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Two doctors charged with involuntary homicide of Eritrean immigrant

Two doctors were this morning charged with the involuntary homicide of an immigrant from Eritrea, back in February 2005.

Police Inspector Joseph Agius testified that he was informed of the death of Sagid IIsraquay Tegualde, a migrant living at the Safi detention centre on February 6, 2005.

The Eritrean had arrived in Malta for the second time on September 17, 2004. He had already entered the country illegally and had been deported.

Mr IIsraquay Tegualde had a history of asthma and suffered from TB and it was not the first time that he had been admitted to St Luke’s Hospital.

A month before his death, he suffered an asthma attack, a doctor from the Paola health centre was called and the patient was referred to hospital. But when the ambulance arrived, he became violent and refused to go.

On February 4, he was taken to St Luke’s Hospital and placed in the M8 ward.

The day after, he was examined by one of the doctors being charged, who is 28. She told the police in her statement that the patient was short of breath, aggressive and refused to be examined.

The doctor called her superior, a 31-year-old doctor who is also being charged with the Eritrean’s involuntary homicide, and informed her what was happening.

This doctor was in another ward visiting other patients and instructed the younger doctor to give the patient five milligrammes of valium to calm him down.

The younger doctor administered the medicine even though she knew asthma sufferers should not be given valium. Later, she gave him nebulised ventolin, he suffered from a heart attack and died soon after.

The senior doctor told the police she had received a call from the other doctor informing her that the patient, who had asthma and tubercolosis, was being aggressive.

She instructed her to give him valium as she had other patients to see to. She said that she visited him two hours later and he complained of chest pains. In view of his asthma history, she decided to give him ventolin.

Next time she visited him, he had died.

An autopsy showed that the Eritrean died from a collapsed lung, intra-pulmonary leakage and bronchial asthma.

The court banned publication of the doctors’ names.

The case continues in December.

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Dr Francis Saliba (44 minutes ago)
The big difference regarding your son’s case is that on your admission he was breaking the law. On present showing at least, the doctors were only doing their level best using their professional skills, secundum artem, to save the life of a severely ill but uncooperative patient. The nationalities of doctors and patient patient is slanderously irrelevant. If that difficult patient were a member of my family and if he abused the medical staff in that fashion I would apologise profoundly for his behaviour and I would express my own gratitude towards the doctors and nurses for their dedication to duty under such distressing situations. I would never agree to be an accomplice to their being hauled to court.
C Falzon (1 hour, 35 minutes ago)
@Anthony Dimech
I don't know much about medicine but from the comments by doctors below it seems to me that the reason they hould not have been prosecuted is that what they did was all according to the correct medical procedures, which I suppose means that the court will almost certainly not find them guilty.
As for banning the publication of the names I see nothing wrong with it. At this time they are only accused of involontary homicide - they have not been found guilty yet (and most likley will not eventually either) so I don't see it would make any sense publishing their names at this time. Once the court case is over then it is another matter - whichever way it decides.
S Azzopardi (2 hours, 9 minutes ago)
@ Anthony Dimech.

The comparison you put forward is indeeed very poor.

The fact that these doctors have been charged with a crime does NOT mean that this is appropriate.

Based on the medical details given these two doctors where not negligent in their care towards this patient.

Anthony Dimech (3 hours, 56 minutes ago)
I wonder how those who are feeling sorry for the Doctors would have felt if instead of the Eritrean immigrant it was a member of their family ? Are you all saying that because they are Doctors they are above the law and should never have been prosecuted? We all have to be accountable in our deeds and that is what we lack in this island.
My son when he was just 19 years old had his name all over the papers just because in a party he was smoking a joint! We solved the great train robbery! On the contrary these 2 doctors who are being accused of involuntary homicide the court banned the publication of the doctors’ names. What a mickey mouse country we live in!
Simon Pace (11 hours, 35 minutes ago)
Is this how we thank our overworked doctors? Most of them go a lot out of their way to help patients. I am very sorry for these doctors, their families and their colleagues.
M Bonello (1 day, 3 hours ago)
Fact 3 - 2 overworked doctors with no senior support had to face quite a complicated patient alone, whilst at the same time having to see probably about 20-30 more patients, having to act as a doctor, phlebotomist, ward clerk, porter etc etc...

In conclusion victimising 2 doctors for an error is one of the gravest mistakes this system can do. In Charging doctors with homicide of such a patient one needs to show that these doctors showed Neglicence (ie not visited the patient, gave diazepam as a too high dose, not started treatment if they knew he needed it. Not investigated if they knew the patient needed investigation etc... and from the above I see nothing has been outlined.)

What I actually see is that these doctors are being made victim of a system that doesn't protect them, but protects the interests of the consultants (that are never there for support). Protects the interest of the management, in that rotas are usually so short staffed with no interest coming from the management that senior help is a rare thing. And putting probably inexperienced doctors at the deep end of things.
M Bonello (1 day, 3 hours ago)
From the article I can see no ACT OF HOMICIDE by the doctors.

This is a very complex situation that with a number of underlying issues that should be tackled hopefully in a non amature way by the authorities.

1st Fact - asthma sufferers should not be given valium - WRONG - Patients suffering from an acute asthmatic attack should not be given Benzodiazepines because it may predispose to respiratory depression. In such case there is no report that the patient had an acute asthmatic attack. Therefore if the patient is aggressive Diazepam 5mgs would have been a good initial tranquilizer. Besides I don't see a link between being given diazepam and this patient's death.

Fact 2 - This patient the patient died of a HEART ATTACK! This might have been precipitated from the salbutamol nebuliser he had, could be from him being aggressive, could be from secondary factors like his TB, and could be just from underlying undiagnosed heart disease. It could have obviously been from all the factors put together. Again I see no act of Homicide here.

(Cont in next article)

Dr Francis Saliba (1 day, 7 hours ago)
Basing myself on the published details, in this case there is absolutely no trace of any evidence that the standard of treatment given fell below the desired level because these doctors were too tired or for any other reason. I am not questioning the acknowledged fact that doctors are chronically overworked and that their dedication often remains churlishly unrecognised. I do not believe that the prosecution could ever find any reputable doctor, without a hidden agenda, who would conscientiously testify that there was anything wrong with the treatment given that could support a charge of manslaughter!
Marianna Galea Xuereb (1 day, 10 hours ago)
So two much needed doctors are being made to waste time and sleepless nights with worry about this court case - rather than being adequately supported to continue to do their best for all patients at Mater Dei and other public health clinics.
A magistrate's and other court employees' time is being wasted and all at over-taxed tax payers' money.
Who decided that these doctors should be taken to court? Would they have been taken to court if the same thing had happened to an ordinary Maltese man born and brought up in Malta?
D Fenech (1 day, 17 hours ago)
There is absolutely nothing wrong in prescribing Valium to an aggressive patient, regardless of having an asthma attack. Valium only decreases the respiratory drive in much higher dosages. Even so, this has nothing to do with the patient's death - he died of a heart attack from the sympathetic overdrive from the Ventolin, which again is a perfectly acceptable drug to give in asthma.

His death, though unfortunate, has absolutely nothing to do with the doctors' decisions. To charge these over-worked under-paid people with involuntary homicide is a slap in the face to the hard work they put in, effectively personally subsidizing the health system in Malta.

It is time for the Health authorities to implement malpractice insurance for all its workers, and not leave every doctor to fend on his own when an overeager paper shuffling public official decides to harass doctors in court. If anybody wants to pursue litigation, this should indeed be a civil matter, not a criminal one!!! What have we come to?
C.ZARB (2 days, 1 hour ago)
Please note

Very few consultants remain at their workplace during the entire night. All consultants do their 8 hr a day job and many do much more then that.
George Debono (2 days, 1 hour ago)
This is quite absurd.

First of all the facts to prevent any further distortions.

A patient is violent and something had to be done about it....................

1)Valium is a perfectly reasonable course of action.

2)It is traditionally taught to medical students that sedative drugs are dangerous to asthmatics on the theoretical basis that they will suppress respiration.

3)But: IS THERE any scientific evidence that valium is truly harmful? I have actually witnessed asthmatic pateints being treated with a far more powerful sedative drugs (opiates) with success and no harm.

4) Valium belongs to a class of drugs (benzodiazepines) which (unlike their predecessors - barbiturates) are believed not to significantly depress rspiration even in heavy dosage.

In a pharmacological experiment in which I took part, 10mg of valium intravenously had virtually no effect on respiration in volunteers.

5mg of Valium is too small dose to be dangerous. It would have done more harm to restrain the patient physically.

And - If the patient was subsequently shown (eg ECG, autopsy, …) to have suffered a heart attack then Valium did not play a part - Valium would have done him good.

To charge these doctors is an outrage.

John Caruana (2 days, 3 hours ago)
I wonder how the Valium could have caused a collapsed lung.
Joseph Scicluna (2 days, 3 hours ago)
@ Dr. Frances Saliba
Thank you for your learned comment. To all other prospective bloggers the less said the better.
Adrian Cachia (2 days, 3 hours ago)
What do we expect when the doctors are overworked!!

Moreover I'd like to ask how many doctors do normal duties while still under training without proper supervision!! The younger doctor asked a senior doctor who was busy with other patients to administer the dose of medicine! We are constantly hearing that the system is under pressure so I do not blame any of the doctors at all and I think that everyone should shoulder his responsability, including the seniors doing the rosters for the doctors shifts!
Joseph Schembri (2 days, 4 hours ago)
Thanks for Dr Francis Saliba for giving us this information. In fact I had already looked up information and found out that in some cases of asthma Diazepam (Valium) can be useful.

In any case 5mg of diazepam is a small dose as for a violent patient up to 20mg can be given. I am told that it is one of the most prescribed drugs in the world and as it has been in heavy use for many decades its profile is very well understood. I am told that giving one small dose of diazepam is safer than giving one small dose of paracetamol.
Dr Francis Saliba (2 days, 4 hours ago)
I wonder who decided that these doctors should be taken taken to court at all. The treatmentt given as described is correct for a VIOLENT and aggressive asthma patient. Chronic asthma patients are dying all the time from pulmonary failure and collapse of the lung with or without that type of treatment . Someone is leaning over backwards so as to appear politically correct uncaring of the fact that, even though their names are witheld, and even they should be considered innocent until they are proven guilty, in actual practice their professional reputation will be tarnished unjustly. Just read some of the comments.
C.ZARB (2 days, 4 hours ago)
Im not justifying anyone but its true that much of the times our doctors are working under heavy workload (loads of patients need to be seen by 1 doctor), for long hours (60-70hrs a week) and they are poorly paid and supervised. In certain areas (even key areas) very few consultants remain at work, and lets face it, those are the times when bad things tend to happen (car accidents etc). Ok the consultants are on call. On the other hand certain decisions need to be taken immediately, so if the consultant is not there then it must be taken by someone else.

Michael Seychell (2 days, 4 hours ago)
All of us commenmting on pending court cases are very wrong in doing so.

Let us all be more responsible and respect the Courts by not commenting on a sub judice case/s anymore. Over the years much damage has been done to justice by our meddling in the past.

It is a known fact that there are persons running amongst us who should be in prison for serious crimes they committed, but through the meddling of politicians, journalists, and others, such persons are still free, and justice has not been done to the victims, and their families and to society.

My appeal is not a question of limiting any one's right to comment on any subject under the sun, but to respect the universal right of justice and this should - or rather must be
administered by the Courts of Law.

Michael Seychell
Christian Sciberras (2 days, 4 hours ago)
Eventhough I can't judge the doctors, (they did act in good faith), the comments below are disgusting.
I agree with Mr. Portelli
John Portelli (2 days, 6 hours ago)
@M. Galea
@Joseph Schembri

What if, the patient in question was your father, your brother, your son, your husband..???
Would you have commented the same on this blog???
Man tends to think differently, much differently when the buck stops with him!!!
Peter Mangion (2 days, 6 hours ago)
are you guys serious??
if it is true that valium should not be given to asthma sufferers they made a big mistake by allegedly doing so.....the patient could have been anyone.

carmel callus (2 days, 7 hours ago)
This is what can happen when you have doctors working day and night under pressure with little time to rest. And they are paid as much as a clerk despite the fact that they carry such a huge responsibility especially when something might go wrong. One has to appreciate that despite all, they save hundres of lives every day!
Joseph Schembri (2 days, 8 hours ago)
It is good that the names of the doctors are not made public. What is of interest is the moral of the story not the gossip value of the names. This should be the rule in every case.
M. Galea (2 days, 9 hours ago)
Is this the thanks we give our overworked doctors?


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