Two Mount Carmel Hospital nurses have been cleared of causing the death of a vulnerable patient, after prosecutors failed to prove that the fits he suffered while under constant watch caused his death.

The patient was found lying uncovered, face down in his bed by a cleaner on March 15, 2018. He called the patient but there was no response.

Meanwhile, the deputy charge nurse who clocked in at 7:00am and was checking the 32 CCTV cameras through his office monitor, also noted that the patient was not moving in bed.

The cleaner rushed out of the ward, alerting the staff at the mental hospital.

An emergency team confirmed that the patient, one of 16 drug addicts receiving treatment at the time, had a “very faint pulse.”

They administered CPR and continued to do so in the ambulance all the way to Mater Dei Hospital where the patient was admitted to the resuscitation room. He died shortly afterwards.

The post mortem examination confirmed that the cause of death was pulmonary thromboembolism, a blood clot blocking the blood flow to an artery in the lungs.

Valentina Bezzina, now 77, and Jessie Valentino Poquiz, now 36, two of the team of four nurses who were on night shift that day, were subsequently charged with causing the death through professional negligence.

They pleaded not guilty.

“Quiet” and “depressed” patient turned “extremely violent”

Throughout the proceedings several staff members testified about the incident and changes in the patient’s behaviour in the days preceding his death.

He was normally a “quiet” type, independent in his ways.

However, for several weeks he refused prescribed medication and his former depression gave way to violent tendencies.

In his last few days, he was psychotic and extremely violent, they testified.

He used to walk about naked, seemingly disoriented, shouting at the window or looking out and talking to himself, getting in and out of fellow patients’ beds and going to the pantry when he needed to go to the toilet.

Doctors were alerted, examined him frequently and administered medication.

While some of the witnesses said that doctors had ordered “level one supervision”- continuous and individual monitoring- other witnesses said that doctors did not.

Understaffing and bad management

Another violent patient had been targeting the victim to attack him. Doctors said that the other patient was to be admitted to a maximum security unit, but that unit could not take him in.

As a result, nurses had to handle “two violent patients in the same ward” the court heard.

A senior doctor who visited the patient that evening issued an observation order, allowing nurses to administer an injection in case of emergency, since he had been “refusing all his tablets for weeks on and off.”

He was administered, “a mood stabilizer,” because he needed to sleep. He had not slept for three days.

“He needed to be secluded in a small space where he could be observed,” testified the staff nurse. But bad management and lack of space did not allow that.

Four nurses on night shift, including the two defendants, were on a roster to monitor the patient.

The prosecution alleged that the victim suffered fits during Bezzina and Poquiz’s turn.

An understaffed ward

When delivering judgment Magistrate Simone Grech observed that the ward was understaffed. It was difficult for the staff to keep up with their duties.

That night, four nurses were tasked with monitoring the patient: Bezzina between 1:00am to 3:00am and Poquiz between 5:00am and 7:00am.

CCTV footage and documents confirmed that the patient suffered fits during their watch.

The court observed all four nurses were performing that duty remotely from another room through CCTV cameras.

Such supervision was certainly not in line with professional expectations, observed the court.

The minister concerned was to “evaluate how constant watch procedure was being followed at the time of the incident and nowadays.”

Just as the inquiring magistrate had suggested, Magistrate Grech said that disciplinary steps were to be taken when constant watch procedure was not followed properly.

Link between fits and patient’s death not proved

The court concluded that the prosecution failed to prove that the fits and the cause of death were connected.

After suffering the first fits, the patient woke up, went to the nurse who replaced Bezzina and asked for a cigarette, saying that he was feeling fine.

No medical experts were summoned to explain whether there was a link between the fits and the man’s death.

The court could not rely on “assumptions” but needed “concrete evidence,” it said.

The only indications were his “strange behaviour,” the doctor’s recommendation to transfer him to a smaller, more secure space and the fits he suffered that night.

He turned over in bed at 5:12am. First aid reached him at 8:40am. The court noted that time lapse too.

The court could not assume that those fits caused the patient’s death and any lingering doubt favoured the accused, who were thus cleared of all criminal liability.

Lawyers Edward Gatt, Vince Micallef and Stephanie Abela were defence counsel.