Emergency room negligence: missed strokes and heart attacks

If an emergency room sent you or a family member home and it later turned out to be a stroke or a heart attack, two different sets of rules may matter. A federal law called EMTALA requires hospital emergency departments to screen and stabilize patients, and state medical malpractice law covers whether the care met the accepted standard. This guide explains both in plain terms, what records to request, and what to write down.

If symptoms are happening now, call 911

If you or someone near you has stroke or heart attack symptoms right now, stop reading and call 911. The Centers for Disease Control and Prevention (CDC) says to call 9-1-1 right away for stroke symptoms, to note the time symptoms first appear, and not to drive to the hospital or let someone else drive you, so that treatment can begin in the ambulance. For heart attack symptoms, CDC says to call 9-1-1 immediately.

Getting care comes first. Everything else in this guide can wait until you or your family member is safe.

The warning signs, as CDC describes them

These lists come from CDC’s public pages. They’re here to help you describe what happened, in the words doctors use. They aren’t a way to decide whether an emergency room made a mistake. That question takes a medical review of the full record.

Stroke

CDC lists these signs of stroke in men and women:

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking, or difficulty understanding speech.
• Sudden trouble seeing.
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
• Sudden severe headache with no known cause.

CDC also notes that if stroke symptoms go away after a few minutes, it may have been a transient ischemic attack (TIA), sometimes called a “mini-stroke,” and that you should tell a health care team about the symptoms right away.

Heart attack

CDC lists these major symptoms of a heart attack:

• Chest pain or discomfort. CDC says most heart attacks involve discomfort in the center or left side of the chest that lasts more than a few minutes, or that goes away and comes back.
• Feeling weak, light-headed, or faint, sometimes with a cold sweat.
• Pain or discomfort in the jaw, neck, or back.
• Pain or discomfort in one or both arms or shoulders.
• Shortness of breath.

CDC adds that unusual or unexplained tiredness and nausea or vomiting can also be symptoms, and that women are more likely to have these other symptoms.

What EMTALA requires of an emergency room

The Emergency Medical Treatment and Labor Act, usually called EMTALA, is a federal law (42 U.S.C. § 1395dd). It applies to hospitals with an emergency department, and its enforcement provisions refer to “participating hospitals,” meaning hospitals with a Medicare provider agreement (§ 1395dd(e)(2)). Because it’s federal law, it applies the same way in every state. In plain terms, it sets three duties.

1. A medical screening examination. When anyone comes to the emergency department and asks for examination or treatment, the hospital must provide an appropriate medical screening examination, within the capability of its emergency department, to determine whether an emergency medical condition exists (§ 1395dd(a)). That includes ancillary services routinely available to the emergency department. This applies whether or not the person has Medicare.
2. Stabilizing treatment or an appropriate transfer. If the hospital determines the person has an emergency medical condition, it must either provide the examination and treatment needed to stabilize it, within the staff and facilities available, or transfer the person to another facility under the law’s transfer rules (§ 1395dd(b)(1)).
3. Limits on transferring an unstable patient. A hospital generally may not transfer a patient whose emergency condition hasn’t been stabilized unless the patient asks in writing after being told the risks, or a physician certifies that the expected benefits of transfer outweigh the risks, and the transfer itself is an “appropriate transfer” (§ 1395dd(c)). In an appropriate transfer, the sending hospital sends the receiving facility the available medical records related to the emergency condition, including observations of signs or symptoms, the preliminary diagnosis, treatment provided, and test results.

The law also says a participating hospital may not delay the screening examination or stabilizing treatment in order to ask about a person’s method of payment or insurance status (§ 1395dd(h)).

Under the statute’s definition, an “emergency medical condition” includes a condition with acute symptoms severe enough (including severe pain) that the absence of immediate medical attention could reasonably be expected to place the person’s health in serious jeopardy, seriously impair bodily functions, or cause serious dysfunction of any bodily organ or part (§ 1395dd(e)(1)). A “transfer” includes a discharge (§ 1395dd(e)(4)).

What EMTALA doesn’t do

People sometimes expect EMTALA to cover every emergency room mistake. Its text is narrower than that.

• It speaks to screening, stabilizing, and transfer. The statute’s requirements are the ones listed above. Its text doesn’t say that an emergency department must reach the right diagnosis. Whether a doctor should have recognized a stroke or a heart attack is generally a medical malpractice question, decided under state law.
• It leaves state law in place. EMTALA says it doesn’t preempt state or local law, except where a state requirement directly conflicts with it (§ 1395dd(f)).
• Its own lawsuit provision names the hospital. A person who suffers personal harm as a direct result of a participating hospital’s violation may bring a civil action against the hospital, for the damages available for personal injury under the law of the state where the hospital is located (§ 1395dd(d)(2)(A)).
• It has its own deadline. No action under that provision may be brought more than two years after the date of the violation (§ 1395dd(d)(2)(C)). That clock is set by federal law and can differ from your state’s medical malpractice deadline.

Which law fits a particular emergency room visit, and whether either one does, is a question for an attorney licensed in your state, usually working with a medical expert.

How medical malpractice law looks at a missed diagnosis

Medical malpractice is state law, so the details differ from state to state. The general idea is similar. A claim usually asks whether the provider failed to meet the accepted standard of care, and whether that failure caused the injury.

Arizona’s statute is a clear example. It requires proof that the provider failed to exercise the care, skill, and learning expected of a reasonable, prudent provider in the same profession or class acting in the same or similar circumstances, and that this failure was a proximate cause of the injury (Ariz. Rev. Stat. § 12-563).

For a missed stroke or heart attack, that means two separate questions:

• What should have been done? What a reasonable emergency provider would have asked, tested, or ordered, given the symptoms and history the patient presented with at the time.
• Did it change the outcome? Whether earlier recognition or treatment would likely have made a difference to the injury. A bad outcome by itself doesn’t answer this.

Both questions turn on medical facts, which is why attorneys in this area usually work with medical experts before deciding whether to go forward.

Deadlines and steps differ by state

In Florida, a medical malpractice action generally must be started within 2 years from the incident or from when it was discovered or should have been discovered, and in no event later than 4 years from the incident, with exceptions (Fla. Stat. § 95.11(5)(c)). Florida also requires a presuit investigation and written notice of intent to each prospective defendant before a lawsuit can be filed (Fla. Stat. § 766.106(2)).

In Arizona, an action for injuries, including medical malpractice, generally must be brought within two years after the cause of action accrues (Ariz. Rev. Stat. § 12-542).

Other states set their own rules. An attorney licensed in your state can tell you which deadlines apply to you, including how they interact with the separate EMTALA deadline.

Records to request from the emergency room visit

Ask for the whole emergency department record, not just the discharge papers. Under federal HIPAA rules, you have a right to inspect and get a copy of your records, and a provider generally must act on your request within 30 days, with one possible 30-day extension if it tells you why in writing (45 C.F.R. § 164.524). Medicare’s hospital rules also give patients the right to access their medical records, and say a hospital must not frustrate legitimate efforts to get them (42 C.F.R. § 482.13(d)(2)).

Ask the hospital’s medical records office, in writing, for the complete emergency department record, including:

• Triage notes, including the time you arrived and the complaint recorded at the front desk or triage station.
• Physician and nursing notes, including the history taken and the physical exam.
• Vital signs recorded during the visit, with times.
• Orders and results for any tests, labs, and imaging, including the images and the written reports.
• Consultation notes, if a specialist was called or consulted by phone.
• The discharge summary and instructions, or the transfer paperwork if you were sent to another hospital, including any transfer certification and the records sent with you.
• Records from the next visit, if you returned to the same or a different hospital, since they often show what was found later.

Keep a copy of your request and note the date you sent it. Keep the originals you receive together and work from copies.

Write down the timeline while you remember it

With strokes and heart attacks, timing matters. CDC notes that the time symptoms first appear helps health care providers determine treatment. For your own records, write down:

1. When the symptoms started, and what they were, in your own words.
2. When you called for help or arrived at the emergency room, and how you got there.
3. What you told triage and the doctors, and who you told.
4. What tests were done, as far as you know, and what you were told about the results.
5. What diagnosis or explanation you were given, and when you were discharged.
6. What happened next: when symptoms returned or worsened, and where you went for care.

Approximate times are fine. Write “around 3 p.m.” when you’re not sure. Family members who were there can write their own notes separately, which can help fill gaps.

Next steps

• Keep getting the care you need. Tell your current doctors what happened in the emergency room so it becomes part of your records.
• Don’t wait for every document before asking about timing. Deadlines can be short, and they differ by state.
• Talk with an attorney licensed in your state about whether EMTALA, state malpractice law, or neither applies. See concerns about a missed or delayed diagnosis and how our service works.
• For a broader checklist, read what to do if you think a doctor made a mistake.

Sources and corrections

We wrote this guide from the primary sources below and checked it against them on September 25, 2026.

• 42 U.S.C. § 1395dd: EMTALA screening, stabilization, transfer, civil enforcement, and preemption
• CDC, Signs and Symptoms of Stroke: stroke signs, calling 9-1-1, noting the time, TIA
• CDC, Heart Attack Symptoms, Risk, and Recovery: heart attack symptoms and calling 9-1-1
• 45 C.F.R. § 164.524: HIPAA right of access and timing
• 42 C.F.R. § 482.13: Medicare hospital patients’ rights, including access to records
• Ariz. Rev. Stat. § 12-563: elements of proof in Arizona
• Ariz. Rev. Stat. § 12-542: Arizona two-year limitation
• Fla. Stat. § 95.11: Florida medical malpractice limitation periods
• Fla. Stat. § 766.106: Florida presuit notice

We are not attorneys, and this guide is not legal advice. Laws change and differ from state to state. If anything here is out of date or wrong, email support@malpracticeattorneys.com with the page name, and we’ll review it and update the page.