A lab report ordered by a cardiologist at an Augusta office in May 2022 showed an elevated D-dimer and a positive antinuclear antibody titer in a 36-year-old woman with intermittent chest pain. The report was faxed to the office; it was filed in the chart without being routed to the ordering physician. The patient was scheduled for follow-up in three months but did not come in (the office did not call her when she missed the appointment). Eight months later, she presented to an Augusta emergency department in cardiac arrest from a massive pulmonary embolism. She survived with anoxic brain injury. The failure-to-treat case did not contest that the cardiologist diagnosed the underlying condition correctly; it argued that the system that should have routed the abnormal results, scheduled the necessary follow-up, and pursued the workup never closed the loop. The treatment that the diagnosis required never happened.
What failure-to-treat claims involve #
Failure to treat occupies the space between a correct diagnosis and the action that should have followed it. The provider identified the condition. The treatment did not happen, or did not happen adequately, or did not happen in time. The patient received no treatment, inadequate treatment, or delayed treatment despite a documented diagnosis, and the harm flowed from the gap.
The category is distinct from misdiagnosis (wrong answer) and delayed diagnosis (late answer) because here the answer was right; only the response failed. The negligence may consist of failing to order indicated treatment, failing to refer to a specialist when specialist treatment is required, failing to follow up on a treatment plan, prematurely ending treatment, or system failures that allowed the treatment plan to fall through.
Common failure-to-treat scenarios #
Several patterns recur.
Anticoagulation failures involve patients diagnosed with conditions requiring anticoagulation (atrial fibrillation, prior pulmonary embolism, certain hypercoagulable states) who do not receive the indicated medication or who are taken off it without adequate clinical justification. The harm typically involves a stroke, recurrent thromboembolism, or other thrombotic event that the anticoagulation would have prevented.
Cancer treatment failures involve patients diagnosed with treatable cancers who do not receive the indicated treatment, receive inadequate treatment, or have treatment interrupted without adequate clinical reason. The damages reflect the difference between the outcome of full treatment and the actual outcome.
Infection treatment failures involve patients diagnosed with serious infections who receive inadequate antibiotic coverage, who have treatment stopped prematurely, or who do not receive the source control (drainage of an abscess, removal of an infected line, surgical debridement) that the infection required.
Cardiac treatment failures involve patients diagnosed with serious cardiac conditions (coronary artery disease, valvular disease, heart failure) who do not receive the indicated medical therapy, surgical intervention, or device therapy. The harm involves the progression of the underlying disease and the cardiac events the treatment would have prevented.
Mental health treatment failures involve patients diagnosed with conditions requiring active treatment (severe depression with suicide risk, psychotic disorders requiring stabilization, substance use disorders requiring intensive intervention) who do not receive the indicated level of care. The harm may involve self-injury, suicide, or other consequences of inadequate treatment.
The standard of care for treatment decisions #
The standard for treatment decisions involves several considerations.
The diagnosis-treatment connection. Once a diagnosis is made, the standard for that diagnosis includes the treatments reasonably indicated. A provider who diagnoses atrial fibrillation has identified a condition for which anticoagulation may be indicated; the failure to consider anticoagulation, or to adequately document the reasoning for not anticoagulating, may breach the standard.
Treatment alternatives. Many diagnoses have multiple acceptable treatment approaches. The standard generally permits the provider to choose among accepted alternatives based on clinical judgment, patient preference, and individual circumstances. The respectable minority doctrine applies: where reasonable providers would disagree about the best approach, a provider’s choice among accepted alternatives generally does not constitute a breach.
Patient preferences and refusals. A patient may decline recommended treatment. The provider’s obligation is to ensure that the patient understands the recommendation, the alternatives, and the consequences of declining, and to document the discussion. A patient’s informed refusal of treatment generally relieves the provider of further obligation to provide that specific treatment, though the provider should continue to manage the patient’s other needs.
System support for treatment plans. Treatment plans often require follow-up, monitoring, dose adjustments, and coordination among providers. The standard recognizes that the individual provider operates within a system, but it does not absolve the provider of responsibility for the system failures that affect the patient’s care.
Documentation gaps that matter #
Failure-to-treat cases often turn on documentation about what the provider intended, what was communicated to the patient, and what follow-up was arranged.
A provider who diagnosed atrial fibrillation but did not document a discussion of anticoagulation faces a harder defense than a provider who documented “discussed CHA2DS2-VASc score of 3, recommended anticoagulation with apixaban, patient agreed to start, prescription sent.” The contemporaneous documentation supports both the recommendation and the patient’s response.
A provider who recommended follow-up without specifying who would arrange it, when it should occur, and how the office would track completion faces a harder defense if the follow-up did not happen. A patient with abnormal results who was told “we’ll call you to schedule” but never called by the office may have a stronger case than a patient who was scheduled at the time of the visit and did not show.
A provider who started treatment but did not document the rationale for stopping it, or did not document discussion of alternative treatment when the first failed, faces challenges defending the treatment decisions.
Several documentation patterns help defendants:
| Documentation | What it shows |
|---|---|
| Specific recommendation | What treatment was actually proposed |
| Discussion of alternatives | Whether the patient was informed of options |
| Risks and benefits | Whether the discussion covered the implications |
| Patient's response | What the patient agreed to or declined |
| Reasoning for choices | Why the specific approach was selected |
| Follow-up plan | What was expected to happen next and when |
Causation in failure-to-treat cases #
Causation in failure-to-treat cases involves the question of what difference the treatment would have made. The plaintiff must prove that timely appropriate treatment would more likely than not have produced a substantially better outcome.
The analysis depends on the underlying condition and the treatment’s expected effect. For some conditions (atrial fibrillation and anticoagulation, treatable cancers and appropriate therapy, serious infections and appropriate antibiotics), the effectiveness data are well-established and the causation analysis is relatively straightforward. For others (some chronic conditions, conditions with variable response to treatment), the analysis is more complex.
The defense in causation has several recurring themes. The treatment would not have been effective in the specific patient. The underlying disease would have produced the same outcome regardless of treatment. The patient’s non-compliance with the partial treatment would have continued, undermining the assumed treatment effect.
For cancer cases, the analysis often involves stage and grade-specific treatment effectiveness data. A patient with early-stage cancer who would have had a 90 percent five-year survival with treatment, and who died of progression at 18 months without treatment, has a strong causation case. The same patient with advanced-stage disease at the time of the alleged failure-to-treat may have a weaker case because the treatment would have been less effective.
Multi-encounter cases #
Some failure-to-treat cases involve multiple encounters over time during which appropriate treatment did not happen. A patient seen six times for the same condition without ever being put on the indicated treatment presents a stronger case than a patient seen once where the treatment was missed.
The multi-encounter pattern allows the plaintiff to argue that the failure was not a single oversight but a pattern of inadequate care. The defense response often involves attempts to characterize each individual encounter as reasonable, with the cumulative pattern emerging only in retrospect.
The patient’s role in the multi-encounter pattern is sometimes contested. A patient who did not return for follow-up, who did not take prescribed medications, or who did not pursue the recommended workup may bear some responsibility under Georgia’s apportionment statute, O.C.G.A. § 51-12-33. The defense may emphasize the patient’s role; the plaintiff response is typically that the provider had ongoing responsibility to engage the patient and pursue the necessary care.
System failures and institutional responsibility #
Many failure-to-treat cases involve breakdowns in the systems that support clinical care: scheduling systems that did not produce appropriate follow-up, electronic health records that did not surface pending issues, communication systems that did not connect specialists with primary care providers, lab result management systems that did not route abnormal findings.
Hospital and institutional defendants may have liability for system failures even when the individual provider’s clinical decisions were defensible. A hospital that did not implement appropriate result-routing procedures, that did not provide adequate staffing for follow-up calls, or that did not maintain functioning communication systems may be directly liable for the consequences of those system failures.
Direct corporate negligence theories supplement vicarious liability in these cases. The plaintiff may argue both that the individual provider was negligent (vicariously imputed to the institution) and that the institution had its own negligent failures (directly imputed to the institution). The two theories produce different evidence and may produce different liability outcomes.
Damages in failure-to-treat cases #
The damages in failure-to-treat cases reflect the difference between the actual outcome and what appropriate treatment would have produced. The framework operates without statutory cap.
Economic damages cover the additional medical costs, the lost earning capacity from the worsened outcome, and any consequential costs. For cases involving preventable strokes, cardiac events, or thromboembolic events, the economic damages can include lifetime disability costs.
Non-economic damages cover the additional pain, suffering, mental anguish, and loss of enjoyment of life. For permanent disability cases, these damages can be substantial.
Wrongful death and survival action damages apply where the failure resulted in death.
The framework applies the standard analysis to treatment omissions #
Failure to treat cases live in the gap between diagnosis and action. The cardiologist’s note in an Augusta office chart that documents “moderate aortic stenosis, will follow” but produces no follow-up appointment, the discharge summary from a Columbus hospital that listed warfarin in the medication list but never sent the prescription to the pharmacy, the abnormal Pap result faxed to a Valdosta clinic in 2022 that sat unread until 2024: these are the documents that prove the treatment did not follow the diagnosis. Damages run from what timely treatment would have prevented: the stroke that came two years later, the pulmonary embolism that came two weeks later, the cervical cancer that became invasive.
This article is for informational purposes only and does not constitute legal advice. Personal injury cases turn on specific facts and applicable law that vary by case. If you have been injured in Georgia and want to understand your legal options, consult a licensed Georgia personal injury attorney.