Accident and Emergency departments are among the most demanding environments in any hospital. Staff work under significant time pressure, often with limited information, and not every poor outcome means that something went wrong with the standard of care provided.
However, where there has been a delay in diagnosis, a missed injury, an unsafe discharge or a failure to act on serious symptoms, it may be appropriate to seek legal advice about whether the care provided should be investigated further. Michael Boylan Litigation has extensive experience representing individuals and families in medical negligence matters arising from A&E care.
About Emergency & Acute Misdiagnosis claims in Ireland
Issues that can arise in emergency-misdiagnosis investigations include strokes attributed to migraine or anxiety, aortic dissection presenting with atypical pain, subarachnoid haemorrhage dismissed as ordinary headache, meningitis sent home as a viral illness, appendicitis treated as gastroenteritis, testicular and ovarian torsion treated medically rather than surgically, missed compartment syndrome, cauda equina with delayed decompression, spinal epidural abscess, bowel ischaemia, perforated ulcers, diabetic ketoacidosis, and toxic shock syndrome. Below are the specific claim types we investigate within this category.
Claim types in this category
Aortic Dissection or Aneurysm Misdiagnosis Claims
Aortic dissection and aortic aneurysms are among the most critical medical emergencies a patient can face.
Appendicitis Misdiagnosis Claims
When you or a loved one visit a GP or an Emergency Department with severe abdominal pain, you place your trust in the medical professionals to identify
Bowel Ischemia / Mesenteric Ischemia Misdiagnosis Claims
Bowel ischaemia, medically known as mesenteric ischaemia, is a serious medical emergency caused by a restriction in blood flow to the bowel.
Cauda Equina Syndrome Negligence Claims
Cauda Equina Syndrome (CES) is a rare but severe neurological condition that requires immediate medical attention.
Compartment Syndrome Negligence Claims
Compartment syndrome is a medical emergency that requires immediate recognition and urgent treatment.
Diabetic Ketoacidosis (DKA) Mismanagement Claims
Diabetic Ketoacidosis (DKA) is a medical emergency. It is a frightening and dangerous complication of diabetes that requires immediate hospital treatment.
Heart Attack Misdiagnosis Claims
Heart disease is the leading cause of death in Ireland, with 6,000 people suffering heart attacks every year.
Meningitis Misdiagnosis Claims
Meningitis is one of the most feared illnesses a family can face.
Ovarian Torsion Misdiagnosis Claims
Ovarian torsion is a serious surgical emergency that requires immediate medical attention to save the ovary and protect future fertility.
Perforated Ulcer Misdiagnosis Claims
A perforated ulcer is a medical emergency that requires immediate attention. When treated quickly, patients often recover well.
Sepsis Negligence Claims
Sepsis is a silent killer, striking quickly and often fatally.
Spinal Epidural Abscess Misdiagnosis Claims
A spinal epidural abscess (SEA) is a rare but potentially devastating medical emergency.
Stroke & TIA Misdiagnosis Claims
Subarachnoid Hemorrhage Misdiagnosis Claims
A Subarachnoid Haemorrhage (SAH) is a medical emergency where minutes and hours matter.
Testicular Torsion Misdiagnosis Claims
Testicular torsion is a urological emergency where every minute counts.
Toxic Shock Syndrome Misdiagnosis Claims
Toxic Shock Syndrome (TSS) is a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.
What Is Accident And Emergency Negligence?
When emergency care may fall below the required standard
Medical negligence in A&E arises where the care provided falls below the standard that a reasonably competent emergency medicine practitioner would have delivered in the same circumstances, and where that failure causes avoidable harm.
This can include:
- Failure to assess symptoms properly: The presenting complaint is not adequately examined or documented.
- Failure to investigate red-flag symptoms: Warning signs such as severe headache, neurological changes or chest pain are not followed up with appropriate tests.
- Delay in arranging tests: Blood work, imaging or other investigations are not ordered in a timely manner.
- Failure to refer to a specialist team: A patient who requires urgent specialist input is not referred or the referral is delayed.
- Incorrect interpretation of results: X-rays, blood tests or scans are misread, leading to a missed or wrong diagnosis.
- Discharge without adequate assessment or safety-netting: A patient is sent home without a clear diagnosis, without follow-up advice, or before their condition has stabilised.
Why a poor outcome is not always negligence
It is important to understand that A&E care often involves urgent decision-making with incomplete information. Some conditions are inherently difficult to diagnose in the early stages, and an unexpected outcome does not automatically mean the care was substandard.
The legal question is whether the treatment fell below the standard expected of a competent practitioner and whether that failing caused or contributed to avoidable harm. Establishing this almost always requires independent medical expert evidence.
Common Accident And Emergency Issues That May Require Legal Review
Delayed diagnosis in A&E
Certain conditions are time-sensitive, meaning that a delay in diagnosis can lead to significantly worse outcomes. These include stroke, sepsis, meningitis, appendicitis, cardiac events and serious infections. Where symptoms were reported and not acted on promptly, this may warrant legal review.
Missed fractures, dislocations and orthopaedic injuries
Fractures are among the most commonly missed injuries in emergency departments. Issues include a failure to order imaging, X-rays that are misread or not reviewed by a radiologist, soft-tissue assumptions made without adequate investigation, and delayed referral to orthopaedic services. A missed fracture can lead to prolonged pain, improper healing and the need for additional treatment.
Head injury and neurological symptoms
Head injuries require careful assessment and monitoring. Where a patient presents with loss of consciousness, confusion, vomiting or neurological changes, there are established protocols for investigation and observation. Concerns may arise where a patient is discharged without adequate monitoring and later deteriorates.
Chest pain, breathing problems and cardiac concerns
Chest pain and shortness of breath can indicate serious conditions including heart attack, pulmonary embolism or cardiac arrhythmia. Where these symptoms are not properly investigated, or where abnormal observations are not acted upon, the consequences can be severe or fatal.
Abdominal pain and surgical emergencies
Abdominal pain in A&E can indicate appendicitis, bowel obstruction, perforation or gallbladder disease. Where pain is dismissed without sufficient investigation, a treatable condition may progress to a surgical emergency. Michael Boylan Litigation has previously secured a settlement of €325,000 for a woman who suffered undiagnosed appendicitis and subsequent rupture.
Cauda equina and spinal red flags
Cauda equina syndrome is a serious condition involving compression of the nerves at the base of the spinal cord. Symptoms such as severe back pain combined with bladder or bowel disturbance, saddle-area numbness or leg weakness are recognised red flags requiring urgent investigation. Delay in diagnosis can result in permanent damage.
Medication errors in emergency departments
Medication errors in A&E can include administering the wrong drug or dosage, failing to check for known allergies, prescribing medications that interact with existing treatments, and errors involving anticoagulants or other high-risk drugs. A failure to review the patient's medication history can have serious consequences.
Unsafe discharge from A&E
A patient may be discharged without a clear diagnosis, without being told what symptoms to watch for, without a follow-up plan, or before abnormal test results have been reviewed. Where a patient becomes seriously unwell shortly after discharge, the adequacy of the discharge decision may need to be examined.
Failure to monitor a deteriorating patient
Where a patient is waiting in A&E or under observation, there is a duty to monitor vital signs and escalate concerns appropriately. Failures in observation charting, repeat review or communication between clinical staff can result in a treatable deterioration being missed.
How A&E Claims Are Investigated In Ireland
Taking a detailed timeline of what happened
The chronology of events is often central to an A&E negligence case. This includes the time of arrival, when triage took place, what symptoms were reported, when tests were ordered and results received, when treatment began, and the circumstances of discharge. Mapping this timeline clearly can highlight where delays or failures may have occurred.
Reviewing medical records and hospital documentation
A thorough review of the hospital records is an essential part of any investigation. Relevant documents may include A&E attendance notes, triage records, nursing notes, observation charts, imaging reports, blood results, referral notes, discharge letters and, where applicable, ambulance records.
Independent medical expert opinion
Expert evidence is usually central in medical negligence litigation. An independent medical expert will assess whether the care provided met the expected standard and whether any failing contributed to the patient's injury or deterioration. The solicitor's role includes identifying the correct expert discipline and assessing the legal significance of the opinion provided.
Assessing causation in A&E negligence cases
It is not enough to show that something went wrong. There must be a demonstrable link between the alleged failure and the harm suffered. This might involve showing that earlier diagnosis would have changed the treatment outcome, or that proper monitoring would have prevented deterioration. Causation is often one of the most contested elements in an A&E negligence case.
Documents That May Be Relevant When Seeking Legal Advice About A&E Care
If you are considering seeking legal advice, the following documents may be helpful:
- Hospital discharge paperwork: Details of your attendance and any instructions given on leaving.
- GP notes after the A&E visit: Records of follow-up consultations or referrals.
- Prescription records: Details of medication prescribed during or after your A&E attendance.
- Follow-up appointment letters: Correspondence regarding further treatment or review.
- Complaint correspondence: Any letters or responses relating to a formal complaint.
- Photographs of visible injury: Images taken at the time, where relevant.
- Notes made by the patient or family shortly after events: Personal records of what happened and when.
Time Limits For Accident And Emergency Claims In Ireland
Medical negligence cases in Ireland are subject to limitation periods, which set a deadline for bringing legal proceedings. The general position is that proceedings must often be initiated within two years from the date of knowledge of the injury and its cause, although the rules in this area can be complex.
Different considerations may apply where the patient is a child or a person who lacks legal capacity. Because limitation issues can significantly affect a person's ability to pursue a claim, it is advisable to seek legal advice promptly where there are concerns about A&E care.
A&E Claims Involving Children Or Vulnerable Patients
A&E treatment involving children
Children may be unable to clearly describe their symptoms, which places additional responsibility on clinical staff to assess carefully and listen to parental concerns. Common issues in paediatric A&E cases include fever and infection, fractures, abdominal pain and head injuries. Accurate records and appropriate follow-up are particularly important in cases involving children.
Elderly or medically vulnerable patients
Older patients and those with existing medical conditions may present with falls, confusion, infection or medication-related complications. These patients may require more detailed assessment before discharge, and communication with family members or carers about ongoing care is an important part of safe discharge planning.
Fatal A&E Negligence Concerns
Some families seek legal advice following the death of a relative after attending an A&E department. Concerns may relate to missed deterioration, unsafe discharge, delayed treatment or failures in communication between clinical staff or with the patient's family.
In these cases, the inquest process, medical records and independent expert review may all form part of understanding what happened. Michael Boylan Litigation has experience in advising families in these sensitive circumstances, including a case involving substantial damages for nervous shock and costs of representation at inquest, and a substantial six-figure settlement for the family of a man who died following admission to hospital with a severe nose bleed.
Why Accident And Emergency Claims Can Be Complex
Emergency departments operate under pressure
The pressured environment of an A&E department is always part of the context. However, pressure does not remove the duty to provide care that meets the expected standard. Where recognised protocols are not followed, the circumstances under which the care was delivered will be considered, but they do not excuse avoidable failures.
Records may be incomplete or difficult to interpret
A&E notes are often brief, handwritten and time-stamped across different hospital systems. Interpreting these records requires experience and, frequently, expert input.
Several teams may be involved
A single A&E attendance may involve emergency doctors, triage nurses, radiologists, laboratory staff, surgical teams, orthopaedic specialists, neurologists, cardiologists and discharge coordinators. Identifying where and how a failure occurred can require careful analysis of each team's involvement.
The later outcome must be linked to the earlier care
Even where a clear failing in A&E care can be identified, the legal case also requires proof that the failing caused or materially contributed to the harm that followed. This is the causation requirement, and it is assessed through independent expert evidence.
Accident And Emergency Claims FAQs
What is an Accident and Emergency claim?
An Accident and Emergency claim is a legal matter in which a patient, or their family, alleges that the care provided in an Emergency Department fell below the expected standard and that this caused avoidable harm. These are medical negligence cases and require both legal and medical expert assessment.
Is every mistake in A&E medical negligence?
No. A poor outcome or an error does not automatically amount to medical negligence. The care must have fallen below the standard expected of a reasonably competent practitioner, and the failing must have caused or contributed to the injury or harm.
Can I request my A&E medical records?
Patients are generally entitled to seek access to their medical records, including A&E attendance notes, under data protection legislation. A solicitor can advise on the specific records needed for a legal assessment.
What if I was discharged and later became seriously unwell?
If you became seriously unwell after being sent home from A&E, the circumstances of your discharge may need to be reviewed. This is particularly relevant where symptoms, test results or clinical observations were not properly considered before the decision to discharge was made.
What if the hospital apologised or carried out a review?
An apology or internal hospital review can be relevant, but it is not the same as an independent legal or medical assessment. Internal reviews may not address the full legal questions of standard of care and causation.
Do A&E claims go through the Injuries Resolution Board?
Medical negligence claims are generally treated differently from standard personal injury claims and are subject to their own procedural requirements. The position regarding the Injuries Resolution Board can depend on the nature of the claim, and specialist legal advice should be sought.
How long does an A&E negligence case take?
Timelines vary considerably. Factors include the time taken to obtain and review medical records, the availability of independent expert evidence, the hospital's response, and whether court proceedings are necessary.
Can family members seek advice after a death linked to A&E care?
Yes. Families who have concerns about the care provided to a relative in A&E, including concerns about deterioration, discharge decisions, delays in treatment or communication failures, may seek legal advice. Michael Boylan Litigation can advise sensitively in these circumstances.
Speak With Michael Boylan Litigation About An Accident And Emergency Concern
Michael Boylan Litigation has years of experience representing individuals and families in medical negligence matters arising from Accident and Emergency care. Notable cases include:
- Damages for a plaintiff who suffered a delayed diagnosis of a cancerous tumour in his knee.
- €925,000 on behalf of a Dublin woman who required a left leg amputation as a result of a failure to diagnose a malignant tumour.
- Settlement of €325,000 for a woman who suffered undiagnosed appendicitis and subsequent rupture.
- Substantial six-figure settlement for the family of a man who died following admission to hospital with a severe nose bleed.
- Substantial damages for nervous shock and costs of representation at inquest.
- A case involving a delay in diagnosis of a neck fracture.
- Settlement of a medical negligence action for drug overdose.
- €755,000 awarded to a former opera singer.
- €95,000 in damages for perforation to colon following colonoscopy.
If you have concerns about care you or a family member received in an Accident and Emergency department, contact Michael Boylan Litigation to discuss your situation. Early legal advice can help clarify whether the care provided should be investigated further.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
