What can I do if an emergency department sent me home and my condition got worse?

Emergency departments are busy places that must decide quickly who needs admission and who can safely go home. Most of those decisions are right. Sometimes a patient is sent home with "gastritis" and returns with a burst appendix, or with "muscle pain" and returns having had a heart attack. This guide explains how such cases are assessed, written by a lawyer who has worked in hospitals as a medical officer.

How does an emergency department normally work?

In broad terms:

1. Triage: a nurse or medical assistant records the complaint and vital signs and assigns a priority category.
2. Assessment: a doctor takes a history and examines you.
3. Investigations: blood tests, ECG, X-ray or scans as indicated.
4. Decision: admit, observe, refer, or discharge.
5. Discharge advice: what to expect and when to come back (often called "red-flag" advice).

Each step is recorded, usually on an ED card or electronic record.

When might a discharge be negligent?

The test is whether the doctor acted as a reasonably competent emergency practitioner would have, judged by the Bolam test as qualified by Bolitho (Federal Court, Zulhasnimar, 2017), not with hindsight. Questions experts ask include:

• Were abnormal vital signs (high pulse, low blood pressure, fever, low oxygen) recorded but not explained or rechecked before discharge?
• Were classic warning features in the history not explored, such as chest pain spreading to the arm or jaw, sudden severe headache, weakness on one side, or pain moving to the lower right abdomen?
• Were basic tests that would usually be done, such as an ECG for chest pain, not done or not reviewed?
• Was the patient in a higher-risk group (elderly, diabetic, pregnant, very young) that called for more caution?
• Was a senior review sought where the diagnosis was uncertain?
• Was clear advice given on when to return, and was it documented?

Which conditions are commonly missed?

Conditions where early signs can be subtle include appendicitis, heart attack, stroke, sepsis, meningitis, ectopic pregnancy, blood clots in the lung, testicular torsion and fractures not seen on initial X-rays. A missed diagnosis is not necessarily negligent; the question is whether reasonable assessment would probably have identified it.

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What should I do now?

1. Get the care you need. If you are worse, return to hospital or seek urgent care; do not delay because of a possible complaint.
2. Keep your discharge papers and any prescriptions or appointment slips.
3. Write a timeline straight away: arrival time, waiting time, what you told triage and the doctor, tests done, what you were told on discharge, and when you got worse.
4. Ask family who were present to write their own notes.
5. Request the ED records: the ED card, triage notes, observation charts, test results with times, ECGs and any imaging. See how to request medical records.

What about causation?

Even if the discharge was negligent, you must show that earlier admission or treatment would probably have made a difference: for example, avoiding a ruptured appendix and a longer operation, or reducing heart muscle damage. This requires expert evidence from emergency medicine and the relevant specialty. See do I need an independent report?

Who is responsible?

In government hospitals, claims involve the Government and the doctors concerned. In private hospitals, ED doctors may be employees or contracted, which affects whether the hospital is liable. See our guide on suing a government hospital and on misdiagnosis claims.

Common mistakes: not writing down what you were told on discharge, losing the discharge slip, and assuming the second hospital's diagnosis automatically proves the first was negligent.

When to speak to a lawyer

Speak to a lawyer if a missed diagnosis led to serious harm or death, especially where your notes show abnormal readings or warning symptoms. A lawyer with medical training can read ED notes the way a clinician does. You can contact us for an initial discussion; every case depends on its facts.

Frequently asked questions

The second hospital said I should have been admitted. Is that enough?

It is useful but not decisive. An independent expert must review what the first team knew at the time and whether their decision was reasonable.

I waited many hours and then was sent home. Is waiting time negligence?

Long waits are distressing but rarely negligent on their own. The question is whether the delay or the discharge decision caused harm.

I was told to come back if worse. Does that protect the hospital?

Documented, specific return advice is part of good practice. It does not excuse missing warning signs that were already present.

Can I complain without suing?

Yes, through the hospital's complaints process, and to the Malaysian Medical Council about a doctor's conduct.

Is there a deadline?

Yes. Strict time limits apply, so seek advice early.

Sources & fact check

Legal points in this article were checked against the primary sources below. The law can change; this is general information, not legal advice.

1. Zulhasnimar bt Hasan Basri & Anor v Dr Kuppu Velumani P & Ors [2017] 5 MLJ 438 (Federal Court) (reported judgment)
2. Ministry of Health, Guidelines on the Preparation of Medical Reports (Garis Panduan Penyediaan Laporan Perubatan)
3. Laws of Malaysia Online, Attorney General's Chambers (official text of Acts)

Fact-checked on 17 Oct 2026