Doctors indicted for negligent homicide: case dismissed
This photograph appeared in local online '' in 2020 when Ms Nunes family described themselves as 'disgusted' the case had taken so long to be decided

Doctors indicted for negligent homicide: case dismissed

Decision refers to 33-year-old mother-of-two who died following what should have been a routine procedure

Three doctors from Leiria’s São Francisco Hospital Centre, accused of a crime of negligent homicide for the death of a patient, will not go to trial, the investigating judge has ruled today.

“(…) I have decided not to prosecute the defendants (…) for the crime of negligent homicide that each of them was charged with or any other crime, ordering the case to be closed,” wrote the judge of criminal instruction in a pre-trial decision.

In the indictment, the Public Prosecutor’s Office stated that on 19 July 2017, the 33-year-old female patient went to the Radiology Service of the San Francisco Hospital Centre to undergo a cardiac CT scan.

After the administration of iodinated contrast for the exam, she lost consciousness and went into respiratory arrest. 

During resuscitation manoeuvres that followed – carried out by two of the defendants – “they did not determine the administration of adrenaline to the victim, which could have reversed the situation”.

Although the third defendant, also a doctor, had ordered the administration of adrenaline, “given the non-reaction of the patient to the dose administered, she should have ordered a higher dose, which she did not do”.

Given these omissions, the victim did not recover heart rhythm amenable to cardioversion, which could have led to a reversal of the clinical picture, having been left with anoxic encephalopathy, “an irreversible state”, the public prosecutor said.

The victim was transported to Santo André Hospital in Leiria “without the defendants accompanying, so, as a result of this omission, advanced life support was interrupted, going to basic life support and, therefore, neither serum nor adrenaline were administered every five minutes, as should have been done”, which caused the victim to enter “cardiorespiratory arrest”.

According to the public prosecutor, the patient recovered a pulse rhythm following resuscitation operations carried out at Hospital de Santo André. The patient remained hospitalised until 18 August 2017, when she was transferred to the District Hospital of Santarém, where she died on 6 December, without ever having regained consciousness.

According to the public prosecutor, “although they could and should have proceeded to the administration of adrenaline at the time and in the doses that were required, as well as having accompanied the victim in the transport to the Santo André Hospital, which would have been the good clinical practice, the defendants did not take such measures, confident that the resulting death would not occur. It was the failure to observe these clinical practices that increased the risk of production of the death of the patient, which came to pass”.

In the decision not to charge the defendants, the judge considered that it was not sufficiently proven, among other aspects, that the administration of adrenaline “could and should have been done” by the two doctors and that the doctor “could and should have administered more doses of adrenaline” after the first dose had no effect.

It was also not sufficiently established that during the transport of the patient to Santo André Hospital, “advanced life support could have been maintained” for the patient and that the two doctors “could have ensured this if they had accompanied the patient” during this displacement.

According to the decision, “there is no sufficient evidence that the defendants committed omissions caused the death of (the patient); that they should have acted differently and that, had they done so, the result of death would not have occurred”.

“In the light of all the evidence gathered, there is no sufficient indication that the defendants did not act with the care that, according to the circumstances, they were obliged to and were capable of, and that such negligence was causal to the serious injuries of (the patient) and his subsequent death,” the judge concluded.

Up till now, this judgement has been reported by State news agency Lusa with no reference to the dead woman’s family, or their reaction.

Back copies of reports have referred to the dead woman as Marisa Nunes, a mother of two young children, who lived in Fazendas de Almeirim.

A local newspaper report in December 2017 described the family as extremely upset and convinced the doctors involved were responsible for gross negligence.

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