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In a landmark decision, the British Columbia Court of Appeal dealt with the profound implications of medical malpractice misdiagnosis in the case of Wolber v. Ivanova, 2024 BCCA 203.

This case centered around Elena Ivanova, who underwent an unnecessary mastectomy after being misdiagnosed with breast cancer. The appellate decision brings to light critical issues concerning causation, the standard of care in medical practice, and the assessment of damages.

Background of the Case

Elena Ivanova was mistakenly diagnosed with a rare and aggressive form of breast cancer based on a pathology report prepared by the defendant, Dr. Wolber. Trusting this diagnosis, Ivanova chose to undergo a full mastectomy—a decision that left her with lasting physical and psychological impacts. After the surgery was performed, a biopsied tissue sample was sent for analysis. The pathologist concluded that the tissue sample showed no signs of cancer.

Legal Proceedings

The jury at the trial found Dr. Wolber negligent and initially awarded Ivanova $400,000 in non-pecuniary damages. Dr. Wolber appealed the decision, challenging both the causation findings and the quantum of damages. The appeal was partially allowed, with the Court of Appeal reducing the damages awarded to $250,000.

Discussion on Causation and Damages

The crux of the appeal involved a detailed analysis of causation. The question was whether Ivanova would have opted for less invasive treatment if not for the misdiagnosis. The appellate court upheld the jury’s findings on causation, emphasizing the deference that appellate courts must afford to a jury’s verdict.

The reduction in damages to $250,000 was a significant aspect of this case. The court applied a “comparative approach,” looking at awards in similar cases to determine a range of acceptable awards. It found the initial $400,000 to be disproportionate in the circumstances, but felt that $250,000 was still likely above what would be awarded by a judge alone. In the Court’s view, an amount of $250,000 struck a balance between deferring to the jury’s findings while at the same time avoiding an award that is unreasonable.

Implications for Medical Malpractice Law

This case highlights several key points for both the legal and medical communities:

  • Standard of Care: The responsibilities of healthcare providers in diagnosing and communicating medical conditions are critically high. Any deviation can lead to severe emotional and physical consequences for patients.
  • Causation in Medical Malpractice: Establishing a direct link between medical negligence and the resultant harm is complex but essential for determining liability.
  • Assessment of Damages: Determining appropriate compensation in cases of medical malpractice involves careful consideration of both the physical and psychological damages suffered by the patient.


This content is not intended to provide legal advice or opinion as neither can be given without reference to specific events and situations. © 2021 Nelligan O’Brien Payne LLP.

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