1 THE TRIAL OF A MEDICAL NEGLIGENCE ACTION J. THOMAS CURRY MCCARTHY TÉTRAULT
2 INTRODUCTION... 1 By the Numbers: Which Cases Are Tried and Why?... 1 Liability Issues... 3 (a) Standard of Care... 3 (b) Causation... 5 (c) Informed Consent... 8 The Efficient Trial of Liability Issues Number of Experts Bifurcation Role of the Trial Judge Overly Broad Claims (Too Many Defendants, Too Many Plaintiffs) Common Experts Witness Statements Cross-Examination and Examination in Chief Agreed Medical Records CONCLUSION... 20
3 THE TRIAL OF A MEDICAL NEGLIGENCE ACTION INTRODUCTION Trials against physicians and hospitals for medical negligence present a challenge to the parties, counsel, expert witnesses and the Court. In almost all cases, expert evidence is vital to the successful prosecution or defence of the claim. The legal issues are unique and require counsel (and Judges) to be familiar with a body of law not particularly well understood by many civil litigation practitioners. This paper reviews the essential elements of a claim for medical negligence including the liability issues of standard of care, informed consent and causation, as well as the issues relating to the proof of damages. The traditional areas of battle during the medical negligence case almost invariably result in a great deal of complexity, even in the most straightforward factual cases. Nonetheless, there are ways and means of reducing the complexity and the expense of a trial of this type. Such methods will be considered in the context of each of the traditional areas of conflict at trial. By the Numbers: Which Cases Are Tried and Why? In Ontario, between January 1, 1995 and December 31, 1999, 213 claims against members of the Canadian Medical Protective Association ( CMPA ) were taken to trial. This represented 43% of such cases taken to trial across Canada. A further (approximately) 2,800 Ontario medical negligence actions were closed according to the records of the CMPA during that same time. This represented 48% of the closed cases (including the trials) across Canada. The statistics relating to these actions are remarkably consistent over the years. About two thirds of the claims started against physicians are dismissed before trial without any payment to the Plaintiff. Of the balance, approximately one third are settled and fewer than 10% are taken to trial. Of those, most are dismissed.
4 - 2 - One might ask reasonably why, if so many cases are commenced, so few are resolved in favour of the Plaintiff. The answer is itself complex but certainly one major element is what might be called case selection. Many cases which are commenced are dismissed without any payment to the Plaintiff because no legal basis for the claim can be established. Plaintiff s counsel are not always experienced in matters of medical negligence and often claims which have no reasonable prospect of success are brought against physicians. When these cases are dismissed, no one should be surprised and no cries for reform should be heard. Equally, certain cases are settled on behalf of medical doctors where it can be said there is no reasonable basis for a defence. In fairness to the Defendant, it cannot be said that in such cases, it is obvious at an early stage that there is no reasonable prospect of a successful defence. To the contrary, only when expert witnesses are consulted are such conclusions usually capable of being made. The same is not true of the cases for the Plaintiff. The Plaintiff commences actions knowing that the onus of proof is upon him or her and therefore a direct need to have consulted an expert witness exists before the claim is issued. Almost without exception, experienced counsel will do so. It is therefore reasonable to suggest that, at a minimum, counsel bringing claims against medical doctors or hospitals arising from allegations of negligence in the provision of care, consult with expert witnesses prior to the commencement of the action in order that claims which are weak or impossible to prove, are not brought. Since the limitation period is sometimes short, there may be situations in which Notices of Action or Statements of Claim must be issued prior to the proper investigation of a claim. Such cases should be rare and before very much occurs, expert witnesses should be consulted. In such cases, the client should be told exactly the basis upon which the claim is being launched. Client expectations often drive bad cases forward. Frequently, counsel carry the expenses for such clients and then cannot withdraw from the positions taken in the lawsuit because their fees are an issue.
5 - 3 - The CMPA has recognized the need to identify and resolve meritorious claims quickly without incurring unreasonable expense on either side. Since an individual physician s entitlement to practice and mobility rights are sometimes impaired by allegations of medical negligence, counsel acting for a physician and the CMPA itself owe a duty to properly investigate claims which are launched and to properly consider all of the circumstances before any settlement is made. This sometimes causes delay and expense. The challenge for counsel for Plaintiffs and Defendants is to identify which cases are which, and to act accordingly. Liability Issues (a) Standard of Care In order to succeed in an action for medical negligence the Plaintiff must show that the Defendant has breached the standard of care as established by the law. Determining the appropriate standard of care in the medical context necessarily involves the use of expert evidence to establish the prevailing and approved practice as well as any changes or advancements in treatment techniques and technology. The medical negligence case is unique in the sense that it involves the exercise of professional judgment and technical skills, and a body of complex scientific knowledge which an ordinary individual will often not comprehend. 1 The standard of care required of a physician is that of a reasonable medical practitioner taking into consideration all of the circumstances. The standard was aptly summarized by the Ontario Court of Appeal in Crits v. Sylvester 2 : The legal principles involved are plain enough but it is not always easy to apply them to particular circumstances. Every medical practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. He is 1 E.I. Picard and G.B. Robertson, Legal Liabilities of Doctors and Hospitals in Canada, 3rd edition, (Carswell: Toronto, 1996). See also A.M. Linden, Canadian Tort Law, 5th edition, (Butterworths: Toronto, 1993). 2 (1956), 1 D.L.R. (2d) 502 at 508 (Ont. C.A.), aff d  S.C.R. 991.
6 - 4 - bound to exercise that degree of care and skill which could reasonably be expected of a normal, prudent practitioner of the same experience and standing, and if he holds himself out as a specialist, a higher degree of skill is required of him than of one who does not profess to be so qualified by special training and ability. The standard which is applied in any given situation will depend on the circumstances surrounding that situation. Therefore, although the test of the reasonably prudent physician is objective in nature, certain factors will tend to alter the standard to be applied. These include the experience and training of the physician 3, the locality of practice 4, the resources available to the physician and the timing of the alleged negligent act 5. The standard is not to be applied in the abstract. Although the basic standard to be applied in the case of medical negligence has remained substantially similar over the years, some issues have arisen in regards to its application in certain situations. For instance, over the years, the courts have addressed issues relating to who should set the standard of care in any given case and what factors should be considered in setting that standard. More recently, the courts have been asked to address issues relating to informed consent and the standard of disclosure, the duty to report and the role of the trier of fact in setting the appropriate standard of care and applying it to a particular fact situation. As noted above, in the past, it has been assumed that no judge or jury would be in position to compare the conduct of a doctor to that required of a reasonable practitioner without the assistance of expert evidence. The physician was not usually found to be negligent unless they failed to conform with the approved practice in their field. That fact 3 Picard, supra; Vail v. MacDonald (1976), 66 D.L.R. (3d) 530 (S.C.C.); Eady v. Tenderenda,  2 S.C.R See section labelled Locality Principle below. 5 See McLean v. Weir (1980), 18 B.C.L.R. 325 (C.A.) where the court states that the physicians conduct is to be judged according to the standards at the time the incident occurred and not when the action is heard or at some other later date. See also Lapointe v. Hopital LeGardeur (1992), 10 C.C.L.T. (2d) 101 (S.C.C.) where the court stated that courts should be careful not to rely on the perfect vision of hindsight in judging a doctors conduct at any given time.
7 - 5 - has been moderated somewhat by decisions permitting triers of fact to find a breach of a standard in claims where the standard is fraught with risk. Such cases are very rare. (b) Causation Claims alleging medical malpractice are like icebergs; the largest and most difficult issues lie below the surface. Causation is one such issue. Experienced Defendant s counsel begin to consider causation on day one of the lawsuit and Plaintiff s counsel are well advised to do the same. Causation is an expression of the relationship that must be found to exist between the tortious act of the wrongdoer and the injury to the victim in order to justify compensation of the latter out of the pocket of the former. 6 In a medical malpractice case, the Plaintiff must establish not only that the doctor s conduct fell below the expected standard of care, but also that the breach of duty caused or contributed to the Plaintiff s injuries. The legal standard of causation is different, however, from the scientific standard. The usual test for causation is the but for test or sine qua non test, according to which the Plaintiff must demonstrate that but for the negligence of the Defendant doctor, he or she would not have suffered the injury or loss. The Plaintiff is not required to establish that the Defendants negligence was the sole cause of the injury. The Plaintiff must also establish, where applicable, that the Defendant s negligence was the proximate or legal cause of his injuries. This is essentially an analysis of reasonable foreseeability. In both cases, the burden of proof lies upon the Plaintiff on a balance of probabilities. (i) Strategic Considerations Questions of causation are questions of fact. Defence counsel will approach a medical legal problem with several key factual issues (including causation) in mind. The 6 Snell v. Farrell (1991) 72 DLR (4th) 289 (SCC) per Sopinka J.
8 - 6 - first point to remember is that almost all of the Plaintiff s starting a claim have had a bad result. A whole series of defences involve proof of the breach of any duty of care owed; including locality, the nature of the specialty and the standard applicable at the time. Most Plaintiff s counsel focus on these issues; partly because these are the issues which are often the most obvious and difficult to prove. These are the issues above the surface of the water. But for the Defendant s counsel, the fun doesn t stop at proof of a breach of the care. Proof of causation lurks around the corner and may be a complete defence. Proof of causation pre-supposes a breach of the standard of care, and the Defendant s counsel will begin to formulate a theory of the case on that issue immediately. Essentially, the counsel asks the question; so what? What if the Defendant was negligent in the performance of surgery or failure to advise of a material risk? Often the answer to the question determines the course of the lawsuit. Here are some practical tips to consider on causation when prosecuting a claim of medical malpractice: 1) CONSIDER CAUSATION EARLY: As described above, the onus of proving a causal link between the Defendant s breach of duty and the Plaintiff s damages lies upon the Plaintiff. It is not satisfactory to focus on the difficult issues of proof of a breach of the standard of care without also developing the case on causation. From day one ask yourself that so what question. Consider what options the Plaintiff and Defendant each had. If the case is one of a failure to disclose then what would a reasonable person have done? Is the loss caused commonly by the Plaintiff s underlying medical condition? Are there other nonnegligent causes?
9 - 7-2) DEVELOP THE FACTUAL RECORD: Just as the breach of the standard of care must be proven on a factual record, so must causation. The proof of causation most often requires proof of lay witnesses like the Plaintiff and evidence of various experts. Experts are discussed below. The lay witnesses must be questioned closely about the factual record relating to the proof of causation. The best examples are cases about informed consent; the Plaintiff must establish that a reasonable patient in his or her circumstances would not have consented to the procedure if a material fact was disclosed. The Plaintiff s counsel should be considering what circumstances the Plaintiff was in to answer that question. Often the Plaintiff had no other option and would have proceeded in any case. This factual inquiry is key and should be made sooner rather than later. Develop the type of record used successfully in Reibl. 3) EXPERT EVIDENCE OF CAUSATION: Expert evidence is required to establish the standard of care in almost every claim against a physician. Sometimes Plaintiff s counsel overlooks the need to develop expert evidence of causation through these same (or other) experts. From the Defendant s perspective, this provides an opportunity to use a Plaintiff s witness to support the Defendant s theory. It is important therefore to obtain expert opinion on each of the elements of the causation argument, including evidence of the objective measure of any informed consent issues. Finally, prepare any expert called to answer questions on causation which may be raised in cross-examination. 4) DEVELOP A COGENT THEORY OF CAUSATION (AND STICK TO IT!): Medical malpractice claims are tough cases. Both sides need to develop a theory of the case which nonetheless may evolve over the course of the lawsuit. By the time of the trial however, counsel needs to have a theory of the case and to pursue it consistently. This is especially true of causation theories which can unravel if left undeveloped. If the
10 - 8 - case on causation is incapable of proof on a scientific or medical standard, even on the general point, the Defendant is in a very strong position. 5) OBSTETRICAL CLAIMS: SPECIAL CAUSATION PROBLEMS : Claims against physicians for obstetrical negligence merit special attention. At one time the medical community believed that cerebral palsy and other brain injuries were caused by events at or around birth. More recent studies have challenged that conclusion with predictable results for claims against doctors. Plaintiff s counsel sometimes seek opinions from those experts who argue a causal link between perinatal asphyxia and cerebral palsy. Be aware of both sides of this debate and be certain to rule out other common causes of the same condition. Before pursuing an obstetrical case, counsel are well advised to develop a theory on causation which is consistent with a conventional approach and which does not require the court to bridge a large gap in the evidentiary record. Far better to face the difficult issues of a lack of proof of causation at the outset than during a lengthy trial. (c) Informed Consent Part of a doctors duty of care includes a legal obligation to inform a patient regarding the risks associated with any given surgery or procedure. This legal obligation relates to the requirement that a patient consent to a surgery or procedure prior to its commencement. In order for consent to be valid, it must be given voluntarily, by someone who has capacity and given by a patient who is informed. The requirement that a patient be informed underscores and gives meaning to the patients right to selfdetermination. The common law has recognized that individuals have a fundamental right to make decisions about their bodies no matter what the doctor may or may not believe is the best course of action. This right of self-determination is potentially meaningless unless the patient is given sufficient information to make a real choice 7. 7 Picard, supra at
11 - 9 - The Supreme Court of Canada in Reibl v. Hughes 8 and Hopp v. Lepp 9, clarified the legal obligation facing a physician regarding what standard of disclosure is required. The Court expressly disapproved of the position that the standard was best left to the judgment of the doctor who was assessing the patients needs. The Court rejected the professional standard of disclosure which had been applied by the courts until that time. As the court stated in Hopp v. Lepp: In summary, the decided cases appear to indicate that, in obtaining the consent of a patient for the performance upon him of a surgical operation, a surgeon, generally, should answer any specific questions posed by the patient as to the risks involved and should, without being questioned disclose to him the nature of the proposed operation, its gravity, any material risks and any special or unusual risks attendant upon the performance of the operation 10. The court held that the materiality of the non-disclosure of certain risks to an informed decision is a matter for the trier of fact who should take into account the medical evidence but also other evidence, including that from the patient and other members of his or her family 11. These decisions restrict the medical professions freedom to control the nature and extent of the information received by the patient. The patient plays a far more active role in decision making in relation to the course of medical treatment that will be taken. Medical paternalism in this context is no longer acceptable. The Ontario Court of Appeal in Videto v. Kennedy 12, summarized the responsibility to disclose information, as laid down by the Supreme Court of Canada as follows: 8 (1980) 14 C.C.L.T. 1 (S.C.C.). 9 (1980), 13 C.C.L.T. 66 (S.C.C.). 10 Ibid., at Reibl v. Hughes, supra note 35 at (1981), 125 D.L.R. (3d) 127 (Ont. C.A.) at
12 The question of whether a risk is material and whether there has been a breach of the duty of disclosure are not to be determined solely by the professional standards of the medical profession at the time. The professional standards are a factor to be considered. 2. The duty of disclosure also embraces what the surgeon knows or should know that the patient deems relevant to the patient s decision whether or not to undergo the operation. If the patient asks specific questions about the operation, then the patient is entitled to be given reasonable answers to such questions. In addition to expert medical evidence, other evidence, including evidence from the patient or from members of the patient s family is to be considered A risk which is a mere possibility ordinarily does not have to be disclosed, but if its occurrence may result in serious consequences, such as paralysis or even death, then it should be treated as a material risk and should be disclosed. 4. The patient is entitled to be given an explanation as to the nature of the operation and its gravity. 5. Subject to the above requirements, the dangers inherent in any operation such as the dangers of the anaesthetic, or the risks of infection, do not have to be disclosed. 6. The scope of the duty of disclosure and whether it has been breached must be decided in relation to the circumstances of each case. 7. The emotional condition of the patient and the patient s apprehension and reluctance to undergo the operation may in certain cases justify the surgeon in withholding or generalizing information as to which he would otherwise be required to be more specific. 8. The question of whether a particular risk is a material risk is a matter for the trier of fact. It is also for the trier of fact to determine whether there has been a breach of the duty of disclosure. In determining the amount of disclosure which is necessary, the essential issue then, is to determine what a reasonable patient in the position of the Plaintiff would consider to be material risks or special or unusual risks. According to the court in White v. Turner 13, a material risk is a significant risk that poses a real threat to the patient s life, health or comfort. The determination as to whether a risk is material, involves a balancing of the severity of the potential result and the likelihood of that result occurring. Therefore, even if there is only a small chance of serious injury or death, the 13 (1981), 15 C.C.L.T. 81 (O.H.C.), aff d (1982), 47 O.R. (2d) 764 (C.A.).
13 risk may be material. Alternatively, if there is a significant chance of slight injury this too may be held to be material. Special or unusual risks are those that are not ordinary, common or everyday risks. These are risks which are extraordinary and uncommon although they are known to occur occasionally. Although these risks would likely not materialize, because of their unusual or special character, the Supreme Court has declared that they should be described to a reasonable patient. As Laskin, C.J.C. stated, even if a certain risk is a mere possibility which ordinarily need not be disclosed, yet if its occurrence carries serious consequences, as for example, paralysis or even death, it should be regarded as a material risk requiring disclosure. 14 None of this means that a physician or surgeon must explain those risks which are commonly associated with any surgery or procedure. Therefore, a doctor need not warn that if an incision is made, there will be bleeding, some pain and a scar will remain. Similarly, a doctor need not inform the patient about the possibility of infection or the hazards associated with anaesthetic which go along with every surgical procedure. The reasonable patient is taken to know all of these common potential complications 15. Medical evidence will be required to assist the court in deciding the degree of probability of the risk materializing and the seriousness of the possible injury. In addition, expert evidence may be necessary to assist in the courts characterization of the risk such as whether the risk is common to all surgery or specific to a particular operation. The medical evidence provided will be relevant in determining whether the risk is material however, it will not be determinative. The test is whether a reasonable person in the patient s position would want to know the risk. 14 Ibid., at Ibid., at 99.
14 The Efficient Trial of Liability Issues There are two main elements of a medical negligence trial which drive costs upward. The first is the expense of expert witnesses both before trail and at trial. The second is simply the length of trial if all issues are litigated. Experts will almost always be required to resolve issues of the standard of care. The question is whether counsel can, by cooperation, reduce the expense incurred by all sides at trial. The timely exchange of expert reports can minimize the expense of retainers for experts to review allegations which may not be in issue. Although obviously this is a problem which is particularly of interest to the Defendant, it is not always possible to persuade Plaintiff s counsel (who have the legal onus of proof) to provide expert reports in a timely way. Many Plaintiff s counsel feel disadvantaged if they serve expert reports and the Defendants focus on these in their reports. Many counsel like to negotiate the exchange of reports outside of the Rules of Practice. This is entirely acceptable. The most effective method for reducing the expense of liability trials is to eliminate unnecessary witnesses and evidence. There is no need, in most cases, to call witnesses whose only purpose is to prove hospital records and other documents. Many times witnesses are called who are called to avoid adverse inferences or in effect to explain notes and records contained in hospital documents already in the record. These witnesses can be avoided if counsel meet ahead of time to resolve the question of their evidence. Number of Experts Somewhat more difficult is the question of the number of liability experts to testify. Some counsel prefer to call more than one witness to testify regarding issues of standard of care or causation. Where such experts approach the matter from different disciplines, those decisions may be reasonable. On the other hand, it is not necessary to have more than one person where one will do. Counsel for the Plaintiff who are uncertain may call two witnesses to establish the standard of practice. This can lead to the Defendant physician and Defendant Hospital to do the same. Trials can be extended by a week on this practice alone. More to the point, experts can often be turned against each other with disastrous results for the case.
15 Bifurcation Bifurcated trials divide the issue of standard of care or causation from the issue of damages. The issue of bifurcation is one which has attracted considerable judicial scrutiny in the last few years. 16 The Rules of Practice in Ontario do not provide any guidances to the manner in which a Trial Judge should approach questions of bifurcation. It is fair to say that in the absence of consent, Trial Judges are loathe to split the question of liability from the question of damages. On consent, such an Order may be obtained where the Court agrees that the determination can be made separately. In medical malpractice cases, it is more common to have the damages agreed between the parties. Where such agreement is not possible, the Court may order that the damages be tried afterwards, if necessary. This happens rarely. In a medical negligence claim, bifurcation should be considered as a second best alternative to an efficient trial with damages either agreed or largely agreed. (i) Damages It is during the trial of the damages aspect of the claim that real ground can be made up. It is here where creative and cooperative counsel can collaborate on cases and experts with a view to minimizing time and expense incurred in the claim. Most of the heads of damage can be broken down and a summary prepared of the evidence, expert reports and quantums. By negotiating fairly, openly and with a view to reducing trial time, counsel can often come to agreement in most items of the damage claim. Where this is not possible, mediations may be successful without undue expense. If the case is tried and damages are not agreed, then at the very least, it ought to be possible to have the trial time reduced by a co-operative approach.
16 Role of the Trial Judge The Trial Judge is important in civil actions for medical negligence. Today Judges are under pressure to have trials conducted efficiently. Since medical negligence cases are among those which can result in long trials, these cases sometimes attract judicial scrutiny. Many people have suggested that one way to increase efficiency at trial in medical malpractice cases is to limit the number of Trial Judges hearing such matters to those experienced in the area. In his report on Liability and Compensation in Health Care (1990), J. Robert S. Pritchard considered the possibility: Another development which offers some potential to facilitate medical malpractice litigation in Canada would be the designation of a small number of justices in each province to assume particular responsibilities for medical and hospital negligence claims. With comparatively frequent exposure to such cases, a handful of judges could gradually accumulate valuable experience and familiarity. The benefits of experience in malpractice cases was stressed repeatedly before us. With good counsel and an experienced judge, all sharing a commitment to expedite the process, the cases are manageable, although often demanding. When any of these elements are lost, trouble begins. Appendix A, p. 257 Indeed, Professor Pritchard made the further suggestion, adopting a proposal by Professor Gary Watson of the Osgoode Hall Law School, that an effort be made to develop guidelines and procedures for the proper processing of medical malpractice claims with the emphasis being placed on expedition, simplicity, disclosure, maximum opportunities for settlement and the avoidance of unmeritorious suits continuing longer than necessary. (at p. 258) Professor Watson s proposal became a recommendation of the Pritchard report. 16 See for instance, a very useful editorial on the subject by David Stockwood, Q.C., Advocates Society Journal, 1999, Volume 18, No. 3.
17 The trial of a medical malpractice action is unlike other trials as outlined above. A Trial Judge is required to examine concepts which may be unfamiliar, both in terms of the evidence and legal principles. 17 Recently, it has become common place for Trial Judges, Court administrators and others to stress the role the Trial Judge should undertake in controlling the judicial process. Frequently, Trial Judges make reference to the decision in Ashmore v. Corp of Lloyd s  2 All E.R. 486 to justify judicial supervision and sometimes counsel and the parties are left in the wake of judicial economy. It is for these reasons that counsel undertaking a complex case like a medical malpractice action has a super-added responsibility to the Court and their client to be well prepared. It is too late by the time the trial commences to resort to the essential legal cases which establish the framework of a medical malpractice action. Equally, it is too late by the time the trial rolls along to determine whether every element of the Plaintiff s claim can be made out. These notions were very much in the mind of Granger, J. when he wrote his lengthy reasons in Marchand v. Public General Hospital et al 18 : 3. Length of Trial This trial lasted an inordinately long time. Initially, I was advised that the trial would be completed within 8-10 weeks. The trial in fact lasted 165 days, and thus spanned a 20 month period. The trial should never have been allowed to last this long. Not only can the litigants not afford the financial costs associated with a trial of this length, the civil justice system cannot afford as well to allocate this amount of time to the litigants. To allocate this much court time to a single trial is clearly unfair to other litigants who are awaiting their turn in the Southwest Region. 17 See Marg Ross, Rules of the Road to Judgment in Medical Malpractice Cases; Advocates Quarterly  Volume 20, p October 7, 1996, 91-GD-16866, at pp
18 In my view, the words of Lord Roskill in Ashmore v. Corp of Lloyd s  2 All E.R. 486 are most appropriate and apply in this situation. Lord Roskill stated at p. 488: The Court of Appeal appear to have taken the view that the Plaintiffs were entitled as of right to have their case tried to conclusion in such manner as they thought fit and if necessary after all the evidence on both sides had been adduced. With great respect, like my noble and learned friend, I emphatically disagree. In the Commercial Court and indeed in any trial court it is the trial judge who has control of the proceedings. It is part of his duty to identify the crucial issues and to see they are tried as expeditiously and as inexpensively as possible. It is the duty of the advisers of the parties to assist the trial judge in carrying out his duty. Litigants are not entitled to the uncontrolled use of a trial judge s time. Other litigants await their turn. Litigants are only entitled to so much of the trial judge s time as is necessary for the proper determination of the relevant issues. That was what Gatehouse J, in my view entirely correctly, sought to achieve by the order which he made, an order which as all your Lordships agree should be restored. Prior to the commencement of this trial, counsel were unable or unwilling to identify and narrow the issues to be determined. It was clear during this trial that prior to the commencement of the trial, [counsel for the Plaintiff] had not determined the method that he would employ to prove the facts upon which his experts would rely. The failure to narrow the issues, determine the facts to be proven and the method of proof greatly lengthened this trial. In my view, the time has come for the judiciary, prior to the commencement of a trial, to become involved in determining the issues to be tried, the evidence to be called and the method of proving facts. In addition, the judiciary should consider placing time limits on direct examination and cross-examination of witnesses. The need for judicial economy must of course be balanced by the need to adhere to principles of fairness and justice. Not every Trial Judge strikes this balance perfectly.
19 In his article, Temptations at the Bench 19, The Honourable Sir Robert McGarry then vice-chancellor of the Chancellor Division, High Court of Justice, wrote of five temptations to which judges are exposed. In his paper, Justice McGarry described how that both judicial silence and judicial intervention both have the effect of lengthening a trial. He found that the best course for a Trial Judge was to stay out of the action and allow counsel the leeway to present the case in the manner best suited to them. Of course the Trial Judge could not know what the evidence will be and must not try to take over the presentation of the case for one side or the other. This leads to another question which is a problem frequently encountered in the trial of medical malpractice cases; the inexperienced counsel. This of course can lead to the Trial Judge taking over the case for one side; usually the Plaintiff. As Justice McGarry wrote, The more the judge does for counsel that counsel ought to have done for himself, the more the judge moves into counsel s shoes and into the perils of self-persuasion and at page 410 on the temptation of brevity: Is it not a virtue in a judge for him to keep things short, to dispose of his cases quickly and so make inroads on the full and over-full list of cases waiting to be heard? What merit can there be in not taking the shortest path that will bring about a proper decision in the case? These are cogent and considerations, and they must be given due weight. Yet there is another consideration Justice in full takes time: but often it is time well spent. (pp ) Overly Broad Claims (Too Many Defendants, Too Many Plaintiffs) All too commonly, claims include parties who do not belong in the action. Sometimes these Defendants complicate proceedings beyond belief with extra pleadings, discoveries, experts and trial time. Since Defendants do not usually recover costs even where successful, there is little incentive to focus on the key Defendants. Counsel should, wherever possible, focus 19  Volume XVI Alberta Law Review, p. 406.
20 on the Defendants who matter or face the prospect that the action will collapse under its own weight. Common Experts Others will address this topic in greater detail but it is worth noting that on occasion a single expert will suffice for both sides. In my own view, this is only realistic for issues of damages. Witness Statements Sometimes witnesses who are not central but who must be heard from to avoid adverse inferences or whose evidence is otherwise important can have their evidence filed in the form of an agreed statement. In each case, counsel must be certain that the exact basis of the evidence is agreed; the Trial Judge should be told that the evidence of the witness as expressed in the statement represents the totality of the witness evidence, even after cross-examination. Sometimes where documents exist in the record but have not been put to the witness in his or her statement, the Court is left in doubt about the weight of the witness evidence. Try to be as complete as possible in the preparation of such statements and be certain to interview the witness to satisfy yourself that you have not overlooked anything. Cross-Examination and Examination in Chief As Justice Granger observed in Marchand, the examination of witnesses in a medical negligence case can be a source of delay and expenses. Counsel should not feel unduly constrained in their preparation for examinations but, as with other types of cases, should endeavour to be as efficient as possible in their examinations.
Introduction Effective Use of Experts By: Peter Kryworuk & Tyler Kaczmarczyk Lerners LLP Litigating the Medical Malpractice Claim Ontario Bar Association April 29, 2013 The importance of expert opinion
1 AN OVERVIEW OF THE LAW REGARDING INFORMED CONSENT By William E. McNally and Bottom Line Research and Communications 1 The Doctrine of Informed Consent in Canada In 1980, the Supreme Court of Canada rendered
SUBMISSION OF THE BAR COUNCIL OF IRELAND TO THE JOINT COMMITTEE ON HEALTH AND CHILDREN ON THE CHALLENGE OF RISING COSTS IN PROFESSIONAL MEDICAL INDEMNITY INSURANCE 1. INTRODUCTION (a) General Remarks 1.
IN THE HIGH COURT OF JUSTICE IN NORTHERN IRELAND PROTOCOL FOR CLINICAL NEGLIGENCE LITIGATION 1. Practitioners are reminded of the need to bear in mind the overriding objective set out at Order 1 rule 1(a)
Tipp FM Legal Slot 29 th May 2012 Medical Negligence John M. Lynch, Principal Today I will discuss medical negligence following a number of recent high profile cases and inquests. Firstly, what is Medical
FACTORS TO CONSIDER WHEN RETAINING MEDICAL EXPERTS IN PROFESSIONAL LIABILITY AND PERSONAL INJURY CASES Gary Srebrolow 416.597.4875 firstname.lastname@example.org Factors to Consider When Retaining Medical Experts
Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.
Legal Action / Claiming Compensation in Scotland This help sheet explains your legal rights if you have been injured as a result of medical treatment and the steps involved in seeking compensation through
: A guide to making a claim 2 Our guide to making a clinical negligence claim At Kingsley Napley, our guiding principle is to provide you with a dedicated client service and we aim to make the claims process
CASE COMMENT by Craig Gillespie and Bottom Line Research On June 29, 2012 the Supreme Court of Canada released Clements v. Clements,  7 W.W.R. 217, 2012 SCC 32, its latest in a series of judgements
EXPLANATION OF LEGAL TERMS Affidavit: After the event litigation insurance: Application notice: Bar Council: Barrister: Basic Charges: Before the Event Legal Expenses Insurance: Bill of costs: Bolam test:
Factors to Consider When Handling a Long Term Disability Benefits Case Several issues may arise in the course of a lawsuit for long term disability benefits. This paper provides strategic suggestions on
Information You are asking advice from Thomson Snell & Passmore about a possible clinical negligence claim. Such claims are complex and it would greatly assist your understanding of the issues if you read
NEGLIGENT SETTLEMENT ADVICE Daniel Crowley and Leona Powell consider the Court s approach to negligent settlement advice. The standard of care owed by a solicitor to his client has been established for
A CLIENT GUIDE TO CLAIMING DAMAGES FOR CLINICAL NEGLIGENCE 1. INTRODUCTION Making a claim for damages (compensation) for clinical negligence can be a worrying and stressful experience. We recognise that
================================================================= This opinion is uncorrected and subject to revision before publication in the New York Reports. -----------------------------------------------------------------
PERSONAL INJURY COMPENSATION CLAIM GUIDE PERSONAL INJURY COMPENSATION CLAIM GUIDE This booklet has been produced by D.J. Synnott Solicitors to give our clients an understanding of the personal injury compensation
Your Guide to Pursuing a Personal Injury Claim 2 Contents Introduction... 3 Important things that you must do... 3 In The Beginning... 4 Mitigating your loss... 4 Time limits... 4 Who can claim?... 4 Whose
www.personalinjury.ffw.com Freephone 0800 358 3848 www.personalinjury.ffw.com Freephone 0800 358 3848 Medical Negligence A client s guide head and shoulders above the rest in terms of skills, experience
CAR ACCIDENT GUIDE TABLE OF CONTENTS Page Introduction... 1 First Step... 1 Finding and Hiring a Lawyer... 1 Financial Arrangements... 2 Your Claim... 3 Documenting Your Claim... 5 Parties to the Claim...
www.ffw.com/personalinjury Freephone 0800 358 3848 www.ffw.com/personalinjury Freephone 0800 358 3848 Medical Negligence A guide for clients The team provides a first class service at all levels of experience.
April, 2011 VOL. 5, ISSUE 2 How To Use The New Expert Witness Rule To Negotiate A Good Deal By Cary N. Schneider Cary N. Schneider is a partner at Beard Winter LLP who specializes in accident benefit and
SUBMISSION OF THE MEDICO-LEGAL SOCIETY OF TORONTO TO THE HONOURABLE COULTER OSBORNE, QC CIVIL JUSTICE REFORM The Medico-Legal Society of Toronto (MLST) is a voluntary association of doctors and lawyers.
PRODUCT LIABILITY Product Liability Litigation The Effect of Product Safety Regulatory Compliance By Kenneth Ross Product liability litigation and product safety regulatory activities in the U.S. and elsewhere
ETHICAL SCENARIO #3 I. FACT PATTERN A Saskatchewan law firm ( SK Firm LLP ) acts on behalf of an out of province (e.g. national) corporation (the Corporation ). SK Firm LLP s role has been solely to file
EXPERT EVIDENCE PAPER 2.1 Working with an Expert These materials were prepared by Leslie J. Mackoff of Mackoff & Company, Vancouver, BC for the Continuing Legal Education Society of British Columbia, October
COMMITTEE ON COURT PRACTICE AND PROCEDURE REVIEW OF PRACTICE AND PROCEDURE IN RELATION TO PERSONAL INJURIES LITIGATION THE SUBMISSIONS OF THE ASSOCIATION OF PERSONAL INJURY LAWYERS FEBRUARY 2003 The executive
Submissions on Civil Liability Reform The Coalition of British Columbia Businesses October 2002 Introduction: The following submissions are made on behalf of the Coalition of British Columbia Businesses.
The Arbitration Process By Drew Clayton Most disputes between investors and brokerage firms are resolved by arbitration, instead of a lawsuit in court. This is because most brokers require their customers
GWASANAETHAU AMBIWLANS CYMRU YMDDIRIEDOLAETH GIG WELSH AMBULANCE SERVICES NHS TRUST CLAIMS MANAGEMENT POLICY Clinical Negligence, Personal Injury, Losses and Compensation Claims Approved by Date Review
Medical Litigation in 2012 Jacob Tse Partner Mayer Brown JSM 8 May 2012 Medical Litigation All kinds of litigation relating to medico-legal matters Legal action for medical negligence 23989412 2 Time limit
PERSONAL INJURY CONFERENCE 2015 PAPER 5.1 Opinion Letters in Personal Injury: Perspectives These materials were prepared by A. Reza Rafi, Manager Litigation Policy of ICBC, Vancouver, BC, for the Continuing
Advice Note An overview of civil proceedings in England Introduction There is no civil code in England; English civil law comprises of essentially legislation by Parliament and decisions by the courts.
Amendments to the Rules to Civil Procedure: Yours to E-Discover Prepared by Christopher M. Bartlett Cassels Brock & Blackwell LLP September 25, 2009 Amendments to the Rules of Civil Procedure: Yours to
S.116 Of The Courts of Justice Act Can Defendants Impose A Structured Settlement on the Plaintiff? Robert Roth Historically, at common law, a plaintiff was not obliged to accept a structured settlement,
FURR & HENSHAW http://www.scmedicalmalpractice.com 1900 Oak Street Post Office Box 2909 Myrtle Beach, South Carolina 29578 (843) 626-7621 (800) 849-2525 email@example.com and 1534 Blanding Street Columbia,
ACCIDENT INVESTIGATION GUIDELINES WITH LITIGATION IN MIND Introduction The purpose of this paper is to alert the reader to concepts used in the defense of construction related lawsuits and to suggest how
WHAT IS LEGAL MALPRACTICE IN CALIFORNIA? A client who sustains harm as a direct result of legal malpractice can file a civil lawsuit against the attorney who was responsible for causing that harm. MICHAEL
5.51 LEGAL MALPRACTICE (Approved 6/79) CHARGE 5.51A Page 1 of 9 A. General Duty Owing An action brought against an attorney alleging negligence in the practice of law is referred to as a malpractice action.
This article originally appeared in The Colorado Lawyer, Vol. 25, No. 26, June 1996. by Jeffrey R. Pilkington TORT AND INSURANCE LAW REPORTER Informal Discovery Interviews Between Defense Attorneys and
2015 Legal Counsel Communications with Expert Witnesses 1 Legal Counsel Communications with Expert Witnesses 2 The role of the expert witness continues to be a hot topic of discussion. Two recent decisions
Chapter 6B STATE ELIGIBILITY GUIDELINES Last Amended: 1 July 2006 Manual of Legal Aid TABLE OF CONTENTS CHAPTER 6B - STATE ELIGIBILITY GUIDELINES GENERAL...3 PROVISION OF LEGAL ASSISTANCE...3 GENERAL GUIDELINES
You are not alone. It was not your fault. You have courage. You have choices. You have power. We re here to help. A Guide for Childhood Sexual Abuse Survivors Breaking the silence. Raising Awareness. Fighting
PRACTICAL ADVICE ON THE MOST EFFECTIVE WAY TO SETTLE YOUR CASE WITH THE GOVERNMENT This article is collaboration between the panel moderator Brian J. Alexander and panel participants, Richard Saltsman,
Date: 20080219 Docket: CI 07-01-50371 (Winnipeg Centre) Indexed as: Pickering v. The Government of Manitoba et al Cited as: 2008 MBQB 56 COURT OF QUEEN S BENCH OF MANITOBA BETWEEN: ) COUNSEL: ) THERESA
12 May 2014 Geoff Bowyer T 03 9607 9497 F 03 9607 5270 firstname.lastname@example.org Professor Barbara McDonald Commissioner Australian Law Reform Commission GPO Box 3708 Sydney NSW 2001 By Email to: email@example.com
The Last Word on Causation From the Supreme Court of Canada (Maybe?) Stephen R. Moore Blaney McMurtry LLP firstname.lastname@example.org The Last Word on Causation From the Supreme Court of Canada (Maybe?) Introduction
FACT PATTERN ONE The following facts are based on the case of Bedard v. Martyn  A.J. No. 308 The infant plaintiff developed a large blood clot in his brain at some time either before or during the
THE THREAT OF BAD FAITH LITIGATION ETHICAL HANDLING OF CLAIMS AND GOOD FAITH SETTLEMENT PRACTICES By Craig R. White SKEDSVOLD & WHITE, LLC. 1050 Crown Pointe Parkway Suite 710 Atlanta, Georgia 30338 (770)
A Practical Guide to Hiring a LAWYER A PRACTIAL GUIDE TO HIRING A LAWYER I. Introduction 3 II. When do you Need a Lawyer? 3 III. How to Find a Lawyer 4 A. Referrals 4 B. Lawyer Referral Service 5 C. Unauthorized
Advocate Magazine March 2011 Why medical malpractice still matters. Despite MICRA limitations, medical-negligence claims still have a crucial role in society BY BRUCE G. FAGEL We all know the statistics
Conditional Fee Agreement: What You Need to Know This document forms an important part of your agreement with us. Please read it carefully. Definitions of words used in this document and the accompanying
GUIDELINES ON SANCTION FOR EMPLOYMENT OF COUNSEL IN CRIMINAL APPLICATIONS Scottish Legal Aid Board January 2010 THE SCOTTISH LEGAL AID BOARD EMPLOYMENT OF COUNSEL IN CRIMINAL APPLICATIONS 1. BACKGROUND
LC Paper No. CB(2)517/05-06(01) SUBMISSION OF THE LAW SOCIETY S WORKING PARTY TO THE LEGCO LEGAL AFFAIRS PANEL REGARDING THE OPERATIONS OF RECOVERY AGENTS IN HONG KONG 1. This is a submission of the Recovery
 JMSC Civ 85 IN THE SUPREME COURT OF JUDICATURE OF JAMAICA CIVIL DIVISION CLAIM NO. 2007 HCV 05051 BETWEEN PAULA WHYTE CLAIMANT AND THE ATTORNEY GENERAL FIRST DEFENDANT AND SOUTH EAST REGIONAL HEALTH
BRITISH VIRGIN ISLANDS CIVIL APPEAL NO.10 OF 2002 BETWEEN: IN THE COURT OF APPEAL SPARKASSE BREGENZ BANK AG and In The Matter of ASSOCIATED CAPITAL CORPORATION Appellant Respondent Before: His Lordship,
NSW COURT OF APPEAL DECISION SUPPORTS LITIGATION FUNDING MARKET Introduction 1. The New South Wales Court of Appeal, in a unanimous Judgment on Thursday 31 March 2005, sent some clear messages to legal
at The Advocates' Society Presented Expert Witness Academy National C. Murray Andrew LLP Lerners & Solicitors Barristers Box 2335 PO ON N6A 4G4 London 519.640.6313 Phone: LAW OF EXPERT EVIDENCE: THE EVERY
A brief guide to professional negligence claims Contents Introduction Do I have a claim? Important considerations Pre-action protocol procedure Court proceedings Contact information Introduction Claims
What is my claim worth? This is probably the most common and important question asked by a Claimant pursuing a personal injury claim. At the end of the day, it is the recovery of compensation for the injury
GENERAL CIVIL JURY CHARGES IN GENERAL NEGLIGENCE CASES General Introduction Ladies and Gentlemen, now that you have heard the evidence and the argument of the attorneys, it is now time for me to instruct
A Practical Summary of the New Supreme Court Civil Rules for Clark Wilson LLP Insurance Clients by: Jennifer Loeb Clark Wilson LLP tel. 604.891.7766 email@example.com Edited by: Larry Munn Clark Wilson LLP
www.goldbergsegalla.com NEW YORK PENNSYLVANIA CONNECTICUT NEW JERSEY UNITED KINGDOM Litigating the Products Liability Case: Discovery New York State Bar Association Buffalo, NY October 22, 2013 Presenter
THE IMPORTANCE OF COMPREHENSIVE NOTES AND RECORDS by: Ryan A. Murray, Oatley Vigmond Personal Injury Lawyers LLP Introduction Comprehensive clinical notes and records are an important part of patient care.
WHAT=S THE DEAL WITH GENERAL AND SPECIAL DAMAGES? By William E. McNally and Barbara E. Cotton 1 There are times in a civil trial lawyer=s life when he or she must know the difference between general and
Working with the Physician s Counsel in Defending Off-Label Use Litigation By Gerald P. Schneeweis Morris Polich & Purdy LLP Working with the Physician s Counsel in Defending Off-Label Use Litigation By
WESTERN AUSTRALIAN FEDERATION OF SEXUAL ASSAULT SERVICES (WAFSAS) FORUM 4 October 2005, Perth Criminal Injuries Compensation By Helen Porter, Office of Criminal Injuries Compensation. INTRODUCTION In this
Policy and Procedure for Claims Management RESPONSIBLE DIRECTOR: COMMUNICATIONS, PUBLIC ENGAGEMENT AND HUMAN RESOURCES EFFECTIVE FROM: 08/07/10 REVIEW DATE: 01/04/11 To be read in conjunction with: Complaints
Expert Witnesses in the Federal Courts A Discussion Paper of the Federal Courts Rules Committee on Expert Witnesses Background The role of the expert witness is to assist the court through the provision
Executive summary and overview of the national report for Denmark Section I Summary of findings There is no special legislation concerning damages for breach of EC or national competition law in Denmark,
A PRIMER REGARDING CONTRIBUTORY NEGLIGENCE By Stuart Ross and Bottom Line Research & Communications 1 Introduction We all deal with allegations of contributory negligence in response to the claims of a
IN THE SUPREME COURT OF BRITISH COLUMBIA Citation: Merlo v. Canada (Attorney General), 2013 BCSC 1136 Date: 20130625 Docket: S122255 Registry: Vancouver Between: Brought under the Class Proceedings Act,
CAUSATION IN TORT AFTER RESURFICE PAPER 1.2 Causation in Tort Since Resurfice: Overview These materials were prepared by David Cheifetz of Bennett Best Burn, LLP, Vancouver, BC, for the Continuing Legal
LEGAL AID ADVISORY COMMITTEE REVIEW INTO ESTABLISHING A CONTINGENCY LEGAL AID FUND IN NORTHERN IRELAND WRITTEN SUBMISSIONS OF THE ASSOCIATION OF PERSONAL INJURY LAWYERS 1. The Association of Personal Injury
JURY INSTRUCTIONS PRELIMINARY INSTRUCTIONS 1. ANTITRUST CLAIMS 2. Elements of Monopoly Claim 2.1 Definition of Monopoly Power 2.2 Relevant Market 2.3 Existence of Monopoly Power 2.4 Willful Maintenance
CHAPTER 34 INFORMED CONSENT FOR THE NURSE I. INTRODUCTION The goal of informed consent is patient autonomy or self-determination. To be autonomous, individuals must be able to control their bodies by controlling
Bridging the Common Law Civil Law Divide in Arbitration by SIEGFRIED H. ELSING * AND JOHN M. TOWNSEND * * INTERNATIONAL ARBITRATION has evolved as a system for resolving disputes among parties from different
WikiLeaks Document Release February 2, 2009 Congressional Research Service Report RS20519 ASBESTOS COMPENSATION ACT OF 2000 Henry Cohen, American Law Division Updated April 13, 2000 Abstract. This report
Compensation Claims Contents Employers' duties What kind of claims may be made? The tort of negligence Tort of breach of statutory duty Civil liability exclusions Conditions to be met for breach of statutory
ATTORNEY GENERAL S GUIDELINES ON PLEA DISCUSSIONS IN CASES OF SERIOUS OR COMPLEX FRAUD A FOREWORD A1. These Guidelines set out a process by which a prosecutor may discuss an allegation of serious or complex
CAUSATION AND LOSSES Professor Lewis N Klar, Q.C. (Based on Klar, Tort Law, 4 th ed at 457-466, and Klar Causation And Apportionment of Losses, Alberta Court of Queen s Bench Conference, November 14, 2008)
MODEL DIRECTIONS FOR CLINICAL NEGLIGENCE CASES (2012) - before Master Roberts and Master Cook Introductory note. These are the Model Directions for use in the first Case Management Conference in clinical
IT S OK TO SAY I M SORRY Anything you say can and will be used against you in a court of law. We are all familiar with this phrase from the Miranda warning. It essentially advises a person accused of a
Conditional Fee Agreement: What You Need to Know This document forms an important part of your agreement with us. Please read it carefully. Definitions of words used in this document and the accompanying