Failure to Diagnose Pulmonary Embolism Lawyer New York

Why PE Is Frequently Misdiagnosed

Pulmonary embolism is notoriously difficult to diagnose because its symptoms overlap with many other, more common conditions. The classic symptoms — shortness of breath, chest pain, and cough — are also the symptoms of pneumonia, heart attack, asthma, and anxiety. This overlap leads to dangerous misdiagnoses.

Common reasons PE is missed include:

• Attributing symptoms to a less serious condition: Emergency physicians may diagnose a patient with shortness of breath and chest pain as having a panic attack, anxiety, musculoskeletal chest pain, or bronchitis — without adequately ruling out PE.
• Failure to recognize risk factors: PE risk factors (recent surgery, immobility, cancer, pregnancy, oral contraceptives, prior DVT/PE, obesity) should trigger a higher index of suspicion. When doctors fail to take a thorough history, they miss these red flags.
• Over-reliance on normal vital signs: A patient with a PE may have normal oxygen saturation, normal blood pressure, and a normal heart rate — particularly early in the course. Assuming that normal vitals rule out PE is a dangerous error.
• Failure to use validated diagnostic tools: The Wells Criteria and PERC (Pulmonary Embolism Rule-out Criteria) are validated clinical decision rules that help physicians determine when to test for PE. Failure to use these tools may constitute a deviation from the standard of care.
• Failure to order appropriate imaging: CT pulmonary angiography (CTPA) is the gold standard for diagnosing PE. D-dimer blood tests can help rule out PE in low-risk patients. V/Q scans are used when CTPA is contraindicated. Failure to order these tests when indicated can be fatal.
• Discharging the patient prematurely: A patient who presents with symptoms concerning for PE should not be discharged without a definitive diagnosis. Premature discharge is one of the most common — and most dangerous — errors in PE cases.

Risk Factors Doctors Should Recognize

A thorough physician should recognize that the following risk factors increase the likelihood of PE and should trigger appropriate diagnostic testing:

• Recent surgery: Particularly orthopedic surgery (hip or knee replacement), abdominal surgery, or any surgery requiring general anesthesia and prolonged immobility.
• Prolonged immobility: Long flights or car rides, bed rest, hospitalization, or paralysis.
• Cancer: Active cancer and cancer treatments increase clotting risk. [Link to: /medical-malpractice/cancer-misdiagnosis]
• Pregnancy and postpartum: Pregnancy increases clotting risk, and the risk remains elevated for several weeks after delivery.
• Oral contraceptives and hormone therapy: Particularly in women who smoke.
• Prior DVT or PE: A history of blood clots is a major risk factor for recurrence.
• Obesity: Increases the risk of DVT and PE.
• Smoking: Damages blood vessels and increases clotting risk.
• Heart failure and chronic lung disease: These conditions increase PE risk.
• Inherited clotting disorders: Factor V Leiden, prothrombin gene mutation, antithrombin deficiency, protein C or S deficiency.
• Age: Risk increases with age, particularly over 60.

The Standard of Care for Diagnosing PE

The standard of care for evaluating a patient with symptoms suggestive of PE requires the emergency physician to:

1. Take a thorough history: Including onset, character, and severity of symptoms; presence of risk factors; and any history of DVT or PE.

2. Perform a physical examination: Including vital signs, lung examination, heart examination, and examination of the legs for signs of DVT (swelling, redness, tenderness).

3. Assess pre-test probability: Use the Wells Criteria or another validated clinical decision rule to determine the likelihood of PE. The Wells Criteria assigns points based on clinical signs of DVT, alternative diagnosis less likely than PE, heart rate >100, immobilization or surgery in the last 4 weeks, prior DVT/PE, hemoptysis (coughing blood), and cancer.

4. Order appropriate diagnostic testing: - Low-risk patients: PERC criteria may be used to rule out PE without testing. If PERC is negative, no further testing is needed. If PERC is positive, a D-dimer should be ordered. If D-dimer is negative, PE is ruled out. If D-dimer is positive, CTPA should be performed. - Moderate or high-risk patients: CTPA should be ordered directly, without relying on D-dimer. A V/Q scan may be used if CTPA is contraindicated (e.g., kidney disease, contrast allergy, pregnancy).

5. Do not discharge without a definitive diagnosis: If PE is suspected, the patient should not be discharged until it is ruled out or treated.

When PE Misdiagnosis Constitutes Malpractice

Pulmonary embolism misdiagnosis constitutes medical malpractice when the emergency physician or treating doctor deviated from the standard of care and that deviation caused harm. Common scenarios include:

• Failure to consider PE in the differential diagnosis: The doctor did not include PE as a possible cause of the patient's symptoms, despite the presence of risk factors and classic symptoms.
• Failure to use validated clinical decision rules: The doctor did not use the Wells Criteria, PERC, or other validated tools to assess PE risk.
• Failure to order appropriate testing: The doctor did not order a D-dimer or CTPA when indicated by the patient's risk and symptoms.
• Misinterpretation of test results: The doctor or radiologist misread a CTPA or V/Q scan, or relied on a false-negative D-dimer in a high-risk patient.
• Premature discharge: The doctor discharged the patient without ruling out PE, and the patient suffered a PE (or worsened PE) after discharge.
• Failure to initiate anticoagulation: In patients with confirmed or high-probability PE, anticoagulation (blood thinners) should be started immediately. Delays in treatment increase the risk of death and complications.
• Failure to follow up: The doctor did not arrange for appropriate follow-up testing or monitoring for a patient at risk of PE.

The Consequences of a Missed or Delayed PE Diagnosis

The consequences of pulmonary embolism misdiagnosis are often catastrophic:

- Death: Untreated PE has a mortality rate of up to 30%. With prompt diagnosis and treatment, mortality drops to less than 10%. Every minute of delay increases the risk of death. - Pulmonary infarction: Death of lung tissue due to blocked blood supply, causing permanent lung damage. - Pulmonary hypertension: Chronic elevation of blood pressure in the pulmonary arteries, causing progressive heart failure (cor pulmonale). - Recurrent PE: A patient who has had one PE is at high risk of recurrence without treatment. - Post-thrombotic syndrome: Chronic leg pain, swelling, and ulcers from untreated DVT. - Need for more aggressive treatment: A patient who presents later may require thrombolytic therapy (clot-busting drugs) or surgical embolectomy (clot removal), which carry higher risks than standard anticoagulation.

Common Defense Arguments and How We Counter Them

Defense attorneys in PE misdiagnosis cases typically argue:

• PE is difficult to diagnose and the symptoms are non-specific. While PE can be challenging to diagnose, the standard of care requires physicians to use validated clinical decision rules (Wells Criteria, PERC) and order appropriate testing. We counter by showing that the doctor failed to follow the standard diagnostic pathway — not that PE was impossible to diagnose.
• The patient's symptoms were atypical. The defense may argue that the patient's presentation was unusual. We counter by showing that the symptoms were consistent with PE and that the risk factors should have triggered a higher index of suspicion.
• The D-dimer was negative. The defense may argue that a negative D-dimer ruled out PE. We counter by showing that D-dimer is only reliable in low-risk patients, and if the patient was moderate or high-risk, a CTPA should have been ordered regardless of the D-dimer result.
• The outcome was inevitable. The defense may argue that even with prompt treatment, the patient would have died. We counter by establishing, through expert testimony, that prompt diagnosis and treatment would have significantly improved the patient's chances of survival.
• The patient contributed to the delay. The defense may argue that the patient delayed seeking care. We counter by showing that the patient presented in a timely manner and that the delay in diagnosis occurred at the hospital, not on the patient's end.

New York Malpractice Law

Pulmonary embolism misdiagnosis cases in New York are governed by CPLR § 214-a (2.5-year statute of limitations from the date of the negligence). If the misdiagnosis involved cancer (e.g., a PE caused by an undiagnosed cancer), Lavern's Law may also apply. New York does not cap non-economic damages. In cases involving death from PE misdiagnosis, a wrongful death claim may be pursued under EPTL § 5-4.1. [Link to: /medical-malpractice/cancer-misdiagnosis]

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.