Failure to refer patients to the correct specialist in a hospital setting

The practice of medicine has become very specialized as a result of insurance specifications and physician areas of expertise. When individuals are placed in a hospital they may need specialized services either during a hospital stay or upon discharge. One goes to a hospital for a “cure” but one physician cannot diagnose or treat all conditions. At times the hospital or head physician responsible refers the patient to a specialist (an expert in dealing with a certain illness or part of the body) to address more specific medical concerns. When they do not refer patients to the necessary specialists, serious medical problems may go undiagnosed and untreated. 

In times of crisis, one of the first places that someone will go is to the emergency room. The physicians on staff are at times able to quickly and easily diagnose the problem. Sometimes they prescribe medication giving proper dosing instructions and determine if the patient needs further hospital assistance. In some situations, however, the illness may be out of the expertise of the hospital physician and a referral will be made to a specialist. Unfortunately, there are times when the hospital can fail to recognize the need for specialized opinion and/or diagnosis and one can be left with a potentially serious, undiagnosed illness as a result. 

There are many reasons why hospitals neglect the referral of patients to medical specialists either during or after the hospital stay. Sometimes, doctors fall under financial pressure to not refer patients to specialists as transferring the patient out of their care sends money into the pockets of another. 

Overcrowding, and fast-paced, urgent care are a large part of the issue. Hospitals are acute care facilities for short-term care. The CDC (Center for Disease Control) states that the average hospital stay is 4.9 days. In that time patients are seen by physicians for an average of seven minutes each day. Per a New York Times article, HMOs are requiring physicians to “keep things moving.” In that time, they need to be able to determine what is wrong and if a patient needs to see a specialist. This type of fast-paced care can lead to serious errors in judgment.

In that seven minutes, a physician must also make a differential diagnosis. Meaning that they must rule out all serious problems first. If there is a possibility that a patient has a serious health issue, they must first bring in a specialist who can rule out that possibility. For example, chest pain might simply be indigestion, but it might also be a heart attack. The heart attack must be ruled out first. 

Also, a referral might be made to a specialist after a patient is discharged from a hospital for further care. For instance, if a patient doesn’t need immediate acute hospital care to deal with a particular illness, they are referred to a specialist for follow-up care to address concerns. If they are not referred or referred to the wrong specialist the consequences may be dire- resulting in injury or possibly death. 

When it comes to dealing with a failure to refer in a hospital setting these situations are the reasons personal injury claims are made:

  • Injuries or illnesses worsen or develop as the result of a failure to refer
  • Misdiagnosis of a condition occurs- an error that would not have happened if the care was in the hands of a specialist in that particular area
  • Poor examination (could be due to rushing, or incompetence) failing to recognize a potentially serious injury, or a failure to order the appropriate diagnostic tests
  • Poor overall evaluation of any physical symptoms.

The costs incurred by patients harmed by a failure to refer are:

  • Further treatment costs – If one is not referred to a specialist, then potentially serious injury or illness could become worse. This would require additional treatment as a result. This cost is generally part of an injury compensation claim.
  • Loss of income – You may be required to take additional time off work to receive treatment for current or developing illnesses or injuries due to the original error.
  • Emotional distress – If the hospital fails to refer a patient for the treatment of a very serious illness or injury, a great deal of pain (either from the original condition or developing complications) can cause much distress for both the patient and their family.

If you or a loved one experienced further injury or a worsening of a medical condition due to a failure to refer to a specialist in a hospital setting, you may be entitled to financial compensation for the damages incurred by these errors. Call the Sweeney Law Firm and let our experts review the facts. You may have a medical malpractice case. If we decide to accept your case, we work on a contingency fee basis, meaning there is no fee for representation unless there is a settlement or recovery of funds made on your behalf.