2023-10-17 08:43:35
The TSJ of Madrid rules that there was a loss of opportunity in the treatment of the patient by not subjecting him to infection detection when he showed symptoms.
The tenth section of the Contentious-Administrative Chamber of the Superior Court of Justice of Madrid has condemned the Community of Madrid to compensate the family of a 79-year-old man who died from covid in the first wave with 10,000 euros. He died at the Ramón y Cajal Hospital in Madrid on March 23, 2023, after testing positive for coronavirus.
The court has condemned the Administration for a loss of opportunity, by not performing a PCR in the hospital when there were suspicions of infection, which was four days before the day they finally did it. To calculate the compensation, the magistrates have taken into account the age of the patient, the high mortality of the covid infection and the lack of treatment that existed in that first week after the State of Alarm was declared.
The Patient Advocate Association points out the sentence as “pioneering”, condemning the Administration for the death of a patient due to covid. However, the TSJ in its resolution has endorsed the assistance given to the deceased the two times he went to the Health Center, so that the judicial reproach for the care focuses on the first time at the hospital, where they did not perform the examination. Covid detection test, even though there were signs of infection.
Chronology of events
Where did the deceased’s infection occur? The family’s defense argued in their lawsuit that it was during an oral surgery that was performed at the Ramón y Cajal University Hospital on March 5, 2020. However, the court reasons that it is not possible to clarify this point, at the time the virus was circulating in the city.
In any case, the events being judged began on March 12, 2020, when the patient went to the Primary Care consultation at the Mar Baltico Health Center, reporting a cold that had been developing for two days, but without fever, dyspnea, nor lack of air. He was prescribed Paracetamol and Cloperastine and sent to his home.
Care at the Health Center
Should they have given him a Covid test at the health center? Well, according to the report of the judicial expert, “from a preventive point of view, it would have been very convenient, but here we find ourselves in a logistical and responsibility problem, since on that date these tests were not carried out in the health centers , although by then, in March 2020, there were already more than 30,000 diagnosed cases of covid in Madrid.”
The TSJ of Madrid considers that “the decision not to admit the patient to a hospital and to send him home with a prescription for paracetamol and Cloperastine was in accordance with his symptoms and the protocols of the Ministry of Health and the Ministry of Health of the Community of Madrid applicable in those moments of the pandemic.” So there is no reproach for the action carried out at the health center.
First care in the Hospital
On March 15, the patient’s family called Summa 112 because they found him on the floor with functional limitations and clumsiness in his speech. The reason for the consultation was disorientation and instability in walking. “No fever or dysthermic sensation.” After performing an examination that included a cranial CT, the patient was sent home, with the following consideration in the discharge report: “Given the patient’s good general condition and the absence of alarm data, it was decided to discharge him with the diagnosis of gait instability resolved and the recommendations to maintain observation and home isolation and, if new symptoms appear, go to the emergency room again.”
In this first action at the hospital, the judicial expert observes some data in the tests that should have raised suspicion of an infection, such as “a very high C-reactive protein” or the “existence of a bronchovascular cluster.” And, at this point, he reproaches that he had not taken a PCR test to rule out covid or, better yet, to have been able to diagnose the disease early.
The Court shares the reasoning of the judicial expert and says that “if we take into account the analytical and radiological signs that the patient presents, the explosive evolution of the pandemic at that time, the number of PCR tests, which were seen being carried out those days. and the possibility of reagents in the hospital, it is not reasonable that on March 15 the emergency service of the Ramón y Cajal Hospital referred the patient to his home without having delved into the investigation of these symptoms of infection, which only four days later It was diagnosed as covid-19, and it should be noted that the judicial expert considers that the patient would have had a better chance of survival (without indicating percentages, but yes, he noted that in this disease the probabilities were slim) if he had been admitted to the hospital. the first day he went to the emergency room.”
Curious demonstration that there were PCRs
How does the court and the judicial expert know that the hospital had enough reagents at that time, in March 2020, to determine the covid infection? Well, because of the statements made by the head of the hospital’s Microbiology service to a media outlet and which were published on March 18, as noted in the trial.
The person in charge said that “the large Madrid hospitals, such as Ramón y Cajal, are doing these days [18 de marzo de 2020] between 200 and 400 coronavirus determinations a day.” Thus, the court states that “the failure to perform the test was not due to logistical reasons.” Come on, there were PCR kits to, in case of suspicion of infection, have confirmed it.
Return to the health center
After this care, on March 16, the patient called 112 again and was treated at the health center, where they did nothing, but where, as the TSJ recognizes, they could not do anything, since they did not have PCR tests or there was treatment against covid. So he returned to his house.
And on March 18, Summa 112 took him to the Emergency Service of the Ramón y Cajal Hospital, where at that time they did do the PCR and saw that he had covid. With the diagnosis of bilateral coronavirus pneumonia, treatment with fluid therapy, bronchodilators, corticosteroids, kaletra, dolquine, piperacillin/tazobactam and oxygen therapy was applied. She did not respond to treatment. He was sedated according to the family and died on March 23.
Scarce resources
The trial also raised whether the limitation of therapeutic effort had responded more to a shortage of resources, of respirators, than to the patient’s situation. After the testimony of several doctors, the court concluded that the decision regarding the patient was due more to the patient’s poor progress than to any other reason.
In short, of all the health interventions to which the patient was subjected from March 5 to his death, on the 23rd of the same month, the court focuses the reproach on the first assistance in the hospital where the tests performed should have raised suspicions. of an infection and, in any case, having subjected the patient to a PCR to rule out having coronavirus.
The diagnostic test took four days, from the 15th when it should have been done to the 19th, which was when it was done. To this delay, the TSJ of Madrid applies the doctrine of loss of opportunity and condemns the community of Madrid to compensate the family of the deceased with 10,000 euros.
In his lawsuit, lawyer Antonio Navarro Rubio, collaborator of the El Defensor del Paciente Association, requested total compensation of 250,000 euros. However, to set the amount the court took into account the circumstances surrounding this case such as “the advanced age of the patient, 79 years”; “the aggressiveness of covid in that first wave”; “The pressure on care and the lack of knowledge of the moment in which the patient was infected and the low probability of his survival once he was diagnosed with Covid 19.” Soledad Valley
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