What are the Key Legal Elements of a Misdiagnosis Claim?
When a doctor fails to diagnose a serious medical condition – or diagnoses it too late – the consequences can be devastating. A patient may miss a critical window for treatment, suffer complications or face a much worse outcome than might otherwise have occurred. But does a missed or incorrect diagnosis automatically mean medical malpractice? Not necessarily.
Misdiagnosis cases can be complex, and a poor medical outcome alone does not establish negligence, as reported by Justia. To have a potential malpractice claim, there generally must be evidence that a healthcare provider failed to meet the accepted standard of care and that this failure caused harm. Here’s what you need to know.
What Is Misdiagnosis?
Misdiagnosis is more than simply getting a diagnosis wrong. In a medical malpractice case, the issue is generally whether a healthcare provider failed to accurately diagnose a patient's condition in a timely manner when another reasonably competent provider would have done so under similar circumstances. A misdiagnosis may take several forms:
- Incorrect diagnosis: The patient is diagnosed with the wrong condition and receives treatment for an illness they do not have.
- Delayed diagnosis: The correct diagnosis is made, but not soon enough to provide timely treatment, potentially affecting the patient's outcome.
- Failure to diagnose: The provider fails to recognize the patient's condition altogether.
- Failure to recognize complications: A primary condition may be diagnosed, but a related complication or worsening of the condition is overlooked.
Some medical conditions are particularly concerning when diagnosis is delayed because treatment may be highly time sensitive. These can include cancer, heart attacks, strokes, serious infections, appendicitis and pulmonary embolisms.
When Does Misdiagnosis Become Medical Malpractice?
Not every diagnostic error is malpractice. Medicine is not always straightforward, and some conditions can be difficult to diagnose, particularly when symptoms are vague or overlap with other illnesses. For a misdiagnosis claim to succeed, several key elements generally must be established:
1. Duty of Care
There must have been a formal healthcare provider-patient relationship. In other words, the provider must have had a responsibility to provide medical care to the patient.
2. Breach of Duty
The provider must have failed to meet the accepted standard of care, the level of care that a reasonably competent provider would have provided under similar circumstances. For example, a breach might involve:
- Failing to order appropriate diagnostic tests
- Misinterpreting or overlooking test results
- Failing to consider the patient's medical history and symptoms
- Failing to recognize warning signs
- Failing to follow up on an abnormal test result
- Failing to refer the patient to an appropriate specialist when necessary
Whether a provider actually breached the standard of care is often a matter that requires review by medical experts.
3. Causation
It isn't enough to show that a provider made a mistake. There must also be a connection between the alleged negligence and the harm the patient suffered. In other words, the question is whether the delayed, missed or incorrect diagnosis caused harm that might have been avoided with appropriate care.
In some cases, a patient may argue that the misdiagnosis reduced their opportunity for a better outcome. This is sometimes referred to as a “lost chance” theory, although the rules surrounding these claims vary by jurisdiction.
4. Damages
The patient must have suffered actual harm. Depending on the circumstances, damages may include:
Economic damages, such as:
- Additional medical expenses
- Costs of future medical care
- Lost wages or reduced earning capacity
- Other financial losses related to the injury
Non-economic damages, such as:
- Pain and suffering
- Emotional distress
- Loss of enjoyment of life
- Other effects of the injury on the patient's quality of life
How Might a Healthcare Provider Defend a Misdiagnosis Claim?
Healthcare providers and their insurers may raise a number of defenses in a malpractice case. For example, they may argue that:
- There was no negligence. The provider may contend that the diagnosis was difficult or that the care provided met the accepted standard of care based on the patient's symptoms and circumstances at the time.
- The misdiagnosis did not cause the harm. A provider may argue that the patient's condition was already too advanced or serious for treatment to have changed the ultimate outcome.
- The patient contributed to the outcome. Depending on the circumstances and applicable state law, the defense may argue that the patient contributed to the delay or missed diagnosis – for example, by failing to provide important medical information, missing appointments or not following medical advice.
Determining whether these defenses apply requires looking closely at the facts and medical records of each individual case.
How Long Do You Have to File a Misdiagnosis Claim?
If you believe you or a loved one may have been the victim of a misdiagnosis, it is important not to wait too long to seek legal advice. Every state has a statute of limitations, which establishes a deadline for filing certain types of lawsuits. In Pennsylvania, the general statute of limitations for medical malpractice is two years from the date of the negligent act or from when the injury was discovered. Because there may be complicating factors on how these deadlines can be interpreted, speaking with an attorney as soon as possible can help you understand whether you may still have a claim.
If you suspect that you or a loved one may have been the victim of a medical mistake at a Philadelphia hospital or doctor's office, contact a top attorney for Philadelphia misdiagnosis lawsuits. In the last few years, almost every teaching hospital in the city of Philadelphia has paid 8-figure verdicts and settlements to clients of Tom Duffy.