides whether they should have been in it at all. The answer to that, and the reason the deferral is defensible, is that the diligence dispute turns on credibility. Deciding it on affidavits would have permanently ended a claim on an untested record, and the Graham analysis itself came out of a case where late institutional disclosure was the reason the plaintiff could not identify the physician sooner.
Practice points
Three things follow for anyone running an estate claim against a hospital.
Plead the Does by role and event, not by number. Eighty placeholders is not eighty times the protection. The value of a Doe defendant lies entirely in the particularity of the surrounding allegation: the specialty, the procedure, the date, the clinical decision said to have been negligent. A generic list of every procedure a hospital performs points at no one.
Build the records paper trail as though it will be an exhibit, because it will be. The failure here was not that the hospital withheld records, or not only that. It was that the plaintiff could not prove what he had asked for or when. Written requests, dated follow ups, and copies of everything sent are what rebut the presumption of prejudice later. Anyone in this position should request their medical records in writing at the outset. Under section 54(10) of PHIPA a custodian must provide a fee estimate before charging for access, and section 54(11) caps the fee at reasonable cost recovery, which the Information and Privacy Commissioner has interpreted narrowly. A complaint to the Commissioner is available where a custodian does not respond, and it generates a record of its own.
Do not save the Trustee Act claim for day 730. Issuing early is the only step that reliably creates time to obtain productions, identify the individual providers, and amend while the misnomer argument still has room to run. Where the hospital’s own process is the bottleneck, the patient relations office and a written access request under PHIPA are parallel routes, and both should be documented.
For families
If a family member died after hospital care and you are trying to work out what happened, two points from this decision matter more than the doctrine.
The first is time. A claim arising from a death generally has to be started within two years of the date of death, and unlike most limitation periods, that one does not wait until you understand what went wrong. Waiting for answers from the hospital is the most common way that deadline is missed.
The second is records. You have a right of access to your family member’s health records, and the practical obstacles that got in the way in this case, incomplete online portals, retiring family physicians, unexplained fees, are common and usually solvable. Ask in writing, keep copies, and escalate early rather than late. Nothing about this decision suggests the underlying care was or was not negligent. It is a procedural ruling about who can be sued, and the merits remain entirely undetermined.
Ramzanali et al v Sunnybrook, 2026 ONSC 4198 (Merritt J.), released July 20, 2026.
Ramzanali v Sunnybrook: Eighty Doe Defendants and the Limits of Misnomer
A patient treated at Sunnybrook over three years, a claim issued on the last day of the Trustee Act limitation period, and eighty Doe defendants. Justice Merritt refused to treat the case as misnomer, holding that the litigation finger pointed at everyone and therefore at no one. The three physicians were added anyway, with the limitation defence preserved for trial.
The hardest structural problem in a medical malpractice claim is often not proving the negligence. It is knowing who to sue before the clock runs out. A patient who spends three years moving through a large teaching hospital is treated by dozens of physicians, residents, fellows and nurses, and the hospital holds the records that identify them. The plaintiff frequently does not have those records when the limitation period expires.
The accepted workaround is to plead John and Jane Doe placeholders and correct the names later under the doctrine of misnomer. Ramzanali v Sunnybrook, 2026 ONSC 4198, released on July 20, 2026, is a reminder that the workaround only does its job if the original pleading did its job first. Justice Merritt refused to treat the case as misnomer, then allowed the three physicians to be added anyway, with the limitation defence preserved for trial. Both halves of that result are worth reading closely.
The claim and the motion
Mr. Zulfikar Ramzanali received care at Sunnybrook Health Sciences Centre from June 2019 until his death on May 4, 2021. The statement of claim was issued on May 4, 2023, the last day of the two year period under section 38(3) of the Trustee Act, and it named eight physicians, the hospital, and eighty John Doe and Jane Doe defendants.
Sunnybrook produced Mr. Ramzanali’s records in its affidavit of documents in December 2024, under a court ordered timetable. Only then were the plaintiffs able to identify the orthopaedic surgeon who performed an amputation and the two gastroenterologists who performed procedures referred to in the claim. They moved to substitute those three physicians for three of the Jane Doe defendants on the basis of misnomer, and alternatively to add them under the doctrine of special circumstances. The defendants did not oppose the balance of the proposed amendments.
Issue one: the litigation finger has to point somewhere
The parties agreed on the law. Misnomer corrects the misnaming or misdescription of a party already before the court; it does not add anyone: Ormerod v Strathroy Middlesex General Hospital, 2009 ONCA 697, 97 O.R. (3d) 321. The operative question comes from the Loy-English principles: read objectively and generously, would a properly informed physician reading the claim recognize that he or she was the target of the allegation? Where the pleading takes a shotgun approach, the requirement is not met. Urie v Peterborough Regional Health Centre describes the failure case as a litigation finger “quivering over a pool of possible individuals.”
The pleading here did not survive that test. Paragraph 9 alleged wide ranging failures across cardiovascular, gastrointestinal, internal and endocrinal medicine. Paragraph 10 alleged that “repeatedly there was incompetence and malpractice” across a series of admissions. Paragraph 25 attributed to every named and unnamed defendant, collectively, a list that ran from surgeries and amputations through scopes, scans, intubations, medications and dressings. No material facts were pleaded about a negligent amputation or negligent gastroenterological care specifically, which is why the plaintiffs needed extensive amendments to advance those allegations at all.
The plaintiffs’ position on the motion was candid and, in the end, fatal. They conceded that the litigation finger pointed at every person from whom Mr. Ramzanali received care, and argued that this necessarily captured the three proposed defendants. Justice Merritt rejected the argument in a sentence that is likely to be quoted for some time: “Misnomer is not for cases where the Plaintiff does not know who to sue.”
The court added a second, independent reason. Even if references to scopes, gastrointestinal medicine and amputations had been sufficient, the proposed defendants could not realistically have identified themselves. Four gastroenterologists saw Mr. Ramzanali, and he had more than one amputation. The description did not narrow the field to these three physicians.
That analysis is the practical distinction between this case and Estate of Henders v Lakeridge Health Oshawa, where the pleading tied unnamed providers to identifiable roles and time periods and the misnomer amendments succeeded. Doe pleading is not a reservation of rights against an entire institution. It works when the claim says, in substance, “the gastroenterologist who performed the colonoscopy on this date,” and fails when it says “everyone who touched this patient.”
Issue two: an absolute limitation period, and a decision deferred
Section 38(3) of the Trustee Act bars an action brought more than two years after the death. Discoverability does not apply to it: Ryan v Moore, 2005 SCC 38, [2005] 2 S.C.R. 53. That makes it materially harsher than the discoverability based scheme that governs most limitation periods for medical malpractice claims in Ontario, and it is why estate claims are so often issued at the edge of the deadline, as this one was.
The doctrine of special circumstances can still permit an addition after expiry. On the Estate of John Edward Graham v Southlake Regional Health Centre framework, the plaintiff must rebut the presumption of prejudice that arises from the loss of a limitation defence, and then show special circumstances. Several of the Graham factors were apparent on this record: the proposed defendants get the benefit of the investigation already done by their co-defendants, they are represented by the same firm as the other physicians, and no trial date has been set. Justice Merritt noted that the onus rests on the plaintiff, while also observing that the proposed defendants did not assert that the claims against them were untenable or that they had stopped practising in Ontario.
Where the record broke down was diligence. The plaintiff Zakyr Ramzanali deposed that he began seeking the records in May 2021, that a patient experience advisor directed him to MyChart, the family doctor, or a paid formal request, that MyChart was incomplete, that the family doctor was retiring, and that Sunnybrook would not waive the fee or even quote one. He said he submitted a request for information form in the autumn of 2021 and heard nothing. Against that, Sunnybrook’s evidence was that the MyChart registration was never completed, that no department has any record of a request, call or voicemail after July 2021, and that no copy of the form was ever produced despite an undertaking to make best efforts. His explanation, that the records were stolen and the proof sits on a hard drive he cannot safely access, was not tested.
The court declined to resolve that conflict on an interlocutory motion. The amendments were allowed, the proposed defendants may plead the expiry of the limitation period, and the special circumstances question goes to the trial judge on a full record. Costs of $4,000, agreed in advance and payable to the successful party, went to the plaintiffs.
What the result is actually worth
On paper the plaintiffs won: leave granted, costs recovered. In substance the outcome is closer to a draw, and arguably worse than that.
A successful misnomer motion is dispositive of the limitation problem, because correcting a name is not adding a party. What the plaintiffs obtained instead is permission to add three physicians who arrive in the action with a live absolute limitation defence, on a record where the court has already noted conflicting evidence about diligence, gaps in the evidence about what was done after the claim was issued, and no evidence that these physicians knew anything about the claim before the two years expired. The claim was issued on day 730, so even the named defendants had minimal notice. Those are not encouraging findings to carry to trial.
The defence view of the deferral is not unreasonable either. The purpose of an absolute limitation period is finality, and three physicians will now spend years in litigation before a trial judge decides whether they should have been in it at all. The answer to that, and the reason the deferral is defensible, is that the diligence dispute turns on credibility. Deciding it on affidavits would have permanently ended a claim on an untested record, and the Graham analysis itself came out of a case where late institutional disclosure was the reason the plaintiff could not identify the physician sooner.
Practice points
Three things follow for anyone running an estate claim against a hospital.
Plead the Does by role and event, not by number. Eighty placeholders is not eighty times the protection. The value of a Doe defendant lies entirely in the particularity of the surrounding allegation: the specialty, the procedure, the date, the clinical decision said to have been negligent. A generic list of every procedure a hospital performs points at no one.
Build the records paper trail as though it will be an exhibit, because it will be. The failure here was not that the hospital withheld records, or not only that. It was that the plaintiff could not prove what he had asked for or when. Written requests, dated follow ups, and copies of everything sent are what rebut the presumption of prejudice later. Anyone in this position should request their medical records in writing at the outset. Under section 54(10) of PHIPA a custodian must provide a fee estimate before charging for access, and section 54(11) caps the fee at reasonable cost recovery, which the Information and Privacy Commissioner has interpreted narrowly. A complaint to the Commissioner is available where a custodian does not respond, and it generates a record of its own.
Do not save the Trustee Act claim for day 730. Issuing early is the only step that reliably creates time to obtain productions, identify the individual providers, and amend while the misnomer argument still has room to run. Where the hospital’s own process is the bottleneck, the patient relations office and a written access request under PHIPA are parallel routes, and both should be documented.
For families
If a family member died after hospital care and you are trying to work out what happened, two points from this decision matter more than the doctrine.
The first is time. A claim arising from a death generally has to be started within two years of the date of death, and unlike most limitation periods, that one does not wait until you understand what went wrong. Waiting for answers from the hospital is the most common way that deadline is missed.
The second is records. You have a right of access to your family member’s health records, and the practical obstacles that got in the way in this case, incomplete online portals, retiring family physicians, unexplained fees, are common and usually solvable. Ask in writing, keep copies, and escalate early rather than late. Nothing about this decision suggests the underlying care was or was not negligent. It is a procedural ruling about who can be sued, and the merits remain entirely undetermined.
Ramzanali et al v Sunnybrook, 2026 ONSC 4198 (Merritt J.), released July 20, 2026.
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.
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Pros and Cons of Juries in Medical Malpractice Lawsuits
Paul Cahill’s June 2019 Lawyer’s Daily article on when to ask for a jury in Ontario medical malpractice cases, drawing on his trial experience and the law on jury notices and appellate deference.