Death from poisoning to a hospital. Insufficient criminal and civil procedures for dealing with medical negligence
Yirdem and others v. Turkey 04.09.2018 (no. 72781/12)
Death patient in hospital from poisoning. Forensic report suggested that the substances detected could not be found in the hospital. Exercise of criminal prosecution against doctors for medical negligence. They were released from the criminal courts after a 9 year trial. The civil proceedings continued for 13 years. The ECtHR ruled that there was a violation of the procedural aspect of the right to life due to insufficient time-consuming procedures in criminal and civil courts. No violation of the substantive aspect of Article 2 of the ECHR.
The applicants, Münüre Yirdem, Derya Şahin Yirdem, and Gülay İlter Yirdem, are three Turkish nationals who were born in 1958, 1973, and 1979 respectively and live in Istanbul. The case concerned proceedings relating to the circumstances of the death in hospital of the applicants’ relative, Nayim Yirdem. The applicants are the deceased’s widow and his two daughters.
In August 2003, three days after being admitted to hospital, Nayim Yirdem died of a cardiac arrest despite doctors’ efforts to resuscitate him. An autopsy showed that his death had been caused by a heart attack and stroke resulting from corrosive poisoning with heptane and toluene, two components of organic solvents. According to a report written in August 2005 by the Forensic Medical Institute, these substances had not been present in the hospital. In April 2006 the public prosecutor charged the medical staff of the hospital’s neurology department with negligence in the performance of their duties.
In May 2010 the defendants were acquitted by the Criminal Court, which based its decision on the findings of an expert report by the National Health Council, according to which the defendants were not guilty of any professional misconduct and the substance in question had most likely been injected before the patient was admitted to hospital. That judgment was upheld by the Court of Cassation in March 2012.
Relying in particular on Article 2 (right to life), the applicants complained of the death of Naim Yirdem, alleging, among other things, that the domestic authorities had failed to establish the origin of the two hydrocarbons found in the deceased’s body.
THE DECISION OF THE COURT
(a) Substantive aspect – Except in cases of manifest arbitrariness or error, it was not the Court’s function to call into question the findings of fact made by the domestic authorities. It followed that the examination of the circumstances leading to the death of the applicants’ relative and the alleged responsibility of the health-care professionals involved were matters which must be addressed from the angle of the adequacy of the mechanisms in place for shedding light on the course of the events.
The applicants did not complain that their relative had been denied access to medical treatment in general or emergency treatment in particular, but complained that the medical treatment provided to him had been deficient because of the negligence of the doctors who had treated him.
No sufficient evidence had been adduced to demonstrate that there had existed, at the material time, any systemic or structural dysfunction affecting the hospitals which the authorities knew or ought to have known about and in respect of which they had failed to undertake the necessary preventive measures, and that such a deficiency had contributed decisively to the death of the applicants’ relative.
Nor had it been demonstrated that the alleged negligence by the health-care professionals had gone beyond a mere error or medical negligence or that those involved in the treatment of the applicants’ relative had failed, in breach of their professional obligations, to provide emergency medical treatment to him despite being fully aware that his life was at risk if that treatment was not given.
The medical treatment provided to the applicants’ relative had been subjected to scrutiny at domestic level and none of the judicial or disciplinary bodies which had examined the applicants’ allegations had ultimately found any fault with his medical treatment.
In view of the foregoing considerations, the Court took the view that the present case concerned allegations of medical negligence. In those circumstances the respondent State’s substantive positive obligations were limited to the setting-up of an adequate regulatory framework compelling hospitals, whether private or public, to adopt appropriate measures for the protection of patients’ lives. The relevant regulatory framework had not disclosed any shortcomings as regards the State’s obligation to protect the right to life of the applicants’ relative.
Conclusion: no violation (unanimously).
(b) Procedural aspect – The applicants had had recourse to two sets of proceedings, one criminal and the other civil, in order to assert their rights. The criminal proceedings had ended with the defendants being acquitted after proceedings lasting over nine years. The civil proceedings had been pending before the domestic courts since 2004.
In terms of the effectiveness of the criminal proceedings, there had been no such shortcomings as could call into question the overall adequacy of the investigation conducted by the domestic authorities. Moreover, the applicants had been granted access to the information yielded by the investigation to a degree sufficient for them to participate effectively in the proceedings.
However, the criminal proceedings had not been prompt and their overall duration – over nine years – had not been reasonable. Proceedings instituted in order to shed light on accusations of medical negligence should not last for so long before the domestic courts. The same was true of the proceedings for compensation brought by the applicants before the civil courts, which had been pending before the domestic courts for over thirteen years. There was nothing in the case file to suggest that such lengthy proceedings were justified by the circumstances of the case. The Civil Court of General Jurisdiction had taken over nine years to conclude that the claim for damages against the hospital should have been lodged with the administrative courts and that it did not have jurisdiction to decide the case.
Such a lengthy time prolonged the ordeal of uncertainty not only for the claimants but also for the medical professionals concerned.
Those factors were sufficient in themselves to conclude that the proceedings at domestic level had been deficient. The domestic authorities had failed to deal with the applicants’ claim arising out of their relative’s death with the level of diligence required by Article 2 of the Convention.
Conclusion: violation (unanimously).
No violation of Article 2 (right to life)
Violation of Article 2 (investigation)
Just satisfaction: EUR 10,000 for non-pecuniary damage and EUR 1,000 for costs and expenses to the applicants jointly(echrcaselaw.com editing).