Manitoba Court of Appeal rules doctor’s negligence didn’t cause patient’s death from cancer
In a significant ruling, the Manitoba Court of Appeal has clarified the legal standards for establishing causation in medical malpractice cases. The case, Tripp v. Ross, 2025 MBCA 25, centered on whether a delayed cancer diagnosis due to a doctor’s negligence directly caused a patient’s death.
The court ultimately concluded that while the physician’s negligence led to an eight-month delay in diagnosing colorectal cancer, this delay was not the proximate cause of the patient’s fatal outcome. The decision underscores the high legal threshold for proving causation in negligence claims, even when medical malpractice is conceded.
The Case Background
The patient first sought medical attention in January 2018 after experiencing abdominal cramps and rectal bleeding. A colonoscopy performed by the defendant doctor identified five polyps, four of which were biopsied. The pathologist’s report flagged a risk of adenocarcinoma, prompting a recommendation for a follow-up colonoscopy in a year.
However, the patient’s symptoms worsened by August 2018, leading to further testing. A barium enema and CT scan revealed a cancerous tumor in the descending colon. By October 2018, the patient was diagnosed with stage IIIC colorectal cancer, requiring extensive surgery, chemotherapy, and other treatments.
Despite aggressive treatment, the patient’s condition progressed to stage IV colorectal cancer with liver metastases by January 2020. The patient passed away in February 2022.
The Legal Battle
The patient’s estate filed a medical malpractice lawsuit, alleging that the doctor’s negligence during the initial colonoscopy caused the eight-month delay in diagnosis, which ultimately led to the patient’s death. The defendant conceded that the delay occurred but disputed its impact on the patient’s prognosis.
The trial court ruled in favor of the defendant, finding that while the negligence caused the delay, it was not the proximate cause of the patient’s death. The court awarded $75,000 for the patient’s pain and suffering during the delayed diagnosis but rejected the claim that the delay worsened the terminal prognosis.
The trial court’s decision relied heavily on expert testimony, particularly from the defendant’s oncologist. The oncologist testified that the patient already had liver metastases by January 2018 and that the delay in diagnosis did not materially alter the patient’s slim chance of survival.
The Appeal Court’s Decision
The patient’s estate appealed the trial court’s decision, arguing that the delay in diagnosis directly contributed to the patient’s death. However, the Manitoba Court of Appeal upheld the ruling, finding no reversible errors in the trial judge’s reasoning or factual findings.
The appellate court emphasized that the trial judge had thoroughly reviewed the evidence, including expert testimony, and correctly applied the legal principles outlined in Benhaim v. St-Germain, 2016 SCC 48. This landmark Supreme Court case established the standards for proving causation in negligence claims.
The Court of Appeal agreed with the trial judge’s conclusion that the patient had only a 30% chance of survival at the time of the negligent colonoscopy. Expert testimony indicated that this estimate was based on statistical survival rates, the size of the liver metastasis detected in 2018, and the type and progression rate of the cancer.
The court further noted that even with earlier detection, the patient’s prognosis would not have improved to a survival probability greater than 50%. Therefore, the delay in diagnosis did not meet the legal threshold for causation required to hold the physician liable for the patient’s death.
Key Takeaways from the Ruling
This landmark decision provides important insights into the legal framework surrounding medical malpractice claims, particularly in cases involving delayed diagnoses. The ruling emphasizes several critical points for both legal practitioners and the public:
- Causation in Medical Malpractice: The case reinforces the stringent standards plaintiffs must meet when proving causation in negligence claims. Even when medical negligence is admitted, the link between the negligence and the resulting harm must be clearly established. In this case, the court found that the eight-month delay in diagnosis, while negligent, did not directly cause the patient’s death.
- Role of Expert Testimony: The decision highlights the pivotal role of medical experts in such cases. The court relied heavily on statistical data and expert opinions regarding cancer progression and survival rates to determine that the delay did not significantly alter the patient’s prognosis. This underscores the importance of credible, evidence-based testimony in resolving complex medical issues in legal settings.
- Application of Legal Principles: The ruling reaffirms the legal standards set by the Supreme Court of Canada in Benhaim v. St-Germain. The court applied these principles to conclude that negligence alone is insufficient to establish liability if no direct causal link to the harm exists. This precedent will likely influence future medical malpractice cases, particularly those involving delayed diagnoses and terminal illnesses.
Conclusion
The Manitoba Court of Appeal’s decision in Tripp v. Ross provides clarity on the high legal standards required to establish causation in medical malpractice cases. While the court acknowledged the eight-month delay in diagnosing colorectal cancer as negligent, it ultimately ruled that this delay did not proximately cause the patient’s death. This ruling underscores the importance of expert testimony and statistical evidence in resolving complex medical negligence claims.
The case highlights the stringent criteria plaintiffs must meet to prove that medical negligence directly contributed to a patient’s harm. Even when negligence is conceded, the absence of a clear causal link between the delay and the fatal outcome means liability cannot be established. This decision will likely serve as a precedent for future medical malpractice cases, particularly those involving delayed diagnoses and terminal illnesses.
Frequently Asked Questions
What was the main issue in the Tripp v. Ross case?
The case centered on whether an eight-month delay in diagnosing colorectal cancer, caused by a doctor’s negligence, directly led to the patient’s death.
What was the court’s ruling?
The Manitoba Court of Appeal ruled that while the delay was negligent, it did not proximately cause the patient’s death. The court found that the patient’s survival chances remained low even with an earlier diagnosis.
How important was expert testimony in this case?
Expert testimony played a crucial role. The court relied on oncologist testimony and statistical data to conclude that the delay did not significantly alter the patient’s prognosis.
What was the outcome for the patient’s estate?
The court awarded $75,000 for the patient’s pain and suffering during the delayed diagnosis but rejected the claim that the delay worsened the terminal prognosis.
What does this ruling mean for future medical malpractice cases?
The decision reaffirms the high legal threshold for proving causation in negligence claims. It will likely influence future cases involving delayed diagnoses and terminal illnesses, emphasizing the need for clear evidence linking negligence to harm.
