A judgement which was delivered on the 3rd June 2019 saw the Court of Magistrates (Malta) presided by Magistrate Dr Doreen Clarke acquitting a Medical Doctor who was represented in these proceedings by Dr Joseph Giglio, after he was accused of having, through imprudence, carelessness, unskilfulness in his art or profession, or non-observance of regulations, caused the death of a patient.
An interesting outcome of this particular case was the Court’s decision to order a ban on the publication of the names of the parties involved, upon the request of the Defence counsel. Many a time, the acquittal of an accused does not necessarily mean that the reputation of the accused remains intact, as though the Court case never took place. This is extremely unfortunate for the innocent person, who having undergone criminal proceedings, would still have his or her reputation irredeemably tarnished upon the publication of his or her name following the Court case. Not this time, however.
Facts of the Case
The patient initially went to the Doctor’s clinic complaining of neck and shoulder pain. Due to the fact that the pain was localised in this specific area, the Doctor naturally focused his clinical examination on this part of the body. The patient suffered from osteoporosis, lived on the top floor in a block of flats which has no lift and did all the shopping and cleaning while suffering from arthritis in her spine. Aware of all these circumstances, the Doctor was confident that this pain was a resultant consequence amalgamated with a result of muscle strain. Consequently, he prescribed Panadols.
The following day, the patient called the Doctor complaining of a general sense of weakness as opposed to the pain in her neck and shoulders. The Doctor thus went to visit her at her home. The patient was not bed ridden, so much so that she was examined in the kitchen. The clinical examination consisted of checking the patient’s blood pressure, her heart beat and her pulse. Moreover, the Doctor asked the questions which are pertinent to a general clinical examination. Resultantly, he prescribed a lower dose of the pills which she was previously taking in order to control her blood pressure since this was found to be low, together with pills which are intended to boost her body energy.
The next day, and thus on the 31st August, in the morning, the Doctor was once again asked to visit the patient due to the fact that the patient was running a temperature. Upon visiting her at around 9.00am he checked her lungs, throat, pulse and blood pressure. While the pulse was a bit high at 84 beats per minute, the blood pressure was still low and giving a reading of 90/60. All the aforementioned results were found in the patient’s medical file which the Doctor kept in his clinic. In the absence of other symptoms and knowing that the patient also suffered from anxiety and that she took medication in this regard to keep calm, he advised her to get in touch with him should her condition deteriorate.
The following day at around 18.00 pm the Doctor was informed that his patient had been admitted to Hospital earlier in the morning and passed away. Since she had been admitted to Hospital and died within less than 24 hours, the practice stands that an autopsy is carried out. This is not a forensic autopsy and due to the fact that the autopsy showed the lungs to be heavy, the cause of death was classified as being an acute heart attack and pneumonia.
Unfortunately, the Magistrate who was 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 which would imply pneumonia. This meant that the whole investigation departed from the wrong premise that the Doctor had not detected pneumonia on the three occasions on which he examined the patient. In reality, it transpired that the patient had actually died from an acute heart attack which occurred at least 6 hours before the time of death.
For the crime of involuntary homicide to subsist, the accused must be proven to have either been imprudent, careless, to have been unskilful in his art or profession, or to have not observed regulations. The occurrence of either one of these scenarios leading to the causality of the death of a person would result in involuntary homicide. Needless to say, it is imperative that the causal link between the cause and effect is proven.
The punishment for involuntary homicide is that of imprisonment for a term not exceeding four years to a fine (multa) not exceeding eleven thousand and six hundred and forty-six euro and eighty-seven cents (€11,646.87).
In this particular case, the Court reached the conclusion that there was absolutely no professional negligence on the Doctor’s part and consequently declared the accused not guilty of the charge of involuntary homicide.
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