When you go to an emergency room with serious or unexplained symptoms, you depend on doctors and other healthcare providers to determine what is wrong and respond appropriately. Emergency medicine often requires physicians to make important decisions quickly, including deciding which laboratory tests, imaging studies, and other diagnostic procedures are necessary.
But what happens when an emergency room doctor fails to order a test that could have revealed a dangerous medical condition?
In some cases, failure to order appropriate diagnostic testing may constitute emergency room malpractice in Florida. If the failure causes a serious diagnosis to be missed or delayed—and that delay results in additional injury, disability, or death—the patient or surviving family members may have grounds for a medical malpractice claim.
What Is ER Malpractice for Failure to Order Proper Testing?
Emergency room physicians are not required to order every conceivable diagnostic test for every patient. Medicine involves judgment, and a bad outcome does not automatically mean malpractice occurred.
The legal issue generally becomes whether the emergency healthcare providers acted consistently with the applicable standard of care under the circumstances.
When a patient's symptoms, medical history, physical examination, vital signs, or other findings reasonably call for additional testing, failing to order that testing may represent a departure from the standard of care.
For example, depending on the circumstances, an ER malpractice case could involve a failure to order:
- CT scans;
- MRI studies;
- X-rays;
- ultrasounds;
- electrocardiograms (EKGs or ECGs);
- cardiac enzyme or troponin testing;
- blood cultures;
- complete blood counts;
- metabolic panels;
- coagulation studies;
- urinalysis;
- pregnancy testing;
- toxicology testing;
- vascular imaging; or
- other laboratory or diagnostic studies indicated by the patient's presentation.
The particular test that should have been ordered depends on the patient's symptoms and the circumstances existing at the time.
Why Diagnostic Testing Is So Important in the Emergency Room
Many medical emergencies do not present with obvious symptoms. A patient may arrive complaining of dizziness, abdominal pain, chest discomfort, weakness, shortness of breath, headache, confusion, or another symptom that could have several possible causes.
Diagnostic testing helps emergency physicians distinguish relatively minor conditions from potentially life-threatening emergencies.
A physician may need to consider multiple diagnoses and determine which dangerous conditions must be ruled out before sending the patient home. When necessary testing is not performed, a serious disease or injury may remain undetected until the patient's condition becomes significantly worse.
In emergency medicine, that lost time can matter.
Examples of Conditions That May Be Missed When ER Testing Is Inadequate
Stroke
Patients experiencing a stroke may present with weakness, numbness, difficulty speaking, confusion, dizziness, balance problems, vision changes, or severe headache.
Depending on the presentation, appropriate evaluation may include brain imaging and other diagnostic studies. A failure to timely investigate symptoms consistent with a stroke can delay treatment and potentially contribute to permanent neurological injury.
Heart Attack
Not every heart attack produces dramatic crushing chest pain. Some patients experience shortness of breath, nausea, fatigue, sweating, back or jaw pain, or relatively mild chest discomfort.
Depending on the circumstances, an appropriate cardiac evaluation may require an EKG, serial troponin testing, monitoring, imaging, or additional testing.
Sending a patient home without adequately investigating potential cardiac symptoms can have devastating consequences.
Pulmonary Embolism
A pulmonary embolism occurs when a blood clot travels to the lungs. Symptoms may include shortness of breath, chest pain, rapid heartbeat, dizziness, or fainting.
Depending on the patient's symptoms and risk factors, additional testing may be necessary to evaluate the possibility of a blood clot. Missing a pulmonary embolism can result in severe complications or death.
Aortic Dissection
An aortic dissection is a medical emergency involving a tear within the wall of the aorta. Symptoms may sometimes resemble those of a heart attack or other conditions.
If the patient's symptoms and clinical findings suggest a possible aortic emergency, appropriate diagnostic imaging can be critical.
Appendicitis
Abdominal pain is one of the most common reasons people visit emergency departments. Although many causes of abdominal pain are relatively minor, others require urgent treatment.
Failure to appropriately evaluate abdominal pain may result in missed appendicitis, potentially allowing the appendix to rupture and causing serious infection or other complications.
Internal Bleeding
Internal bleeding can occur following trauma or as the result of other medical conditions. Depending on the patient's presentation, imaging, blood testing, observation, or repeated examinations may be necessary.
A patient who is discharged despite signs of internal bleeding may deteriorate rapidly.
Sepsis
Sepsis is a potentially life-threatening response to infection. Fever, abnormal vital signs, confusion, weakness, rapid breathing, and other findings may warrant further investigation.
Failure to order appropriate laboratory studies, cultures, imaging, or other testing can contribute to delayed recognition and treatment of infection and sepsis.
Ectopic Pregnancy
An ectopic pregnancy can become life-threatening if it ruptures and causes internal bleeding.
In a patient of childbearing age presenting with certain symptoms, pregnancy testing, ultrasound, laboratory testing, or other evaluation may be appropriate depending on the circumstances.
When Does Failure to Order a Test Become Medical Malpractice?
The fact that a doctor did not order a particular test does not, by itself, establish malpractice.
A Florida medical malpractice claim generally requires evidence establishing that the healthcare provider breached the applicable standard of care and that the breach caused injury.
In a failure-to-test case, several important questions may include:
- What symptoms did the patient report?
- What were the patient's vital signs and examination findings?
- What diagnoses should reasonably have been considered?
- What testing should have been ordered under the circumstances?
- Would the omitted test probably have identified the condition earlier?
- Would earlier diagnosis have changed the treatment available to the patient?
- Did the diagnostic delay cause or substantially contribute to additional injury or death?
Medical expert review is typically critical to answering these questions.
Failure to Consider the Differential Diagnosis
One important issue in emergency room malpractice cases is the physician's differential diagnosis.
A differential diagnosis is essentially the process of considering reasonable potential explanations for a patient's symptoms and determining which possibilities should be investigated or ruled out.
Suppose a patient presents with symptoms that could indicate either a relatively benign condition or a dangerous medical emergency. The physician may be required to consider the more serious diagnosis and determine whether testing is necessary to reasonably exclude it.
A malpractice claim may arise when a dangerous diagnosis should have been considered but was not appropriately investigated.
Abnormal Test Results Can Also Require Additional Testing
ER malpractice involving diagnostic testing does not always involve a complete failure to order tests.
Sometimes an initial test is performed, but the results should prompt additional testing or evaluation.
For example, laboratory abnormalities, questionable imaging findings, abnormal vital signs, or an inconclusive initial study may require further investigation.
Potential negligence may therefore involve:
- failing to follow up on abnormal laboratory results;
- failing to order additional imaging;
- failing to repeat testing when clinically appropriate;
- failing to obtain a specialist consultation;
- failing to monitor a patient long enough;
- misinterpreting diagnostic results; or
- discharging a patient despite unresolved warning signs.
Can the Hospital Be Liable for Failure to Order Proper Testing?
Potential liability depends on the facts of the case and the relationship between the healthcare providers and hospital.
A claim may potentially involve an emergency physician, nurse, radiologist, specialist, hospital, medical group, or other healthcare provider or entity.
Hospital liability can involve complicated issues concerning employment relationships, agency, hospital policies, staffing, communication systems, and institutional responsibilities.
Determining who may be legally responsible requires careful investigation of how the patient's emergency room care was provided.
What If the ER Doctor Ordered a Test but Misread the Results?
Failure-to-diagnose cases may involve more than one medical error.
An ER physician might order an appropriate study but fail to recognize an abnormal finding. A radiologist may allegedly misinterpret an imaging study. A critical laboratory result might not be communicated promptly. Or an abnormal result might be documented without appropriate follow-up.
These cases require examining the entire diagnostic process—not simply whether a test was ordered.
What If the Patient Was Discharged From the ER Too Soon?
Premature discharge can be another important issue.
Emergency departments routinely discharge patients whose conditions do not require hospitalization. But discharge may be inappropriate when serious symptoms remain unexplained or when additional testing, observation, consultation, or treatment is reasonably necessary.
A patient who is discharged may later experience a dramatic deterioration and return to the hospital with a much more advanced condition.
In these cases, the investigation may focus on what the medical team knew—or reasonably should have known—before discharge.
Proving That the Missing Test Would Have Made a Difference
One of the most important—and often most contested—issues in an ER malpractice case is causation.
It is generally not enough to establish that additional testing should have been performed. The patient must also establish the required causal connection between the alleged negligence and the resulting injury.
Consider a patient who should have received diagnostic imaging at 10:00 a.m. but did not receive it until many hours later.
The investigation may need to determine:
- what the earlier test likely would have shown;
- whether it would have resulted in an earlier diagnosis;
- what treatment would have been available at that time;
- whether earlier treatment probably would have produced a better outcome; and
- what additional harm resulted from the delay.
These issues frequently require testimony from qualified medical experts in the appropriate specialties.
Evidence in an ER Failure-to-Test Malpractice Case
A detailed investigation may involve reviewing evidence such as:
- emergency department records;
- triage documentation;
- nursing notes;
- physician notes;
- vital-sign records;
- medication administration records;
- laboratory results;
- radiology reports and actual imaging studies;
- EKGs;
- consultation records;
- discharge instructions;
- ambulance and EMS records;
- records from subsequent hospitalizations;
- electronic medical record timestamps; and
- hospital policies and procedures when relevant.
The timeline can be especially important. Electronic records may help establish when symptoms were documented, when tests were ordered, when results became available, when physicians reviewed those results, and when the patient was discharged or admitted.
Medical Experts in Florida ER Malpractice Cases
Medical malpractice claims generally require qualified medical experts to evaluate whether the care complied with the applicable standard of care and whether any departure caused the patient's injuries.
Depending on the allegations, experts might include specialists in:
- emergency medicine;
- radiology;
- neurology;
- cardiology;
- surgery;
- infectious disease;
- critical care medicine; or
- another relevant specialty.
The appropriate experts depend on the condition that was allegedly missed and the medical providers involved.
What Damages May Be Recoverable?
When ER malpractice causes additional injury, a patient may potentially seek compensation for legally recoverable damages, depending on the circumstances.
These can include damages associated with additional medical treatment, lost income, diminished earning capacity, disability, pain and suffering, and other losses recognized under Florida law.
When the failure to diagnose and treat a medical emergency results in death, eligible survivors and the estate may potentially have claims under Florida's wrongful death laws.
The damages available depend heavily on the individual facts of the case.
How Long Do You Have to File an ER Malpractice Lawsuit in Florida?
Florida medical malpractice claims are governed by specific statutes of limitation and repose, and medical negligence claims generally involve mandatory presuit procedures before a lawsuit can proceed.
Determining the applicable deadline can be complicated because it may depend on when the incident occurred, when the injury was discovered or reasonably should have been discovered, the identity of the potential defendants, and other circumstances.
Do not assume that you have a particular amount of time based on a general rule found online. If you suspect emergency room malpractice, having the case evaluated promptly can help preserve evidence and protect potential legal rights.
What Should You Do If You Believe an ER Failed to Order Necessary Testing?
If you or a family member suffered serious harm after an emergency room visit, obtaining the complete medical record can be an important first step.
It can also be useful to preserve discharge paperwork, test results, photographs, medication information, subsequent hospital records, and a chronology of what happened.
Most importantly, potential medical malpractice cases should be evaluated based on the actual medical evidence. A qualified attorney can review the circumstances and determine whether the case warrants evaluation by appropriate medical experts.
Frequently Asked Questions About ER Malpractice and Diagnostic Testing
Can I sue an ER doctor for not ordering a CT scan?
Potentially. The question is not simply whether a CT scan was omitted. The issue is whether the applicable standard of care required the test under the circumstances and whether the failure to perform it caused legally compensable harm.
Is a missed diagnosis automatically medical malpractice?
No. Doctors can sometimes miss a diagnosis despite providing appropriate care. A malpractice claim generally requires proof of a departure from the applicable standard of care and resulting injury.
Can I have a case if the ER sent me home and I was hospitalized the next day?
Possibly. A subsequent hospitalization does not automatically prove malpractice, but it may warrant investigation—particularly if serious symptoms or abnormal findings were present during the initial ER visit.
What if the correct diagnosis was eventually made?
A later diagnosis does not necessarily eliminate a malpractice claim. The key issue may be whether the delay caused additional harm that probably could have been avoided with timely diagnosis and treatment.
Can a hospital be responsible for an ER doctor's mistake?
Potentially, depending on the circumstances. Hospital liability can involve employment, agency, institutional negligence, policies, staffing, and other legal and factual considerations.
Speak With a Florida Emergency Room Malpractice Lawyer
When emergency room doctors fail to order appropriate diagnostic testing, serious medical conditions can go undetected until valuable treatment opportunities have been lost.
At J.P. Gonzalez-Sirgo, P.A., we represent individuals and families in Florida medical malpractice claims involving allegations of delayed diagnosis, failure to diagnose, inadequate diagnostic testing, hospital negligence, and other serious medical errors.
If you believe an emergency room failed to properly investigate symptoms and that failure resulted in serious injury or the death of a loved one, contact J.P. Gonzalez-Sirgo, P.A. to discuss your potential claim.
Call today for a free and confidential consultation.
Have you or someone you know been injured as a result of medical malpractice? Contact Florida Hospital and Medical Malpractice Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Miami Attorney Gonzalez-Sirgo directly at jp@yourattorneys.com or by text at (305) 929-8935.
This article is for informational purposes only and does not constitute legal advice.
