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Justice Muise of the Supreme Court of Nova Scotia recently released his reasons in McIntosh v. Isaac Walton Killam – Grace Health Centre.

Why is it important?

This case is important to Nova Scotians, and Haligonians in particular because the IWK-Grace Health Sciences Centre and the Halifax Infirmary are both teaching hospitals. Much of the primary medical care provided to patients in these hospitals is provided by students (both medical and nursing) obtaining further training in their profession.

This is the training model used in all teaching hospitals in Canada and the United States. Essentially doctors and nurses "learn by doing", under the supervision of doctors or nurses with more training and experience.

However, patients in hospitals are usually not told whether the person that is treating them is a student and whether it is their first day in the hospital or whether they have been training for years.

One of the issues that Justice Muise had to determine was whether a student nurse should be held to a lower standard than a registered nurse with more training and experience.

Standard of Care for Student Doctors

I have previously discussed the standards that courts in Canada expect for medical students: Medical Malpractice Claims in Canada: Standard of Care for Medical Students – Anderson v. Greene.

Standards for Student Nurses

Justice Muise had this to say about the issue:

The nursing student is to be held to the standard of care expected of a registered nurse of average competence and ordinary skill facing the circumstances in question. Judicial comments to that effect have been made in Tekano (Guardian ad litem of) v. Lions Gate Hospital, 1999 CarswellBC 1709 (B.C.S.C.), at paragraph 109, and in Dixon v. Calgary Health Region, 2006 CarswellAlta 378 (A.B.Q.B.), at paragraph 73.

The standard of care expected of nurses is dealt with in the same way as the standard of care expected of other health professionals. Useful comments, in relation to the standard of care of health professionals generally, are contained in paragraph 6.26 of the Canadian Health Law Practice Manual (Markham: LexisNexis Canada Inc., 2000) where it is stated:

“The conduct of the institution and its health professionals will be judged on whether the care provided met a reasonable standard in the particular circumstances of the case. The health practitioner is not held to a standard of perfection. The test is not whether the patient received the best care possible from the health practitioner in question. Rather, the Court will look at what the reasonable health professional in a comparable setting would have done in like circumstances.”

Teaching Hospitals Can Be Dangerous

There is a well documented increase in morbidity and mortality rates (death) for patients who are admitted to teaching hospitals in July. Researchers have concluded that in fact the spike in mortality rates is usually due to the fact that July is when medical students begin their training in their new specialties: Beware the July Effect:Hospital Deaths Spike in Summertime

Become an Advocate

As patients, we all have certain rights. One of those rights is to be provided with competent medical care. Most of the health care professionals who treat patients here in Nova Scotia are capable and dedicated professionals. However, everyone makes mistakes and lack of experience can lead to medical errors.

If you have a concern about the lack of experience of anyone that is providing you with medical care you have the right to ask that a more experienced professional provide your treatment.

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