Five Lessons from Malpractice Cases in Hospice and Palliative Care

Key Message: Medical malpractice in hospice and palliative care is uncommon, but when examined closely, it reveals important lessons. Five real-world cases highlight communication failures, caregiver education gaps, diagnostic errors, and care transitions as opportunities to reduce liability and strengthen safety and trust at the end of life.

Abstract: Background
Hospice and palliative care is often viewed as low risk specialty for malpractice. However, legal claims do arise and when they do, they often reflect preventable lapses in clinical care, documentation, and communication. Examining these cases can be a powerful learning tool to guide safer, more aligned end-of-life care.

Objective
We will use five illustrative malpractice cases from the United States involving hospice and palliative care to extract valuable, actionable insights that we can apply at the bedside to improve safety for patients and reduce legal risk for practitioners.

Methods
Five cases from publicly available court documents and case summaries were selected based on relevant to bedside clinicians and a range of issues, including symptom management, caregiver and environmental safety, and diagnostic errors. Each case was holistically analyzed to derive clinician-relevant lessons.

Findings
Five major risk domains were identified:
1. Diagnostic error may result in inappropriate hospice enrollment, exposing clinicians and hospices to liability [1]
2. Hospice providers carry legal and ethical duties not only to the patient, but also to caregivers and the home environment [2]
3. Failure to educate family caregivers on safe medication administration may constitute negligence [3]
4. Consent should be explicit and clearly documented when transitioning to hospice or comfort-focused care to avoid liability [4]
5. Clinician-family conflict over symptom management, especially if paired with an uncoordinated or abrupt discharge, can trigger claims of neglect or abandonment  [5]

Summary
Malpractice claims in hospice & palliative medicine remain rare. Clinicians practicing in this space should maintain awareness of current and prior litigation in order to learn how to best care for patients while avoiding pitfalls that can expose us to liability.

References: [1] Candelario v. MJHS Hospice & Palliative Care, 223 A.D.3d 517 (N.Y. App. Div. 1st Dep’t 2024).
[2] Mason v. Amed Community Hospice, Inc., No. 01‑19‑00731‑CV (Tex. App.—Houston [1st Dist.] Aug. 1, 2019).
[3] Krela v. Kryla, No. 6:12-cv-01089-TC (D. Or. filed June 18, 2012). Complaint available at: https://thaddeuspope.com/images/Krela_D_Ore.2012_complaint.pdf
[4] Upper Chesapeake Health Center, Inc. v. Gargiulo, No. 2157, Sept. Term 2013 (Md. Ct. Spec. App. June 22, 2015) (unpublished opinion).
[5] McGregor v. Hospice Care of Louisiana, Inc., 13 So. 3d 385 (La. Ct. App. 1st Cir. 2009).