In Ali v. Abu-Laban, 2025 BCSC 1157, the Plaintiff attended the emergency room at Vancouver General Hospital in 2014 with symptoms consistent with pneumonia. He was assessed by a Doctor who ordered a chest x-ray, diagnosed pneumonia, prescribed antibiotics, and recommended repeat imaging in 7-10 days. After the Plaintiff was discharged from the hospital, a radiologist reviewed the x-ray and reported not only the diagnosis of pneumonia, but also a “nodular-appearing 2.7cm region” and recommended follow-up imaging and a CT scan if the density persisted.
The Doctor did not contact the Plaintiff or his family physician after receiving the radiologist’s report. A carcinoid tumour was ultimately discovered incidentally in June 2018, requiring surgical removal. The surgery was successful, and the Plaintiff’s long-term physical prognosis remains excellent. The Plaintiff brought an action alleging negligence arising from the failure to follow up on the radiologists’ 2014 findings.
ISSUE #1: STANDARD OF CARE
The central question was whether the Doctor met the standard of a prudent and diligent emergency physician when he chose not to communicate the radiologist’s findings. The Court concluded that he did not. While the initial ER assessment and discharge were appropriate, the radiologist’s report raised a new and potentially serious issue unrelated to pneumonia. The Court held that the standard of care required of the Doctor was to follow up either with the patient’s family physician or directly with the patient to ensure the abnormal finding and recommended imaging were clearly communicated. Critically, the Court emphasized that patients are entitled to all material medical information, particularly where new imaging findings raise the possibility of a condition more serious than the presenting diagnosis. In circumstances where the emergency physician is the only provider who knows what information was actually conveyed to the patient, the duty to follow up becomes especially important.
ISSUE #2: CAUSATION & CONTRIBUTORY NEGLIGENCE
The Defendant argued that it had not been proven that the Plaintiff would have obtained a repeat x-ray in 2014, or that any such x-ray would have revealed a tumour. The Court rejected these arguments. Firstly, the Court accepted that, had the abnormality been explained, in plain terms, the Plaintiff would have pursued follow-up imaging. The Plaintiff’s past smoking, prior missed medical appointments, and imperfect memory did not detract from the common sense inference that a reasonable patient, especially one told that the abnormality might represent something other than pneumonia, would obtain repeat imaging.
Second, un-contradicted expert evidence demonstrated that the 2018 tumour was radiographically visible in the 2014 x-ray and would likely have been detectable on a CT scan at that time. The slow-growing nature of carcinoid tumours supported this conclusion. Thus, “but for” the failure to communicate the radiologist’s findings, the tumour would likely have been diagnosed four years earlier.
The Court then assessed whether the delayed diagnosis caused the Plaintiff a compensable injury beyond the physical consequences of the tumour itself. The judge found that the delay contributed to a serious psychological reaction, feelings of betrayal, loss of trust in the health-care system, social withdrawal, depressed mood, and recurring suicidal ideation. The Court applying Saadati v. Moorhead, 2017 SCC 28 held that this amounted to compensable mental injury, and was beyond “mere upset.”
The final causation question concerned contributory negligence. The Court rejected the argument that the Plaintiff’s smoking caused or contributed to the tumour, relying on expert evidence that typical lung carcinoids are not related to smoking. However, the Court found that the Plaintiff bore some responsibility for failing to obtain the recommended follow-up x-ray and for providing outdated information about his family physician upon ER admission. While recognizing that these failures occurred under stressful circumstances, and were mitigated by the Plaintiff’s limited understanding of the risks, the Court concluded that his conduct contributed to the delayed diagnosis. The Court apportioned fault at 70% to the Doctor, and 30% to the Plaintiff.
CONCLUSION: KEY LEGAL PRINCIPLES
Ali v. Abu-Laban reinforces several important principles governing medical negligence in British Columbia:
- Emergency physicians may have a duty to follow up with a patient or their family physician when post-discharge imaging identifies clinically significant abnormalities. The duty does not end at discharge if new information arises that the patient needs to make informed decisions about their care.
- Patients are entitled to all significant medical information, including unexpected or uncertain findings that may have diagnostic importance. Failure to communicate such information can breach the standard of care.
- Delay in diagnosis can produce compensable mental injury, even where the patient’s physical prognosis is unchanged, provided the psychological harm is serious, prolonged, and exceeds ordinary emotional upset.
- Patients may be found contributorily negligent for failing to obtain recommended follow-up imaging, especially were the advice was clear and the failure contributed to the delayed diagnosis.
Taken together, the decision highlights the importance of robust communication protocols in ER settings and the legal risks that arise when clinically significant information is not conveyed to the patient or their primary care provider.