Introduction
It is expected that prior to any elective treatment, a physician owes a duty to the patient to provide adequate disclosure of risks.[1] This duty has been expanded over the years to include all advising doctors, even if they are not involved in the treatment directly. It has also been expanded to include “disclosing the nature of the proposed treatment and any material, special, or unusual risks of the treatment."[2] The Ontario Court of Appeal recently applied these duties of care to multi-step elective treatment plans in the case of Denman v. Radovanovic (hereinafter “Denman”).
The Facts
The plaintiff, Michael Denman had sustained a flow-related aneurysm and an anterior ventricle malformation (“AVM”) following what had either been a seizure or a stroke.[3] His initial treatment at Saint Michael’s Hospital had resolved the aneurysm.[4] A subsequent procedure of Gamma Knife stereotactic radiosurgery had not resolved the AVM. [5] The AVM remained in stable condition. [6]
This prompted a case conference with the defendant physicians Dr. Radovanovic (neurosurgeon), Dr. ter Brugge (diagnostic radiologist) and Dr. Pereira (neuroradiologist and neurosurgeon who performed the surgery thereafter). [7]
During this case conference, a multi-step treatment plan was decided upon to effect a cure for the AVM.[8] This plan would have only benefited Mr. Denman if the embolization procedures fully resolved the AVM.[9] The first two procedures resulted in only partial embolization but had not caused further damage.[10]
Mr. Denman agreed to proceed with a third embolization attempt. Following this third procedure, there were complications and emergency surgery was required.[11] Mr. Denman was left paralyzed on his left side, fully reliant on others for all his care, and limited to communicating through writing and gestures.[12] He had been the primary breadwinner in his household before this final embolization attempt.
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