A&E clinical negligence reports
Independent reports from consultants in emergency medicine on triage, investigation and discharge decisions in A&E, prepared to CPR Part 35 for courts in England and Wales.
Emergency departments make fast decisions with limited information, and many negligence claims against them concern a diagnosis that was missed or a patient sent home too soon. Allegations include a missed fracture or tendon injury, sepsis not recognised or treated in time, a head injury discharged without the imaging it needed, a missed stroke, heart attack or testicular torsion, and discharge without clear advice on when to return.
Expert Medical Examination arranges independent reports from consultants on the GMC Specialist Register in emergency medicine, and if the instructing solicitor needs a second expert on causation, we can arrange that too.
Sepsis and time-critical conditions
In sepsis, stroke, heart attack and torsion, the timing of treatment matters. The expert identifies when the condition should have been recognised and what treatment should have started.
Head injury and imaging decisions
Head injury claims often ask whether a CT scan should have been requested before discharge. The expert considers the history, examination and risk factors recorded at the time against the guidance then in force, and whether the decision was one a reasonably competent emergency clinician would have made.
Missed fractures and tendon injuries
Scaphoid, hip and cervical spine fractures and hand tendon injuries can be missed on a first visit. The report considers whether the examination, imaging and follow-up plan met a reasonable standard, including whether the patient should have been reviewed in a fracture clinic.
Evidence on the first hours of care
An A&E claim turns on what was known, or should have been found, at the time, and whether the response was within the range of reasonable emergency practice. The expert reads the triage notes, observations and decisions as an emergency physician would.
- Missed fractures and soft tissue injuries
- Sepsis recognition and delayed antibiotics
- Head injury assessment and imaging decisions
- Missed stroke, heart attack and testicular torsion
- Triage and waiting time claims
- Unsafe discharge and safety-netting advice
- Children seen in the emergency department
- Breach of duty reports on emergency care
Emergency medicine clinical negligence reports: FAQs
Is a junior doctor in A&E judged by a lower standard?
No. A hospital doctor is judged by the standard of the post they were filling, not their personal experience. In FB v Princess Alexandra Hospital NHS Trust [2017] EWCA Civ 334, the Court of Appeal held that a senior house officer in an emergency department had to be judged by the standard of a reasonably competent SHO in that setting, and that being relatively inexperienced did not lower it.
Which A&E decisions does the expert examine?
Triage, history taking and examination, the tests and imaging ordered, how results were acted on, referral to the right specialty, and the decision to discharge, including the advice given to the patient on leaving. Each is judged against what a reasonably competent clinician in that role would have done at the time, not with hindsight of the eventual diagnosis.
Does the emergency medicine expert address causation as well?
Only in part. The emergency medicine expert can say what the department should have done, such as admit, refer or arrange imaging. What that would have achieved for the patient is normally a question for a specialist: an orthopaedic surgeon for a missed fracture, a vascular surgeon for missed limb ischaemia, or a urologist for a missed testicular torsion.
Which A&E records does the expert need?
The ambulance patient report form, the triage record, the emergency department notes and observation charts, blood results, the imaging itself as well as the radiology reports, and the discharge letter. Timings matter in these claims, so the records should show when each assessment, result and decision happened, and an electronic record with its time stamps is more useful than a printed summary.
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