A nurse and an aide found criminally responsible for the death of a frail patient who choked on chicken when left without supervision, had their punishment reduced on appeal.

Nurse David Sant and nursing aide Carol Bonnici were found guilty of involuntary homicide in 2019, seven years after the 64-year old dementia patient and stroke survivor was found lying lifeless, face-down on the bathroom floor, after choking on his meal. 

According to his medical file, the Karin Grech hospital patient could not lead an independent life and needed assistance with many basic, everyday tasks, including feeding, since he could not chew his food properly. 

That is why “verbal prompting and supervision” had been recommended by his therapists, observed the Court of Criminal Appeal.

Presided over by Madam Justice Edwina Grima, the court rejected the argument put forward by the appellants that no “constant watch” had been indicated. It was “evident that some form of supervision had to be exercised,” the court said.

Moreover, in a hospital where patients were supposed to be under the care of doctors and nurses, the patient “choking on his food, managed to leave his room, cross the corridor, reach the bathroom out of breath, collapse and pass away without anyone realizing what was happening,” the court observed.

Still, while confirming the criminal responsibility of the appellants, the court dwelt upon a series of factors which had contributed to the patient’s death and which were not all attributable to the nurse and his aide. 

The nature of the food served, with chicken being classified as ‘soft food,’ was not a decision taken by the appellants. 

Moreover, the hospital practice of meting out treatment at mealtimes placed a greater burden on nurses who, besides, were expected to lend a hand as the need arose, sometimes neglecting their assigned duties to handle tasks which fell beyond their remit. 

Indeed, in this case, Sant had been supervising a trainee nurse who was administering medication to other patients, while Bonnici had been feeding two other patients, when the victim was served the tray of food by a third party and left to his own devices. 

Nor was there any policy to ensure that meals were only served when nursing staff were present, the court went on. 

Sant had popped in to check on his patients before going out on break, and had spotted the victim, seated in bed, while other staff collected the food trays. He had given the handover, reporting that all was well without actually checking whether the patient had ingested any food.

The nursing aide had checked on the patient a while earlier and finding him asleep, had gone to feed the other patients under her care. Returning half an hour later, she found his bed empty. 

The autopsy had clearly established that the victim had choked on his food, revealing a large chunk of food “obstructing the opening of the larynx.”

'Death not attributable solely to the appellants'

The court also observed that there had been a lack of surplus staff to lend a hand.

All factors put together meant that the medical care afforded had fallen short of the expected standard, thus contributing to the incident which would otherwise have been foreseen, not only by the appellants but also by the hospital administration and those superior in rank to the nurse and his aide. 

It was the duty of the appellants that day to ensure that the patient came to no harm, being well aware of the risks since the man had been receiving treatment in hospital for three months.

It was useless to argue that the victim was due to be discharged within two days of the fatal episode. 

However, for the purpose of punishment, the court took note of the fact that the death was not attributable solely to the appellants, who had a clean criminal record and had “scrupulously” attended all hearings in court and had never obstructed the course of justice.

For these reasons, the court reduced the punishment by halving the fines handed down by the first court, namely from €7,000 to €4000 for Sant and €2,000 for Bonnici instead of the original €4,000. 

Chief nurse Maria Bondin, who had also faced charges, had been cleared of all wrongdoing by the Magistrates’ Court.

Superintendent Dr Geoffrey Azzopardi prosecuted. 

Lawyers Stephen Tonna Lowell and Kris Scicluna assisted the appellants.

Dr Stefano Filletti represented the patient's family.