An early discharge from a hospital can cause as much damage as any other medical mistake. If a patient is discharged from a hospital with a serious medical condition, doctors will not be able to respond immediately to problems associated with the condition. The resulting damage can be the difference between life and death. As a result, the victim of an early discharge may have a valid medical malpractice claim.
This article will describe some common types of early discharge cases, emergency readmissions, and what a patient must prove to be in order to be successful in this kind of a medical malpractice case.
Common Types of Early Discharge Cases
Infant early discharge cases are the most common type of early discharge case. Because of the long list of problems that can occur early in life and the serious consequences that can be linked to those problems, infants should remain in a hospital for the first 48 hours after birth. This is according to a list of recommendations published by the American Academy of Pediatrics (AAP).
The 48 hour mark is a minimum guideline for healthy infants, but longer stays are recommended for infants experiencing complications. In addition to the 48 hour rule, the AAP list of recommendations includes 16 points, primarily related to health indicators that should guide the discharge of a healthy infant from a hospital. The list includes:
- normal and stable vital signs for at least the past 12 hours
- at least two successful feedings
- urination and the spontaneous passage of at least one stool
- hearing screening, and
- assessment of family, environmental, and social risk factors.
Of course, early discharge is not a problem that only affects infants. Adults can be the victims of early discharge as well. For example, a surgical patient might be discharged before adequate testing for infection is completed. Or, a heart surgery patient might be discharged before adequate testing of a pacemaker is completed.
Emergency Readmissions
In most early discharge cases, patients are readmitted to a hospital under emergency conditions. It is important to note that the hospital need not act negligently during the emergency readmission for the patient to have a valid medical malpractice case. In many early discharge situations, significant damage will have occurred before the patient is readmitted. The patient may be able to sue for any preventable harm, i.e. damages that would not have occurred if the patient had not been discharged from the hospital in the first place.
Also, doctors are more prone to make mistakes in emergency situations, so medical malpractice law tends to grant emergency room doctors some leeway. But if the emergency situation only came about because of the inappropriate early discharge, the hospital will not be given leeway if a mistake is made during the ensuing emergency treatment.
The Malpractice Lawsuit
The different factual possibilities for cases involving wrongful early discharge are infinite. But when patients sue for medical malpractice, courts analyze almost all cases using the same formula. Most medical malpractice lawsuits revolve around two critical elements:
- negligence on the part of a doctor or other treatment provider, and
- harm caused by that negligence.
Proving Negligence. The question of whether a doctor was negligent boils down to the question of whether the patient was discharged too early. But the real question is, “how early is too early?”
That question is answered by determining the standard of care. In medical malpractice lawsuits, patients must prove two things to demonstrate negligence:
- standard of care, and
- breach of the standard of care.
Standard of Care refers to the level of competence that most doctors would have achieved in similar circumstances.
The standard of care varies by case. In early discharge cases, the standard of care might require a doctor to:
- perform specific tests to ensure the patient is healthy
- monitor a patient’s vital signs for a specific amount of time to ensure stability
- schedule a follow-up visit, or
- diagnose an underlying condition.
In the vast majority of cases, proving the standard of care requires expert testimony. The patient (usually through an attorney) consults an expert witness who offers an opinion as to the quality of care that most doctors would have provided in similar circumstances.
Breach of the Standard of Care is simply a fancy way of saying that the patient (again through the expert witness) needs to methodically show how the defendant doctor’s conduct fell short of the standard of care, and was negligent under the circumstances. For example, if the standard of care required the doctor to wait until an infant was showing no sign of jaundice before discharging the infant, and the doctor failed to keep the infant for observation even while the symptoms were still obvious, the expert would document this treatment -- showing what the doctor did in the context of what he or she should have done.
Showing Harm Caused by the Negligence
In order to win a medical malpractice lawsuit, the patient must prove that the doctor’s negligence caused foreseeable harm. This harm can take many forms, including:
- pain and suffering
- cost of medical bills
- loss of earning capacity, and
- loss of the ability to enjoy life’s pleasures.
The critical issue is whether the negligence actually caused the harm. It is insufficient to show that a patient suffered harm after a mistake was made.
For example, imagine a doctor discharged a cancer patient after a round of chemotherapy. The patient died shortly after being discharged. Even though the death occurred shortly after the patient was released from the hospital, it may have been perfectly reasonable for the release to take place, and the patient’s family would not necessarily have a medical malpractice case against the doctor. The family would have to show that the discharge was inappropriate, AND that it contributed to the patient's death. If the death would have occurred even if the patient had still been in the hospital, the doctor would not be liable for medical malpractice.
