Background
Bonnie Bradley, an emergency department nurse, received a tetanus vaccination from Dr. Richard Wang, then a first-year family medicine resident. Bradley testified that she immediately experienced severe pain and saw that the needle had been inserted too high and too far toward the front of her arm. She subsequently developed persistent pain, restricted movement, and adhesive capsulitis, or “frozen shoulder,” and stopped working.
The parties agreed that administering the vaccine in the location Bradley described would breach the standard of care. The trial judge accepted Bradley’s eyewitness account over Wang’s evidence about his usual practice, found that the negligent injection caused her injuries, and concluded that she could not return to her former work or perform the alternative jobs proposed by Wang. The judge awarded $931,585 for lost income and $361,600 for pension loss.
The Court’s Holding
The Court of Appeal for Ontario dismissed Wang’s appeal. It held that the trial judge had adequately addressed the principal challenges to Bradley’s credibility and reliability and was entitled to prefer her direct observation of the injection over Wang’s evidence of his usual practice. That factual assessment attracted substantial appellate deference.
The court also found no error in the causation analysis. Expert evidence indicated that Bradley’s immediate, severe, and continuing symptoms were extremely unlikely after a properly administered vaccination, and her previous tetanus vaccinations had caused no problems. That evidence supported the finding that, but for the improper administration, she likely would not have suffered the injury.
Finally, the court held that the trial judge had addressed mitigation in substance despite not using that term. Wang bore the burden of proving both unreasonable mitigation efforts and that mitigation was possible. Because he failed to establish that suitable work was available where Bradley reasonably resided, his mitigation argument failed. The court affirmed the judgment and awarded Bradley $50,000 in costs.
Key Takeaways
- A trial judge may prefer a patient’s direct eyewitness evidence over a physician’s evidence of usual practice, and that credibility finding is entitled to substantial deference when the key challenges have been addressed.
- The “but for” test may be satisfied through expert evidence about the likely outcome of proper treatment, the rarity and nature of alternative reactions, and the patient’s medical history.
- A defendant alleging failure to mitigate must prove not only that the plaintiff failed to take reasonable steps, but also that a realistic mitigation opportunity existed.
Why It Matters
The decision illustrates the deference appellate courts give to reasoned trial-level credibility findings in medical-negligence cases, particularly when the physician has no specific recollection and relies on customary practice. It also confirms that evidence about what probably would have happened after proper treatment can support conventional “but for” causation without impermissibly inferring negligence merely from the injury.
For damages claims, the ruling underscores that identifying hypothetical alternative employment is insufficient. A defendant must establish that suitable work was realistically available to the injured plaintiff, taking account of the plaintiff’s functional and geographic limitations.