Nurse as patient safety guarantor

Description of the facts

The ultimate Court ruling afraid a nurse, J.C., a associate of the sanitary transport squad who transported the patient in an ambulance to a specialised infirmary for neurological consultation. The man was in a state of impaired consciousness (disorientation of person, place and time), suffering from brain hematoma and hyponatremia. While driving, the patient, left unattended at the rear of the ambulance, got out of the vehicle, jumped on the road and died under the wheels of an incoming bus. The indictment accused a caregiver of manslaughter of a individual under her care, i.e. an offence against Art. 155 KK. Court of First Instance J.C. guilty and sentenced to 1 year imprisonment, conditionally suspending its execution for a period of 2 years.

The indictment besides included the admissions doctor, D.B.who has issued a sanitary transport order. The prosecutor accused him of exposing the patient to the immediate danger of serious injury (Article 160(2) of the KK). According to the indictment, a doctor, contrary to applicable regulations and medical knowledge, mistakenly qualified a patient with severe neurological and psychiatric disorders to be transported in a sitting position without predicting the possible consequences of his decision, thereby expanding the hazard to the patient's life and health. However, the territory Court acquitted the suspect of the alleged act.

As a consequence of the appeals made, the Court of First Instance held an acquittal to the physician. He besides acquitted the nurse, indicating that the event was highly different and unpredictable.

Cassation and position of the ultimate Court

This judgement was challenged by the Prosecutor in the part concerning the nurse. The prosecutor alleged a gross violation of substantive law – Article 2, Art. 9 § 2, Art. 155 KK and Art. 11(1) of the Law of 15.7.2011 on the profession of caregiver and midwife (Journal of Laws of 2024 item 814; hereinafter: PiełogPołożU), by misapplying them, by incorrectly verifying the grounds for nonsubjective attribution of the effect, which was expressed in the absence of designation of the scope of the duties charged as a caregiver and correlated with the precautionary rules.

The ultimate Court took the cassation into account and turned the case over for retrial. In his message of reasons, he stressed that criminal liability for the effect only justifies the conduct of the perpetrator, which importantly increases the hazard of that effect. In order to adopt the criminal nature of the contribution to the effect, it is essential to establish that the offender, regardless of another conditions for the nonsubjective attribution of the effect, importantly increased the hazard of its occurrence. According to SN, the appeal court mistakenly accepted that the behaviour of a patient who abruptly got up opened the ambulance door and jumped consecutive under an ambulance-driving car was so utmost that in practice the probability of predicting specified behaviour was negligible.

The cassation court, citing Article 11(1) of the kid Care Service, pointed to the normative pattern of a "good" caregiver for whom providing the patient with safety is simply a key rule in medical care and who performs his duties with care and caution to a degree higher than required in everyday life. For the Court of First Instance, it was crucial that the suspect caregiver read the medical records of the patient being transported before the start of medical transport, which indicated that he was a highly alcohol-dependent person, with a deficiency of cerebral cortex. On the day of the incident, he was confused about the place, time and his own person. During the interview conducted by the on-call doctor at the hospital, he was illogical: he forgot his name and where he lives. He had a brain hematoma with a brain contusion. In addition, he was diagnosed with hyponatremia, i.e. a low serum sodium level.

In this situation, the behaviour of the nurse, who, having cognition of the patient's condition (with the hazard of developing alcohol delirium syndrome and the occurrence of aggressive or auto-aggressive disorders), left him without direct supervision, sitting in the driver's compartment separated by a metallic wall, violated its rules of caution: care for the patient, due care and caution. The caregiver should supply the patient with continuous care, through continuous reflection and direct contact. She could then, without endangering herself, prevent the danger to the victim, if she did not physically halt him from taking off his seat belts, then by trying to calm down and alerting the driver to pull over and halt the ambulance.

SN further recalled that the resulting crimes committed by omission, specified as in this case, do not require examination of the causal link in an empirical sense. It is only the normative plane that matters: whether the perpetrator violated the work to act in a way that importantly and criminally increased the hazard of a prohibited effect. The survey of objectively attributing the effect excludes the examination of the causality of the omission – it is adequate to conclude that the behaviour of the perpetrator has made the unacceptable threat a reality.

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