A sepsis misdiagnosis claim arises when a patient’s body is mounting a life-threatening response to infection and the warning signs are missed or put down to something else, delaying the antibiotics, fluids and treatment of the source that sepsis requires. In Virginia, it is a medical malpractice claim, and it often involves nurses and hospital systems as well as physicians.
Blank Kim Injury Law represents sepsis survivors and families who lost someone to sepsis, throughout Northern Virginia, from our Fairfax office. These cases often involve older parents or patients recovering from surgery, and we work with the family members who were at the bedside. Robert Kim speaks Korean, and our paralegals speak Spanish.
What sepsis is and how it progresses
Sepsis is not an infection itself. It is the body’s overwhelming response to an infection, which begins to damage its own organs. Without prompt treatment, it can progress to septic shock, in which blood pressure falls so low that organs stop getting enough blood, even with fluids.
Almost any infection can lead to sepsis. The most common sources are:
- Pneumonia and other lung infections
- Urinary tract and kidney infections
- Abdominal infections, including a leak after bowel surgery or a ruptured appendix
- Skin and wound infections, including pressure ulcers
- Infected IV lines, catheters and surgical sites
Warning signs that should trigger a sepsis evaluation
Sepsis rarely announces itself with one dramatic symptom. It shows up as a cluster of changes, many of which are recorded in the vital signs long before anyone names the problem:
- Fever or chills, or an abnormally low temperature
- A fast heart rate
- Fast breathing or shortness of breath
- Low blood pressure
- New confusion, agitation or unusual sleepiness
- Little or no urine
- Cold, clammy or mottled skin
- Severe pain or a feeling that something is very wrong
Hospitals use screening tools to catch this pattern, including early warning scores built into the electronic record that alert nurses and physicians when vital signs cross set thresholds. A screening alert that fires and is dismissed, or a nurse who records worsening vital signs without notifying a physician, is a frequent starting point in these cases.
The first hours: what timely sepsis care looks like
International guidelines from the Surviving Sepsis Campaign set out steps to start quickly once sepsis is suspected. Studies have tied delays in antibiotics to higher death rates in septic shock, and hospitals report their sepsis care to the Centers for Medicare & Medicaid Services under a quality measure known as SEP-1.
| Step | Why it matters |
|---|---|
| Measure lactate, and repeat it if elevated | A high level signals that tissues are not getting enough oxygen |
| Draw blood cultures before antibiotics | Identifies the organism so treatment can be targeted |
| Give broad-spectrum antibiotics promptly | The single most important treatment; delay allows the infection to spread |
| Give IV fluids for low blood pressure or high lactate | Restores blood flow to organs |
| Start vasopressor medication if blood pressure stays low | Keeps blood pressure high enough to perfuse the brain, kidneys and heart |
| Find and control the source | Draining an abscess, removing an infected line or repairing a surgical leak |
Where sepsis gets missed
In the emergency department
Patients with early sepsis are sent home with a diagnosis of a virus, flu or dehydration, sometimes with blood cultures still pending. When those cultures come back positive after discharge, someone has to call the patient back. Read more on our emergency room errors page.
After surgery
Fever, a fast heart rate and belly pain in the days after an operation are sometimes attributed to normal recovery when they signal a leak, an abscess or a wound infection. See our page on surgical errors.
On a hospital floor
A patient admitted for something else develops an infection, and the vital sign trend worsens over a shift. Delays in calling the physician or the rapid response team are a common failure.
In nursing homes and at home
In older adults, a urinary tract infection often shows up as sudden confusion rather than fever. When confusion is treated as dementia getting worse, the infection progresses. Neglect claims against facilities are covered on our nursing home abuse and neglect page. Patients receiving chemotherapy, whose immune systems are weakened, need an urgent evaluation for any fever.
What a delay in sepsis treatment can cost
- Septic shock and failure of the kidneys, lungs or liver, sometimes requiring dialysis or a ventilator
- Loss of fingers, toes or limbs from reduced blood flow, discussed on our amputation injury page
- Lasting problems with memory, concentration, sleep and strength, often called post-sepsis syndrome
- Long stays in intensive care and rehabilitation facilities
- Death
Proving a sepsis delay
Sepsis cases are unusually well documented, because vital signs, lab results and medication times are all recorded to the minute. The records we obtain include:
- The vital sign flowsheet, which shows the trend over hours
- Nursing notes and records of calls to physicians
- Early warning score alerts and whether they were acknowledged or overridden
- The time antibiotics were ordered compared with the time they were actually given, from the medication administration record
- Lactate and culture results, with collection and result times
- Rapid response and code team records
- The hospital’s SEP-1 documentation for the admission
Physicians in emergency or critical care medicine and nurses who can address nursing standards review the care. An infectious disease or critical care physician then explains what earlier treatment would likely have prevented.
Sepsis claims under Virginia law
Every provider in the chain, from the triage nurse to the attending physician, is held to the standard of a reasonably prudent provider in the same field in Virginia, under Va. Code § 8.01-581.20. The claim must be supported by a qualified expert witness’s written opinion before suit is served, under Va. Code § 8.01-20.1. Suit generally must be filed within two years of the malpractice under Va. Code § 8.01-243(A), and total damages are capped by Va. Code § 8.01-581.15.
Sepsis is a leading cause of death in hospitals. When a loved one died, the personal representative brings the claim, generally within two years of the death; see our page on malpractice wrongful death claims. The broader framework is on our Virginia medical malpractice page.
