Seoran v. (British Columbia) Interior Health 2022 BCSC 335 is a trial decision involving an assault between a patient and a psychiatrist.

In 2014 at the Inpatient Psychiatry Unit of the Penticton Regional Hospital, a Psychiatrist was providing care for an involuntary patient who had been admitted to the hospital a little over a week prior.  The patient was a trained fighter and a world-ranked jiu-jitsu competitor.  While being interviewed, the patient violently assaulted the Psychiatrist resulting in serious injuries including a broken jaw, facial fractures, dental injuries, a concussion, major depression and PTSD.

The injuries impacted the Psychiatrist greatly.  As of the date of trial, he remained unable to return to his work as a psychiatrist.  Several experts testified that it was very unlikely that he would ever be capable of returning to work as a medical doctor.

The Psychiatrist sued the Interior Health Authority (IHA) for having inadequate practices, policies and procedures to deal with a high risk violent patient which could have prevented the assault.

The defendant (IHA) argued that the assault of the Psychiatrist was a sudden and unprovoked attack, and that the Psychiatrist was well aware of the risks posed by the assailant patient.  The defendant IHA also argued that the Psychiatrist is precluded from advancing this claim under the terms of his contract with IHA that required him to obtain coverage from WorkSafeBC. Last, the IHA also argued that the Psychiatrist failed to prove that its conduct fell below the standard of care required in all of the circumstances, and that his claim should therefore be dismissed.

As discussed in prior blog posts on medical malpractice claims, the standard of care assesses whether or not the conduct of healthcare professionals failed to meet the standard of care and whether this failure caused the injury.  In this case, the trial judge when dealing with the standard of care issue first considered what the IHA would have done had it acted properly.  The trial judge will then consider whether a reasonably competent health authority with the same qualifications would have done in the same circumstances.

The fatal flaw of the Psychiatrist’s case was that there was no expert evidence provided to the court to consider what the standard of care was for the IHA and how the IHA failed to meet this standard of care.  As noted by the trial judge:

[271]     As a general rule, courts rely on expert evidence when assessing whether or not the conduct of healthcare professionals failed to meet the requisite standard of care, unless the failure is so obvious that no expert evidence is needed (Bahinipaty, para. 40). The challenge for the court in the absence of any evidence on the standard of care is while it may be a relatively straightforward matter for the court to entertain suggestions about what could have been done, it is difficult to reach conclusions about what should have been done. In the context of this violent assault, one can always speculate with the benefit of hindsight about what could have been done to prevent it, but that alone is insufficient.

[272]     In the absence of any context or evidence regarding the prevailing model of care in psychiatric units generally, the court is ill-placed to assess or evaluate the treatment model that was in place at the IPU in Penticton. As a result, the court is left to speculate as to where IHA should have been along the continuum between an open therapeutic model of care and the historical prison-like model.

The trial judge dismissed the case entirely because the Psychiatrist failed to prove the applicable standard of care:

[278]     I find that the plaintiff has failed to prove the applicable standard of care. Without evidence of the required standard, the court is left without any method of determining and assessing the defendant’s conduct, whether with regard to psychiatric care generally, the organization and management of the IPU at PRH, or the management of a patient with the characteristics of Mr. Nield.

[279]     While there may be cases where a breach of the standard of care might be inferred from all of the surrounding facts and circumstances or alternatively is so obvious that expert evidence is not required, this is not such a case.

[280]     It follows that the plaintiff has failed to prove that the defendant was negligent, and the claim must be dismissed.

The trial judge went on to set out what he would have awarded the Psychiatrist had he been successful in proving the standard of care issue.  In total, he would have been awarded close to 10 million dollars which was mostly in relation to his loss of income as of the date of trial and into the future.  Unfortunately, the IHA offered to settle the case before trial for $625,000.00.  Because the Psychiatrist was not successful at trial, he is ordered to pay some of the IHA’s legal costs.

To read more about this Assault Claim and the Trial result, please see this link to a news article.

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