Lengthy criminal proceedings against three nursing staff members at Karen Grech hospital over the death of a patient who choked on his food are nearing their end.

Following the death in March 2012, chief nurse Maria Bondin, 61, from Paola, nursing aide Carol Bonnici, 59, from Siggiewi and nurse David Sant, 34, from Gharghur, ended up charged with involuntary homicide. All three are maintaining their innocence in respect of the death of the 64 year old patient.

The victim suffered from dementia and had to be supervised while eating, the court had been told. He had been recovering at the rehabilitation hospital when he choked on a piece of chicken and was discovered 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 earlier this week. Filletti is counsel to the widow of the deceased. “Choking on food, the patient passed away face down on the floor of the toilets of hugging a toilet, “continued Filletti. “This was a terrible, tragic death. It could have been avoided. We’re not after a pound of flesh but someone has to answer for this.”

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

Yet, the meat should not have been served to that particular patient without having been properly mashed and thickened to the consistency specified by the man’s 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.

Filletti pointed his finger at the accused. “The system, even if rudimentary, was functioning. It was the fault of those handling it.” The lawyer’s arguments were supported by the testimony of Superintendent Dr Jeffrey Azzopardi, who explained that the staff had been on full complement on the day of the incident.

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

The defence lawyers however stressed that it had been the system that had failed rather than the accused trio. As proof of this, they pointed to the fact that after the tragic death, hospital rules had been changed.

“We don’t know who made the rules or who changed them,” argued defence lawyer Stephen Tonna Lowell, assisting the nursing aide. 

“The 6-month magisterial inquiry had been inconclusive. No fingers had been pointed at anyone. The police had been asked to continue to investigate,” 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.

The charges had been pressed against the three members of staff on the grounds that no-one had checked the food nor supervised the patient, the lawyer went on.

An internal inquiry, concluded in 2012, had also proved inconclusive, 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.

Tonna Lowell stressing that it was the system in place at the time and that only after the tragedy that rules had been changed.

As for his client, “What is she doing here today?” the lawyer repeatedly asked, pointing out that the nursing aide had been allocated patients in two rooms when she noted that the victim had gone missing.

“She was either expected to have x-ray eyes or powers attributed to Padre Pio,” concluded 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.

Lawyer Michael Sciriha, assisting the chief nurse, also questioned how charges could be made against his client when she had not been responsible for supervising or feeding patients.

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.

In fact 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, Grech argued.

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

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