Michael Hodgins on CES, court standards and Bogoroch & Associates’ spinal cord injury work
Across Canada, delayed or missed diagnosis of Cauda Equina Syndrome (CES) is one of the most frequent and high-stakes medical-malpractice scenarios in spinal care. If not diagnosed and treated expediently, patients may face life-altering impairments.
“Cauda equina syndrome is a medical emergency where timing and recognition are critical,” says Michael Hodgins, associate at Bogoroch & Associates LLP. “Courts in Canada are clear: when red-flag symptoms appear, healthcare providers must act promptly. Where that doesn’t happen, courts may find providers breached the standard of care.”
Canadian courts clear on standard of care in diagnosing CES
Canadian courts have repeatedly emphasised the need for swift action on the part of healthcare providers. In one key decision, Williams v. Rosenstock, an Alberta Court found an emergency physician breached the standard of care by failing to properly assess and diagnose CES in a timely manner when the patient was experiencing severe low back and abdominal pain, leg pain, and urinary urgency/frequency.
“The court held that the decision to discharge the patient was not responsive to the risk, given the red-flag nature of her symptoms,” Hodgins says, adding that the court in another CES case, Chrysostom v. Kempenaar, made a similar finding.
In Chrysostom, the Ontario Superior Court found two emergency physicians breached the standard of care for failing to ask the patient about saddle area numbness when she presented with some other red-flag symptoms. Because the patient had reported saddle numbness to the triage nurse, Hodgins explains, it was reasonable to assume she would have told the ER physicians about this symptom if she was asked.
“In both cases, the court found that if CES had been appropriately suspected, emergency imaging would have been ordered and follow up with an orthopaedic or neurosurgeon would have occurred,” Hodgins says.
Overall, the caselaw is clear. Providers must ask direct questions about saddle-area numbness and bladder/bowel dysfunction when patients report back pain plus leg symptoms. When red-flag features are present, they must order urgent MRI and escalate rapidly to avoid permanent damage, and pre-existing spinal conditions do not remove the duty to act swiftly on new or worsening symptoms. Finally, causation must clearly be established, with plaintiffs showing earlier intervention more likely than not would have improved their outcome.
Patients who suffer spinal cord injuries can recover non-pecuniary damages as well as compensation for past and future economic loss, including lost wages, the cost of future therapies, and housekeeping. Close loved ones can claim damages as well, which include the loss of the care, guidance, and companionship of the injured person, and the value of services they now must provide.
Bogoroch & Associates secure multi million-dollar settlement in spinal cord injury case
Bogoroch & Associates knows well what underpins a successful case when it comes to a delayed or missed CES diagnosis. In May 2025, the firm secured a multi-million settlement for a client left permanently disabled by a catastrophic surgical error.
A former executive at the peak of his career, the client’s nerve roots were transected during spinal surgery, causing him to lose the ability to work and require lifelong care.
“Multidisciplinary expert evidence confirmed the profound, irreversible impact on his physical, psychological, and professional life,” Hodgins explains. “The settlement provided excellent compensation for the loss of his independence, career trajectory, and quality of life, reflecting the devastating scale of the harm he suffered.”
Bogoroch & Associates’ work in catastrophic spinal cord injury cases reflects a practice built to handle the most challenging medical malpractice and personal injury claims from intake through to settlement or trial. The firm’s approach combines rigorous economic and medical analysis with the kind of meticulous advocacy that ensures even the most complex cases are advanced to their full potential.
“Experienced medical malpractice lawyers should explore every avenue and ensure that any compensation fairly reflects the loss in light of the established legal principles of what can be recovered,” Hodgins sums up. “At the firm, we remain steadfast in our commitment to our clients and their families, and to holding the healthcare system to account so that those whose lives have been upended by spinal cord injury have the resources and support they need to move forward.”
This article was produced in partnership with Bogoroch & Associates LLP
