When ERs fail to act quickly

“ER Malpractice: Failure to act quickly”

An “Emergency Room” (“ER”) is supposed to be for emergencies. Unfortunately, there are times when people in genuine need of emergency care for dire conditions get put “to the back of the line” and suffer injury or even death.

Many ER cases arise when the ER fails to fulfill their basic function to prioritize true emergencies.

The first job in an ER is called “Triage.” Triage is typically done by a trained nurse, who makes an initial assessment of the patient. Triage is supposed to identify which patients need to be seen right away, or within a short time, and which can wait longer. This is one place where the proper prioritization of care can break down, and cases may be brought against a hospital for improper triage.

Once called in for treatment, a patient is often seen initially by a student-doctor or “Resident” (as opposed to a fully-trained “Attending”). Initial assessment is another point where patient care is affected. Most Residents are trained and competent. But some have been poorly-trained or stretched too thin by the staffing decisions of the hospital. Many cases arise when a Resident fails to recognize medical urgency –or when a Resident even starts the wrong treatment.

An Attending (fully-trained doctor) should see the patient within a time appropriate to their condition. This should generally be a physician specially trained in Emergency Medicine, or from a field that relates to the specific condition (such as a Neurologist for suspected stroke). Some cases are considered so urgent by-definition (such as heart attack or stroke) that an Attending evaluation should occur within a few minutes of patient arrival to the ER. [1]

Improper Discharge from the ER

Some patients may adequately be “discharged” in a few hours when stable. For example, an asthmatic is successfully stabilized, or a cut is sutured, and the patient given an appointment to follow up as an outpatient.

But in other times, the patient requires admission. Discharging a patient requiring admission may be considered “negligent discharge.” [2]

In other situations, a proper discharge cannot be made until tests verify that the patient is stable. This may include blood tests that can be performed “Stat” in the Emergency Department or imaging studies such as X-ray or CT-scan.

In other cases, a patient cannot safely be discharged until cleared by “Consult” with a suitable specialist.

For pregnant patients, a recurring malpractice situation is the hospital, or Obstetrician, improperly deciding that a woman beginning labor may be discharged to home to continue labor—though a proper evaluation may indicate the need to admit for closer observation or even to expedite delivery.

Other ER malpractice may occur in potential surgical emergencies. For example, some types of nerve compression must be “decompressed” within a 24 hour period to avoid loss of function. [3] We have handled other surgical emergency cases such as bowel obstruction, that requires urgent surgical care to avoid permanent loss of digestive function.

If the care was improper, we know how to prove it in Court.

[1] See, “Mission Lifeline” (American Heart Association, 2021, www.heart.org).
[2] Patients are legally entitled to receive needed care in an ER, regardless of ability to pay, under New York State law as well as federal statute known as “EMTALA” (Emergency Medical Treatment and Labor Act).
[3] A recurring situation is known as “cauda equina” which involves a type of compression injury to the lower back. Also, a “neurogenic bladder” (nerve dysfunction of the bladder) may require urgent urology treatment, to avoid loss of bladder function.