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Canadian Journal of Gastroenterology
Volume 13, Issue 1, Pages 79-84

Malpractice and Avascular Necrosis: Legal Outcomes

Rose M Carter

Department of Oral Health Sciences, Faculty of Medicine and Oral Health Sciences, University of Alberta, Edmonton, Alberta, Canada

Received 27 November 1997; Accepted 5 December 1997

Copyright © 1999 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


Every physician, but particularly specialists, have reason to be concerned about medical legal issues. Avascular necrosis has been established as a possible serious complication of steroid treatment in inflammatory bowel disease. Two specific Canadian cases illustrating the sequence of medical history, time, expert testimony and legal outcomes are presented. Awards plus costs in the order of $1 million or more were the result of these legal proceedings. The courts stated the major factors in finding liability against doctors were the failure to show the patient had been fully informed of treatment options. There was considerable weight given to expert testimony and the patient recollection of events to support their contentions. Adequate contemporaneous record keeping was absent to contradict evidence of the patients. The judges in both illustrative examples leaned heavily on Supreme Court of Canada guidelines whereby the patient must be informed at all stages of the medical process.