Andorra Doctor Denies Negligence in Elderly Woman's Rib Fractures After Falls

A doctor charged with minor injuries due to serious professional negligence in treating an 81-year-old woman at Andorra's Salita care home has denied misconduct, but expert witnesses disagreed on whether imaging was required after her three falls in May 2018.

The retired 68-year-old physician, who oversaw the facility's medical services at the time, testified at the Tribunal de Corts that he examined the patient on her eighth day at the centre—after her initial fall on the first night and two more during her 15-day stay. He noted mild right scapula pain without bruising, prescribed analgesics and anti-inflammatories as low-risk options for her age, and suggested hospital transfer for a chest X-ray when pain continued. He claimed the family agreed to conservative treatment with rest instead.

Family members, however, insisted they trusted the doctor's judgment and never refused transfer, noting no such refusal appeared in the medical records. Pain intensified the day after discharge, leading to hospital admission where scans revealed six fractured ribs, a pleural effusion requiring drainage, and acute bronchitis. The woman, who had early dementia, diabetes, hypertension, and took antidepressants and anxiolytics, remained hospitalised for 28 days and never recovered her prior condition.

On the trial's second day, the head of forensic and legal medicine ratified a prior inspector's view that imaging was essential after the third fall to assess injury extent, given poor painkiller response and respiratory risks. She said a chest X-ray would have been among her first steps, and antibiotics may have been inadequately prescribed, potentially worsening complications.

A legal medical expert for the family called the care inadequate for a frail, multi-morbid patient, stressing hospital transfer and tests were needed despite absent external bruising—a sign the fractures predated discharge. She rejected claims of a post-discharge fall causing the injuries.

The defence's geriatrician expert countered that fractures do not prove malpractice, transfers carry risks outweighing benefits in the elderly, and conservative management was reasonable. Even with earlier diagnosis, treatment would likely have stayed the same, she said, adding imaging is not always essential and complications like effusions show clear clinical signs.

Salita bears subsidiary civil liability if the doctor is convicted. The third and final day focused on closing arguments.