For many years, practitioners in different disciplines assumed that they were protected from liability if they merely lived up to the standard of practice in their own community or similar localities. This has historically been known as “the locality rule”.  It was derived from an early Supreme Court of Canada decision in which the court set out the following test to determine whether a practitioner falls below the standard of practice:

“The test of reasonable care applies in… malpractice cases as in other cases of alleged negligence.  As has been said in the United States, a [practitioner] must possess and use that reasonable degree of learning and skill ordinarily possessed by practitioners in similar communities in similar cases [emphasis added]…”

However, a recent Ontario case involving alleged medical negligence clearly stands for the proposition that patients are entitled to the same level of care regardless of where they live.

In Crawford v. Penney, a baby suffered traumatic injury at birth when her mother delivered in Smiths Falls, Ontario, approximately one hour away from Ottawa.  The defendants argued, among other things, that they were essentially country doctors who could not be expected to provide the same level of care that the mother would have received had she delivered at a high risk obstetric unit in Ottawa.

Mr. Justice Power noted that practitioners “in the country” did not believe that they needed to be as proficient as a practitioner in an urban setting. However, His Honour held that the locality rule should be abandoned, citing improvements in modern communications, education and the uniformity of examinations for physicians in Canada.  He also noted that the locality rule permitted an inferior brand of medicine for rural Canadians, which could not be accepted. Rather, a single standard promotes upgrading of practice across the country.  Justice Power noted that Smiths Falls Hospital, although a community hospital, is situated within easy reach of Ottawa or Kingston, both of which could provide expert care.  His Honour went on to note that when the child was born, fifty percent of babies were delivered by family physicians.  As a result,

“It would be a sad comment indeed for the law to imply a lesser standard of care in some communities as opposed to others. This is not to say, however, that all physicians possess the same ability and have access to the same resources.  These physicians and localities must recognize their limitations and refer patients, where possible, to experts and to larger medical facilities.”

The court therefore refused to concede that persons living in less urban areas are not entitled to the same level of care as those living in more urban areas. At the same time, while the court acknowledges that not everyone has access to the same facilities or expertise, it emphasized the importance of referring patients to appropriate facilities and providers when it is necessary to do so.  Practitioners can expect that regulators would likely adopt a similar position as well.

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