Andalusian health service ordered to pay €156,000 after A&E doctors mistake fatal pulmonary embolism for muscle pain

Now the TSJA (High Court of Justice of Andalucía) is holding the SAS (Andalusian health service) liable for damages in connection with the young woman's death. The health authorities must pay compensation to the young woman's parents and brother totalling 156,183.99 euros, plus the corresponding statutory interest. The ruling dismisses the SAS appeal.

The case dates back to 26 January 2020. At around 6pm, the young woman and her mother went to the primary care A&E department (SUAP) at the Cruz de Humilladero health centre. She reported "shortness of breath", with symptoms worsening when she breathed in.

Upon arrival, she had a heart rate of 118 beats per minute and an oxygen saturation level of 98 per cent. After being given a nebuliser treatment and ibuprofen, she showed "little clinical improvement". She was referred to the hospital A&E department for further tests.

At 7.49pm on the same day, she was admitted to the A&E department at the Virgen de la Victoria hospital with "rib pain and shortness of breath". The examination revealed tenderness on palpation of the left side.

Half an hour later, she was discharged with a clinical diagnosis of "mechanical-type rib pain". She was prescribed a muscle relaxant and an anti-inflammatory to be taken alternately with a painkiller, but the discomfort persisted.

On 2 February, the young woman returned to hospital, this time to the A&E department at the Valle del Guadalhorce hospital. She arrived at 1.36pm, complaining of rib pain. She explained that she was feeling it in her back.

The examination revealed tenderness on palpation of the trunk muscles. At 2.23pm, she was discharged with a different diagnosis: "muscle spasm". The recommended treatment included various medications (diclofenac, metamizole, diazepam), local dry heat and gradual walking.

Four days later, the young woman suffered a cardiac arrest at home. The paramedics began advanced resuscitation, as they already suspected a pulmonary thromboembolism, and transferred her to hospital. Resuscitation attempts continued for two hours without success.

The post-mortem examination revealed the presence of thromboembolic processes in both pulmonary hilums and established PTE as the underlying cause of death.

The family brought a claim for financial liability. The Malaga administrative court partially upheld their appeal in September 2024, overturned the administrative decision and set the compensation at 156,183.99 euros, to be divided among the three family members. To this amount must be added statutory interest from 4 February 2021, the date on which the administrative claim was lodged.

The SAS referred the matter to the TSJA. Its appeal challenged the court's assessment of the evidence and denied that a causal link could be established between the care received and the patient's death. The authorities stated that the healthcare workers had carried out a medical history and made a diagnosis consistent with the symptoms the patient presented.

They also held that it was impossible to know when the thromboembolism had developed and that, had it already been present during previous consultations, it would have manifested in a "certainly atypical" manner, possibly due to the young woman's young age.

However, the panel of judges rejected this argument after reviewing all the medical records. They stated that in this case "all the elements of financial liability in healthcare are present". The judges highlighted the fact that the patient was treated at various A&E departments before dying from PTE.

The ruling states that unlawful harm occurred "as a result of the actions described and the gross diagnostic error of mistaking a pulmonary embolism for muscle pain". It adds that the patient "has no legal obligation to endure" such harm, which ultimately led to her death.

In the court's view, "the existence of a causal link between the diagnostic error and the outcome is evident", given the documentation included in the case file and the witness and expert evidence presented.

The court states that the key lies in determining whether the measures that could have been required in accordance with the available medical knowledge were correctly applied. "The mere existence of an injury is not sufficient," the ruling states. It is necessary to examine what the correct medical course of action was, regardless of the outcome.

The ruling can be appealed to the court of cassation.

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