Six ER Malpractice Lawsuits That Are Reshaping Emergency Medicine Liability

Emergency medicine has always carried outsized legal risk. Clinicians make high-stakes decisions under time pressure, with incomplete information, on patients they have never met. But the past two years have seen a measurable escalation in both the frequency and magnitude of malpractice verdicts against emergency departments — a trend that legal analysts, risk managers, and emergency medicine professional societies are watching with growing alarm.

Between January 2024 and April 2026, ER Times identified more than 40 significant malpractice verdicts or settlements exceeding $5 million involving emergency departments in the United States. Six of those cases — selected for their legal significance, clinical lessons, and geographic diversity — are examined in depth here.

The combined value of the six cases in this report exceeds $123 million. They span cardiac emergencies, pediatric sepsis, neurological misdiagnosis, psychiatric holds, obstetric emergencies, and trauma. Together, they paint a picture of an emergency medicine liability landscape that is shifting — and not in providers' favor.

Several factors are driving the surge. Plaintiff attorneys have become more sophisticated in their use of electronic health record data, demonstrating to juries exactly when a physician last reviewed a chart, how long a patient waited for a critical test, and what the standard of care required at each decision point. Post-pandemic staffing shortages have created documented gaps in supervision and coverage that are increasingly being used as evidence of institutional negligence. And jury attitudes toward hospitals — particularly those owned by private equity — have hardened considerably since 2020.

"The days of the sympathetic ER doctor who was just doing their best are not over," said one plaintiff's attorney who has litigated three of the cases in this report. "But juries are now much more willing to hold systems accountable, not just individual physicians. That's a fundamental shift."

In March 2025, a Harris County, Texas jury returned an $18.7 million verdict against a Houston-area hospital system after a 54-year-old construction worker presented to the emergency department with chest pain, diaphoresis, and left arm radiation — and was discharged with a diagnosis of musculoskeletal pain after a single ECG and a troponin draw.

The patient, identified in court records as R.M., collapsed in the hospital parking lot approximately 90 minutes after discharge. Bystanders initiated CPR. He was transported back to the same emergency department, where a repeat ECG revealed a massive anterior STEMI. Despite emergent catheterization, he suffered severe anoxic brain injury and died six days later.

The plaintiff's case centered on three failures. First, the initial ECG — which the attending physician reviewed and documented as "normal" — was later analyzed by a cardiologist expert witness who identified subtle but recognizable ST-segment changes in leads V1 through V4 consistent with a hyperacute STEMI or early LAD occlusion. Second, the single troponin draw was obtained only 45 minutes after symptom onset — well within the window during which a first troponin may be falsely negative. The standard of care, plaintiff's experts argued, required either a repeat troponin at three hours or a cardiology consultation before discharge. Neither occurred. Third, the physician's documentation showed he spent fewer than eight minutes with the patient before ordering discharge.

The defense argued that the ECG changes were within normal limits and that the physician's clinical judgment was reasonable given the patient's atypical presentation and lack of prior cardiac history. The jury rejected that argument after deliberating for less than four hours.

The verdict included $4.2 million in economic damages, $8.5 million in non-economic damages, and $6 million in punitive damages — the last of which the trial judge later reduced to $4 million under Texas's statutory cap on exemplary damages. The hospital system has appealed.

A $22.1 million settlement was reached in October 2024 in a Broward County, Florida case involving a nine-year-old girl who presented to a pediatric emergency department with three days of fever, lethargy, and decreased oral intake. She was triaged as a level 3 (urgent) patient and waited two hours and 22 minutes before being seen by a physician.

When the attending physician evaluated her, she had a temperature of 39.8°C, heart rate of 138, and capillary refill of three seconds. A complete blood count was ordered. The white blood cell count returned at 24,000 with 18% bands. The physician documented "viral illness vs. early bacterial infection" and ordered a single dose of oral amoxicillin and discharge with return precautions.

The child was brought back by ambulance six hours later in septic shock. Blood cultures drawn on the second visit grew Streptococcus pneumoniae. Despite aggressive resuscitation and ICU admission, she suffered hypoxic-ischemic encephalopathy and sustained permanent cognitive and motor deficits. She will require lifelong care.

The plaintiff's experts argued that the combination of fever, tachycardia, elevated WBC with bandemia, and prolonged capillary refill met the Systemic Inflammatory Response Syndrome (SIRS) criteria for pediatric sepsis and required immediate IV antibiotics, IV fluid resuscitation, and hospital admission — not oral antibiotics and discharge. The hospital's own pediatric sepsis protocol, introduced into evidence, specified that any patient meeting two or more SIRS criteria with a suspected infectious source should trigger a sepsis alert and mandatory IV access.

The defense acknowledged the protocol existed but argued the physician exercised reasonable clinical judgment in a busy department. The hospital settled before trial, reportedly after internal documents revealed the sepsis protocol had not been reviewed or updated in four years and that compliance audits had never been conducted.

A Franklin County, Ohio jury awarded $14.3 million in February 2025 to the family of a 61-year-old woman who presented to a Columbus-area emergency department with sudden-onset dizziness, nausea, vomiting, and difficulty walking. The attending physician documented "benign positional vertigo" and performed a Dix-Hallpike maneuver, which was negative. The patient was given ondansetron and meclizine and discharged after three hours.

She returned by ambulance the following morning unable to speak or move her right arm. MRI revealed a large posterior circulation infarct involving the cerebellum and portions of the brainstem — a stroke that, based on diffusion-weighted imaging characteristics, had been evolving for at least 18 to 24 hours. She survived but is permanently disabled, requiring full-time care.

The plaintiff's neurology expert testified that the patient's presentation — sudden-onset dizziness with gait instability in a 61-year-old with hypertension and a prior TIA — was a textbook HINTS-positive presentation for central vertigo. The HINTS exam (Head Impulse, Nystagmus, Test of Skew) was not documented in the chart. The physician testified at deposition that he was "not familiar" with the HINTS protocol.

The defense argued that posterior circulation strokes are notoriously difficult to diagnose in the emergency setting and that CT imaging — which was obtained — is insensitive for posterior fossa ischemia in the first 24 hours. The jury was unpersuaded, particularly after plaintiff's counsel introduced evidence that the hospital's own stroke protocol required MRI for any patient over 50 with new-onset dizziness and a vascular risk factor — a protocol the physician had not followed.

The largest verdict in this report — and one of the largest ER malpractice awards in California history — came in a Los Angeles County case decided in September 2024. A jury awarded $31.5 million to the family of a 29-year-old man who died while in four-point restraints in an emergency department during an involuntary psychiatric hold under California's Welfare and Institutions Code Section 5150.

The patient, identified in court filings as D.W., was brought to the emergency department by police after a mental health crisis call. He was agitated and combative on arrival. He was placed in four-point restraints within 12 minutes of arrival. Over the next 47 minutes, nursing documentation showed he was checked twice — once at 15 minutes and once at 40 minutes. At the 47-minute mark, a nurse found him unresponsive. Resuscitation was unsuccessful. The medical examiner ruled the cause of death as positional asphyxia complicated by excited delirium and physical restraint.

The plaintiff's case was built on three pillars. First, the hospital's own restraint policy required continuous monitoring — defined as visual observation at least every 15 minutes with vital signs every 30 minutes — for any patient in four-point restraints. The documentation showed a 25-minute gap in observation. Second, expert testimony established that the prone positioning of the patient's torso — documented in a nursing note as "patient positioned on side, leaning forward" — is a recognized risk factor for positional asphyxia, particularly in the context of physical agitation and stimulant intoxication (toxicology showed cocaine metabolites). Third, the department was operating at 142% capacity that evening, with a nurse-to-patient ratio of 1:9 in the psychiatric bay.

The defense argued that the patient's death was caused by his own drug use and underlying psychiatric condition, not by any failure of care. The jury awarded $8.5 million in compensatory damages and $23 million in punitive damages — the latter based on findings that the hospital had received three prior complaints about restraint monitoring in the psychiatric bay and had taken no corrective action.

A $9.8 million settlement was reached in a Fulton County, Georgia case in which a 27-year-old woman presented to an Atlanta-area emergency department with lower abdominal pain, vaginal spotting, and a positive home pregnancy test. A urine pregnancy test confirmed pregnancy. A pelvic ultrasound was ordered but not completed before the patient was seen by the attending physician, who documented "threatened abortion" and discharged her with instructions to follow up with her OB-GYN within 48 hours.

The ultrasound was completed after the physician had already signed the discharge order. The radiology report, available in the electronic health record 22 minutes after the patient left the department, noted "no intrauterine pregnancy identified; adnexal fullness on the right; clinical correlation recommended." The report was not reviewed by the discharging physician, who had already left the department at shift change.

The patient collapsed at home four hours later. Emergency surgery revealed a ruptured right ectopic pregnancy with approximately 1.5 liters of hemoperitoneum. She survived but required bilateral salpingectomy and will be unable to conceive naturally.

The plaintiff's case focused on two failures: the physician's decision to discharge before reviewing the pending ultrasound, and the hospital's lack of a system to flag critical radiology results for patients who had already been discharged. The hospital's EHR had a "pending results" notification feature that had been disabled by the IT department 18 months earlier due to alert fatigue complaints — a fact that proved devastating in litigation.

In February 2026, a Cook County, Illinois jury returned a $27.4 million verdict against a Chicago-area hospital system after a 44-year-old man presented following a motor vehicle collision and was discharged without identification of a C5 fracture that was visible on his CT scan.

The patient presented with neck pain and midline tenderness following a rear-end collision at highway speed. A CT cervical spine was obtained and read by a radiology resident as "no acute fracture or malalignment." The attending emergency physician reviewed the radiology report — but not the images themselves — and cleared the patient's cervical spine. The patient was discharged in a soft cervical collar with instructions to follow up with his primary care physician.

Three days later, the patient tripped on a step at home and fell. The fall caused displacement of the previously undiagnosed C5 fracture, resulting in complete cervical spinal cord injury at the C5 level. He is now quadriplegic.

The plaintiff's case was built on two independent failures. First, a neuroradiology expert reviewed the original CT images and testified that the C5 fracture — a subtle but definite cortical disruption of the anterior vertebral body — was visible on the axial and sagittal reconstructions and should have been identified by a competent radiologist. The residency program's supervision logs showed the attending radiologist had not reviewed the resident's read before it was finalized. Second, the emergency physician's documentation showed he relied entirely on the radiology report without independent image review — a practice that plaintiff's experts argued fell below the standard of care for a high-mechanism cervical spine injury.

The verdict included $12.4 million in future care costs, $9 million in non-economic damages, and $6 million in punitive damages against the hospital for its supervision practices. The hospital's radiology department had been cited in a prior internal quality review for inadequate attending oversight of resident reads — a document that was produced in discovery.

Across six cases, six states, and two years, several patterns emerge with striking consistency.

Protocol violations are the plaintiff's best friend. In five of the six cases, the plaintiff's attorneys were able to introduce the hospital's own written protocols — sepsis alerts, restraint monitoring requirements, radiology supervision policies, pending result notification systems — and demonstrate that those protocols were not followed. When a hospital has a written standard and its own staff does not meet it, the defense of "reasonable clinical judgment" becomes nearly impossible to sustain.

Electronic health records are a double-edged sword. EHR timestamp data was used in four of the six cases to establish exactly when physicians last accessed a chart, how long patients waited for critical tests, and when results were available but not reviewed. The same systems that protect providers by documenting care are increasingly being used to establish the precise moment a standard of care was breached.

Staffing shortages are becoming a liability argument. In three cases — the pediatric sepsis case, the restraint death, and the cervical spine case — the plaintiff successfully argued that inadequate staffing ratios or supervision structures created the conditions for the harm. As hospitals continue to operate with reduced nursing and physician coverage, this argument will only become more powerful.

Prior notice amplifies punitive exposure. In two of the four jury verdicts that included punitive damages, the plaintiff introduced evidence that the hospital had prior notice of the specific systemic problem — whether through internal quality reviews, prior complaints, or disabled safety features — and failed to act. Courts have consistently held that punitive damages are appropriate when a defendant knew of a risk and consciously disregarded it.

The cases in this report are not outliers. They are the visible tip of a much larger litigation landscape that is reshaping how emergency medicine is practiced, documented, and defended. For clinicians, risk managers, and hospital administrators, several practical implications follow.

Know your department's protocols — and follow them. The single most consistent finding across these cases is that hospitals were held to their own written standards. If your department has a sepsis protocol, a restraint monitoring policy, or a pending results notification system, those documents will be produced in discovery if a patient is harmed. Compliance is not optional.

Document your clinical reasoning, not just your conclusions. In the STEMI case and the stroke case, the physicians' documentation showed what they did but not why they ruled out the more serious diagnosis. Documenting the specific features that made you consider and reject a high-risk diagnosis — and what safety netting you provided — is increasingly important in defending against hindsight bias in litigation.

Never discharge before reviewing pending critical results. The ectopic pregnancy case is a cautionary tale about shift-change handoffs and pending results. If you ordered a test, you own the result — even if you are no longer physically in the department when it returns. Systems that allow patients to be discharged with pending imaging or laboratory results that could change the disposition are a known liability risk.

The Arizona precedent changes the calculus in one state — and may spread. As detailed in our companion investigation, Arizona courts have recently removed a key protective standard that previously required plaintiffs to prove gross negligence in emergency care cases. That shift — from gross negligence to ordinary negligence — dramatically lowers the bar for successful malpractice claims and is being watched closely by plaintiff's attorneys in other states. See our full analysis at the link below.