Proving that a healthcare provider was negligent does not complete a medical-malpractice claim. The plaintiff must also connect that negligence to the injury and establish that the damage was not too remote.
The Supreme Court of Canada’s October 23 decision in Hemmings v. Padmore, 2026 SCC 34, brings that distinction into focus.
The Court dismissed both appeals, leaving the anesthesiologist liable while declining to restore liability against the obstetrician and hospital. The judges divided over the appropriate outcomes and reasoning. Supreme Court of Canada: Hemmings v. Padmore summary.
A divided decision on responsibility
The case concerned severe brain damage following anesthesia complications during an emergency caesarean section.
The Court distinguished factual causation - whether the injury would have occurred without the negligence - from remoteness, which asks whether the injury was a reasonably foreseeable consequence.
The reasons supporting dismissal identified deficiencies in the analysis concerning the nurse and obstetrician. For the anesthesiologist, the evidence supported the causal connection despite the absence of an express counterfactual analysis in the trial reasons. Supreme Court of Canada: Hemmings v. Padmore summary.
Build each causal step separately
For litigators, the practical lesson is to build each causal step separately.
Evidence that establishes a breach of the standard of care may not answer what would have happened had proper care been provided. Likewise, establishing a factual contribution does not eliminate the need to address remoteness.
That distinction should shape expert instructions, trial submissions and the proposed findings sought from the judge. Counsel should identify the particular negligent act, the alternative course of events and the evidence connecting that alternative to the outcome.
Read the reasons and record together
The fractured decision also requires care when describing its precedential effect. Agreement on the disposition should not be mistaken for unanimity on every aspect of the analysis.
For appellate counsel, the reasons raise the further question of when the record adequately supports a finding that the trial judge did not expressly articulate. That assessment requires close attention to the reasons and evidence, rather than a demand for particular wording alone.
Negligence identifies the failure. Causation and remoteness determine responsibility for the injury.
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Sources: Supreme Court of Canada: Hemmings v. Padmore summary · Supreme Court of Canada: case record 41350 .