Why Pulmonologists and Intensivists Get Sued: Missed Lung Cancer, Missed PE, and the Bronchoscopy Injury

By John Mahoney · June 2026 · 9 min read

Pulmonology and critical care lives at the intersection of two of the highest-risk arenas in medicine: the ambulatory clinic where lung cancer and pulmonary embolism are missed, and the intensive-care unit where the sickest patients in the hospital are kept alive by the narrowest of margins. That dual exposure gives the specialty a distinctive malpractice profile — moderate claim frequency, but a severity tail among the steepest in medicine, because most of these claims end in death or permanent injury. For a med-mal attorney, the pulmonology file is usually one of two cases: a missed diagnosis in the outpatient setting, or a procedural or management failure in the ICU.

This guide walks through what the closed-claims data shows about why pulmonologists and intensivists get sued — how often, how severe, which conditions and procedures drive the claims, and what separates a strong case from a weak one — for plaintiff and defense med-mal attorneys triaging a pulmonary/critical-care file.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. The data on this specialty is drawn from a smaller and more varied evidence base than the highest-volume fields, so the figures below should be read as reported patterns rather than precise rates. Always verify the controlling standard of care and the underlying records before relying on any generalization.

The Frequency and Severity Reality

Pulmonology and critical care sits in the medium band for claim frequency. Unlike the largest fields, it has no clean, directly measured annual rate — its risk tier is inferred from insurer reports and ICU-cohort studies rather than a single headline percentage, so the frequency picture is directional. What is consistent across the sources is the severity.

The outcomes are catastrophic. Reportedly about 81% of inpatient pulmonary/critical-care claims involved death or permanent injury, and death was the most common outcome in ICU claims (reported across a wide range, roughly 42% to 72% depending on the subspecialty). The payment rate is relatively low — reportedly around 26% of claims paid — but indemnity per paid claim is high, with a reported median around $286,000. Procedure-specific litigation runs higher still: bronchoscopy claims have reported median plaintiff verdicts near $1.73M and median settlements around $648,000. This is a low-volume, high-stakes specialty — most claims do not pay, but the ones that do tend to involve a dead or permanently injured patient.

The Dominant Allegation Types

Pulmonology/critical care straddles the cognitive/procedural divide, and its allegations reflect both halves:

• Failure or delay in diagnosis and treatment (diagnostic error) — the leading allegation, especially on the outpatient side. This is the cognitive half: the lung cancer or PE that was missed.
• Procedure-related injury / improper performance of a procedure — reportedly about 31% of claims involve a procedure. In bronchoscopy claims specifically, a procedural complication is reportedly the single most-alleged reason (around 29%), ahead of failure to diagnose (around 28%) and failure to treat (around 18%).
• Improper management or monitoring of treatment — particularly medication monitoring, with anticoagulation reportedly the most commonly implicated drug.
• Communication failures, including a recurring and specific criticism: managing hospitalized patients by phone without a personal evaluation, plus handoff and documentation failures.

For screening, the first move is to locate the case on the cognitive/procedural axis: an outpatient case is almost certainly a missed-diagnosis claim, while an inpatient or ICU case is more likely procedural or management. The allegation prior and the proof strategy differ accordingly.

The "Cannot-Miss" Conditions and Procedures

Pulmonary/critical-care claims cluster around a recognizable set of high-severity drivers.

• Lung cancer. Missed or delayed diagnosis is the dominant outpatient driver (reportedly around 28% of outpatient claims) — archetypally an incidental pulmonary nodule never followed up, allowing a curable cancer to advance.
• Pulmonary embolism. The classic high-severity, often-fatal diagnostic-error claim — the diagnosis you have to consider to catch.
• Procedural injury. Laceration or perforation is reportedly the most common inpatient final diagnosis; also pneumothorax and hemorrhage from bronchoscopy, thoracentesis, chest-tube, and central-line placement.
• ICU adverse events. Failures in patient assessment and therapy management — mechanical ventilation, sepsis, and anticoagulation-related bleeding such as a retroperitoneal hematoma — plus failure to diagnose or treat infections and other deterioration leading to death or permanent injury.

The lung cancer and PE misses map onto the cancer and vascular categories of the cross-specialty "Big Three." A missed lung cancer with an unfollowed nodule, or a missed PE with a treatable window, is the high-merit outpatient signal; a bronchoscopy or line-placement injury is the high-value inpatient signal.

The Contributing Factors That Decide Who Pays

The contributing factors are consistent — and several are the communication-and-documentation levers that drive payment across every specialty:

• Clinical judgment and patient assessment. The leading contributing factor; diagnostic errors here reportedly reflect breakdowns in assessment more than gaps in knowledge.
• Selection and management of therapy / medication monitoring. A top ICU factor, with inadequate anticoagulation monitoring a recurring theme.
• Communication among providers and with the patient and family. The recurring criticism — managing hospitalized patients by phone without personal evaluation — converts a defensible course into an indefensible one.
• Documentation deficiencies. Reportedly present in about 27% of paid pulmonology claims — a defensibility problem independent of whether the care was negligent.
• Technical skill / procedural performance. Procedure-related claims reportedly carry markedly higher odds of payment (one ICU cohort reported an odds ratio around 2.29) — the procedural injury is disproportionately likely to pay.

The single most actionable system theme recurs across the cognitive specialties: failure to close the loop on a test result. The incidental pulmonary nodule no one tracked, the imaging recommendation never acted on — this is the preventable fingerprint of the outpatient lung-cancer claim, and the first thing both sides should screen for.

Strong Case vs. Weak Case in Pulmonology and Critical Care

The specialty splits into outpatient-cognitive and inpatient-procedural cases, and the strong/weak analysis runs along that same seam.

What strengthens a plaintiff's case

• Outpatient: a documented incidental nodule or abnormal imaging never followed up, or a missed PE with a treatable window, plus a progression interval establishing that the delay changed the prognosis.
• Inpatient/procedural: a procedural injury (perforation, pneumothorax, hemorrhage) where technique or consent is in question — procedural claims pay at higher odds.
• A hospitalized patient managed by phone without personal evaluation at a decisive moment, or indicated medication monitoring (anticoagulation) not performed, with a resulting bleed or thrombotic injury.

What strengthens the defense

• A documented differential and a reasonable workup — pulmonary diagnosis is a probability discipline, and a chart showing the dangerous conditions were considered is strong even when the outcome was bad.
• A realized procedural complication that was a known, disclosed risk of a properly performed and consented procedure — the recognized-complication defense.
• Closed-loop documentation showing the nodule or abnormal result was tracked and follow-up offered or completed.

That causation point is decisive here more than in almost any other specialty. The typical ICU claimant was gravely ill before the alleged negligence, so the defense's strongest argument is often not "we met the standard of care" but "the patient would have died anyway." The strongest plaintiff cases are those where the treatable window was clearly open — the early-stage nodule, the survivable PE — and the delay or injury demonstrably closed it.

The Expert and Merit Questions Come Early

Because these cases turn on standard-of-care judgment and on causation in critically ill patients, the expert is central and the qualification fight starts at the pre-suit gate. The expert who signs the certificate of merit must typically be qualified to opine against a pulmonologist or intensivist, and the same specialty-match and reliability questions feed directly into a later motion to exclude — an attack especially sharp on this specialty's contested causation opinions.

Bottom Line

Pulmonology and critical care is a moderate-frequency, high-severity specialty where most viable claims end in death or permanent injury. The claims split cleanly: outpatient cases are missed-diagnosis claims — lung cancer and pulmonary embolism, usually traceable to a closed-loop follow-up failure on an incidental finding — while inpatient and ICU cases are procedural or management claims, with bronchoscopy and line-placement injuries and anticoagulation-monitoring failures recurring. Procedural claims pay at higher odds; thin documentation and managing patients by phone are the recurring defensibility failures.

For both sides, the work is the same: locate the case on the cognitive/procedural axis, screen first for the unfollowed test result, and run the causation question hard — especially in the ICU, where the patient's baseline severity is the defense's most powerful argument. Confirm the expert match and merit filing early, and verify every generalization against the actual records.

Questions? Contact us at [email protected] or (856) 979-6525

🔎 Screening a case in a different specialty? Browse all 70 specialty malpractice-risk guides in one place — Why Doctors Get Sued: Malpractice Risk by Specialty →