The psychiatrist on trial for the death of an acute patient in Córdoba, facing an eight-year prison sentence, Carmen Prada, argued this Thursday in the oral hearing that the patient did not intend to commit suicide, as the victim’s family has repeatedly claimed. “The patient had a risk of not controlling his behavior, but he had no suicidal intentions,” argued the head of mental health at Reina Sofía Hospital, for whom the prosecution is requesting four years in prison. The private prosecution raises the sentence to eight years for two involuntary manslaughters, as it considers her responsible for the death of the patient and another man whom the patient killed years earlier. The thesis defended by the doctor is that the patient did not commit suicide but that his death was due to heart disease complicated by pulmonary edema and the intake of antidepressant drugs.
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The patient Francisco Miguel León Benítez died in 2020. The trial seeks to determine whether the head of mental health should have declared the forced hospitalization in a psychiatric center of the acute patient, which his family had been requesting since 2010 due to his constant episodes and violent outbursts, which would have prevented his death at 39 years old, and that of another man whom the patient killed in self-defense five years earlier, a crime for which he was acquitted. In parallel, Judge Carmen Gema González, head of the Córdoba Criminal Court 4, must decide whether the doctor committed a crime of denial of healthcare assistance by not forcing the patient’s hospitalization, who suffered repeated psychotic outbreaks over a decade.
“There is no preventive confinement,” the doctor defended at the end of her statement, which lasted an hour and a half and in which she appeared noticeably nervous and with a deep voice. Before her interrogation, the victim’s father, Francisco León, had warned of the constant complaints and claims he filed since 2010 before the emergency courts, the prosecution, the Andalusian government, the police station, and the hospital. “I warned countless times about what was going to happen. I reported it and no one did anything. They took him to the Emergency Room, gave him sedatives, then to Mental Health and then back to the street. He did not take the treatments and tried to take his own life several times,” he censured with a broken voice. Since 2006, his son attended more than fifty medical consultations, was treated by two psychologists and five different psychiatrists, and suffered eight episodes of acute crises with respective hospitalizations.
The head of mental health treated the patient on several occasions and this Thursday declared before the judge that he suffered episodes of high behavioral dysfunction and a mixed personality disorder, but that his episodes were caused by the consumption of psychoactive substances, which enhanced his symptoms and made him lose control in critical episodes. “This person suffered from a mixed personality disorder with substance abuse, it was not a severe mental disorder. I do not agree with the affective schizoid disorder,” the doctor stated about the diagnosis made by a private psychiatrist. The victim’s parents and siblings testified in the oral hearing that when they showed the alternative diagnosis of another psychiatrist to the head of mental health, she ignored her expert colleague’s opinion and even refused to read it.
The patient suffered eight hospitalizations after the outbreaks, but his usual routine for a decade was to be attended by community mental health services without being admitted. After killing the other man, he spent three years in pretrial detention before his acquittal. “My son came out of jail much worse than when he went in because he suffered abuse,” lamented the father.
The doctor rejects the hypothesis that the man had ended his life voluntarily. “I rule out the possibility of suicide. The family expressed to me that the situation was unmanageable and coexistence impossible (…) But the patient’s evolutionary follow-up did not depend on me, but on the community team,” she argued before the magistrate.
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“Substance use caused him to lose control. If he did not consume, the symptoms of the personality disorder and outbursts of anger did not increase. He had the disorder whether he consumed or not, but this triggered it,” the doctor, the patient’s reference psychiatrist, specified. “He was always advised that it was necessary to attend the addictive behaviors team and the drug dependency service. He was very impulsive and there were confrontations, but at no time was he identified as a severely mentally ill patient with serious disorders,” the doctor added.
On the contrary, his relatives highlighted that the patient had “several suicide attempts and stomach washings” in hospital emergency services. “My son has suffered abandonment by the institutions and that is why he died. We asked for help but the doctor told us nothing nor referred him. She said that the report [from the private psychiatrist] did not interest her, that she did not want to know anything about the report,” criticized the patient’s mother. His brother concluded: “We were helpless.”
The prosecution has reiterated that the victim did not receive home care to monitor the illness and thus attend to the family’s requests, desperate because of his violent behavior, as he even assaulted his father in 2014. The doctor defended that the patient’s pathology did not require home care until he died in 2020, but from 2021 when a protocol was developed. On the contrary, the family’s defense has stated that the general health law is very clear in this regard and establishes better care for mental health patients than that received in this case.
While the victim’s family, along with the Córdoba prosecution, accuses the psychiatrist, the Medical Association of Córdoba, the Andalusian Health Service (SAS), and two insurers, who would face economic compensation if the doctor is found guilty, are involved in the defense. The trial will have two more sessions next week before being ready for sentencing. Experts proposed by the parties will testify, and there will be a deeper examination of whether the law supported the actions of the head of mental health, in an unprecedented case in Spanish justice since no psychiatrist has faced a prison request for alleged healthcare neglect of an acute patient, according to psychiatric scientific societies.
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