Misdiagnosis and Failure to Diagnose

Failure to diagnose and misdiagnosis of an illness or injury are the basis of many medical malpractice lawsuits. Misdiagnosis on its own is not necessarily medical malpractice, and not all diagnostic errors give rise to a successful lawsuit. Even highly experienced and competent doctors make diagnostic errors. Instead, the misdiagnosis or failure to diagnose must result in improper medical care, delayed treatment, or no treatment, which in turn must result in a worsening of the patient's medical condition in order for the malpractice to be actionable.

A misdiagnosis case may involve a wrong diagnosis, a missed diagnosis, a delayed diagnosis, or a failure to recognize complications that change or aggravate an existing condition. Sometimes a doctor diagnoses one condition correctly but misdiagnoses another condition or fails to realize that there is a second diagnosis that needs to be made.

What Does a Plaintiff Need to Prove in a Failure to Diagnose Case?

A patient bringing a failure to misdiagnose case must prove that there was a doctor-patient relationship, that the doctor failed to live up to the standard of care in diagnosing the patient's condition, and that the doctor's failure to diagnose or misdiagnosis actually and proximately caused an actual injury. Most often, failure to diagnose cases involve disputes related to the applicable standard of care and whether the doctor's failure to diagnose caused the plaintiff's injury.

Whether the doctor lived up to the standard of care will likely require an expert opinion. One of the issues the expert will examine is the defendant doctor's differential diagnosis method. When trying to diagnose a patient, a doctor makes a list of diagnoses in order of probability and tests them by asking the patient questions, making further observations of the patient, or ordering tests. The goal is to rule out diagnoses until there is only one diagnosis remaining. However, in many instances, a doctor learns more information that requires him or her to supplement the list with other potential diagnoses.

A patient trying to prove misdiagnosis must show that a doctor in the same or similar specialty would not have misdiagnosed the illness or injury. The plaintiff will have to show that the doctor did not include the correct diagnosis on the list and that a competent doctor would have included it. Alternatively, the plaintiff must show that the doctor listed the correct diagnosis but did not perform the right tests to arrive at the correct diagnosis by the end of the differential diagnosis method.

Another reason that misdiagnosis happens is a faulty lab result or test. Errors in test results can happen because of flawed equipment or human error. In some cases, a technician who administers the test inappropriately, or a secondary doctor who misreads a scan, resulting in a doctor making an incorrect diagnosis, can be held liable. If the hospital staff makes a mistake, the hospital can be held directly liable.

Causation can be the most challenging element for plaintiffs to prove in a failure to diagnose cases. A plaintiff must prove that the misdiagnosis caused the injury to worsen more than it would have had a correct diagnosis been made. This means, for example, that a plaintiff will need to show that a delayed cancer diagnosis resulted in the patient's wrongful death, whereas the patient would have lived longer if it had been caught at the right time by the defendant.

Misdiagnosis in a hospital emergency room can be caused by the pressure and reduced time available to look into various differential diagnoses. Unusual illnesses or illnesses that are distinctive to a particular population are more likely to be missed. For example, a homeless person who comes to the emergency room asking for pain medication may be taken less seriously than an ordinary person who comes in wearing clean clothes and complaining of stomach pains. This may result in a missed diagnosis of appendicitis regarding the homeless person.

In most states, first responders in a medical emergency situation (such as an EMT or a firefighter) are protected from lawsuits unless the first responder does something reckless or intentional. This protection for first responders does not apply to emergency rooms in hospitals, although in some states an emergency room doctor must act with gross negligence to be held liable for harm that occurs before the patient is stabilized.

Many doctors are not employees of the hospital, and in general a hospital cannot be held vicariously liable for a non-employee's negligence. However, when a patient goes to the emergency room, the hospital cannot tell the patient what a doctor's employment status is. Therefore, hospitals may be held liable for an emergency room doctor's medical malpractice.