CASE EVALUATION
Case Evaluation
In the recent Goodwin v Nadel, 2017 ONSC 1641 (CanLII) case, the Ontario Superior Court struck a doctor’s limitations defence, despite the fact that the claim was not brought for 11 years after treatment. This result is significant, in that it reaffirms that in certain instances of alleged professional negligence, the ‘discoverability doctrine’ will apply, extending the applicable limitations period.
Facts of the Case
The facts in the Goodwin case are relatively straightforward. In 2000, Ms. Goodwin was diagnosed with Irritable Bowel Syndrome (IBS). In 2002, she went into labour, at which time Dr. Nadel (insured by the Canadian Medical Protective Association) performed an episiotomy (an incision made in the perineum — the tissue between the vaginal opening and the anus), which extended to a fourth degree laceration. Neither Dr. Nadel nor the attending nurse informed Ms. Goodwin that the laceration was not properly repaired.
Ms. Goodwin did not have any rectal bleeding or changes in bowel habits within six weeks of delivery and was not aware of problems related to the laceration. Over time, Ms. Goodwin had increased problems with her bowels, and her doctor continued to treat her for IBS.
In 2003, Ms. Goodwin was referred to Dr. Shannon, an OB/GYN, at which time she learned that in most cases, episiotomies are no longer performed. This admittedly caused her to question Dr. Nadel’s care. Subsequently, in 2004, Ms. Goodwin delivered her second child, at which time she suffered a second degree perineal tear, which was repaired at the time.
Ms. Goodwin’s symptoms continued to worsen. By 2009, she had developed fecal incontinence. Early that year, she saw Dr. Nguyen, who concluded that her symptoms were consistent with IBS. At a later appointment, in January 13, 2011, Dr. Nguyen learned of her obstetrical history, at which time he suggested a possible connection between her symptoms and perineal trauma from childbirth. Dr. Nguyen referred her for an anorectal manometry (a test to measure and assess pressure, reflexes and sensation in the rectum, to help evaluate the cause and determine treatment for fecal incontinence) at McMaster. Dr. Nguyen reviewed the results with Ms. Goodwin in early July 2011, at which point he identified that her bowel incontinence was caused by the episiotomy (performed by Dr. Nadel in 2002). Thereafter, suit was commenced on May 1, 2013.
The Limitations Defence
The Canadian Medical Protective Association (through Dr. Nadel) sought to defeat this claim, initially by alleging that the statute of limitations began to run when Ms. Goodwin delivered her fist child in 2002, and suffered a laceration. The Court rejected this argument, finding the Ms. Goodwin believed the laceration was properly repaired at the time and lacked knowledge that it was causing her ongoing health problems.
The CMPA next argued that the statute of limitations began to run in January 2011, at which time Dr. Nguyen raised the possibility that Ms. Goodwin’s condition could be linked to Ms. Goodwin’s obstetrical history, and ordered further testing at McMaster. However, as Dr. Nguyen’s working diagnosis continued to be IBS, this argument was likewise rejected.
In doing so, the Court noted that a medical opinion may extend the running of the limitations period where the opinion contains new information about the medical care not previously available to the prospective plaintiff. In this case, the McMaster test results contained new information that was not previously available, and same was not communicated to Ms. Goodwin prior to July 2011. As such, she did not know (and according to the Court could not reasonably have known) that what she thought was a repaired laceration was linked to her ongoing symptoms, and accordingly, the doctor’s limitations defence failed.
The Takeaway
The Goodwin case is likely to have broad impact in terms of the applicability of the discovery doctrine in cases involving professional negligence. From an analytical perspective, there is little reason to limit the ruling in this case (that the limitations period was extended by the receipt of new information, which served to link Ms. Goodwin’s injuries to Dr. Nguyen’s prior conduct) to cases of medical malpractice, when it is just as analogous to cases involving legal malpractice or other types of professional malpractice.
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