HSC 432 Module 2 Case Study #1: Litigation and Medical Malpractice Example

A Missed Heart Attack in the Emergency Department: A Medical Malpractice Analysis Under Arizona Law

Student Name

BS in Health Sciences, Arizona State University

HSC 432: Legal Issues in Health Care

Instructor Name

Month Day, Year

A Missed Heart Attack in the Emergency Department: A Medical Malpractice Analysis Under Arizona Law

The Fact Pattern

Ms. R., 52, arrives at a Phoenix emergency department at 11 p.m. with upper abdominal pain and shortness of breath. An electrocardiogram is read as nondiagnostic. No cardiac enzyme test is ordered. Dr. T., an emergency physician employed by a staffing group that contracts with the hospital, diagnoses gastroesophageal reflux and discharges her. At 7 a.m. she collapses at home with a heart attack. She survives with permanent heart damage and cannot return to work. Eighteen months later she consults a lawyer.

Issues

1. Can Ms. R. prove medical negligence against Dr. T.?

2. Can the hospital be held responsible?

3. Are there procedural barriers or defenses?

Rule: Medical Negligence in Arizona

Ms. R. carries the burden on four elements: duty, breach, causation and damages. Arizona's statute defines the necessary proof: the provider failed to exercise the care, skill and learning expected of a reasonable, prudent provider in the same profession or class in the state acting in the same or similar circumstances, and that failure was a proximate cause of the injury (Ariz. Rev. Stat. § 12-563).

Application

Duty. A physician-patient relationship formed when Dr. T. evaluated Ms. R., so a duty of care existed.

Breach. The question is whether a reasonable emergency physician would have done more. An emergency medicine expert for Ms. R. would probably say that a middle-aged patient with upper abdominal pain and shortness of breath requires serial electrocardiograms and cardiac enzyme testing before discharge. Research supports the foreseeability of the risk: in a multicenter study, 2.1% of patients with acute myocardial infarction were mistakenly discharged, and those with a normal or nondiagnostic electrocardiogram or shortness of breath as the main symptom were more likely to be sent home (Pope et al., 2000).

Causation. Ms. R. must show it is more likely than not that proper testing would have led to admission and treatment that would have prevented or reduced the heart damage. This will turn on expert testimony about timing, since the attack occurred about eight hours after discharge.

Damages. Permanent heart damage, medical costs and lost earnings are compensable. Arizona's constitution bars laws that cap damages for death or injury, so no statutory limit applies.

Hospital Liability

Dr. T. is employed by a staffing group, not the hospital, so ordinary respondeat superior may not apply. However, courts often hold hospitals liable for emergency physicians under an apparent or ostensible agency theory when patients reasonably believe the physician works for the hospital and nothing tells them otherwise. Ms. R. came to the hospital's emergency department, not to a particular doctor, which supports that claim.

Procedural Barriers and Defenses

Timing. Arizona generally requires personal injury actions to be filed within two years (Ariz. Rev. Stat. § 12-542). At 18 months, Ms. R. must act quickly.

Expert affidavit. Arizona requires a preliminary expert opinion affidavit in claims against licensed health care professionals when expert testimony is needed (Ariz. Rev. Stat. § 12-2603), and the expert must generally share the defendant's specialty, here emergency medicine.

Comparative fault. If the defense shows Ms. R. ignored discharge instructions to return for worsening symptoms, a jury could reduce her recovery in proportion to her fault, because Arizona uses pure comparative fault (Ariz. Rev. Stat. § 12-2505).

Conclusion

Ms. R. has a strong claim on duty and damages, a credible claim on breach supported by expert testimony and research on missed diagnoses, and a contested causation question. The hospital likely faces apparent agency liability. Filing promptly with a qualified emergency medicine expert is essential. Most malpractice claims involving injury from error result in payment, while many claims without error do not (Studdert et al., 2006), so the strength of the expert review will shape whether this case settles.

References

Ariz. Rev. Stat. § 12-542 (2025).

Ariz. Rev. Stat. § 12-563 (2025).

Ariz. Rev. Stat. § 12-2505 (2025).

Ariz. Rev. Stat. § 12-2603 (2025).

Pope, J. H., Aufderheide, T. P., Ruthazer, R., Woolard, R. H., Feldman, J. A., Beshansky, J. R., Griffith, J. L., & Selker, H. P. (2000). Missed diagnoses of acute cardiac ischemia in the emergency department. New England Journal of Medicine, 342(16), 1163-1170. https://doi.org/10.1056/NEJM200004203421603

Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A., Yoon, C., Puopolo, A. L., & Brennan, T. A. (2006). Claims, errors, and compensation payments in medical malpractice litigation. New England Journal of Medicine, 354(19), 2024-2033. https://doi.org/10.1056/NEJMsa054479