The Den Bosch Court of Appeal has sentenced GGZ Eindhoven (GGzE) to a conditional fine of 19,500 euros. The healthcare institution only has to pay this if it commits another error within two years. According to the judge, an unconditional fine would be at the expense of ‘the already fragile care that is so badly needed. New clients could indirectly be the victims of this’.
Professor of Health Law Martin Buijsen of Erasmus University speaks of a unique case. “It is rare that a healthcare institution is prosecuted for the death of a patient.” It is more usual for individual doctors to be summoned before the disciplinary court, as happened in this case.
‘But everyone knows that care can sometimes be flawed,’ says Buijsen. ‘This ruling therefore sends a strong signal to other institutions: if necessary, we can go to the criminal court, so watch out. That has an impact, because a conviction is disastrous for the good name of a healthcare institution.’
Lawyer Wendy van Egmond, who represents the parents, also calls the ruling an important signal. ‘Not only to the mental health sector, which is struggling with major staff shortages, but also to politicians. This is not allowed.’
Heart failure
The case revolves around the death of Janneke van Erum, a 29-year-old woman who suffered from psychosis. In April 2013, she was admitted to the emergency psychiatry department to try another medication: clozapine. But soon she felt unwell. Among other things, she became bedridden and had to vomit. Her family sounded the alarm, but there was no adequate response. Less than a month later, Janneke died of heart failure.
According to the court, the treating physician should have monitored the patient more closely because of the serious side effects. In addition, GGzE had to contend with a high workload and insufficient supervision of the attending physician assistant.
In addition, the court notes, an admission report and treatment plan were missing, among other things. ‘The institution bears the responsibility for all shortcomings, both in the organizational field and in the field of the actions of the staff within the institution’, according to the court.
Shortcomings
Earlier, the treating psychiatrist and the assistant physician were reprimanded under disciplinary law. During the disciplinary case, the psychiatrist said that the situation on the work floor was ‘so serious’ due to underemployment that he had already indicated before Janneke’s death that he would resign if no structural changes were made.
During the criminal case, GGzE argued that the organization is not responsible for the death of the patient, partly because, according to the institution, it is not irrefutable that she died as a result of the medication. The occupancy rate would also meet the standards and the protocol for the drug clozapine would have been acted upon.
The court previously acquitted the care institution, but the court of appeal does not agree. ‘In the period before the woman’s death there were many shortcomings. As a result, the institution has failed to fulfill its duty to call in the necessary medical assistance in time.’
According to the court, this is particularly culpable because it concerns a specialized care institution for emergency psychiatry, ‘which can be subject to particularly high requirements’.
‘Incident’
José van Erum, Janneke’s mother, is happy with the court’s recognition. “My daughter died because the clinic failed to observe her properly and neglected her. There has been an accumulation of errors. That is why we thought it was important that not only individuals, but the entire institution should be held responsible for this.
‘I hope this statement sends a signal to other healthcare institutions: you are being watched, you can’t just get away with everything.’
Branch organization GGZ Nederland says it is a sad matter. “But we do consider it an incident.”
