Seven years after patient choked to death, court case against nurses draws to an end

Seven years after patient choked to death, court case against nurses draws to an end

Hospital staff accused of involuntary homicide through negligence

Seven years after a patient at Karin Grech Hospital choked to death over a piece of chicken, criminal proceedings against three members of the nursing staff are drawing to an end.

Chief nurse Maria Bondin, 61, from Paola, nursing aide Carol Bonnici, 59, from Siggiewi and nurse David Sant, 34, from Gharghur, were arraigned and accused of involuntary homicide following the incident on Following that fateful day back in March 7, 2012.

They protesting their innocence in respect of the death of the then-64 year old patient.

The man, who suffered from dementia and was to be supervised while eating, had been recovering at the rehabilitation hospital when he choked on a piece of chicken and was found face down on the bathroom floor after going missing from his ward.

“It was like something out of a Charles Dickens novel,” lawyer Stefano Filletti said in court when making final arguments on behalf of the man’s widow, who has been seeking closure for the past seven years.

“He took a piece of food, walked to the toilet and took his last breath face down on the bathroom floor, close to the toilet bowl,” continued Dr Filletti. “This was a terrible, tragic death. It could have been avoided. We’re not after the pound of flesh but someone has to answer for this.”

This was a terrible, tragic death. It could have been avoided. We’re not after the pound of flesh but someone has to answer for this- Widow's lawyer

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

Yet, the meat could not have been served to that particular patient without having been properly cut up and thickened to the consistency indicated by a speech-language pathologist.

“The food was heated and served. No one checked what had ended up on his plate…The thickening process was a medical process not a catering task. Someone was to do it and keep an eye on him,” Dr Filletti argued, stressing that the fault lay not on the hospital system but on the staff who had been negligent in their duties.

“The system, even if rudimentary, was functioning. It was the fault of those handling it”, Dr Filletti concluded, his arguments backed up by Superintendent Dr Jeffrey Azzopardi, pointing out that the staff had been on full complement on the day of the incident.

Besides, the feeding instructions had been clearly fixed to the patient’s bed, the prosecuting officer argued. “Those were orders, so the negligence was absolute.”

Defence: It was the system that failed, not the staff

Those arguments were promptly rebutted by the defence lawyers who stressed that it had been the system that had failed rather than the co-accused, so much so that after the tragic death, hospital rules had been changed.

“We don’t know who made the rules or who changed them,” argued Dr Stephen Tonna Lowell assisting the nursing aide, the lowest ranked among the three co-accused who sat silently at the dock all throughout the two-hour long hearing.

“The six-month magisterial inquiry was inconclusive. No fingers were pointed at anyone. The police had been asked to continue to investigate,” Dr Tonna Lowell continued, pointing out that the inquiry had been instituted only after the widow had voiced her concerns regarding the death of her husband with a private lawyer.

Charges had been instituted against the three members of the nursing staff on the grounds that no-one had checked the food nor supervised the patient, the lawyer went on.

READ: Chicken that choked a man to death was classified as a 'soft food', court hears

An internal inquiry, concluded in 2012, had also proved inconclusive, Dr Tonna Lowell said, adding that several questions had been left unanswered, such as why chicken had been classified as ‘soft food’ at the time. After the incident, it was re-classified as part of the ‘regular’ diet, the court was told.

The patient had not been placed ‘under constant watch’ nor was he to be fed by carers but was only to be supervised while eating, the lawyer went on, further questioning how the chicken could have been mashed when there had been no liquidizer in the ward, the only cutlery being the plastic ones provided by the caterer.

“This was the system!” Dr Tonna Lowell remarked, stressing that it was only after the tragedy that rules had been changed.

As for his client, the lawyer said that at the time the nursing aide had been allocated patients in two room.

“She was either expected to have x-ray eyes or powers attributed to Padre Pio,” concluded Dr Tonna Lowell with a hint of sarcasm, while questioning how the aide could have been watching over the sleeping patient, when a tray of food had allegedly been placed before him, while she had been in another room.

Dr Michael Sciriha, assisting the chief nurse, whilst supporting the arguments raised by Dr Tonna Lowell, also questioned how charges could be levelled against his client when, according to her job description, she had not been responsible for supervising or feeding patients.

As for the third co-accused, the staff nurse who had given ‘a hand over’ before the incident occurred, he had informed the other nurse that the patients were ‘ok’, before taking his break, defence lawyer Joseph Grech said.

Moreover, the food could not have been checked earlier on since it had been delivered in a sealed warmer that unlocked automatically by means of a timer and the food served immediately while still warm, Dr Grech argued.

“Something went wrong with the hospital management at the time. Things have now changed after that tragic incident,” the defence concluded.

Magistrate Donatella Frendo Dimech, adjourned the case to March for judgment.