The Physician's Duty to Diagnose

Overview

A (diagnostic) is an opinion about the nature of a patient's condition, and an opinion can be wrong without anyone being at fault. Quebec law treats the physician's duty to diagnose as an (obligation de moyens): the physician must deploy the reasonable means a prudent and diligent practitioner would use to reach the correct conclusion, but does not guarantee that conclusion. Courts therefore examine the process rather than the outcome. They ask where the diagnosis was made, what the physician knew or could have known at the time, whether the patient cooperated, and whether the physician listened, read the file, examined the patient completely, and referred the case when it exceeded the physician's competence. This note, the seventh in the Medical Liability series, sets out the notion of diagnosis, the elements courts weigh, the recurring categories of diagnostic fault (faute), and the modern rules on communicating a diagnosis and disclosing accidents. The related duty to inform before treatment is the subject of the next note on informed consent.

Learning Objectives

Explain why the duty to diagnose is an obligation of means and what that classification implies for the burden borne by the patient.
Recognize the recurring categories of diagnostic fault drawn from Quebec case law: poor listening, failure to consult the file, incomplete examination, and failure to refer.
Describe the physician's obligation to communicate a diagnosis in a way the patient understands, and the post-2002 framework for disclosing accidents and complications.

The Notion of Diagnosis

Diagnosis as a Reserved Activity

The Medical Act (Loi médicale) defines the practice of medicine as the evaluation and diagnosis of any health deficiency in a human being in interaction with the environment, together with the prevention and treatment of disease. Among the activities the Act reserves to physicians, the first listed is diagnosing illness (art. 31 Loi médicale). Diagnosis is thus at the centre of what it means to practise medicine. The reservation is not exclusive in the everyday sense: dentists and nurses, among others, also make diagnoses within their own fields. What matters for civil liability is that diagnosing is part of the physician's work, and a physician who undertakes it must do so with the attention the profession itself demands.

That demand is spelled out in art. 46 of the Code de déontologie des médecins: the physician must elaborate the diagnosis with the greatest attention, using the most appropriate scientific methods and, where necessary, seeking the most enlightened advice. The article already contains the three ideas that structure the case law: attentiveness, appropriate investigation, and consultation or when the physician's own resources are insufficient.

An Obligation of Means

Professors Philips-Nootens and Kouri summarize the intensity of the obligation: the physician must strive to arrive at the correct diagnosis by taking all the reasonable means available, as any prudent and diligent practitioner would, and no reproach can be made if the diagnosis nonetheless fails. It happens regularly that a diagnosis remains imprecise despite an appropriate medical approach. For that reason no can be imposed.

The Superior Court (Cour supérieure) put the same idea in a single sentence in Succession de El-Masri c. Bernier, 2021 QCCS 1475: diagnosing is nothing like an exact science, which calls for a certain tolerance, and what must be considered are the means deployed rather than the accuracy of the conclusion. Dufour c. Tanios Hanna, 2018 QCCS 4434, is to the same effect. The distinction between an error and a fault is therefore the organizing principle. An error is a wrong conclusion. A fault is a wrong conclusion reached because the physician omitted a step that a in the same situation would have taken. The patient who sues must prove the latter, not merely the former.

Two further remarks frame the analysis. First, the constant development of new techniques and the deepening of medical knowledge have considerably widened the diagnostic possibilities open to physicians. The wider the range of available investigations, the wider the range of possible reproaches, since a test that was unavailable yesterday may be an expected step today. Second, this expansion cuts both ways. Physicians sometimes multiply tests defensively; at other times a battery of tests is genuinely required to identify the patient's pathology. Courts assess whether the tests actually performed were those a prudent practitioner would have ordered in the circumstances, no more and no less.

Courts Do Not Arbitrate Scientific Controversies

The Supreme Court of Canada set the outer limit of judicial review of a diagnosis in Lapointe c. Hôpital Le Gardeur, [1992] 1 RCS 351. Given the number of possible methods among which health professionals must sometimes choose, and given the distinction between error and fault, a physician will not be held liable if the diagnosis and treatment correspond to those recognized by medical science at the time, even where opposing theories exist. The Court adopted the words of André Nadeau: courts have no jurisdiction to settle scientific disputes or to choose among the divergent opinions of physicians on certain subjects, and may find fault only where rules accepted by the whole of the profession have been violated. It also endorsed Justice Brossard's formulation that it is not for the tribunal to choose between two scientific schools of thought where both appear equally reasonable and both rest on scientific writings.

The practical consequence is a two-part inquiry. If the physician followed a recognized approach, the fact that another approach might have produced the correct answer is irrelevant. If the physician departed from rules the profession as a whole accepts, the departure may be a fault regardless of the physician's personal convictions.

Elements Courts Consider

The Circumstances

Diagnosing in an emergency department differs from diagnosing in a scheduled consultation, and the analysis changes accordingly. Philips-Nootens and Kouri observe that the context in which a diagnosis is made obviously plays an important role. The emergency physician does not know the patient who walks in, knows nothing of the patient's life, habits, or character, and that unfamiliarity can itself generate communication problems. The information available in an emergency setting is limited, and the standard of the reasonably prudent physician is applied to a practitioner working with that limited information.

Context does not lower the standard; it defines the circumstances in which the standard is applied. The emergency physician remains bound to take the reasonable steps that the emergency setting permits, which is why, as the cases below show, failing to take vital signs or to read the existing chart in an emergency department is still a fault.

Judging by the Knowledge Available at the Time

The single most important methodological rule is that the court must place itself at the moment the diagnosis was made. In Lapointe, the Supreme Court warned that courts must take care not to rely on the perfect vision that affords. The judge assesses the physician's conduct on the basis of the elements the physician had at that moment, not on the basis of what later events revealed.

Tremblay c. Claveau, 1990 CanLII 3398 (QC CA), illustrates the rule. A one-year-old child contracted pneumococcal bacterial meningitis that left her profoundly deaf. Her parents sued the pediatrician who had seen her on June 18 and 20, 1980, for failing to diagnose the meningitis that a lumbar puncture performed at the hospital on June 21 revealed. The Court of Appeal (Cour d'appel) reconstructed the chronology and drew attention to a decisive point: the two physicians who examined the child after Dr. Claveau reached the same diagnosis he had, even though the clinical picture had deteriorated since his second consultation. New symptoms had appeared late on the Friday and on the Saturday morning; Dr. Claveau did not have the benefit of those signs when he examined the child, and the physicians who did observe them still did not diagnose meningitis. Judged by what was observable on June 20, his diagnosis was not a fault. Lauzon c. Ranger, REJB 2002-35918 (C.S.), applies the same reasoning.

The rule has a corollary for evidence. Expert testimony that reasons backward from the confirmed diagnosis to what "should have been obvious" carries little weight unless it identifies signs that were actually present, and reasonably detectable, at the time of the consultation.

The Patient's Lack of Cooperation

The patient's cooperation is fundamental to a correct diagnosis, since the depends on what the patient reports. Sirois c. Baillargeon, EYB 1996-105373 (C.A.), shows the consequence of withholding information. During a bar fight on March 20, 1982, the appellant punched another man, fractured four of his teeth, and cut his own hand in the process. According to the treating physician, the patient told him he had cut himself on glass, and the physician provided the care appropriate to that kind of wound. The experts agreed that the injury was in fact a human bite, that a human bite carries a high risk of virulent infection requiring rapid action, and that its treatment differs considerably from that of a glass cut. After a detailed review of the facts and a careful weighing of the testimony, the trial judge found that there was no doubt the physician had not been informed of the circumstances of the injury. The physician had treated the wound described to him; had he known the true mechanism of injury, he would have treated it differently. No fault was found.

The lesson is symmetrical. The physician must ask, and must sometimes probe to discover the true reason for the consultation; the patient must answer truthfully. A diagnosis built on a false history is not a faulty diagnosis if the physician had no reasonable means of discovering the truth.

Faults in the Diagnostic Process

Time Pressure and the Differential Diagnosis

Philips-Nootens and Kouri note that time constraints weigh increasingly on many physicians: a tight schedule, an inflexible operating calendar, a last-minute consultation, an emergency to handle between two cases, and countless other irritants force physicians to work under pressure. It is understandable that a physician feels rushed, but a faulty diagnosis is no less reprehensible for that. A crowded schedule is not an excuse.

Jean-Pierre Ménard adds the methodological safeguard the profession itself teaches. Because a diagnosis is uncertain in many cases, medicine instructs the physician to consider one or more differential diagnoses until the principal diagnosis is formally established. A is the elimination, by reasoning, of conditions adjacent to the one the physician is seeking to identify. As long as the diagnosis is not established with sufficient certainty, the physician must keep in mind other conditions whose presentation, signs, and symptoms closely resemble those of the principal diagnosis. Several of the cases that follow are, at bottom, cases where the physician settled on a benign explanation without eliminating the serious alternative.

Poor Listening

The anamnesis, the collection of information supplied by the patient, is the first step of the therapeutic process. Philips-Nootens and Kouri insist that, elementary as it seems, the physician must ask why the patient is consulting and must sometimes uncover the real reason over the course of the interview. This step cannot be neglected at any price: it directs the physical examination and the investigation, and it allows the patient to feel heard and understood. Some encounters, they observe, are true dialogues of the deaf in which the patient leaves with a prescription for a problem the patient never complained of.

Lauzon c. Taillefer is the reference case. An ophthalmologist disregarded a patient's complaints and quickly concluded that she had a cataract when in fact she had glaucoma. The court held him liable. The physician should have been all the more attentive because the patient had been specifically referred to him by an optometrist, which signalled that a trained professional had already seen something warranting a specialist's attention.

Failure to Consult the File

The medical file is a continuing conversation among the professionals who treat a patient, and a physician who ignores a colleague's recorded recommendation does so at their peril. Montpetit c. Léger, EYB 2000-20238 (C.S.), is the illustration.

The patient first presented to the emergency department on December 29, 1988, with severe headaches. Two general practitioners working in emergency medicine, Dr. Léger and, on the following shift, Dr. Aboussouan, checked whether the headaches stemmed from a benign pathology such as migraine and ordered the basic analyses. The court found that Dr. Léger had no reason to send the patient immediately to neurology for a CT scan and was entitled to keep him under observation to assess the effect of the medication. Dr. Aboussouan suggested a sinus x-ray and, once the medication had almost eliminated the headaches, discharged the patient. He noted in the file that if the pain persisted the patient should be sent to neurology. Given the clinical picture at that time, an immediate referral was not imperative. Neither of these physicians was at fault.

The patient returned on January 2, 1989. The headaches were again intense and were now accompanied by vomiting. The general practitioner on duty, Dr. Desaulniers, sent him home with a prescription and an appointment at the clinic the following week. The court held that, given the medical knowledge of the time and the published guidelines for emergency diagnosis, Dr. Desaulniers had to know that a persistent headache accompanied by vomiting could herald a pathology more serious than migraine and had to treat the patient as high risk. It was unacceptable that Dr. Aboussouan's recommendation had not been followed. Dr. Desaulniers was held liable.

Two rules emerge. A physician must always check what is written in the file. And the recommendations of a previous physician must be taken into account by the next one, particularly when the file itself sets out the condition (persistence of symptoms) under which a further step was to be taken.

Incomplete Examination

The classic case is Hôpital Notre-Dame de l'Espérance c. Laurent, [1974] C.A. 54: a physician diagnosed a contusion rather than a fracture of the leg because he had not ordered an x-ray. The pattern, a physician who tells the patient to rest without taking the film that would have revealed the fracture, recurs often enough to have become the textbook example of an incomplete examination. The fault is the omission to perform, or to pursue, the tests the situation required.

The later cases extend the principle across specialties:

Massinon c. Ghys, [1996] R.J.Q. 2258 (C.S.): the physician failed to pursue the necessary examinations after discovering a palpable mass in the patient's breast that presented indirect signs of malignancy.
Stéfanik c. Hôpital Hôtel-Dieu de Lévis, [1997] R.J.Q. 1332 (C.S.): gynecologists failed to perform certain tests and in-depth examinations during a twin pregnancy in which twin-to-twin transfusion syndrome developed.
C.L. c. St-Arnaud, 2011 QCCS 2360: an obstetrician diagnosed false labour over the telephone, deferring to the nurse's judgment, when in fact the patient was in premature labour that a manual examination would have detected. The physician did not come in. The court observed that some diagnoses simply cannot be made without tests or manoeuvres performed on the patient. It also considered whether the magnitude of the departure amounted to under art. 1474 CCQ and concluded that the question was unnecessary to decide; the examination was incomplete and conducted at a distance, and the physician had not acted as a prudent and diligent practitioner.
Succession de El-Masri c. Bernier, 2021 QCCS 1475: in the emergency department, the physician diagnosed muscular back pain without taking vital signs or noting the pulse. The evidence indicated that an aortic dissection was probably under way. The physician reached the wrong diagnosis because the necessary examinations were not performed.

The through-line is an imperative to investigate. A physician who forms a benign impression and acts on it without the examination that would confirm or exclude the serious alternative cannot invoke the tolerance the law extends to honest diagnostic error.

Worked example: the missed aortic dissection

A 58-year-old man arrives at a community hospital emergency department at 2 a.m. complaining of sudden, severe pain between the shoulder blades that began while he was carrying groceries. The triage nurse records that he looks pale. The emergency physician, who has eleven patients waiting, asks whether he lifted anything heavy, hears "yes," palpates the thoracic spine, finds it tender, diagnoses a muscular strain, and discharges him with an anti-inflammatory. No blood pressure is taken in either arm and no pulse is recorded. Four hours later the patient collapses at home from an aortic dissection.

The analysis begins with context: an overnight emergency department, an unknown patient, and a plausible mechanical explanation offered by the patient himself. Placing oneself at 2 a.m. and setting hindsight aside, the question is whether a reasonably prudent emergency physician, with the same information, would have stopped at a muscular strain. The answer turns on the differential diagnosis. Sudden severe interscapular pain in a pale 58-year-old is a presentation for which a prudent practitioner keeps aortic dissection in mind until it is excluded, and exclusion begins with vital signs. Following El-Masri, the omission to take vital signs is an incomplete examination, and the wrong diagnosis flows from the omitted step rather than from an honest error of judgment. The crowded waiting room explains the haste but does not excuse it. The patient's cooperation is not in issue, since he answered the question he was asked truthfully; the fault lies in the question the physician did not ask and the examination the physician did not perform. Fault is likely established, and the remaining questions of causation (lien de causalité) and damage (préjudice) follow the general rules discussed later in the series.

Failure to Refer to a Specialist

Every professional must know the limits of their own competence. Article 42 of the Code de déontologie des médecins requires the physician, in the practice of the profession, to take account of personal abilities, limits, and the means at hand, and, where the patient's interest requires it, to consult a colleague, another professional, or any competent person, or to direct the patient to one of them. The principle applies to every profession: recognizing one's own incompetence in a given matter is a deontological duty and a means of self-protection.

The civil consequence is stated by Philips-Nootens and Kouri as a warning. If the general practitioner steps outside their field of competence, they run a strong risk of being compared to the specialist to whom the act belongs, because the physician should in that case have referred the patient. Salehi c. Bahamin, [1995] R.R.A. 1045 (C.S.), in the words of Justice Normand, states the test: if a general practitioner provides care that belongs to a specialty, the general practitioner's conduct must be compared with that of the specialist, and the test is that of the specialist acting normally in similar circumstances. The consequence is double. The physician who fails to refer commits a fault, and the physician's diagnostic work is then judged by the higher standard of the specialty the physician chose to enter.

Communicating the Diagnosis and Disclosing Accidents

The Duty to Be Understood

The duty to diagnose does not end when the physician forms an opinion. Article 29 of the Code de déontologie des médecins requires the physician to ensure that the patient or the patient's legal representative has received the explanations relevant to understanding the nature, purpose, and possible consequences of the examination, investigation, treatment, or research the physician is about to undertake, and to facilitate and respect the patient's decision. The obligation is to be understood, not merely to speak. The physician must explain the diagnosis so that the patient can make an informed decision.

Laferrière c. Lawson, [1991] 1 RCS 541, arose from a physician's failure to communicate a cancer diagnosis to his patient. The patient's death was certain and nothing further could be done for her, and the physician chose not to inform her. The omission was nonetheless a failure to communicate. The case belongs to a period in which patients trusted physicians to decide whether they should be told, sometimes on the theory that silence would let the patient enjoy her remaining time. That paternalistic model no longer describes the law.

Kiley-Nikkel c. Danais, [1992] R.J.Q. 2820 (C.S.), shows how far the duty extends. A woman discovered a lump in her left breast. The tissue was analyzed, breast cancer was diagnosed, and she underwent a complete mastectomy. Other pathologists later reviewed the samples and found that the diagnosis was wrong: she had never had cancer. The surgeon, rather than the pathologist, went to tell her. When informed that she did not have cancer and that a diagnostic error had occurred, the patient did not react. Her file was later transferred to Saskatchewan, where she moved, and she continued to believe that she had cancer. The court found two distinct faults. The pathologist was at fault for the erroneous diagnosis; more thorough testing should have been carried out before a mastectomy proceeded. The surgeon committed no fault in diagnosis or treatment, and the pathologist was not faulted for relying on his colleague to communicate the error. The surgeon, however, breached his duty to inform because he did not ensure that the patient had understood the disclosure of the serious error. The claim was allowed. The teaching is that a diagnosis, and a diagnostic error, must be disclosed, and that disclosure means securing comprehension, not merely uttering the words.

Disclosure of Accidents and Complications

The natural reflex of a physician who has made an error may be to say nothing. A ministerial committee report on in the health network (the Francoeur Report, 2001) recommended a shift toward transparency, and the recommendation was implemented in two ways.

The first was an amendment to the Code de déontologie des médecins in 2002, which introduced art. 56: the physician must inform, as soon as possible, the patient or the patient's legal representative of any liable to produce, or that has produced, significant consequences for the patient's state of health or physical integrity. Disclosure is now mandatory, and failing to disclose is a deontological breach independent of any civil liability. The case law remains limited, but two disciplinary decisions show the rule in operation.

In Médecins (Ordre professionnel des) c. Poirier, 2007 CanLII 73347 (QC CDCM), the surgeon did not dispute that he had failed to tell his patient, after the operation, that the blade of his scalpel had broken and that he had had to leave a fragment in the patient's back. He argued that he had no obligation to mention it because the patient was in perfect condition, functioned well, and had no sequelae. The disciplinary council rejected the argument: finding oneself after surgery with a piece of broken scalpel blade in one's back unquestionably affects physical integrity, and the accident was also liable to affect the patient's health. The physician was found guilty on that count. Médecins (Ordre professionnel des) c. Christou (2016, QC CDCM) reached a similar conclusion regarding a surgeon who failed to inform his patient that a complication had occurred during surgery, that he had had to leave a piece of drain in place, and, later, that he had removed it during a subsequent operation.

The second implementation was legislative. The LSSSS was amended to require documentation, a risk-management committee, and a local register of incidents and accidents in every institution. Article 233.1 LSSSS obliges every employee of an institution, every professional practising in a centre it operates, every intern, and every person providing services to users under a service contract to declare to the executive director, as soon as possible, any incident or accident they have observed. The declaration is made on the prescribed form, which is placed in the user's file. Every hospital in the province must therefore have a mechanism for declaring an incident or accident, whether it stems from the act of a physician, a nurse, an employee, or any other professional practising there.

Risk Management and the Protection of Disclosures

Article 56 of the Code requires the physician to admit that something went wrong, yet nothing in the Code exonerates the physician who does so. The legislature addressed the tension in art. 183.3 LSSSS. Answers given by a person in the course of risk-management activities, including any information or document supplied in good faith in response to a request from a risk manager or a risk-management committee, cannot be used and are not admissible as evidence against that person or anyone else before a court or a body exercising adjudicative functions. Nothing in the contents of the risk-management file, including reasoned conclusions and any accompanying recommendations, can constitute a declaration, acknowledgment, or of a professional, administrative, or other fault of a kind that would engage a party's civil liability. The provision completes art. 56: disclosure of an accident or complication is not an extrajudicial admission capable of engaging liability, and the system is intended to be preventive.

C.B. c. Fortin, 2014 QCCS 537, illustrates the protection in litigation. The assistant director of planning and communications at Hôpital Sainte-Justine, who also served as risk manager in 2004 and 2005, was questioned about the persons she had met in the plaintiff's file. She rightly relied on art. 183.3 LSSSS and refused to disclose what those persons had told her. The court explained that the privilege does not belong to the risk manager; it exists for the benefit of the persons who make declarations to her and for the benefit of the system put in place to facilitate the communication of information that can, on occasion, be delicate.

Synthesis

The duty to diagnose is an obligation of means. The physician must take the reasonable means to arrive at the correct diagnosis: listen to the patient, read the file, examine the patient completely, order the tests the presentation calls for, keep the differential diagnosis open until the serious alternatives are excluded, and refer to a specialist when the matter exceeds the physician's competence. The physician who does all of this and is still wrong has committed an error, not a fault. The court assesses the process from the standpoint of the moment the diagnosis was made and with the information then available, and it will not choose between reasonable schools of scientific thought.

When something goes wrong, the physician must do two things. First, complete the incident or accident declaration form of the institution where the physician practises, as art. 233.1 LSSSS requires. Second, inform the patient of the situation, as art. 56 of the Code de déontologie des médecins requires. That disclosure need not, and prudently should not, take the form of an express admission of fault. The physician can and should express regret: art. 2853.1 CCQ provides that an apology cannot constitute an admission of fault, and art. 183.3 LSSSS ensures that what is said within the risk-management process cannot be turned into an extrajudicial admission engaging civil liability.

Practice Checklist

Characterizing the obligation

Frame the claim as a breach of an obligation of means: identify the step a reasonably prudent physician would have taken, not merely the wrong result.
Determine whether the disputed diagnosis reflects a recognized school of thought (no fault) or a departure from rules accepted by the whole profession.

Contextual assessment

Fix the moment of the diagnosis and list only the signs, symptoms, history, and test results actually available then.
Identify the setting (emergency, scheduled consultation, telephone) and the limits on information it imposed.
Verify what the patient reported and whether any material fact was withheld or misdescribed.

Diagnostic process

Confirm that the physician took a proper history and addressed the complaint the patient actually raised.
Confirm that the physician read the file, including any recommendation recorded by a previous physician.
Confirm that the physical examination, vital signs, imaging, and laboratory tests appropriate to the presentation were performed or pursued.
Check whether a serious differential diagnosis was excluded before a benign diagnosis was adopted.
Determine whether the matter fell within a specialty and, if so, whether the physician referred the patient or must be judged by the specialist's standard.

Communication and disclosure

Verify that the diagnosis, and any diagnostic error, was explained in terms the patient understood.
Where an accident or complication occurred, confirm that the institutional declaration was filed (art. 233.1 LSSSS) and that the patient was informed (art. 56 Code de déontologie).
Identify any statement made within the risk-management process and assess its inadmissibility under art. 183.3 LSSSS.

Glossary

Accident or complicationaccident ou complication: An event liable to produce, or that has produced, significant consequences for the patient's health or physical integrity, triggering the physician's duty of disclosure under art. 56 of the Code de déontologie des médecins.
Anamnesisanamnèse: The collection of information supplied by the patient, the first step of the therapeutic process.
Diagnosisdiagnostic: The determination of the nature of a disease from the information given by the patient, the study of signs and symptoms, and laboratory results.
Differential diagnosisdiagnostic différentiel: The reasoned elimination of conditions whose presentation resembles the one the physician is trying to identify, kept in mind until the principal diagnosis is established with sufficient certainty.
Extrajudicial admissionaveu extrajudiciaire: An out-of-court acknowledgment of a fact that may be used against its author; art. 183.3 LSSSS prevents risk-management disclosures from being treated as such.
Gross faultfaute lourde: A fault denoting gross recklessness, gross carelessness, or gross negligence under art. 1474 CCQ.
Hindsightrecul: The perfect vision that later events afford; courts must resist judging a diagnosis by what was learned afterward.
Obligation of meansobligation de moyens: The debtor undertakes to use the reasonable care and diligence of a prudent practitioner without guaranteeing the result. The duty to diagnose belongs to this category.
Obligation of resultobligation de résultat: An undertaking to achieve a specific outcome; not applicable to diagnosis.
Reasonably prudent physicianmédecin raisonnablement prudent: The abstract standard against which the diagnostic process is measured, adjusted for specialization and circumstances.
Referralréférence: Directing the patient to a colleague, another professional, or a competent person when the patient's interest requires it, under art. 42 of the Code de déontologie des médecins.
Risk managementgestion des risques: The institutional system, required by the Act respecting health services and social services, for declaring and analyzing incidents and accidents.

References and Further Reading

Civil Code of Quebec: arts. 1457, 1458, 1474, 2849, 2853.1.
Medical Act (Loi médicale), RLRQ, c. M-9: art. 31.
Code de déontologie des médecins: arts. 29, 42, 46, 56.
Act respecting health services and social services (Loi sur les services de santé et les services sociaux), RLRQ, c. S-4.2: arts. 183.3, 233.1.
Report: La gestion des risques, une priorité pour le réseau, report of the ministerial committee (Francoeur Report), 2001.
Selected case law: Lapointe c. Hôpital Le Gardeur, [1992] 1 RCS 351; Laferrière c. Lawson, [1991] 1 RCS 541; Tremblay c. Claveau, 1990 CanLII 3398 (QC CA); Sirois c. Baillargeon, EYB 1996-105373 (C.A.); Hôpital Notre-Dame de l'Espérance c. Laurent, [1974] C.A. 54; Kiley-Nikkel c. Danais, [1992] R.J.Q. 2820 (C.S.); Salehi c. Bahamin, [1995] R.R.A. 1045 (C.S.); Massinon c. Ghys, [1996] R.J.Q. 2258 (C.S.); Stéfanik c. Hôpital Hôtel-Dieu de Lévis, [1997] R.J.Q. 1332 (C.S.); Montpetit c. Léger, EYB 2000-20238 (C.S.); Lauzon c. Ranger, REJB 2002-35918 (C.S.); Lauzon c. Taillefer; C.L. c. St-Arnaud, 2011 QCCS 2360; C.B. c. Fortin, 2014 QCCS 537; Dufour c. Tanios Hanna, 2018 QCCS 4434; Succession de El-Masri c. Bernier, 2021 QCCS 1475; Médecins (Ordre professionnel des) c. Poirier, 2007 CanLII 73347 (QC CDCM); Médecins (Ordre professionnel des) c. Christou (2016, QC CDCM).
Doctrine: Suzanne Philips-Nootens and Robert P. Kouri, Les éléments de la responsabilité médicale, 5th ed., Montreal, Éditions Yvon Blais, 2021; Jean-Pierre Ménard, "L'erreur de diagnostic : fautive ou non fautive", in Développements récents en responsabilité médicale et hospitalière (2005); André Nadeau, as quoted in Lapointe; L. Manuila, A. Manuila and M. Nicoulin, Dictionnaire médical, 5th ed., Paris, Masson, 1992.

Disclaimer

This article is for informational purposes only and does not constitute legal advice. Quebec civil law may evolve through legislation and judicial interpretation. For advice on a specific situation, consult a qualified Quebec lawyer or notary.