Diagnostic Errors And Medical Malpractice In Maryland

When a person is suffering from a serious disease, timely diagnosis by a medical professional can be critical. An early diagnosis can mean starting treatment when the disease is still in early (and more treatable stages) which can lead to effective medical intervention as opposed to the very serious consequences that result from disease progression over a longer period of time, which can include severe damage to overall health and even death. Many times when a patient visits a medical professional and receives an incorrect diagnosis, the patient or their loved ones may want to initiate some type of legal action against the medical professional responsible for the initial diagnosis. While it is true that there are certain circumstances under which a medical malpractice claim may be brought due to issues with diagnosis, a mere mistake in diagnosis is not sufficient for a claim.

One of the most common causes of medical malpractice in Baltimore are diagnostic errors.

A diagnosis refers to the way medical professionals identify a disease, illness, or medical problems based on signs and symptoms. Improperly diagnosing an illness or condition in a patient can lead to disastrous results. If a doctor acts negligently in diagnosing a patient, thereby causing undue harm and suffering to the patient, the doctor can be held liable, and the patient may be entitled to compensation.

Doctors often rely on differential diagnoses to assess the possibility that one or more diseases may be the cause of the patient’s signs and symptoms.

To come up with differential diagnoses, doctors need to understand the cause of the disease or condition, the mechanism of the disease process, and the consequences of the disease.

Failing to diagnose is the most common lawsuit brought against doctors in the United States. About 1 in 20 adults in the US, or 12 million patients a year, are misdiagnosed. That means that, about 5% of adults are misdiagnosed by their doctors annually. Half of those misdiagnoses have harmful health implications.

Diagnosis Process

There are certain steps doctors and medical professionals must follow to arrive at a diagnosis. These steps are:

Gathering the facts, including the medical history and physical exam findings
Analyzing available data to formulate a hypothesis relating to the cause of the patient’s signs and symptoms
Reaching a differential diagnosis and selecting one or more conditions to pursue based on likelihood and severity

Missed, Failed, and Delayed Diagnoses Resulting In Medical Malpractice

There are different types of failures to diagnose. Common diagnostic errors include:

Missed diagnosis
Failure to diagnosis
Delayed diagnosis
Failure to order proper tests
Failure to refer the patient to a specialist
Failure to follow up with a patient
Failure to review available data including, but not limited to, vital signs, radiographic studies, and laboratory data.

A failure to diagnose means the patient was not diagnosed with a disease or condition, which resulted in delayed treatment or a complete failure to treat. Failure to diagnose can lead to potentially permanent and/or life-threatening complications.

A missed diagnosis means the patient was diagnosed with an illness or condition that is different than the one the patient actually suffered from. A misdiagnosis puts the patient on a treatment path for the wrong illness or condition, resulting in a complete failure to treat or delayed treatment.

A delayed diagnosis means the patient’s doctor failed to timely notice signs and symptoms of a disease or condition. Delayed diagnoses can lead to lifelong injuries particularly when prompt and correct treatment is of the essence.

Not all missed, failed, and delayed diagnoses are caused by negligence. A doctor’s diagnosis must be negligent first and must result in harm to the patient in order to be compensable.

Medical Malpractice And Diagnostic Errors In Baltimore

The consequences of a missed, failed, or delayed diagnosis range from minor to severe.

A failed diagnosis can be the result of:

Having incomplete data
Failure to order or repeat tests and other procedures
Ignoring available data, including test results, radiographic findings, and physical exam findings
Failure to assess and adjust the diagnosis with ongoing treatment
Lack of thoroughness in diagnosing the patient
Incomplete medical knowledge

Steven E. Pegalis, American Law of Medical Malpractice 3d , § 3:12 (2005).

According to a study based on combined results of malpractice lawsuits and autopsy data, the five most common misdiagnosed illnesses are:

Infections
Cancers, or precursors of cancers
Heart attacks
Pulmonary embolism, (a sudden blockage to the one or more arteries in the lungs typically resulting from blood clots)
Cardiovascular diseases, involving plaque buildup in the arteries

TYPES OF DIAGNOSTIC ERRORS

There are several types of diagnostic errors a medical professional could make. These include, but are not limited to:

DELAYED DIAGNOSIS:

In the case of delayed diagnosis, the patient would have suffered harm even if the medical professional had not been involved, but the delay in diagnosis contributed to worse harm. For example, a woman visits her primary care physician complaining of fatigue and other symptoms. She is informed that she is merely under too much stress and should engage in self-care and relaxing techniques, then come in for a follow-up a few months later. This pattern repeats itself for a few months, until the physician finally agrees to run lab work, which reveals that the woman has a malignant tumor on her thyroid. At the point the cancer is discovered, it is much further advanced than when the woman made her first visit complaining of fatigue. The treatment required now is much more extensive and carries a much higher risk than the treatment which could have been performed if the cancer was discovered at the outset.

MISDIAGNOSIS:

In the case of misdiagnosis, a medical professional examines symptoms and identifies the medical cause incorrectly. Misdiagnosis could result in treatment for a condition that the patient isn’t even suffering, while the actual disease remains untreated. Using another example, a man visits his primary care physician complaining of a cough. The doctor inaccurately diagnosis the man with a bacterial infection and prescribes antibiotics, when, in fact, the man was suffering from a viral infection. The antibiotics do nothing, while the viral condition worsens, leading to pneumonia and severe dehydration, which causes the man to collapse and be hospitalized for several days. The inaccurate diagnosis and resulting treatment prevented the patient in this scenario from seeking proper care for his ailment.

MISSED DIAGNOSIS:

A patient is examined and given a clean bill of health, when he or she was actually suffering from an ailment that a physician did not identify.

FAILURE TO DIAGNOSE A RELATED DISEASE:

In this case, the physician accurately diagnoses an illness that the patient is suffering from, but fails to identify a condition that is closely related with the diagnosed illness. For example, diabetic individuals can have issues with kidney function due to the effect diabetes has on the metabolic process. If a doctor accurately diagnosed a patient with diabetes, but failed to diagnose kidney malfunction, despite symptoms, this may be a failure to diagnose a related disease.

FAILURE TO DIAGNOSE AN UNRELATED DISEASE:

In this case, the physician accurately diagnoses an illness that the patient is suffering from, but fails to identify a second condition that is not related to the diagnosed illness. For example, if a patient presents with localized pain in the ankle following a fall while canyoneering, the physician orders x-rays and accurately diagnoses a fracture. However, the patient also has an elevated temperature and is in reality suffering from a staph infection due to contact with the canyon water during the fall. Even though the patient has an elevated temperature (indicative of an infection), the physician does not investigate further and only diagnoses the ankle injury. This could be an instance of failure to diagnose an unrelated disease.

FAILURE TO RECOGNIZE COMPLICATIONS:

This is when a physician makes a correct diagnosis, but does not identify complications which can affect and/or aggravate the illness. For example, an expectant mother in her third trimester visits a physician with symptoms indicating she is suffering from pre-eclampsia. The physician accurately diagnoses her condition, but fails to perform any examination of the fetus (when pre-eclampsia can often lead to complications of the health of the fetus and/or complications during the birthing process). If the fetus did, in fact, suffer harm that went undetected, this could be grounds for a claim that the physician failed to recognize a complication.

WHEN CAN DELAYED DIAGNOSIS AND MISDIAGNOSIS BE MALPRACTICE?

There are thousands of ailments a patient may be suffering from, and many of these present with very similar symptoms. Physicians and other medical professionals are not always correct the very first time in diagnosing a condition. A misdiagnosis does not always mean that medical malpractice was committed. To rise to the level of malpractice, three elements must be met:

1. A PHYSICIAN-PATIENT RELATIONSHIP EXISTED

The American Medical Association defines a physician-patient relationship as existing when “a physician serves a patient’s medical needs, generally by mutual consent between physician and patient (or surrogate). In some instances, the agreement is implied, such as in emergency care or when physicians provide services at the request of the treating physician. In rare instances, treatment without consent may be provided under court order.”

2.THE PHYSICIAN WAS NEGLIGENT

A physician must adhere to a standard of reasonable care when treating a patient. Reasonable care can be thought of as adhering to the accepted standard of care for the particular procedure being performed under the circumstances at hand. For example, if a doctor working in a hospital setting were to intubate a patient using a ballpoint pen, this would probably not adhere to the accepted standard of care for this procedure under the circumstances. However, if an emergency medical technician performed this same action while on a hike 12 miles into the backcountry, this could adhere to the accepted standard of care under the given circumstances. When it comes to determining negligence in diagnosis, the “differential diagnosis” method employed by the physician will be examined. Differential diagnosis is the systematic method a physician utilizes to identify a particular medical condition. The doctor will perform a preliminary evaluation, which can include testing and/or observations. The doctor will then generate a list of diagnoses in order of probability. Next, the doctor will test each potential diagnosis by questioning the patient, making further observations, performing certain tests, or referring the patient to a physician who specializes in the diagnosis. This method should rule out all conditions the patient does not suffer from, leaving only the one correct diagnosis. For malpractice to have occurred, it must be proven that a doctor of a similar standing (this can include specialty and experience level), under similar circumstances, would not have misdiagnosed the patient’s illness. This generally means a patient must demonstrate a) The physician did not include the correct diagnosis on the differential diagnosis list, while a reasonably competent physician under similar circumstances would have b) The physician did include the correct diagnosis on the differential diagnosis list, but failed to perform the appropriate tests Another possibility for negligence comes not only from the list of potential diagnoses, but from the way in which testing is performed. Testing could yield inaccurate results if there are issues with either the equipment itself or the medical professionals involved in performing and interpreting the results. Again, for a successful malpractice claim, it must be demonstrated that any error involved in testing was the result of failure to adhere to accepted standard for the particular testing procedure (and thus negligence was the root cause).

3. THE PATIENT SUFFERED HARM

Finally, the patient must have suffered some type of harm as the result of a diagnostic error. It must be demonstrated that due to the diagnosis in question, the patient’s illness progressed to a point beyond where it would have had the patient been given a timely, correct diagnosis and that this progression had a negative effect on treatment. Imagine again a patient with cancer. If this patient visits her primary care physician complaining of a nagging cough and is diagnosed with a viral infection when the true cause is stage 1 lung cancer. This patient receives the wrong diagnosis multiple times from her primary care physician (and no referral to a specialist) until 6 months later, when tests are finally ordered which reveal cancer. If there is no progression and the treatment would have the same outlook as the very first day the woman visited her primary care physician, the woman probably did not suffer harm that would suffice in order to sustain a successful malpractice claim. However, if 6 months later the cancer has progressed and spread to other areas, requiring much more aggressive treatment with a very different prognosis, there is a good likelihood that the patient can demonstrate she suffered harm due to the delayed diagnosis.

Malpractice Due to Misdiagnosis, Failure to Diagnose, or Delayed Diagnosis

Determining whether or not a diagnostic error was malpractice can be incredibly complicated. If you are unsure if a diagnostic error was made during the course of your treatment, you should seek out the advice of an experienced medical malpractice attorney. At Gilman & Bedigian, we work closely with our staff physician to investigate potential diagnostic errors. We know the devastating effects that such errors can have on individuals and their families and we are dedicated to advocating for compensation that allows you and your family to heal and move forward.