Case Type
Urgent Care Appendicitis Misdiagnosis Expert Witness
Evaluating Standard of Care in Missed Abdominal Emergencies
Appendicitis is one of the most common, and dangerous, missed diagnoses in Urgent Care Medicine. Dr. Max Lebow provides expert analysis to determine if a missed appendicitis diagnosis was an inevitable atypical presentation or a breach of the standard of care.
The Challenge
The Urgent Care Dilemma: No CT Scan
Unlike the Emergency Department, where a CT scan is often the default for abdominal pain, an Urgent Care provider must rely on clinical judgment, physical exam, and history to rule out a surgical emergency.
When a patient is sent home with a diagnosis of "gastroenteritis" or "constipation" and their appendix subsequently ruptures, the central legal question becomes: Did the provider meet the Urgent Care Standard of Care given the limited resources available?
The Standard of Care for an Urgent Care Provider Shifts To:
The Focused Physical Exam
Specifically, was the Right Lower Quadrant (RLQ) evaluated and documented?
History Taking
Did the provider ask about the migration of pain, anorexia (loss of appetite), or fever?
Triage Decision
Did the patient's vital signs or exam findings mandate an immediate transfer to the ER?
Expert Analysis
Key Questions Dr. Lebow Investigates
When reviewing a missed appendicitis case, Dr. Lebow scrutinizes the medical record for specific "red flags" and mandatory protocols.
Was the RLQ Examined?
Every abdominal pain patient must have the Right Lower Quadrant evaluated and documented to rule out appendicitis. If the record shows a generic 'soft, non-tender' exam without specific reference to McBurney's point or the RLQ, it may indicate a 'templated' exam rather than a genuine assessment.
Were Vital Signs Ignored?
Did the patient have a low-grade fever or tachycardia (fast heart rate) that was dismissed as viral illness?
The 'Safety Net' Instructions
The most common mistake in Urgent Care is failing to provide time-specific and place-specific follow-up.
Negligent:
"Follow up if not better."
Prudent:
"Go to the ER immediately if pain moves to the right side, if you vomit, or if fever develops."
Case Patterns
Common Misdiagnosis Patterns
Dr. Lebow has reviewed numerous cases involving these common fact patterns:
'Gastroenteritis' vs. Appendicitis
Attributing vomiting and pain to a 'stomach flu' without documenting the absence of peritoneal signs.
'Constipation' vs. Obstruction/Appendix
Prescribing laxatives to a patient with localized tenderness.
Atypical Presentations
Defending providers who discharged a patient who truly had no RLQ tenderness at the time of the visit (retrocecal appendix), but ensuring the documentation supports that decision.
Why It Matters
Why Retain an Urgent Care Specialist?
Hiring a general ER expert can backfire in these cases. An ER expert might testify that "standard of care requires a CT scan," which is not the standard for an Urgent Care center.
Dr. Lebow clarifies the distinction: The duty of the Urgent Care provider is not to see the appendix, but to perform a sufficient exam to identify risk and refer appropriately when signs are present.
Have an Abdominal Pain Case?
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