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Delayed Diagnosis of Pulmonary Embolism: Lawyer for PE Malpractice in New York
Excerpt: A pulmonary embolism (PE) is a life-threatening blood clot in the lungs that is frequently misdiagnosed as anxiety, pneumonia, or musculoskeletal pain. When doctors fail to diagnose PE in time, the result can be catastrophic injury or death. This guide explains the medical standards of care and your legal rights in New York.
Table of Contents
- What Is a Pulmonary Embolism?
- Why PE Is Frequently Misdiagnosed
- Risk Factors Doctors Must Recognize
- The Standard of Care for PE Diagnosis
- How Delayed PE Diagnosis Causes Harm
- Common Diagnostic Errors
- Proving Malpractice in PE Cases
- New York Legal Framework
- Compensation in PE Malpractice Cases
- Frequently Asked Questions
What Is a Pulmonary Embolism?
A pulmonary embolism (PE) is a blockage in one of the pulmonary arteries in the lungs, typically caused by a blood clot that has traveled from the deep veins of the legs (deep vein thrombosis, or DVT). The clot lodges in the pulmonary artery, blocking blood flow to a portion of the lung.
The DVT-PE Connection
PE most commonly originates as a DVT in the legs. The clot breaks off and travels through the right side of the heart to the lungs. This is why DVT prevention and early detection are critical to preventing PE.
Severity
PE severity ranges from small, asymptomatic clots to massive, life-threatening emboli that cause sudden cardiac arrest. The mortality rate for untreated PE is approximately 30%, but with prompt diagnosis and treatment, it drops to under 8%.
[Image: Diagram showing blood clot traveling from leg vein to pulmonary artery]
Why PE Is Frequently Misdiagnosed
PE is one of the most commonly misdiagnosed conditions in emergency medicine. The symptoms of PE overlap with many less serious conditions:
PE Symptoms
- Sudden shortness of breath (dyspnea)
- Chest pain that worsens with deep breathing (pleuritic pain)
- Cough (possibly with blood)
- Rapid heart rate (tachycardia)
- Leg swelling or pain (from DVT)
- Anxiety or sense of impending doom
- Lightheadedness or fainting
Conditions PE Is Mistaken For
| Misdiagnosis | Why It Happens | |---|---| | Anxiety/panic attack | Shortness of breath, chest pain, and anxiety overlap | | Pneumonia | Chest pain, cough, and shortness of breath overlap | | Musculoskeletal pain | Chest pain attributed to muscle strain | | Asthma/COPD exacerbation | Shortness of breath in patients with lung disease | | Heart attack | Chest pain and shortness of breath overlap | | Costochondritis | Chest wall pain attributed to inflammation |
Risk Factors Doctors Must Recognize
The standard of care requires doctors to recognize PE risk factors and maintain a high index of suspicion when they are present:
Major Risk Factors
- Recent surgery — particularly orthopedic, abdominal, or pelvic surgery
- Prolonged immobility — bed rest, long flights, or car rides
- Cancer — active malignancy increases clot risk
- Pregnancy and postpartum — pregnancy increases clot risk 4-5 fold
- Hormone therapy — oral contraceptives, hormone replacement therapy
- Prior DVT or PE — the strongest risk factor
- Obesity
- Smoking
- Inherited clotting disorders — Factor V Leiden, prothrombin gene mutation
When these risk factors are present alongside PE symptoms, the standard of care requires the doctor to actively rule out PE — not dismiss the symptoms as something less serious.
The Standard of Care for PE Diagnosis
Clinical Assessment
The standard of care requires doctors to use a validated clinical prediction tool to assess PE probability:
Wells Score
The Wells Criteria stratifies patients into low, moderate, or high probability of PE based on:
- Clinical signs of DVT
- PE as the most likely diagnosis
- Heart rate > 100 bpm
- Immobilization or surgery in past 4 weeks
- Prior DVT/PE
- Hemoptysis (coughing blood)
- Malignancy
Diagnostic Testing
Based on the clinical probability, the standard of care may require:
| Test | When Used | What It Shows | |---|---|---| | D-dimer | Low probability patients | Elevated levels suggest clot formation | | CT pulmonary angiography (CTPA) | Moderate/high probability | Gold standard — directly visualizes the clot | | Ventilation-perfusion (V/Q) scan | CTPA contraindicated (kidney disease, dye allergy) | Shows mismatched airflow/blood flow | | Lower extremity ultrasound | When DVT is suspected | Shows clot in leg veins | | ECG | Initial evaluation | May show signs of right heart strain |
The Standard of Care Requires
- Recognizing PE risk factors and symptoms
- Using a clinical prediction tool (Wells score)
- Ordering appropriate diagnostic tests based on clinical probability
- Not discharging the patient without ruling out PE when risk factors and symptoms are present
- Prompt initiation of anticoagulation when PE is confirmed
How Delayed PE Diagnosis Causes Harm
Massive PE and Sudden Death
The gravest consequence of a missed PE diagnosis is a massive PE — a large clot that blocks blood flow to the lungs, causing sudden cardiac arrest and death. This can occur hours or days after the initial presentation.
Pulmonary Infarction
When a clot blocks blood flow to a portion of the lung, the lung tissue may die (pulmonary infarction), causing permanent lung damage.
Pulmonary Hypertension
Chronic or recurrent PE can cause pulmonary hypertension — high blood pressure in the pulmonary arteries — leading to right heart failure and reduced life expectancy.
Post-Thrombotic Syndrome
Untreated DVT can cause post-thrombotic syndrome — chronic leg pain, swelling, and ulcers.
Common Diagnostic Errors
1. Failure to Consider PE
The most common error is simply not considering PE in the differential diagnosis, particularly in younger patients or those with atypical presentations.
2. Attributing Symptoms to Anxiety
PE presents with shortness of breath and chest pain — symptoms also associated with anxiety and panic attacks. Women and younger patients are particularly vulnerable to having their symptoms dismissed as anxiety.
3. Failure to Order CTPA
When the clinical probability warrants imaging, failing to order a CT pulmonary angiogram (CTPA) is a deviation from the standard of care.
4. Over-Reliance on Normal D-dimer
While a normal D-dimer can help rule out PE in low-risk patients, it is not reliable in moderate or high-risk patients. Failing to image a moderate or high-risk patient because the D-dimer is normal is a common error.
5. Failure to Recognize DVT
PE often originates as DVT. Failure to recognize and treat DVT allows the clot to grow and potentially embolize to the lungs.
6. Premature Discharge
Discharging a patient with PE symptoms without ruling out the condition can be fatal if the patient develops a massive PE at home.
Proving Malpractice in PE Cases
Key Evidence
- Emergency department records — documenting the evaluation, vital signs, and disposition
- Imaging studies — CTPA, V/Q scan, or chest X-ray
- Lab results — D-dimer, troponin, BNP
- EKG — for signs of right heart strain
- Clinical prediction scores — was a Wells score calculated?
- Expert testimony — from emergency medicine physicians and pulmonologists
Establishing Breach
We must prove that the standard of care required the doctor to consider and rule out PE — based on the patient's symptoms, risk factors, and clinical presentation — and that the doctor failed to do so.
Establishing Causation
We must prove that if PE had been diagnosed and treated promptly, the patient would have survived or suffered less harm. This requires expert testimony on PE treatment, survival rates, and the timeline of deterioration.
New York Legal Framework
Statute of Limitations
2.5 years from the date of the malpractice (or discovery under Lavern's Law).
Wrongful Death
If the patient died, the wrongful death statute of limitations is 2 years from the date of death (EPTL § 5-4.1).
[Link to: /wrongful-death/eptl-5-4-1]
Notice of Claim
Required within 90 days for municipal hospitals (NYC Health + Hospitals — Bellevue, Harlem, Jacobi, Kings County, Lincoln, Elmhurst, etc.).
No Damage Caps
New York does not cap damages in medical malpractice cases.
Compensation in PE Malpractice Cases
Economic Damages
- Past and future medical expenses
- Lost wages and lost earning capacity
- Future care costs
Non-Economic Damages
- Pain and suffering
- Loss of enjoyment of life
- Emotional distress
Wrongful Death Damages
- Medical and funeral expenses
- Lost financial support
- Loss of parental guidance and consortium
[Link to: /medical-malpractice/settlements]
Frequently Asked Questions
Q: Can a pulmonary embolism be misdiagnosed? A: Yes. PE is one of the most commonly misdiagnosed conditions in emergency medicine, frequently mistaken for anxiety, pneumonia, or musculoskeletal pain.
Q: How is PE diagnosed? A: The standard of care involves assessing clinical probability (Wells score), ordering a D-dimer for low-risk patients, and CT pulmonary angiography (CTPA) for moderate or high-risk patients.
Q: What happens if PE is not treated? A: Untreated PE has a mortality rate of approximately 30%. With prompt treatment, mortality drops to under 8%.
Q: How long do I have to file a PE malpractice lawsuit in New York? A: Generally 2.5 years from the date of the malpractice (or discovery under Lavern's Law). For wrongful death, 2 years from the date of death.
Q: What if my loved one died because of a missed PE diagnosis? A: You may have a wrongful death claim under EPTL § 5-4.1. The statute of limitations for wrongful death is 2 years from the date of death.
Q: How much does a PE malpractice lawsuit cost? A: MDLaw Firm handles these cases on a contingency fee basis — you pay nothing unless we recover compensation.
If you or a loved one has been affected by a delayed or missed pulmonary embolism diagnosis in New York, contact MDLaw Firm at 347-524-5777 for a free consultation. Our experienced medical malpractice attorneys will review your medical records, consult with medical experts, and fight for the compensation your family deserves.
This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.
If you or a loved one suffered from a misdiagnosis or delayed diagnosis, contact our Misdiagnosis lawyers today for a free, confidential consultation. Call 347-524-5777 or request a case review online.