Of ED malpractice claims that closed during a 10-year period, 42% involved diagnosis, according to CNA’s Hospital Professional Liability Claim Report 2015. CNA is a Chicago-based provider of professional liability insurance. (The full report is available at www.cna.com/healthcare.)
“Examples of allegations related to diagnosis include delay in establishing a diagnosis, failure to or delay in obtaining or addressing diagnostic test results, and failure to diagnose and misdiagnosis,” says Joyce Benton, CNA’s assistant vice president for risk control. Here are some actual cases, all of which settled for $1 million:
-
A patient was evaluated in the ED three separate times and discharged home after complaints of progressive back pain. Later, at another facility, she was diagnosed with a spinal epidural abscess and underwent surgical intervention. “The ultimate, and unfortunate, outcome was paraplegia,” Benton says.
-
The emergency physician (EP) did not appropriately follow-up with a patient after receiving a CT scan report. “The delay in diagnosis resulted in a worse prognosis, and the patient required additional surgery and chemotherapy,” she says.
-
A patient experienced bleeding following thyroglossal tumor surgery. She was evaluated in the ED by a mid-level provider, who discharged her home with pain medicine. “Shortly afterward, she returned to the ED in respiratory distress, was resuscitated, and taken to surgery for control of active bleeding,” Benton says. “The patient sustained significant brain injury.”
-
A patient presented to the ED with complaints of respiratory distress and heaviness in his arms. Following a chest X-ray, the patient was incorrectly diagnosed with pneumonia and discharged home. “The patient returned to the ED a few hours later in cardiac arrest and died,” Benton says.
The ED was one of the top three locations in regard to frequency, and was one of the top five in regard to average total paid claims by location. The top five average total paid claims by clinical service, in order, were perinatal, behavioral health, surgery, medicine, and emergency medicine.
“We were surprised that claims occurring in the ED were not one of the top three locations in regard to average total paid for closed claims by location,” Benton says. Here are other findings:
-
The data set of 107 closed claims involving the ED had an average total payment of $276,879 by location. The closed claims were paid by CNA on behalf of organizations with professional liability coverage insured through the primary hospital program. Indemnity and expense payments included only monies paid by CNA on behalf of its insureds, Benton says.
“Self-insured retentions and other possible sources of payment for other parties, such as noninsured physicians, in response to a claim cannot be determined, and therefore, are not included in this report,” she says.
-
ED claims range considerably in terms of severity, with many claims having a paid indemnity less than $100,000.
-
At the opposite end of the spectrum, six of the 20 $1 million paid indemnity claims involved the ED.
-
Assessment and monitoring-related allegations included failure to properly or fully complete a patient assessment, failure to assess the patient’s concerns or symptoms, delayed or untimely patient assessment, failure to monitor patients who are identified as an elopement risk, failure to monitor and address vital signs, and failure to monitor per order or protocol.
“These allegations have the highest average severity,” Benton says. In one such case, a patient was evaluated in the ED and determined to meet the criteria for involuntary commitment.
“While waiting for admission, she eloped and could not be found. Soon after, she was struck by a car and sustained fatal injuries,” Benton says.
