When Does Misdiagnosis Qualify as a Malpractice Case?

When does misdiagnosis qualify as malpractice? When a doctor's diagnosis is wrong and causes harm.

Medical misdiagnoses are more prevalent than you might imagine, and they can lead to serious injuries or even fatalities. Researchers at Johns Hopkins estimate that diagnostic errors cause between 80,000 and 160,000 deaths each year in the United States, making them the primary cause of medical malpractice claims. If you or a loved one has suffered harm due to a misdiagnosis, it’s crucial to understand when such cases may qualify as medical malpractice. The experienced medical malpractice lawyers at Raynes & Lawn in Philadelphia are here to guide you through your rights and legal options in such situations. Let’s explore the nuances of misdiagnosis and when it may rise to the level of medical malpractice.

What is a Misdiagnosis?

The term misdiagnosis encompasses various diagnostic errors, including:


Misdiagnosis is a grave medical error, one that often has dire consequences for the patient. This occurs when a healthcare provider incorrectly diagnoses a patient with a medical condition they do not have. For instance, a patient may be mistakenly diagnosed with acid reflux when they are actually experiencing a heart attack. Such errors can have severe consequences, as the patient may receive the wrong treatment or none at all, potentially resulting in death.

Failure to Diagnose

Failure to diagnose is another critical facet of medical malpractice. It ensues when a medical practitioner does not identify an existing condition within a patient. This lapse can occur due to a variety of factors, such as insufficient examination or a misinterpretation of the patient’s symptoms. This situation is compounded when a patient exhibits clear and apparent symptoms of a medical condition, yet no diagnosis is rendered. Consequently, patients are left without the knowledge of their ailment, deprived of appropriate treatment, and susceptible to the progression of their condition.

To illustrate, contemplate a case in which a patient presents with unmistakable symptoms indicative of a severe medical condition, such as ovarian cancer. Despite these obvious signs, the healthcare provider fails to accurately diagnose the ailment, erroneously assuring the patient of their good health but may need a change of diet to combat their bloating. This misstep can have severe consequences, as the patient is denied timely intervention, allowing the condition to worsen over time.

Delayed Diagnosis

A delayed diagnosis occurs when a healthcare provider finally diagnoses a condition, but it comes too late for effective treatment. For example, if a doctor mistakenly identifies a tumor as benign, the patient may go months without appropriate treatment. By the time the cancer is correctly diagnosed, it may have progressed to a stage where it cannot be treated successfully.

The Prevalence of Misdiagnoses in Healthcare

Recent research conducted by the Johns Hopkins University School of Medicine and CRICO Strategies has shed light on the extent of misdiagnosis-related malpractice cases. The study, which analyzed over 55,000 malpractice claims from CRICO Strategies’ CBS database (Comparative Benchmarking System), revealed a troubling reality. It found that a staggering one-third (34%) of malpractice cases resulting in death or permanent disability could be attributed to inaccurate or delayed diagnoses, making misdiagnosis the primary cause of serious harm among medical errors.

Additionally, the study found that an astounding 74% of diagnostic errors causing severe harm were associated with three categories of conditions: cancer (37.8%), vascular events (22.8%), and infection (13.5%). The cumulative malpractice payouts for severe misdiagnoses lawsuits in the three aforementioned categories amounted to $1.8 billion over a decade.

Many misdiagnoses happen in a moment of uncertainty. Misdiagnoses are particularly prevalent in emergency departments, where healthcare professionals often face significant time constraints and high-pressure situations. The urgency of the emergency department can lead to hurried assessments and, consequently, diagnostic errors. Certain populations and less common conditions may be at higher risk of misdiagnosis in these settings. For instance, young women experiencing heart attacks may face a higher risk of misdiagnosis compared to older men with similar symptoms.

Commonly Misdiagnosed Conditions

Several medical conditions are frequently misdiagnosed, particularly by family practice doctors. These conditions include:

  • Breast Cancer
  • Heart Attack
  • Colon Cancer
  • Appendicitis
  • Lung Cancer
  • Stroke
  • Sepsis
  • Brain hemorrhage
  • Pulmonary embolism
  • Prostate cancer
  • Asthma
  • Lyme disease
  • Lupus

Women, in particular, may be at a higher risk of misdiagnosis for certain conditions, such as heart attacks or strokes.

Why Do Misdiagnoses Occur?

While the reasons behind diagnostic errors are numerous and often intertwined, they can be dissected and categorized to shed light on their origins.

Communication Challenges

One pivotal contributor to diagnostic errors lies in communication breakdowns between patients and healthcare providers. Patients may inadvertently fail to articulate their symptoms accurately, leading to an incomplete clinical picture. Likewise, doctors, in some instances, might miss critical information within the patient’s narrative, thus hindering the diagnostic process. Effective communication between patients and healthcare providers is paramount for an accurate diagnosis, making any disruptions in this exchange a potential source of misdiagnosis.

Test-Related Factors

Diagnostic errors can also be attributed to issues related to medical tests. In some cases, incorrect tests might be ordered, diverting attention away from the actual underlying condition. Furthermore, even when appropriate tests are conducted, errors can transpire during the interpretation of test results. An inaccurate interpretation can lead to an erroneous diagnosis, potentially compromising patient care.

Atypical Symptoms and Complex Cases

Patients who exhibit atypical symptoms or present with complex medical conditions can be particularly susceptible to diagnostic errors. In such cases, healthcare providers may struggle to discern the underlying cause of the symptoms, potentially leading to misdiagnosis. Conditions like stroke, which can manifest with atypical symptoms such as dizziness, exemplify the diagnostic challenges posed by non-classical presentations.

Inherent Diagnostic Uncertainty

The field of diagnosis is inherently characterized by a degree of uncertainty. With several thousand known diseases and a multitude of symptoms, healthcare providers are tasked with navigating a vast diagnostic landscape. Patients often present with symptoms that could be attributed to a myriad of underlying conditions, further complicating the diagnostic process. This inherent uncertainty can pose challenges in arriving at an accurate and timely diagnosis.

Consequences of Misdiagnoses

The consequences of misdiagnoses can vary widely. While some may result in no harm or minimal harm if promptly corrected, others can lead to severe injuries or fatalities. For example:

Cancer Misdiagnosis

A misdiagnosis of cancer can allow the disease to progress unchecked, making treatment more challenging once it’s correctly diagnosed. Patients may suffer irreversible harm due to the delay. On the other hand, a benign condition may be misdiagnosed as cancer, which can also have life-altering consequences if the misdiagnosis is not checked in time.

One of the most ominous consequences, however, is the unhindered advancement of the patient’s cancer. While the misdiagnosis persists, the malignancy continues to grow and spread throughout the body. When the cancer is eventually correctly diagnosed, the treatment landscape has often been dramatically altered. What might have initially necessitated a relatively straightforward intervention could now demand a multifaceted, aggressive approach, including extensive surgeries, chemotherapy, and radiation therapy. The misdiagnosis transforms a potentially curable scenario into a complex, high-stakes battle against an advanced malignancy.

Unnecessary Treatments

Patients misdiagnosed with conditions they do not have may undergo unnecessary treatments, including surgeries or medication regimens. These interventions can cause additional harm and complications.

Consider this: The administration of medications intended to treat a misdiagnosed condition can yield adverse effects and complications. Patients may experience medication side effects, allergic reactions, or drug interactions that result in additional health challenges. These adverse effects not only undermine well-being but can also necessitate further medical attention.

Beyond the physical ramifications, misdiagnosis-induced treatments can exact a toll on patients’ mental and emotional well-being. The psychological distress stemming from enduring unnecessary procedures and grappling with the uncertainty of a misdiagnosed condition can be profound, leading to anxiety, depression, and a diminished quality of life.

How to Prove a Misdiagnosis Malpractice Case

If you intend to file a medical malpractice lawsuit based on misdiagnosis, you’ll need to establish several key elements of the case:

1. Doctor-Patient Relationship

Firstly, you must demonstrate the existence of a doctor-patient relationship. This relationship forms when a patient seeks medical care, establishing a duty of care.

2. Expected Medical Standard of Care

You’ll need to show that the doctor owed you a duty to provide medical care consistent with the expected medical standard of care. This standard varies depending on the medical specialty and geographic location.

3. Substandard Care

To prove malpractice, you must establish that the care you received fell below the expected standard of care. This involves demonstrating that the doctor’s actions or decisions constituted negligence or incompetence compared to a reasonably skilled practitioner in the same field and region.

4. Causation

Crucially, you must prove that the doctor’s negligence directly caused your injuries. You need to establish that your condition worsened, resulting in harm due to the misdiagnosis, such as delayed treatment or unnecessary procedures.

5. Economic and Non-Economic Losses

To recover damages in a medical malpractice case stemming from misdiagnosis, you must demonstrate that you suffered economic and/or non-economic losses due to the misdiagnosis. Economic losses may include medical expenses, lost wages, therapy costs, and other financial hardships. Non-economic losses encompass physical pain, emotional distress, disability, disfigurement, and a diminished quality of life.

Standard of Care and Negligence

The concept of the “standard of care” plays a pivotal role in misdiagnosis malpractice cases. It refers to the level of care, skill, and expertise that a reasonably competent medical professional in the same field, region, and under similar circumstances would provide. The standard of care serves as the yardstick against which a doctor’s actions or decisions are evaluated.

In cases of misdiagnosis, medical negligence often involves one of the following types of mistakes:

  • Failure to Include the Correct Condition: This type of negligence occurs when a doctor overlooks the diagnosis when systematically considering and eliminating possible conditions based on certain criteria and test results. The medical professional may fail to include the accurate condition due to certain criteria matching with another condition or results being inconclusive. Essentially, this is when the doctor overlooks a viable diagnosis.
  • Failure to Order Appropriate Tests or Procedures: Another facet of medical negligence in misdiagnosis cases pertains to the failure of a healthcare provider to order essential tests or procedures that could have been instrumental in arriving at the correct diagnosis. This oversight can impede the diagnostic process, potentially resulting in an inaccurate or delayed diagnosis.
  • Failure to Identify the Correct Diagnosis: Even if the correct diagnosis is considered during the differential diagnosis, a doctor might still make an error by failing to identify it, despite having relevant information and test results.This form of negligence can lead to the persistence of the patient’s condition without proper treatment, causing further harm or complications.

If you are unsure whether you have a medical malpractice case, please talk to a Philadelphia medical malpractice lawyer like those at Raynes & Lawn. Our team can determine through thorough investigation whether your misdiagnosis is indeed a case of medical negligence.

Legal Considerations for Medical Lawsuits Involving Misdiagnosis

When it comes to pursuing legal action against doctors and surgeons, particularly in cases involving misdiagnosis, understanding the relevant legal framework is crucial. In Pennsylvania, the statute of limitations and the type of legal actions available can vary based on the circumstances of the case.

Wrongful Death

Pennsylvania law provides avenues for a patient’s family to seek justice using wrongful death and survival actions should that individual pass away due to medical malpractice. It’s important to note that these actions are initiated after the patient’s death, and the time limit for filing them begins on the date of the patient’s demise.

A significant legal precedent, the 2017 Pennsylvania Supreme Court case Dubose v. Quinlan, clarified that the standard 2-year statute of limitations for personal injury actions doesn’t apply to wrongful death and survival actions related to medical malpractice. Instead, Pennsylvania’s Medical Care Availability and Reduction of Error Act governs these cases. Specifically, Section 1303.513(d) of the Act outlines the time constraints.

For a death or survival action, the claim falls under 42 Pa.C.S. § 8301 (relating to death action) or 8302 (relating to survival action). As such, the action must be commenced within two years after the death in the absence of affirmative misrepresentation or fraudulent concealment of the cause of death.

For example, if a patient was initially misdiagnosed with a migraine after experiencing a stroke in a Philadelphia hospital and later succumbed to a massive brain hemorrhage, the statute of limitations for both wrongful death and survival actions would begin on the date of the patient’s death, not the date of the initial misdiagnosis.

When the Patient Survives

When a patient survives medical negligence, the statute of limitations in Pennsylvania follows the usual 2-year timeframe for personal injury actions, as specified in 42 Pa.C.S. § 5524(2). In cases of medical malpractice or hospital negligence where the patient survives, the clock starts ticking on the date of the incident or the date the medical negligence occurred.

Consider the same scenario as before, but with a different outcome: the patient survives the massive brain hemorrhage but sustains serious, permanent damage. In this situation, the patient must file their medical or hospital malpractice lawsuit within 2 years of the date of the initial hospital visit when the stroke was initially misdiagnosed.

Recoverable Damages in a Misdiagnosis Malpractice Lawsuit

In a misdiagnosis malpractice lawsuit, individuals may be eligible to recover various types of damages, which are intended to compensate them for the losses and harm they have endured due to the medical negligence. These recoverable damages typically encompass:

Economic Damages

These are quantifiable financial losses resulting from the misdiagnosis. Here are what economic damages include:

  • Medical Expenses: This encompasses both past and anticipated future medical costs incurred due to the misdiagnosis. It includes expenses related to doctor’s visits, hospital stays, surgeries, diagnostic tests, medications, therapy, and rehabilitation. Future medical expenses may account for ongoing treatments, follow-up procedures, and long-term care necessitated by the misdiagnosis.
  • Lost Income: Economic damages extend to compensation for lost wages, salaries, and any other forms of income that the patient could not earn due to the misdiagnosis. This category considers both past income losses and future earning capacity reductions resulting from the misdiagnosis. Future lost income might apply if the patient’s condition leads to a permanent disability or diminished ability to work.

Non-Economic Damages

These are intangible losses that lack a precise monetary value but are equally critical. Non-economic damages categories commonly encompass:

  • Pain and Suffering: Patients may be entitled to compensation for the physical pain, discomfort, and emotional distress endured due to the misdiagnosis. This category acknowledges the profound suffering experienced by the patient as a result of the healthcare provider’s negligence.
  • Emotional Distress: Damages for emotional distress encompass the psychological anguish, anxiety, fear, or trauma resulting from the misdiagnosis. Patients may experience severe emotional distress when confronted with the consequences of an erroneous diagnosis.
  • Disability and Disfigurement: In cases where the misdiagnosis leads to a patient’s disability or physical disfigurement, this category accounts for the resulting reduction in their overall quality of life. It acknowledges the lasting impact of the misdiagnosis on the patient’s physical abilities and appearance.
  • Loss of Consortium: Damages for loss of consortium address the harm suffered by a patient’s spouse or family members due to the misdiagnosis. It acknowledges the strain placed on relationships, loss of companionship, and the emotional toll experienced by family members witnessing the patient’s suffering.
  • Diminished Quality of Life: Patients may be eligible for compensation for the diminished quality of life they endure as a direct consequence of the misdiagnosis. This category recognizes the patient’s inability to enjoy life as they did before the misdiagnosis and acknowledges the lasting effects on their daily existence.

Wrongful Death Damages

In cases where the misdiagnosis leads to a patient’s death, specific categories of damages may include:

  • Funeral and Burial Expenses: This encompasses the costs associated with arranging the patient’s funeral, burial, or cremation services. It helps relieve the financial burden placed on surviving family members.
  • Loss of Financial Support: Damages address the financial contributions the deceased would have provided to their family if not for the fatal misdiagnosis. It compensates surviving family members for the economic support they have lost.
  • Loss of Companionship: This category acknowledges the emotional and relational losses experienced by surviving family members due to the loss of their loved one. It covers the disruption of familial bonds and relationships.
  • Emotional Distress: Surviving family members may be entitled to compensation for the psychological suffering they endure as a result of the patient’s death. This recognizes the emotional trauma experienced by those close to the deceased.

Punitive Damages

Awarded less frequently, punitive damages serve as a form of punishment for healthcare providers guilty of gross negligence, recklessness, or intentional misconduct. These damages aim to deter similar behavior in the future and often have legal limitations and thresholds.

Talk to the Hospital Malpractice Lawyers of Raynes & Lawn

If you or a loved one has been misdiagnosed and suffered significant harm as a result, it’s essential to consult a Philadelphia medical malpractice attorney at Raynes & Lawn. Our law firm boasts over five decades of experience in representing victims of medical malpractice. We collaborate closely with medical experts to build strong cases. Your well-being is our top priority, and we’re here to fight for your rights and compensation in the face of medical misdiagnosis. To learn more about the potential merits of your claim, contact us for a free consultation at 1-800-535-1797.

For the general public:  This Blog/Website is made available by the law firm publisher, Raynes & Lawn, for educational purposes. It provides general information and a general understanding of the law but does not provide specific legal advice. By using this site, commenting on posts, or sending inquiries through the site or contact email, you confirm that there is no attorney-client relationship between you and the Blog/Website publisher. The Blog/Website should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

For attorneys:  This Blog/Website is informational in nature and is not a substitute for legal research or a consultation on specific matters pertaining to your clients.  Due to the dynamic nature of legal doctrines, what might be accurate one day may be inaccurate the next. As such, the contents of this blog must not be relied upon as a basis for arguments to a court or for your advice to clients without, again, further research or a consultation with our professionals.