Medical-legal analysis of claims for patrimonial liability in primary health care and extra-hospital emergency services in the Community of Madrid

Abstract

Introduction

Primary care (PC) and out-of-hospital emergency services (SUMMA112) are high-risk areas for malpractice claims due to their volume of activity and inherent uncertainty. Compensation claims that do not involve criminal liability require a preliminary administrative procedure. We analyzed the reasons and outcomes of these resolutions.

Materials and methods

This is a cross-sectional observational study of advisory opinions issued by the Legal Advisory Commission of the Community of Madrid regarding compensation claims for out-of-hospital healthcare liability between 2013 and 2022. The variables analyzed included administrative, clinical, judicial, temporal, and compensatory factors.

Results

A total of 616 rulings, 75 (12.2%) were related to out-of-hospital care: 43 (57.3%) in family medicine in PC and 28 (37.3%) in SUMMA112. Of these 42.7% were partially or fully upheld. The median compensation was €37,744 (range €600–€370,000). The 34 (45.3%) patients who died received more favorable outcomes (55.9% vs. 31.7%) with higher compensations (€47,900 vs. €22,900). The average delay between the claim and the opinion was 775 days. Reasons for claims included delayed or erroneous diagnosis in 42 cases (50,6%), treatment errors in 14 (16,9%), malpractice in 10 (12%), informed consent issues in 9 (10,8%) and adverse treatment effects in 7 (8,4%). The most frequent diseases were acute cardiovascular conditions (27%, including myocardial infarction and stroke), oncological diseases (16%), vaccine-related incidents (8%), and trauma (8%).

Conclusions

Acute cardiovascular and oncological pathologies generated the highest number of claims. Diagnostic delay or error was the primary reason cited, often linked to the loss of opportunity. Less than half of the claims were upheld, with compensation amounts significantly lower than those requested, and higher amounts awarded in cases involving patient death. Resolution times exceeded two years.