Doctor cleared of involuntary homicide after court finds patient died of heart attack

A doctor has been cleared of having, through negligence, caused the death of his patient in 2016 after it emerged that an investigation into her death had omitted to mention heart attack as a cause of death and instead listed undiagnosed pneumonia.

The case dealt with the death of a 56 year-old woman who died in the emergency room at Mater Dei hospital in September 2016. The patient had first gone to her doctor’s clinic complaining of a pain in her neck and shoulder.

Since the pain was localised in this area, the doctor focused his clinical examination on this part of the body and since he knew that she suffered from osteoporosis, lived on the top floor in a block of flats with no lift and did all the shopping and cleaning and had arthritis in her spine, he was confident that the pain was a result of this and a result of muscle strain. Consequently, he told her to take paracetamol.

The following day she called the doctor again, complaining of a general sense of weakness. He went to visit and examined her, checking her blood pressure and her pulse. He prescribed a lower dose of the pills she was taking to control her blood pressure since he found it to be low and gave her pills to counteract her lethargy.

The next day in the morning, the doctor was asked to visit his patient again because she was now running a temperature. Upon visiting her in the morning of 31 August 2016, he checked her lungs, throat, pulse, finding it to be slightly high at 84 beats per minute and her blood pressure, which was still low, at 90/60.

The results of the various examinations were found in the patient’s medical file which the doctor had in his clinic. Knowing she was being medicated for anxiety and in the absence of other symptoms, he told her to get in touch with him if her condition deteriorated

The next day at around 6pm he was informed that she had been admitted to hospital earlier in the morning and had died. Since she had been admitted to hospital and died within less than 24 hours, an autopsy had to be carried out. Her lungs were found to be heavy and congested and the cause of death was classified as being an acute heart attack and pneumonia.

The doctor was subsequently charged with involuntary homicide, through negligence or imprudence.

But the court was told that because the Magistrate carrying out the inquiry was never informed that the histopathological report showed that the lungs were heavy because they were congested with blood (denoting an acute heart attack) and not water (implying pneumonia), the investigation departed from the wrong premise that the doctor had not detected pneumonia on the 3 occasions he examined the patient.

In reality, it transpired that she had died from an acute heart attack which occurred around 6 hours before the time of death.

Magistrate Doreen Clarke concluded that there was no professional negligence on the part of the doctor, declaring the accused not guilty of the charge of involuntary homicide. The court said it was “convinced that the behaviour of the accused in the exercise of his profession was not only correct and expected, but had no connection with the death” of the woman.

The court had upheld a request by defence lawyer Joe Giglio for a ban on the publication of the names of the parties involved.

Inspector Trevor Micallef prosecuted.