Why Are Medical Negligence Claims in A&E Increasing? The Risks of Delays, Pressure and Inexperienced Staff

A&E departments are under enormous pressure. But when delays, overcrowding and staffing pressures result in a patient receiving inadequate care, the consequences can be devastating.

Recent BBC reporting has highlighted concerns about an increase in medical negligence claims arising from treatment in Accident & Emergency departments. The issue deserves careful consideration.

A&E is one of the most challenging areas of the NHS. Doctors and nurses are required to assess patients with a huge range of conditions, often with limited information and under considerable time pressure. But pressure on an emergency department does not remove the requirement to provide safe and appropriate medical care.

When a patient has suffered serious injury because their symptoms were not properly assessed, a diagnosis was missed, appropriate investigations were not undertaken, or treatment was delayed, there may be grounds for a medical negligence claim.

At Aston Knight Solicitors, we regularly act for patients and families in complex medical negligence cases. We understand that what initially appears to be a straightforward A&E attendance can sometimes conceal a much more serious failure in care.

Why are A&E departments under so much pressure?

There is no single explanation.

Emergency departments are dealing with a combination of increasing demand, difficulties transferring patients into hospital wards, staffing pressures, ambulance delays and patients presenting with increasingly complex conditions.

NHS England has recognised the risks associated with overcrowding, including difficulties identifying and clinically prioritising the sickest patients and delays in investigation, treatment, specialist care and admission.

For an individual patient, however, the important question is not simply how busy the hospital was. It is whether the care provided was reasonable and appropriate in the circumstances.

Long waits in A&E can create serious risks

A long wait in A&E is not necessarily medical negligence.

Some patients will inevitably have to wait because emergency departments must prioritise those who are most seriously ill.

The concern arises when a patient’s condition deteriorates during a prolonged wait and there is a failure to recognise or respond appropriately to that deterioration.

For example, a patient may attend A&E with:

• severe abdominal pain;
• chest pain;
• difficulty breathing;
• symptoms of a stroke;
• signs of sepsis;
• a serious infection;
• a head injury;
• internal bleeding;
• a fracture or other serious injury; or
• symptoms which initially appear relatively minor but subsequently become significantly worse.

A patient may be triaged and then wait several hours before being reviewed. If their condition changes during that period, there should be appropriate systems for recognising and responding to that deterioration. The longer a patient remains waiting without appropriate reassessment, investigation or treatment, the greater the potential risk where their condition is serious or deteriorating.

Does being treated by a junior doctor mean that negligence has occurred?

No. This is an important distinction.

Doctors in training are an essential part of the NHS workforce and are capable of providing excellent care.

The issue is not whether a doctor is a junior doctor. The issue is whether the doctor was appropriately trained, competent for the task they were undertaking and adequately supervised when supervision was required. This becomes particularly important in emergency medicine because patients may present with complex symptoms and the consequences of getting the diagnosis wrong can be extremely serious.

A junior doctor may quite properly assess a patient in A&E. But there must be appropriate systems for obtaining senior input where a case is outside that doctor’s level of experience, where the diagnosis is uncertain, or where the patient’s condition is concerning.

The problem is therefore not simply one of qualifications. It is also about experience, supervision, staffing levels, communication and the systems within which clinicians are working.

What happens when the wrong diagnosis is made?

One of the most serious risks in A&E is a missed or delayed diagnosis.

Emergency medicine frequently involves making decisions based upon limited information.

A patient may have symptoms which could indicate several different conditions. The doctor may need to decide whether further blood tests, imaging, specialist review or observation is required. Sometimes the initial diagnosis will be wrong despite reasonable care. That does not automatically mean negligence. Medical negligence generally requires more than simply showing that the diagnosis was incorrect.

The question is whether the care fell below the standard reasonably expected of the medical professional and whether that failure caused or materially contributed to the patient’s injury.

Examples can include failing to:

• take an adequate medical history;
• carry out an appropriate examination;
• recognise important symptoms;
• appreciate abnormal observations;
• arrange appropriate blood tests;
• arrange appropriate imaging;
• consider an important differential diagnosis;
• seek senior or specialist advice;
• monitor a patient whose condition was deteriorating;
• act upon abnormal test results;
• communicate important information during a handover; or
• arrange appropriate follow-up after discharge.

An Aston Knight case study: £8,500 recovered after an A&E diagnosis was missed

The risks associated with diagnostic errors in A&E are not merely theoretical.

Aston Knight Solicitors has acted for patients where a failure to correctly identify an injury during the initial hospital assessment resulted in unnecessary treatment and further avoidable suffering.

One such case involved Mr B, whose name has been anonymised for confidentiality.

Mr B suffered an injury to his knee while working as a security officer at a nightclub. He attended hospital the following day and gave a full description of his symptoms. He was examined by the medical team but was not given appropriate radiological imaging before a diagnosis was reached.

He was diagnosed with a torn quadriceps muscle. The diagnosis was wrong.

Mr B was taken to theatre for surgery on the basis of that diagnosis. However, during the operation, the treating surgeon realised that there was no torn quadriceps muscle. The wound therefore had to be closed and stitched.

An MRI scan was subsequently undertaken and revealed the actual injury: a torn ligament in the knee. Mr B then required further surgery to repair the ligament.

As a result of the original failure to correctly diagnose his injury, Mr B had suffered the consequences of the underlying knee injury but had also undergone an unnecessary operation, experienced additional pain and suffering and was left with a scar from the unnecessary surgery.

Aston Knight obtained an independent report from a lower limb surgeon, who confirmed that there had been negligence. Following negotiations, £8,500 compensation was recovered for Mr B.

He was delighted with the outcome and said:

“Aston Knight Solicitors were very helpful, professional, easy to understand and I would highly recommend them.”

Why is this case relevant to the pressures facing A&E?

Mr B’s case demonstrates an important distinction.

The problem was not simply that the first diagnosis happened to be wrong.

The issue was whether the diagnosis had been reached following an appropriate assessment and investigation and whether the failure to correctly identify the injury caused avoidable harm.

In this case, the incorrect diagnosis resulted in the wrong treatment being undertaken.

Instead of receiving appropriate treatment for his torn ligament, Mr B underwent surgery for an injury he did not have. He then required further surgery once the correct diagnosis was established. This is one of the risks associated with diagnostic errors in emergency medicine.

A patient may arrive at A&E with a genuine but difficult-to-diagnose condition. If appropriate investigations are not undertaken, if warning signs are overlooked or if an alternative diagnosis is not considered, the consequences can extend well beyond the initial hospital attendance.

Mr B’s experience is a clear example of why appropriate clinical assessment and investigation are so important, even in a busy emergency department.

The danger of “diagnose and discharge”

Another concern is when a patient is discharged from A&E without the underlying condition being properly identified. Again, discharge itself does not mean that something has gone wrong.

Many patients attending A&E can and should be safely discharged. The question is whether the decision to discharge was reasonable based upon the symptoms, examination findings, test results and information available at the time.

If a patient is discharged despite warning signs which should have prompted further investigation or observation, the consequences can be serious. A patient may return hours or days later with a significantly more advanced condition.

Examples might include:

A missed fracture which subsequently requires more extensive treatment.
A missed infection or sepsis which progresses and becomes life-threatening.
A missed heart attack resulting in permanent heart damage.
A missed stroke resulting in avoidable neurological injury.
A missed bowel obstruction or perforation resulting in emergency surgery.
A missed internal injury following trauma which subsequently becomes life-threatening.

In some cases, the earlier diagnosis would have made a significant difference to the patient’s outcome. That is where medical negligence can become a serious legal issue.

Handover problems can also contribute to mistakes

A&E is rarely a simple process involving one doctor seeing one patient from beginning to end.

Patients may be assessed by one clinician, reviewed by another, discussed with a senior doctor, transferred between departments and subsequently handed over to another team. Every handover creates another opportunity for important information to be lost.

A significant symptom, abnormal test result or change in condition may not be properly communicated.

This is particularly concerning in an overcrowded department where staff are under pressure and patients may remain in the department for many hours. Good communication, documentation and escalation are therefore critical components of safe emergency care.

Are staffing shortages increasing the risk?

Staffing is clearly part of the wider picture.

An emergency department may have large numbers of patients but insufficient doctors, nurses or other healthcare professionals to assess and monitor them safely. The result can be increasing pressure on individual clinicians.

That pressure can contribute to:

• rushed assessments;
• incomplete histories;
• inadequate examinations;
• delays in investigations;
• delays in reviewing test results;
• insufficient monitoring;
• poor communication;
• inadequate handovers; and
• failures to escalate deteriorating patients.

Importantly, a hospital cannot necessarily defend a claim simply by saying that it was busy or understaffed.

The legal question remains whether the care provided to the individual patient met the appropriate standard and whether any breach caused injury.

Does a long A&E wait automatically mean medical negligence?

No. This is one of the most important points for patients to understand.

A long wait can be extremely distressing, but waiting time alone does not establish negligence. There may be entirely legitimate clinical reasons why one patient is treated before another.

However, a delay becomes much more concerning where:

1. the patient has symptoms requiring urgent assessment or treatment;
2. the patient’s condition deteriorates while waiting;
3. staff fail to recognise that deterioration;
4. appropriate observations or reassessment are not undertaken;
5. necessary investigations are delayed;
6. abnormal results are not acted upon; or
7. treatment which should reasonably have been provided is significantly delayed.

In those circumstances, it may be appropriate to investigate whether the delay caused avoidable harm.

What if you were told that everything was fine?

Patients sometimes leave A&E having been reassured that there is nothing seriously. They may subsequently discover that they had a significant medical condition.

This can understandably leave patients asking:

“How could they have missed this?”

The fact that the eventual diagnosis was serious does not, by itself, establish negligence. But it may warrant further investigation. The medical records can be particularly important. They may reveal:

• what symptoms were reported;
• what observations were recorded;
• who assessed the patient;
• what examinations were undertaken;
• what investigations were requested;
• what the results showed;
• whether the results were acted upon;
• whether senior medical advice was sought;
• what diagnosis was made;
• why the patient was discharged; and
• what safety-netting advice was provided.

These records can allow an independent medical expert to consider whether the treatment provided was reasonable.

What should you do if you believe an A&E mistake caused you harm?

If you believe that you or a member of your family suffered avoidable injury because of treatment received in A&E, it is important to obtain specialist legal advice.

The first step will usually be to understand exactly what happened. This may involve obtaining the A&E records, ambulance records, GP records, subsequent hospital records, imaging and test results.

It may also be necessary to obtain an independent medical expert opinion. The expert will consider the treatment provided and, importantly, whether different treatment would probably have resulted in a better outcome.

That second question is crucial. It is not enough to identify something that could have been done differently.

A medical negligence claim generally requires evidence that the failure caused or materially contributed to the injury or loss suffered.

The Aston Knight Difference

At Aston Knight Solicitors, we specialise in complex and rejected personal injury and medical negligence claims.

We understand that some cases are difficult to investigate.

The records may be extensive. There may be conflicting evidence. There may be uncertainty about exactly when a patient’s condition deteriorated or whether an earlier diagnosis would have changed the outcome. These are precisely the cases where specialist investigation matters. Mr B’s case is an example.

The initial diagnosis was wrong and the consequences were significant. But establishing a successful claim required more than simply demonstrating that the diagnosis had been incorrect.

We obtained the appropriate independent medical evidence and established that there had been negligence, ultimately recovering £8,500 for Mr B.

The Aston Knight Difference is our determination to look beyond the obvious.

A case may initially appear difficult. That does not necessarily mean that there is no claim.

Our role is to examine the evidence carefully, identify what went wrong and obtain appropriate independent medical evidence to establish whether the treatment fell below the required standard and caused avoidable harm.

Frequently Asked Questions

Can I claim compensation if I waited too long in A&E?

Potentially, but a long wait alone does not establish medical negligence. There would generally need to be evidence that the delay was unreasonable in the circumstances and caused or materially contributed to an injury or worsening of your condition.

Can I claim if an A&E doctor missed my diagnosis?

Potentially. A missed diagnosis can amount to medical negligence where the care provided fell below the appropriate standard and the failure caused avoidable injury or worsened the patient’s outcome.

Can a junior doctor be negligent?

Yes, but being a junior doctor does not itself mean that the treatment was negligent. The relevant issues include the doctor’s competence for the task, the circumstances in which they were working and whether appropriate supervision was available where required.

Does NHS staff being understaffed mean I automatically have a claim?

No. Staffing difficulties do not automatically establish negligence. The focus is on the care provided to the individual patient and whether any breach of duty caused injury.

What if I was discharged from A&E but became seriously ill afterwards?

You may still have a potential claim. The important issue is whether the decision to discharge was reasonable based on the information available at the time and whether a different course of treatment would probably have resulted in a better outcome.

How do I know if I have a medical negligence claim?

It can be difficult for a patient to assess this without reviewing the medical records and obtaining appropriate expert evidence. Specialist legal advice can help establish whether further investigation is warranted.

If you believe your A&E treatment went wrong

If you or a loved one has suffered an injury or deterioration in health following treatment in A&E, you may understandably want answers.

You may have been told that there was nothing wrong, only to discover later that you had a serious condition.

You may have waited many hours before being assessed.

You may believe that important symptoms were ignored, investigations were not carried out, or that your condition deteriorated without an appropriate response. You deserve to know whether the care you received was reasonable.

Aston Knight Solicitors specialises in complex and rejected medical negligence claims. We provide expert advice, personal service and a determined approach to every case.

If you believe that a missed diagnosis, delayed treatment or other failure in A&E caused you avoidable harm, contact Aston Knight Solicitors today to discuss your circumstances and find out whether your case should be investigated.