Physical therapy malpractice: think it can’t happen to you? Even the most experienced PTs are at risk of getting sued over a malpractice dispute. A simple oversight, accident, or lapse in judgment can precipitate painful consequences for your patient and—if they sue—you and your practice. (It’s why I ALWAYS recommend liability insurance for physical therapists! I personally use My PT Insurance.)
One of the best ways you can prevent a malpractice lawsuit is to anticipate and avoid the circumstances that can lead to one. So keep reading for an overview of malpractice in physical therapy as well as 9 detailed case studies.
Physical Therapy Malpractice Overview
A malpractice lawsuit seeks compensation for personal damages, injuries, or lost wages that result from a medical professional’s services. To be considered malpractice, the prosecution must prove that the PT owed a duty of care, breached that duty, and caused the patient harm.
But in PT language, what does a breach of duty look like? According to a 2020 report from the Healthcare Providers Service Organization (HPSO), the most common instances of malpractice in physical therapy involved the following allegations:
- Improper management of patient’s treatment
- Failure to supervise or monitor the patient
- Improper performance of therapeutic exercise
- Equipment-related malfunction
- Improper performance of manual therapy
These actions or inactions can cause severe harm to the patient, including reinjury, new injury, infection, fractures from falls, burns, and even death.
Costly Malpractice Claims
The indemnity claims of a physical therapy malpractice can range widely, from a few thousand dollars to over a million. Among closed claims, the average indemnity against a physical therapist in 2020 settled for over $134,000.
This amount can reflect up to three types of damages:
- Economic: quantifiable costs, such as medical bills and lost wages
- Non-economic: personal costs, such as inconvenience, pain, and trauma
- Punitive: legal recompense for proven malice, fraud, or intentional negligence
Malpractice in Physical Therapy: 9 Case Studies
As you’ll see in the following case studies, malpractice can occur in all kinds of scenarios, whether hospitals, outpatient clinics, or at home. There’s no patient too young or too old to sue for malpractice, and PTs and PTAs as well as PT students can be liable.
Cases of Poor Supervision
PTs are responsible for supervising both patients and the PT students who interact with them. Unfortunately, a busy caseload can distract even the most dutiful of PTs. Below are three case studies of poor supervision, with two resulting in falls—some of the most damaging incidents for a patient’s injuries and a PT’s liability.
1. Failure to supervise patient (Source: Block O’Toole & Murphy)
A 54-year-old male patient visited a PT clinic after sustaining an ankle fracture. During the course of treatment, the patient was instructed to use the stationary bike and then dismount to continue a different exercise. But as the patient attempted to dismount the bike, he lost his balance and tipped the bike backwards. He fell to the floor with the bike on top of him. Following this event, the patient suffered a dislocation of a cervical fusion he had had performed years before. The new injury later required surgery and more physical therapy.
To the PT’s defense, this patient had a history of cervical spine injuries—at least four spinal surgeries over the previous 25 years before his ankle fracture incident. However, because the PT wasn’t present to supervise and assist the patient’s dismount, the case was ruled in favor of the patient and settled for over $1.4 million.
2. Failure to provide a safe environment (Source: HPSO report)
A 90-year-old male patient was in an acute care rehabilitation hospital for physical therapy. His Certified Nurse Assistant (CNA) took him to the PT treatment area to receive therapy, but his PT was still attending to another patient. So she told him and the CNA to wait while she performed an ultrasound for the other patient.
After leaving the patient, the PT heard a loud thud and hurried back to find the patient had fallen off the treadmill. In his fall, he had injured his shoulder, which later required surgery. Although she had never instructed him to use the treadmill, the PT was at fault for leaving the patient in an unsafe environment and assuming the CNA would monitor him. The claim was resolved but cost her over $75k in total.
3. Failure to supervise PT student (Source: HPSO.com)
A 45-year-old male patient underwent shoulder arthroscopy for a near full-thickness tear to his rotator cuff. After four weeks, he began physical therapy treatment and made good progress until an incident with a PT student. During this incident, the student, unsupervised, pressed the patient to perform a range of motion exercise. The patient felt a pop, pain, and swelling in his shoulder during the exercise. He later needed another surgery for a partial tear, then sued the PT clinic as well as the therapists involved.
Although the student PT was left unsupervised for longer than is deemed acceptable, the malpractice incident was not the sole reason for the patient’s reinjury. Careful documentation showed that the patient was non-compliant with therapy and repeatedly resumed activities—such as fishing and playing darts—that worsened his injury. In fact, after his second surgery, he tore it his rotator cuff a third time and became permanently injured. The case was ultimately settled during the mediation process, costing the PT clinic over $150k in total.
Cases of Poor Written Communication
As PTs, we like to focus more on action than on paperwork. But in court, what’s on paper—whether the referring physician’s orders or our own documentation—is worth its weight in gold.
4. Failure to diagnose a DVT and incomplete documentation (Source: HPSO.com)
A 45-year-old female patient suffered a severe sprain in her right ankle from falling at work. Her orthopedist subsequently gave her a CAM walking boot and a script for physical therapy. During the first day of treatment, the patient complained of soreness and pain in her right calf, and the PT performed a Pratt test, which was negative. However, the PT did not document either the test or the patient’s pain.
This continued on the second day—the patient complained of pain, the PT evaluated but did not elicit a positive Pratt test. Throughout treatments, the patient exhibited fatigue, shortness of breath, and calf tenderness. The PT failed to document these findings and continued treatment, but did express concern that the patient consult her physician. The patient disagreed and left, only to be found dead in her home two days later.
Autopsy revealed the patient died from a DVT in her right leg. Because the PT failed to diagnose and document this condition—despite the patient’s risk factors in smoking, taking birth control, and using a CAM boot—they were found liable, incurring the PT business over $500k in indemnity.
5. Failure to follow referring physician’s orders (Source: HPSO.com)
A 17-year-old female gymnast underwent ORIF surgery to repair a broken humerus. Her surgeon then ordered physical therapy but did not check the box to indicate passive range of motion (PROM) for her therapy. Nevertheless, within two weeks her PT began administering PROM, and the patient felt a pop and pain in her arm. A trip the next day to her surgeon revealed a second fracture, requiring additional surgery.
Despite the PT’s failure to follow the physician’s orders—not to mention document or assess the patient’s complaint of pain—the case was ruled in favor of the PT, costing over $110k to defend and settle.
Cases of Skin Damage from Thermal Therapies
As PTs, we rely on many modalities to help our patients recover. But those pain-relieving measures can backfire, especially when they involve powerful TENS units or ice machines. Below are two such cases:
6. Improper use of a biophysical agent (Source: HPSO report)
A healthy 70-year-old male patient underwent a total knee replacement and was receiving physical therapy. During one of his TENS treatments, he experienced extreme pain. The pads were removed to reveal third-degree burns, which later became infected. The patient had to then undergo three surgical revisions to his TKA as a result of the TENS therapy misuse. Unsurprisingly, the patient sued, and his claim incurred over $700k.
7. Failure to issue warning of ice therapy danger (Source: Schmidt Firm, PLLC)
(Although this incident involves a physician, not a physical therapist, it’s worth including in this lineup of case studies.) A 15-year-old patient injured her leg and was prescribed a cold therapy machine to aid her recovery. After hours of use, the patient sustained severe skin necrosis, scarring, and nerve damage, requiring multiple reconstructive surgeries and resulting in permanent injury. Her referring physician had allegedly failed to warn her of the potential for severe injury, nor had he disclosed the fact that his practice benefited financially from her purchase of the device. The lawsuit cost the physician over $500k in punitive damages.
Allegations That Were Later Ruled Out
In many cases, the physical therapist is found to be not at fault for a patient’s injuries. Below are three examples of such cases:
8. Failure to evaluate and treat (Source: Kriesman Law Offices)
A 44-year-old female patient underwent ligament repair surgery to her left knee’s MCL and was given an immobilizer and a script for physical therapy. Over the next couple days, she received physical therapy treatment, including passive range of motion (PROM) exercises.
Months later, the patient’s surgical site became infected and required another ligament repair surgery, as well as a total knee replacement. After over $850k in medical expenses, the patient sued the PT for $1 million, alleging that the PROM exercises performed after her initial MCL surgery caused her infection and reinjury. Since her knee was in an immobilizer, she contested, the PT should never have given her those PROM exercises.
In defending the case, word got out that the patient had sustained a fall at home weeks after therapy. The infection and re-injury to her knee didn’t manifest until after the fall, so the PT was exonerated, and the patient lost the case.
9. Improper management of patient’s treatment (Source: HPSO.com)
A 68-year-old post-stroke patient was given physical therapy to strengthen his left ankle and improve his gait. During progressive weight-bearing exercise, the patient heard a pop in his foot, followed by pain and swelling in the days afterward. A podiatrist later diagnosed him with a metatarsal fracture, and the patient went on to experience neuropathy in his feet and weakness in his legs. He sued for $995k, alleging the PT’s weight progression caused a foot fracture which derailed his recovery efforts after the stroke.
The patient was unable to secure expert witnesses, which undermined his efforts to sue the PT business. Further, there was no evidence to back up his allegations that the fracture caused nerve damage or required later surgery, nor that the PT was at fault for the injuries. All in all, the case was dismissed, but it cost more than $112k to defend the insured PT business.
Physical Therapy Malpractice: Summary
The moral of these regrettably true stories is that the legal system takes physical therapy malpractice very seriously, and so should every PT. You can mitigate your risk of a lawsuit by exercising caution with a patient’s injuries, reporting and evaluating increased pain, and writing defensible documentation. But beyond such standard practice, make sure you have ample insurance. Professional liability insurance is available for just $150/year from My PT Insurance, with coverage of up to $1 million of indemnity per occurrence or $3 million per year.
