Ali v. Abu-Laban, 2025 BCSC 1157 (CanLII)
Facts
The plaintiff, a 29-year-old smoker, attended the emergency room in March of 2014 with a severe cough, phlegm, chest pain, crackling in the lungs and a low-grade fever. He saw the defendant ER physician, Dr. Abu-Laban, and was given a chest x-ray, which Dr. Abu-Laban interpreted as having an infiltrate left base consistent with pneumonia. The plaintiff was discharged with a diagnosis of pneumonia and told to follow up with his family physician for a repeat x-ray in one week to confirm resolution of the illness.
The x-ray was reviewed by a radiologist at the hospital several days later. In addition to a consolidation in the left lower lobe consistent with pneumonia, the report noted “a nodular-appearing 2.7 cm region is seen.” A follow up x-ray was recommended and a CT scan if the density remained. A carcinoid tumour was discovered in 2018 and surgically resected. It was common ground that the plaintiff’s physical prognosis in 2018 when the tumour was discovered was no different than it would have been four years prior, as the cancer had not spread. The damages claimed were psychological. The plaintiff’s evidence was that he would have gone for a follow up chest x-ray had he known about a nodule that could have been malignant. He thought the follow-up chest x-ray that Dr. Abu-Laban recommended was only necessary if the symptoms didn’t clear up.
Dr. Abu-Laban testified that the radiologist’s report was consistent with his own interpretation of the x-ray and thus no further steps were needed. Dr. Abu-Laban’s evidence was that if there was a discrepancy that changed the plan, he would have contacted the patient or the family doctor.
The plaintiff’s expert testified that the “2.7 cm nodule” represented a significant discrepancy from Dr. Abu-Laban’s interpretation and that the standard of care required a documented attempt to contact the patient and inform him of the finding and need for follow up. Defence experts said this was not necessary.
A very key assumption both defence experts were provided was that Dr. Abu-Laban was correct in his view that the radiologist’s report did not differ from his own interpretation. Their opinions were based on this assumption.
Reasons
Justice Veenstra of the British Columbia Supreme Court found the standard of care was breached. The radiologist’s comments did raise an issue of significance. Dr. Abu-Laban himself acknowledged that if he had seen the radiologist’s report as giving rise to a discrepancy, he would have contacted either the patient or the family doctor to highlight the discrepancy – he just did not think there was a discrepancy in this case.
The court found that, if the plaintiff had been notified of the nodule, he would have gotten the required second x-ray. However, because he was recommended to get a follow up x-ray in any case, albeit precautionary, he was found 30 percent contributorily negligent for not having carried out this step.
The plaintiff was awarded $40,000 for non-pecuniary general damages and $25,000 for past loss of earning capacity given that he lost more income in 2018, when the tumour was discovered, than he would have in 2014 when it ought to have been.