Can I File a Maryland Medical Malpractice Lawsuit Over a Doctor’s Failure to Refer?

One doctor’s failure to refer a patient to another healthcare provider for evaluation and treatment could have devastating consequences. The patient’s condition could worsen and become more difficult to treat. The treatment options that remain could be more dangerous and put the patient at risk for debilitating side effects.

The doctor who failed to make a referral could be held liable for medical malpractice. The victim’s lawyer would need to prove the doctor’s decision fell outside of accepted standards in the medical community.

If you think a doctor should have referred you to a specialist and this failure caused damages, call The Law Offices of Peter T. Nicholl. Our experienced Maryland medical malpractice lawyers are here to answer your questions and explore legal options. Our services come with no upfront costs.

Learn more by calling us: 410-297-0271 We are ready to help you.

What is a Medical Referral?

A medical referral is a recommendation for a patient to see another medical professional. One doctor directs a patient to another for specialized care or services. This typically occurs when a patient’s needs exceed the referring provider’s expertise or available resources.

Doctors often make referrals for:

• Specialists, such as a cardiologist, neurologist, gastroenterologist, urologist, endocrinologist, dermatologist or orthopedist
• Diagnostic tests like an MRI, CT scan, blood work, stress test, echocardiogram, angiogram, sleep study, genetic testing, mammogram and more
• Allied health professionals, who are not doctors or nurses but specialists in a highly specific area, such as audiologists, dieticians, chiropractors or speech-language pathologist

The process involves the primary care physician identifying the need for specialized care, preparing a referral letter or form, and scheduling an appointment with the specialist or facility. The patient then attends this appointment for further evaluation or treatment.

There are numerous benefits of medical referrals, including:

• Access to specialized expertise
• Coordinated care between healthcare providers
• Potentially faster diagnosis and treatment

While referrals are an important tool in the diagnostic and treatment process, there can be challenges, such as appointment delays, poor communication between providers, or lack of insurance coverage for the doctor the patient is being referred to.

For many patients, referrals are not an optional thing. Their health insurance plan requires them to get a referral before seeing anyone who is not their primary care physician.

What is a Failure to Refer?

Failure to refer means the medical provider in question never made a referral or did not do so in a timely manner, and this caused the patient some type of harm. Doctors have a duty to make a referral when they do not possess the knowledge or experience to provide an accurate diagnosis and/or effective treatment.

There are numerous reasons why doctors may fail to refer a patient for treatment, including:

• Misdiagnosis or underestimation of the seriousness of the patient’s symptoms
• Overconfidence in one’s own abilities to manage the condition
• Lack of awareness about available specialists or treatments
• Financial considerations or pressure to minimize referrals
• Poor communication between healthcare providers
• Oversight or administrative errors, such as the failure of the doctor’s office to make the referral, even though the doctor requested staff to make one

Doctors and other healthcare providers can take various steps to try to prevent failure to refer. For example, healthcare systems often implement guidelines, decision support tools, and regular training for providers.

It is also critical for there to be open communication between primary care and specialist providers.

When Should a Doctor Make a Referral to Another Medical Professional?

Understanding when a doctor should make a referral to a specialist is crucial for ensuring that patients receive appropriate and timely care. However, the answer may depend on many factors, including the:

• Medical issue you are dealing with
• Training and experience of the doctor you saw
• Symptoms you reported to the doctor

Essentially, doctors are required to provide treatment until you no longer need it or until you stop seeing the doctor in question. If your condition gets better or it can no longer be treated, the doctor may have met the standard of care.

It is possible the doctor may not have the qualifications to treat your illness. He or she may not specialize in treating the part of the body that is affected by your condition. For example, a general practitioner is not going to have the same knowledge and experience as a cardiologist.

If this happens, the doctor may have an obligation to refer you to another doctor who has the knowledge and experience to treat you.

Would another doctor in a similar situation have referred you to a specialist? If the answer is yes, the doctor you met with may have had a legal obligation to make a referral.

Specific Examples of Times When Doctors Should Make Referrals

Here are some specific examples of situations where doctors should probably refer patients to other medical professionals:

• Patients with persistent headaches and vision changes should be referred to a neurologist or ophthalmologist.
• Patients with unexplained weight loss and persistent abdominal pain should be referred to a gastroenterologist.
• Patients experiencing chest pain and shortness of breath should be referred to a cardiologist.
• Patients with suspicious moles or skin lesions should be referred to a dermatologist.
• Patients suffering from chronic joint pain and stiffness should be referred to a rheumatologist.
• Patients with recurrent urinary tract infections or blood in urine should be referred to a urologist.
• Patients with a persistent cough and difficulty breathing should be referred to a pulmonologist.
• Patients experiencing irregular menstrual cycles or pelvic pain should be referred to a gynecologist.
• Patients with severe depression or anxiety not responding to initial treatment should be referred to a psychiatrist.
• Patients with chronic back pain with possible nerve involvement should be referred to an orthopedist or neurosurgeon.
• Patients experiencing unexplained fatigue and hair loss should be referred to an endocrinologist.
• Patients with frequent nosebleeds or persistent sinus problems should be referred to an otolaryngologist (ENT).
• Patients with suspected food allergies or severe allergic reactions should be referred to an allergist/immunologist.
• Patients showing signs of memory loss or cognitive decline, especially older adults, should be referred to a geriatrician or neurologist.
• Patients with symptoms of chronic kidney disease, such as swelling and high blood pressure, should be referred to a nephrologist.

Making a Proper Referral

If your doctor determines it is best for you to see another medical professional, he or she needs to be cautious about where you are referred.

• Referring you to a doctor or facility that can be trusted – Doctors should only refer you to a doctor or medical facility that is properly accredited and licensed. Referring you somewhere that is in trouble with regulatory authorities could be considered negligent.
• Giving patients options – Physicians often give patients a few options when they make a referral. They may also tell you to contact your insurance company to find a specialist in your network.
• Explaining the referral – When making a referral, the doctor should explain his or her decision. The doctor should explain why your medical issue is beyond the scope of his or her training, experience and medical knowledge. For example, the doctor could explain what kind of services the specialist may be able to provide.
• Documenting the decision – The doctor’s decision should be documented in your medical records. Your records should explain why the referral was made and to whom it was made.

How Can a Doctor’s Failure to Refer Harm the Patient?

A doctor’s failure to refer a patient to a specialist when needed can have significant and far-reaching consequences. The implications can affect a patient’s health, treatment options, and overall quality of life. Understanding these consequences is crucial for anyone who might be considering legal action for medical malpractice due to a failure to refer.

1. Worsening of Your Medical Condition

When a doctor fails to refer a patient to a specialist, the underlying condition can deteriorate. For many illnesses, early intervention is crucial for effective treatment. For instance, conditions like cancer or cardiovascular diseases often require prompt and specialized care to prevent progression.

Without timely referral, a patient’s condition may worsen, leading to more severe symptoms, complications or even a loss of treatment options. For example, undiagnosed cancer may advance to a stage where it becomes less treatable or incurable, significantly impacting the patient’s prognosis and survival chances.

2. Delayed Diagnosis and Treatment

A referral to a specialist often leads to a more accurate diagnosis and targeted treatment. If a primary care physician fails to make a necessary referral, the patient might be misdiagnosed or receive inappropriate treatment.

This delay in accurate diagnosis can result in prolonged suffering, ineffective treatments, and the escalation of the illness. For example, a patient with a suspected autoimmune disorder might receive general treatment instead of being referred to a rheumatologist who could provide a more precise diagnosis and effective treatment plan.

3. Increased Medical Costs

Failing to refer a patient to a specialist can lead to increased medical expenses in the long run. Initial treatments that are not adequately targeted can be more expensive and less effective, leading to additional tests, procedures, or hospitalizations.

If a condition worsens due to lack of proper referral, the costs associated with more aggressive treatments, advanced care, or emergency interventions can escalate significantly. For example, treating advanced cancer may require extensive chemotherapy, surgery, or radiation therapy, all of which can be far more costly than early, specialized treatment.

4. Emotional and Psychological Impact

The emotional toll on patients who experience a doctor’s failure to refer can be profound. The anxiety of dealing with a deteriorating condition, coupled with the frustration of feeling that proper care was not provided, can lead to significant psychological distress.

Patients may experience feelings of betrayal, helplessness, or anger, which can impact their overall well-being. The stress of coping with a worsening health condition can also affect family members and caregivers, adding to the emotional burden.

5. Potential for Legal Action

In cases where a doctor’s failure to refer results in significant harm, patients may consider pursuing a medical malpractice lawsuit. To establish a case, it must be proven that the failure to refer was a deviation from accepted medical standards and directly led to injury or worsening of the condition.

Legal claims can be complex and require expert testimony to demonstrate that another competent physician would have made the referral and that the lack of it caused the patient’s adverse outcomes.

6. Impact on Quality of Life

The consequences of a doctor’s failure to refer can profoundly affect a patient’s quality of life. Advanced or untreated conditions can lead to chronic pain, disability or diminished ability to perform daily activities. For some, this might mean an inability to return to work, participate in social activities, or enjoy a previously normal lifestyle. The ongoing impact on daily functioning and overall life satisfaction can be significant.

If you or a loved one has suffered due to a failure to refer, it is important to consult with a legal professional to explore your options for seeking justice and compensation for the harm caused.

Can I File a Medical Malpractice Lawsuit Over a Failure to Refer?

Your lawyer may be able to hold a medical provider liable for medical malpractice for failing to refer you to another doctor for treatment. Your lawyer would need to prove:

• The standard of care for the situation demanded a referral.
• The doctor’s failure to refer you resulted in an injury and damages. For example, your lawyer may be able to show how your medical condition got worse and resulted in the need for costly or invasive treatment.

If you have cancer, your lawyer may be able to show how failing to refer you resulted in a worse prognosis. For example, if the doctor referred you when your cancer was in its early stages, it may have been possible to perform surgery to remove the entire tumor. Your lawyer may provide evidence about how patients in a similar situation who were referred to another doctor had more success with treatment.

Your case is going to require an expert witness to explain, in detail what the standard of care was for your situation. The witness will also need to explain how a delay in treatment or misdiagnosis resulted in an injury and damages (medical expenses, lost wages, pain and suffering, etc.).

Contact Us to Discuss Your Maryland Medical Malpractice Claim

Doctors, hospitals and medical malpractice insurers are going to fight hard to avoid accountability for damages. That is why you need a lawyer with significant experience to fight for your interests.

Our law firm has obtained millions in compensation for victims of medical malpractice. We have the resources and legal knowledge needed to investigate and build a detailed case to fight for your rights.

There are no upfront fees or legal obligations. Call us at 410-297-0271.