Health authorities, Mount Carmel management, cleared of responsibility for 1989 patient suicide

A court has cleared the authorities and management of Mount Carmel Hospital of responsibility for the 1989 suicide of a patient in their care.

The Director of Psychiatry at the facility, together with the Chief Medical Officer, the Parliamentary Secretary for Health and the Minister for the Interior and Social Development had been defendants in a lawsuit filed by the Van Den Hoek family over the death of Junping Van Den Hoek, who died as a result of suicide on 24 December 1989 whilst she being treated at Mount Carmel for paranoid schizophrenia.

Van Den Hoek had been on a family visit to Malta when she had to be admitted to St Luke's hospital following an attempted overdose of prescription medicinals. She was subsequently transferred to Mount Carmel Hospital in Attard. The woman hung herself from her belt, having been left unattended shortly after her admission to the facility.

The deceased's family had asked the courts to hold the defendants responsible for her death, arguing that the woman's death could have been avoided had the necessary precautions been taken.

It emerged from the evidence that, as a result of her condition, in the months before her death the deceased had killed one person and attempted to kill another, before trying to kill herself in January 1985. A court had ordered that she be committed to a mental hospital for a year, later extended by another 12 months.

A Senior House Officer at Mount Carmel had examined the woman and testified that she showed none of the symptoms of depression or delusions and had told medical staff at the facility that she had stopped hearing voices, had no suicidal wishes and “wanted to see her only child grow.” She was given an injection of Fluanxol on admission, the doctor saying that he had been aware that the medication needed at least three days to become effective.

After being visited by her husband, the woman had been calm and had asked to go to the bathroom.

Some minutes later a health assistant had discovered the patient hanging from the flushing reservoir, strangled by a noose she had made out of her coat's cloth belt.

It was explained to the court that even patients under constant watch were allowed to visit the bathroom alone.

A court-appointed independent expert had concluded that “from careful examination of the evidence I could not find any lack of management or medical negligence in this unfortunate case.”

In her decision on the issue, Madame Justice Anna Felice presiding the First Hall of the Civil Court, noted that the staff had followed the hospital's guidelines and removed dangerous articles carried by the patient before she had been admitted. The plaintiffs had not contested the assertion that patients were allowed to use the bathroom unsupervised.

“The care and attention given to the patient at Mount Carmel Hospital were those deemed necessary after the hospital doctor's evaluation, which was not criticised in any way by the court-appointed medical expert.”

The court held that the patient had died because of reasons beyond the defendants' control. It said that although the loss of the patient was tragic, it was not the result of the defendants' incompetence or negligence, but that of the patients mental state. It could not assign blame for the incident on the defendants in the lack of concrete evidence of wrongdoing.

“Unfortunately, once the patient chose the path that led to her taking her own life, despite all the efforts to help her by the doctors and nurses, this court does not find the actions of the [defendants] censurable because those actions had been in line with what was reasonably expected of them by the practices in force at the time.”