Types of Medical Malpractice: A Comprehensive Guide to Identification and Classification

Types of Medical Malpractice: A Comprehensive Guide to Identification and Classification

Medical malpractice can occur in almost any area of medicine and at any stage of treatment - from initial diagnosis through ongoing treatment and rehabilitation. To better understand your rights and identify whether you have experienced medical malpractice, it's important to be familiar with the different types of malpractice and the characteristics of each.

In this comprehensive article, we will review all the major types of medical malpractice, explain how they manifest, and present real-life examples.

1. Diagnostic Malpractice - The Most Common Type

Diagnostic malpractice is one of the leading causes of medical malpractice lawsuits in Israel and worldwide.

Misdiagnosis

Definition: A misdiagnosis occurs when a doctor diagnoses the wrong disease or makes an error in identifying the medical problem.

Common Examples:

Cancer Diagnosed as a Benign Condition

• Patient complains of a lump in the neck
• Doctor diagnoses "benign fatty tumor" without performing a biopsy
• Six months later, it's discovered to be lymphoma (lymph node cancer)
• Result: The disease progressed without treatment

Heart Attack Diagnosed as Heartburn

• Patient arrives at the emergency room with chest pain
• Doctor diagnoses "reflux" and sends patient home with stomach medication
• The next day, the patient returns with a full heart attack
• Result: Heart muscle damage that could have been prevented

Meningitis Diagnosed as the Flu

• Child with high fever and headaches
• Doctor diagnoses "virus" and sends home
• Condition worsens and bacterial meningitis is discovered
• Result: Permanent brain damage

Asthma Attack Diagnosed as Anxiety

• Patient with shortness of breath
• Doctor diagnoses "panic attack"
• Turns out to be severe asthma requiring urgent treatment
• Result: Dangerous deterioration

Missed Diagnosis

Definition: Failure to identify a disease or medical condition that should have been identified given the symptoms and tests.

Examples:

Missed Fracture on X-ray

• Patient arrives after a fall with wrist pain
• X-ray taken, doctor doesn't identify small fracture
• Patient returns two weeks later, fracture has developed into more serious damage
• Result: Need for surgery that could have been avoided

Missed Blood Clot (Pulmonary Embolism)

• Patient after surgery with shortness of breath and chest pain
• Doctor doesn't suspect blood clot in leg that traveled to lung
• Result: Large clot that's life-threatening

Missed Colon Cancer from Inflammatory Diseases

• Patient with recurring diarrhea and abdominal pain
• Doctor diagnoses "irritable bowel syndrome" (IBS)
• Doesn't refer for colonoscopy despite age over 50
• Result: Colon cancer discovered late

Delayed Diagnosis

Definition: The disease is eventually diagnosed, but with significant delay that caused damage.

Examples:

Breast Cancer Discovered Late

• Patient felt a lump in breast
• Doctor: "Come back in 6 months"
• Doesn't refer for immediate mammogram/ultrasound
• After 6 months: Cancer has spread to lymph nodes
• Result: Need for chemotherapy and extensive surgery, reduced chances

Diabetes Not Diagnosed in Time

• Patient with increased thirst, fatigue, weight loss
• Doctor doesn't refer for blood sugar test despite clear symptoms
• Diabetes discovered at stage of complications (kidney/eye damage)
• Result: Complications that could have been prevented

Why Is Diagnostic Malpractice So Common?

• Time Pressure: Doctors under high workload with limited time per patient
• Premature Final Diagnosis: Not performing additional tests despite doubts
• Cognitive Bias: Doctor "locked into" a certain diagnosis and doesn't consider alternatives
• Poor Communication: Doctor doesn't listen to patient or doesn't ask enough questions
• Lack of Follow-up: Test results "fall through the cracks" and no one follows up

How to Identify Diagnostic Malpractice?

Warning Signs:

• Doctor didn't ask detailed questions about symptoms
• Doctor didn't perform thorough physical examination
• Doctor dismissed your symptoms as "it's nothing" or "it's in your head"
• Doctor didn't refer for additional tests despite concerning symptoms
• Diagnosis that doesn't explain all symptoms
• Lack of follow-up after tests

What to Do:

• Get a second opinion!
• Demand referral for tests or to a specialist
• Document everything - dates, symptoms, what the doctor said
• Don't give up if you feel something isn't right

2. Surgical Malpractice - Errors in the Operating Room

Surgical malpractice is one of the most serious categories, although less common than diagnostic malpractice.

"Never Events" - Events That Should Never Happen

These are errors so basic they are considered unacceptable under any circumstances.

Surgery on Wrong Organ or Side

• Surgery on left knee instead of right
• Removal of healthy kidney instead of diseased one
• Surgery on wrong eye

Example from Actual Lawsuit: Patient arrived for removal of diseased right kidney. The team mistakenly removed the healthy left kidney. The patient was left with only one diseased kidney and required dialysis.

Leaving Surgical Instruments Inside Patient's Body

• Scissors, forceps, needles
• Gauze or surgical sponges
• Other instruments

Example: After abdominal surgery, patient suffered from pain and recurring infections. Two months later, an X-ray revealed surgical forceps in the abdomen. Additional surgery was required for removal.

Incorrect Marking of Surgical Site

• Law requires clear marking of surgery location
• Failure to mark or incorrect marking is malpractice

Technical Errors in Performing Surgery

Nerve Damage

• Facial nerve damage in ear surgery → facial paralysis
• Radial nerve damage in shoulder surgery → limited arm movement
• Nerve damage in spinal column → leg weakness/paralysis

Example: Patient underwent spinal surgery. During surgery, the surgeon damaged the nerve innervating the leg. Patient was left with permanent weakness in right leg and difficulty walking.

Damage to Adjacent Organs

• Bowel damage in gynecological surgery
• Damage to major blood vessels

Uncontrolled Bleeding

• Failure to identify bleeding during surgery
• Improper treatment of bleeding
• Result: Shock, severe anemia, sometimes death

Surgery Using Wrong Technique

• Using non-standard technique
• Surgery not appropriate for clinical condition
• Incorrect incisions or sutures

Anesthesia Problems

Anesthesia is a critical part of surgery, and anesthesia errors can be fatal.

Common Problems:

Wrong Dosage

• Too high a dose → respiratory arrest, brain damage, death
• Too low a dose → Waking during surgery (Anesthesia Awareness)

Example: Patient woke during surgery but couldn't move or speak (muscle paralysis). She felt the pain of surgery but couldn't alert anyone. This is an extremely severe psychological trauma.

Unchecked Allergy

• Giving anesthesia drug patient is allergic to
• Despite allergy being documented in medical file
• Result: Anaphylactic shock, brain damage, death

Intubation Problems (Inserting Breathing Tube)

• Difficulty inserting tube → oxygen deprivation
• Tube in wrong place (esophagus instead of trachea)
• Result: Brain damage from lack of oxygen

Improper Monitoring

• Failure to monitor blood pressure, pulse, oxygen
• Result: Failure to identify problem in time

Sterility Problems and Infections

Failure to Meet Sterilization Standards

• Non-sterilized surgical instruments
• Non-sterile gloves
• Result: Serious infections in surgical wound

Example: Patient underwent eye surgery. Due to sterilization failure, he developed severe eye infection (endophthalmitis) leading to blindness in the eye.

Improper Wound Care

• Improper cleaning of wound
• Defective sutures
• Neglect in post-surgical care

Post-Surgical Care Malpractice

Malpractice doesn't end when surgery ends. Post-operative care is critical.

Lack of Follow-up

• Failure to identify complications early
• Failure to check test results
• Failure to give clear instructions to patient

Failure to Treat Complications

• Post-surgical bleeding not treated
• Infection not identified in time
• Blood clots not prevented

Example: Patient after orthopedic leg surgery developed blood clot. Despite complaints of swelling and pain, staff didn't perform appropriate examination. The clot traveled to lung and caused pulmonary embolism that was fatal.

How to Identify Surgical Malpractice?

Warning Signs Before Surgery:

• You didn't meet with anesthesiologist before surgery
• You didn't receive detailed explanation before signing consent form
• Surgery wasn't clearly marked
• Staff didn't perform "Time Out" (pause to verify all details are correct)
• Allergies weren't checked

Warning Signs During or After Surgery:

• Unusual pain that's not explained
• Wound infection
• Impaired function that wasn't present before surgery (weakness, numbness)
• Urgent repeat surgery that's not explained
• Information concealment or lack of transparency from staff

3. Medication Errors - Errors That Can Be Fatal

Medication malpractice is very common and represents approximately 15% of lawsuits. Medication errors can occur at any stage: prescribing, preparation, administration, monitoring.

Common Errors

1. Giving Medication Patient Is Allergic To

Classic Example: Patient with penicillin allergy (documented in medical file!) receives antibiotic from penicillin family. He develops anaphylactic shock and requires urgent emergency room treatment.

Why This Happens:

• Not reading medical file
• Poor documentation of allergies
• Poor communication between teams
• Time pressure

2. Wrong Dosage

Too High Dosage:

• Child receives adult dose
• Error in unit conversion (mg instead of grams)
• Dose duplication (two doctors prescribe same medication)

Example: Two-month-old infant received medication dose appropriate for 2-year-old child - 10 times the correct dose. Infant developed severe side effects and required prolonged hospitalization in intensive care.

Too Low Dosage:

• Antibiotic at insufficient dose → infection not treated
• Blood pressure medication at low dose → cardiac event

3. Giving Wrong Medication

Examples:

• Medication with similar name (Sound-Alike, Look-Alike)
• Example: Celebrex (anti-inflammatory) instead of Celexa (antidepressant)
• Reading unclear doctor's handwriting
• Computer or system error

Example from Lawsuit: Patient was supposed to receive Metformin (for diabetes). Mistakenly received Methotrexate (chemotherapy). He developed severe side effects from chemotherapy, including liver and blood damage.

4. Wrong Route of Administration

Examples:

• Intravenous medication given orally
• Medication that should be given slowly given at high speed
• Intramuscular injection instead of intravenous

Example: Patient received intravenous potassium too quickly. This caused life-threatening arrhythmia (Cardiac Arrest). Potassium must be given slowly!

5. Dangerous Drug Interactions

The Problem: Patient receives two or more medications with dangerous interaction between them.

Common Examples:

• Warfarin (blood thinner) + Aspirin → life-threatening bleeding
• MAO Inhibitors (antidepressants) + SSRIs → fatal serotonin syndrome
• Statins (cholesterol lowering) + certain medications → muscle and kidney damage

Example: Patient received Warfarin from cardiologist and antibiotic from family doctor. Interaction not checked. Antibiotic increased warfarin's effect, patient developed brain hemorrhage.

6. Continuing Medication Despite Side Effects

Example: Patient receives antibiotic and complains of mild rash. Staff continues giving antibiotic. Rash develops into severe allergic reaction (Stevens-Johnson Syndrome) causing serious skin damage and prolonged hospitalization.

Prescription Malpractice

Common Errors:

• Illegible writing (handwriting)
• Missing details (dosage, frequency, treatment duration)
• Prescribing medication inappropriate for patient (due to age, medical condition, allergies)

Example: Doctor prescribed Aspirin for child with fever. Aspirin is forbidden for children with viral illnesses due to risk of Reye's syndrome (fatal disease). Child developed the syndrome.

How to Prevent Medication Errors?

As a Patient, Do This:

• Always update on all medications you're taking (including vitamins and herbal remedies)
• Tell about allergies - at every visit!
• Ask questions:
  • What's the medication name?
  • What's it for?
  • What's the dosage?
  • How do I take it?
  • What are the side effects?
• Check the label - make sure your name is on it
• If something doesn't look right - ask!
• Keep an updated list of all your medications (including dosages)

4. Birth Injuries - The Most Serious Category

Birth injuries are one of the most serious and sensitive categories, as they affect both mother and baby. They constitute approximately 25% of medical malpractice lawsuits.

Compensation in birth injury lawsuits is typically the highest, as damage to an infant may affect their entire life.

Untreated Fetal Distress

The Problem: During labor, the baby may go into distress - lack of oxygen, pressure on umbilical cord, etc. Fetal distress is identified by fetal monitor.

Signs of Fetal Distress:

• Fetal heart rate too high or too low
• No variation in heart rate (heart not responding to movements)
• Sudden drop in heart rate
• Amniotic fluid with meconium (fetal stool)

Malpractice Occurs When:

• Staff didn't monitor fetus properly
• Distress signs were ignored or dismissed
• Staff didn't act quickly (didn't perform emergency C-section)
• Delay in C-section decision

Results:

• Lack of oxygen to brain (Hypoxia/Anoxia)
• Cerebral Palsy
• Developmental delay
• Permanent brain damage
• Death

Example: During labor, monitor showed clear signs of fetal distress for 45 minutes. Staff didn't act fast enough to perform C-section. Baby was born with severe brain damage from lack of oxygen, and remained with severe cerebral palsy. Verdict: 8 million NIS compensation.

Improper Use of Delivery Instruments

Vacuum or Forceps: These tools are designed to help with delivery when baby is "stuck," but improper use can cause serious damage.

Malpractice in Tool Use:

• Using forceps in inappropriate situations
• Excessive pulling force
• Repeated use after failure
• Wrong angle

Possible Damages:

• Skull fracture
• Brain hemorrhage (Intracranial Hemorrhage)
• Brachial plexus injury (Erb's Palsy) - paralyzed arm
• Facial nerve damage

Example: During complicated delivery, midwife used vacuum too long and with too much force. Baby was born with severe brachial plexus injury, leading to partial arm paralysis. Despite surgeries and rehabilitation, arm remained with limited function.

Delay in Performing Emergency C-Section

When Emergency C-Section Is Required:

• Fetal distress
• Placenta previa (placenta blocking cervix)
• Placental abruption (placenta detaching before birth)
• Umbilical cord prolapse (cord coming out before baby)
• Labor progression stopped

Malpractice: When there's clear reason for emergency C-section, and staff waits, refuses, or delays without good reason.

"Golden Time": In most cases of fetal distress, there are 15-30 minutes to perform emergency C-section before irreversible damage occurs.

Example: Mother with partial placental abruption (discovered by bleeding). Staff hesitated and waited. After 40 minutes, when condition worsened, C-section was performed. Baby suffered from lack of oxygen and remained with brain damage.

Uterine Rupture

What It Is: The uterus tears during labor - rare but life-threatening complication.

Risk Factors:

• Birth after previous C-section (VBAC)
• Use of contraction-inducing medications (Pitocin/Oxytocin) without proper monitoring
• Uterus with scar from previous surgery

Malpractice:

• Giving Pitocin at too high or too fast dosage
• Improper monitoring of contractions
• Failure to identify rupture signs (sudden pain, bleeding, drop in fetal heart rate)

Results:

• Massive bleeding
• Emergency hysterectomy (uterus removal)
• Mother's death
• Baby's death or serious damage

Infections During or After Birth

Infection in Mother:

• Fever above 38 during labor (Chorioamnionitis)
• Surgical wound infection after C-section
• Endometritis (uterine infection)

Infection in Baby:

• Blood infection (Sepsis)
• Pneumonia
• Meningitis

Malpractice:

• Failure to identify infection signs
• Failure to give antibiotics in time
• Neglect of hygiene and sterility

Example: Mother with fever during labor. Staff didn't give antibiotics. Baby was born with blood infection that led to neurological complications.

Lack of Proper Monitoring After Birth

After Birth, Must Monitor:

• Mother's bleeding
• Vital signs (blood pressure, pulse)
• Baby's condition (breathing, color, activity)

Malpractice:

• Failure to identify postpartum hemorrhage (PPH)
• Failure to treat high blood pressure (pre-eclampsia)
• Failure to identify baby's breathing problems

Example: Mother after birth with significant bleeding. Nurses didn't alert doctor in time. Woman lost life-threatening amount of blood and required multiple transfusions and prolonged intensive care hospitalization.

Injury to Mother During Birth

Possible Injuries:

• Severe perineal tears (3rd or 4th degree) not treated properly
• Damage to ureter or bladder during C-section
• Damage to blood vessels
• Hysterectomy (uterus removal) that wasn't necessary

5. Emergency Room Malpractice

The emergency room is a high-pressure environment with many patients and limited time. Emergency room malpractice represents approximately 10-15% of lawsuits.

Discharge Too Early

The Problem: Patient is discharged home despite concerning symptoms requiring further investigation or hospitalization.

Examples:

Chest Pain Discharged as "Anxiety"

• Patient arrives with chest pain
• Initial EKG normal (but doesn't always detect heart attack!)
• Discharged home without additional tests
• Next day returns with full heart attack

Abdominal Pain Discharged Without Investigation

• Child with severe abdominal pain
• Doctor: "It's a virus, go home"
• Next day: Appendicitis bursts, serious infection

Headache Discharged Without CT

• Patient with sudden severe headache ("worst in my life")
• Discharged with painkillers
• Turns out to be subarachnoid hemorrhage - life-threatening

Signs That Should Have Prevented Discharge:

• Severe or worsening symptoms
• Abnormal vital signs (high fever, high/low blood pressure, rapid pulse)
• Unexplained symptoms
• Patient unable to function

Failure to Perform Necessary Tests

Examples:

Failure to Perform Brain CT After Head Injury

• Elderly patient fell and hit head
• Doctor: "Looks fine, go home"
• CT not taken
• Later subdural hematoma discovered

Failure to Perform Blood Tests in Suspicious Situations

• Suspected myocardial infarction - Troponin not checked
• Suspected infection - white blood cells not checked
• Suspected blood clot - D-Dimer not checked

Failure to Perform X-rays After Trauma

• Patient after fall with pain - no X-ray
• Undiagnosed fracture worsens

Long Wait Times

The Problem: Waiting for long hours can lead to condition worsening.

Example: Patient with sharp abdominal pain waits 6 hours in emergency room. During wait, condition worsens. Eventually gallbladder rupture discovered that developed into peritonitis - life-threatening infection.

When This Is Malpractice:

• When triage didn't properly assess severity of condition
• When patient wasn't checked again during wait
• When patient deteriorates and no one notices

Lack of Communication Between Teams

Example: Patient arrives at emergency room and receives initial diagnosis. Then transferred to another doctor or department. Information not transferred properly. New doctor doesn't know about important symptoms or tests performed.

Result:

• Duplicate tests
• Missing critical information
• Condition worsening

6. Orthopedic Malpractice

Orthopedic malpractice represents approximately 20% of lawsuits and involves injuries to bones, joints, tendons, and muscles.

Fracture Not Diagnosed or Treated Incorrectly

Missed Fracture on X-ray

• "Hidden" fracture that radiologist or doctor didn't identify
• Small fracture that developed into complex one

Example: Patient fell on wrist. X-ray taken. Doctor didn't identify small scaphoid fracture. Patient returned to work. After 3 months, fracture developed into complex fracture with blood vessel damage, requiring complex surgery and bone graft.

Incorrect Fracture Treatment

• Cast in wrong position
• Failure to refer for surgery when needed
• Unrealistic prediction of return to normal condition

Example: Child with complex arm fracture. Doctor tried to reduce and cast, but position wasn't good. Parents weren't referred to surgeon. Fracture healed with deformity, and child remained with permanent limitation in arm movement.

Malpractice in Orthopedic Surgeries

Joint Replacement (Knee, Hip)

• Incorrect installation of artificial joint
• Nerve or blood vessel damage
• Joint infection

Example: Patient underwent hip replacement surgery. Surgeon installed joint in wrong position, causing one leg to be 2 cm shorter than the other. Patient suffers from limping and can't walk without assistance. Repeat surgery required.

Spinal Surgeries

• Spinal cord or nerve damage
• Surgery at wrong "level" (surgery on wrong vertebra)
• Screw implanted in wrong place

Example: Patient underwent herniated disc surgery. Surgeon damaged nerve during surgery. She remained with chronic leg pain and permanent weakness.

Nerve Damage During Surgery

Possible Damages:

• Peroneal nerve damage in knee surgery → foot paralysis (Foot drop)
• Radial nerve damage in arm → limited hand
• Facial nerve damage in ear surgery → facial paralysis

Lack of Proper Post-Surgery Follow-up

Example: Patient underwent orthopedic leg surgery. He complained of severe swelling and pain. Doctor ignored and said "it's normal after surgery." Turns out patient developed Compartment Syndrome - condition where tissue pressure rises and damages blood flow. Without urgent treatment, this can lead to permanent muscle and nerve damage, and sometimes amputation.

7. Lack of Informed Consent

This is a special category of malpractice. According to the Patient Rights Law, a doctor must explain to the patient:

• The proposed treatment
• Possible risks and complications
• Existing alternatives
• What will happen if not treated

When There Is Malpractice:

• Doctor didn't explain at all
• Doctor explained partially or insufficiently
• Doctor concealed information about risks
• Patient didn't sign informed consent form

Example: Patient underwent spinal surgery. Doctor didn't explain there's risk of nerve damage and paralysis. Doctor also didn't explain there's conservative alternative of physiotherapy and medications. After surgery, patient remained with leg weakness. Court determined there was malpractice in obtaining informed consent - patient didn't receive all necessary information to make informed decision.

Exceptions: In emergency situations, when patient is unable to give consent (unconscious), treatment can be given without consent.

8. Mental Health and Psychiatric Treatment Malpractice

Examples:

• Failure to identify suicidal tendencies
• Discharge of dangerous patient who harms self or others
• Prescribing inappropriate psychiatric medications
• Lack of proper follow-up of high-risk patient

9. Pediatric Treatment Malpractice

Children are a special risk group, as they can't always describe symptoms.

Examples:

• Failure to identify serious infection (meningitis, blood infection)
• Incorrect medication dosages (adult medication instead of child)
• Failure to diagnose rare childhood diseases

Example: Infant with high fever and vomiting. Doctor diagnosed "virus" and sent home. Next day, infant hospitalized with bacterial meningitis. Antibiotics not given in time, and infant remained with permanent hearing damage.

Summary

There are many different types of medical malpractice, and each can cause significant harm. Recognizing the different types can help you:

• Identify if you've experienced malpractice
• Seek help as early as possible
• Understand your rights

Always Remember:

• If something doesn't seem right - don't ignore it!
• You're entitled to a second opinion
• Document everything - dates, names, symptoms
• Contact a medical malpractice attorney if you suspect malpractice

Medical malpractice is serious, and the system exists to protect you. Don't hesitate to take action.

This article provides general information only and does not constitute legal or medical advice.