Emergency medicine is decision-making with incomplete information, under time pressure, about people the clinician has never met. Some bad outcomes there are nobody’s fault, and we say so.
But an emergency department is also the single most common setting for the claims we are asked about, for a structural reason: it is where the highest-risk conditions arrive undifferentiated, get sorted quickly, and are either investigated or sent home. When that sorting goes wrong, the consequences are severe and they are documented minute by minute.
Triage: the first decision, and the most consequential
Triage assigns an urgency category that determines how quickly you are seen. It is recorded, with times, along with the observations taken at the time.
That makes it unusually good evidence. A patient triaged as low urgency whose recorded observations were already abnormal, or who then waited hours while deteriorating, produces a documentary trail that is difficult to explain away afterward.
Repeat observations matter as much as the first set. Where a patient’s condition worsened in the waiting room and nobody re-checked or escalated, that is a failure in its own right.
The duty to examine everyone who presents
Federal law requires hospitals with emergency departments to provide an appropriate medical screening examination to anyone who comes in seeking care, regardless of their insurance or ability to pay, and to stabilize an emergency condition before transferring them.
That obligation is separate from an ordinary malpractice claim and is proven differently. It becomes relevant where someone was turned away, sent elsewhere without stabilization, or given a screening so cursory it was not really an examination at all.
If you were sent away from an emergency department without being examined, tell us — it is a different route with different requirements, and people rarely know it exists.
Where emergency care fails
- The classic misses, where the presentation did not match the textbook: heart attack in a younger patient or a woman, stroke, sepsis, pulmonary embolism and cauda equina syndrome
- Imaging not ordered, or ordered and not read before discharge
- Results returning after the patient has left, with nobody following up
- Handoff failures at shift change, where the plan for a patient does not survive the change of staff
- Discharge without a workup, particularly where the same complaint has brought someone back more than once
- Inadequate discharge instructions, with no safety-netting about what should bring the patient straight back
- Understaffing and boarding, where admitted patients occupy the department and new arrivals are not monitored
- Medication errors given under time pressure
A return visit within days for the same complaint is one of the strongest patterns there is, because the second presentation is documented evidence that the first assessment did not resolve the problem.
Who the claim is actually against
This surprises people: emergency physicians are frequently not employed by the hospital they work in. They are often employed by a staffing group that contracts with the hospital, which affects who a claim is brought against.
Nurses and technical staff usually are hospital employees, and the hospital may also be responsible in its own right for staffing levels, protocols and systems. Working out the structure early matters, because it determines who has to be named and within what deadlines — particularly where the hospital is a government body.
How these claims are proven
- The full ER record: triage note, observation charts with times, nursing notes, physician notes and the discharge paperwork.
- Timing throughout: arrival, triage, first clinician contact, tests ordered, results returned, discharge.
- What happened next, including any return visit, admission or transfer, which frequently shows what the first visit missed.
- Staffing and department conditions on the day, where delay is in issue.
- Expert review by an emergency physician, on whether the care fell below the standard and whether that caused the harm.
Maryland requires a certificate from a qualifying expert before the claim proceeds, and it is filed with the state health care dispute office first, as with any medical malpractice claim.
Deadlines
Maryland malpractice claims generally run five years from the injury or three years from discovery, whichever comes first, with different rules for children.
A publicly operated hospital can require written notice far sooner, which is easy to miss when a patient does not know who owns the hospital they attended. If you are unsure, ask early.
