Two nursing staff fined for involuntary homicide of elderly patient, one acquitted

A nurse and nursing aide at Karin Grech Hospital have been fined after they were found responsible for the death of an elderly patient in 2012

A nurse and nursing aide at Karin Grech hospital were deemed responsible by the court for the death of an elderly patient who choked on his food
A nurse and nursing aide at Karin Grech hospital were deemed responsible by the court for the death of an elderly patient who choked on his food

A nurse and nursing aide at Karin Grech Hospital have been fined after they were found responsible for the death of an elderly patient who choked to death on food, with the court saying that they had failed in their duties, despite their good intentions.

Nurse David Sant and nursing aide Carol Bonnici were convicted of involuntary homicide this morning by Magistrate Donatella Frendo Dimech. In the same proceedings, Chief nurse Maria Bondin was cleared of all wrongdoing.

Chief nurse Bondin, 61, from Paola, nursing aide Bonnici, 59, from Siggiewi and nurse Sant, 34, from Gharghur, had been charged with involuntary homicide following the death of the 64-year-old man in March 2012.

Magistrate Frendo Dimech noted that although the incident had occurred in 2012, the case started being heard before a different magistrate two years later. The first sitting before her was then held in November 2018.

The court discarded the accused’s statements to the police as they had no lawyer present. The three accused had testified before an internal board of inquiry without being given the faculty of being assisted by a lawyer of their own choosing, despite the internal inquiry being started after the police report was filed.

Also discarded was the report drawn up by the Mater Dei Hospital legal office about the internal inquiry, which had been presented but not confirmed on oath and therefore had no probatory value. Even had the report been authenticated, said the court, it would not have been admissible as it was up to the prosecution to bring as witnesses the same persons who testified in that inquiry as otherwise, it would all be hearsay, said the court.

Magistrate Frendo Dimech had been told how the victim suffered from dementia and had to be supervised while eating. He had been recovering at the rehabilitation hospital when he choked on a piece of chicken and was discovered face down on the bathroom floor after going missing from his ward.

Victim placed on soft food diet

The victim who had difficulty chewing had been placed on a soft food diet. He had been served a chicken meal shortly before he met his fate, at a time when hospital regulations labelled chicken as ‘soft food’.

The court had been told that chicken was suitable food for the patient as long as it was properly mashed and as long as the patient is supervised while he ate it.

The deceased patient had been recovering from a stroke which made swallowing difficult and suffered from severe dementia. Despite this, the man’s widow had told the court that she would often find her husband eating unsupervised.

A doctor had told her that her late husband had been found around 90 minutes after his death, but the court said that this was not supported by the evidence, which showed that the patient was found 30-40minutes after being served his food, at around 12pm.

The court observed that a note had been stuck to the patient’s bed reading “Position for Feeding: seated/propped up” and “Supervise during feeding.”

Sant had been the nurse responsible for the patient, and his nursing aid was Bonnici. The pair had six patients allocated to their care. Bondin was the nursing officer in charge of the ward.

At the time of the incident, Bonnici had been feeding another patient in another room. The identity of the person who handed the meal to the patient was never established, something which the court remarked was unacceptable, condemning the fact “that patients are in contact with unidentified persons without any control or restriction.”

The problem, however, was not that the patient was given food, but that there was no supervision from the moment he was left with food in front of him to when it was eaten, despite the instruction.

The court said that it, therefore, had to determine whether this was negligence.

It ruled that Bonnici was negligent by failing to predict the consequences of her failure to supervise, despite the knowledge of the danger the patient would be in if not supervised while eating. This fell short of the level of diligence expected from her profession.

With regards to Sant, the court said that they had also been negligent when he failed to ascertain whether the victim had eaten and if so, taking away his plate. Sant had admitted not checking whether the patient had actually eaten and instead had made an assumption.

Sant was reckless, negligent and irresponsible in his actions, said the court. His failure to supervise led to the death of a patient entrusted to his care when he could have easily predicted the consequences of this failure ruled the magistrate.

Knowing that the patient liked to eat, taking into consideration that he was at risk of obstruction of his airway, together with the fact that he suffered from dementia and would wander made a greater obligation that he be supervised while in the presence of food, she said.

“His death is a testament to and a result of their failure to supervise him as they were obliged to do. The nexus between their actions…and his death has been amply proven.”

On the other hand, Bondin had carried out her duties perfectly, assuring that every patient was allocated a nurse and nursing aid, that the staff were all aware of the instructions relating to each patient. She had even chosen to place the patient in the room which saw the most movement and which was, therefore, easier to keep an eye on. By no stretch of the imagination can there be said to be negligence or abandonment, said the court. “To the contrary, in the very unfortunate circumstances of this case, Maria Bondin did everything she could to ensure that the patient is given the best care. Her efforts to save his life were also noted.”

Punishment reflects grade of negligence

While finding Sant and Bonnici guilty of involuntary homicide, the court also noted that there were reasons for their mistakes. Sant was taking care of a trainee nurse at the time of the incident, and Bonnici was feeding a patient who was far more vulnerable than the deceased.

Their dedication to the patients was also evidenced by their reporting for work earlier than requested, observed the court.

On punishment, the magistrate said that nothing would repair the damage suffered by the victim or his family. Punishment should reflect the grade of negligence in the actions of the persons accused which, while criminal, did not merit a custodial sentence.

“David Sant and Carol Bonnici can in no way be seen as a threat to society; rather they are persons who with vocation and dedication serve their duties with those who need help the most. There is no need for a deterrent in their sentences and society would certainly not benefit from their imprisonment. The fact that they enjoy a clean criminal record and that their failure was not down to them not caring… militate towards them being fined.”

The court noted that it was not requested to liquidate damages.

Therefore, while clearing Maria Bondin of all guilt, the court found Bonnici and Sant guilty as charged, fining Bonnici €4,000 and Sant €7,000. They are also to suffer the costs of appointing court experts, some €1,644.

Superintendent Jeffrey Azzopardi prosecuted. Lawyers Michael and Lucio Sciriha for Bondin, lawyer Stephene Tonna Lowell appeared for Bonnici and lawyer Kris Scicluna appeared for Sant.

Lawyer Stefano Filletti appeared parte civile. 

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