Health Ministry seeks inquiry into death of patient at psychiatric hospital

Report from the Israeli Newspaper Ha'Aretz - A truly disturbing set of circumstances

The Health Ministry's Northern District Psychiatrist, Dr. Eli Griner, has called for an independent investigation into the death last month of a 55-year-old former patient at the Mizra state psychiatric hospital in Acre. Her case was referred to the ministry's ombudsman, Prof. Shimon Glick.

The patient died on November 15 in Closed Ward No. 10. Griner's recommendation to Health Ministry Director General Avi Israeli was prompted by "substantial question marks" regarding the physical and mental treatment the patient received at the hospital, the product of a review of the case by his deputy, Dr. Nabil Jeraisi.

According to Mizra's internal review report, the patient was diagnosed with schizophrenia and slight retardation and lived at a Galilee hostel for mental patients. She was treated for years with psychiatric medications and for cardiac and thyroid conditions. On October 28 she was forcibly admitted to Mizra in a severely psychotic state that manifested as violent behavior toward those around her and psychomotor disquiet, which led to severe falls and bruising.

On November 6 she began having convulsions. She was sent to Western Galilee Hospital in Nahariya, where she spent eight days in an internal medicine ward. There she was found to have pneumonia, and the suggestion arose that her convulsions were an adverse reaction to a psychiatric drug she had received by injection. A substitute medication was recommended.

On November 15, after her return to Mizra, she was found to be suffering a speech disturbance, and was placed under observation. Her doctors decided that after she recovered from pneumonia she should receive electroshock therapy - a treatment that had previously brought about improvement in her mental state. In preparation for this treatment, she was referred for consultation with an internist and a neurologist.

On November 15, at 4:30 P.M., the patient was placed in a wheelchair in the ward and tied with a sheet to prevent her falling out. About five minutes later she was found in the chair, dead.

Mizra appointed an internal review, led by Dr. Mina Kushnir, which concluded that the hospital had acted correctly. But Jeraisi's team, while acknowledging that Mizra's staff had worked hard to treat the patient and addressed the medical recommendations of the Nahariya hospital, said that the cause of death "remains in our opinion unclear," and questioned part of the treatment.

In Griner's report to Israeli, the psychiatrist wrote that he cannot understand why the woman was not sent back to Nahariya immediately upon her return, since she displayed "dramatic changes for the worse in her condition" in a short period of time, to the point where she could not hold a pen in hand to sign her name.

Griner also asked why the woman was not examined the day she returned from the Nahariya hospital by Mizra's expert internists and neurologists. He noted that the doctors at Mizra began preparations for the course of ECT despite the patients's "poor physical condition."

Haaretz has learned that another patient died two years ago in that same closed ward at Mizra. In that case, the patient, a 32-year-old man from Peki'in, was admitted after his mental state deteriorated. Then too, an internal review headed by Dr. Kushnir ruled that "the treatment was without failings." The Health Ministry found that the patient had been "very heavily medicated" and that "without a doubt" some of the drugs he received increase the risk of cardiac arrest, but that there was no reason to suspect negligence. It was therefore decided that no external investigation was necessary.