In March 2026, a Mobile County, Alabama jury returned a $50 million verdict against a hospital after a patient was discharged despite a serious blockage of his coronary arteries. The patient died. The case — which turned on allegations that providers failed to diagnose and treat a life-threatening cardiac condition in the emergency department — is one of the largest failure-to-diagnose verdicts in recent memory, and it underscores a pattern that has generated significant malpractice exposure for decades: the missed myocardial infarction.
What makes these cases legally devastating is not that coronary artery disease is rare or obscure. It is one of the most common and thoroughly studied causes of ED visits in the United States. The clinical red flags are well-established. The problem is that atypical presentations — chest pressure that localizes to the jaw, arm, or back; nausea and diaphoresis without chest pain; exertional dyspnea in an older diabetic patient — create the conditions under which diagnostic anchoring takes hold, the workup is abbreviated, and the patient is sent home.
From an expert witness perspective, failure-to-diagnose cardiac cases are analyzed at three distinct points: the triage decision, the diagnostic workup, and the discharge determination. Plaintiff experts look at whether the provider obtained an EKG within 10 minutes of arrival for any complaint that could plausibly be cardiac in origin — the benchmark established by AHA/ACC guidelines. They look at whether serial troponin values were ordered and properly interpreted. And they look at whether a risk stratification tool — HEART Score, TIMI, or equivalent — was applied and documented.
What plaintiff experts look for in these cases:
- EKG timing documentation — was it obtained within 10 minutes of triage for a potentially cardiac complaint?
- Serial troponin strategy — were values drawn at the appropriate intervals, and was a rising pattern recognized?
- Risk stratification — was a validated score applied, documented, and factored into the disposition decision?
- Differential diagnosis breadth — did the note reflect consideration of ACS, PE, and aortic dissection, or did it anchor on a musculoskeletal or GI etiology early?
- Discharge documentation — was the reasoning for discharge explicitly connected to the clinical findings, or was it templated language?
The Alabama verdict also carries an institutional liability dimension that attorneys should not overlook. When a patient with documented risk factors — hypertension, diabetes, hyperlipidemia, prior smoking history — presents with a complaint that has any plausible cardiac component, the institution’s protocols for cardiac screening become relevant. If the hospital had a chest pain observation protocol and the physician chose not to activate it, that decision will be scrutinized. If the protocol existed on paper but was inconsistently applied, the institution faces direct liability separate from the treating provider.
The AMA’s April 2026 benchmark survey found that emergency physicians face a 42% lifetime malpractice claim rate — among the highest of any specialty. Missed cardiac diagnoses account for a disproportionate share of both the frequency and severity of those claims. Cases like the Alabama verdict are not outliers; they are the foreseeable endpoint of a recurring documentation and clinical reasoning failure that plaintiff attorneys know exactly how to build a case around.
References
- Morris James LLP. “Largest Medical Malpractice Verdicts of the Past Year.” June 2026.
- AMA. “Medical Liability Claim Frequency Among U.S. Physicians.” April 2026.
- Amsterdam EA et al. “2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation ACS.” J Am Coll Cardiol. 2014;64(24):e139-e228.
- Six AJ et al. “The HEART Score for the Assessment of Patients with Chest Pain in the Emergency Department.” Crit Pathw Cardiol. 2010;9(1):19-24.
