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Nurse acquitted of ambulance call death

TT/The Local/rm · 30 Nov 2011, 13:31

Published: 30 Nov 2011 13:31 GMT+01:00

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"This is completely wrong, it is beyond all criticism. We will appeal this verdict," the young man's mother Eva Vassilakis told daily Aftonbladet.

Although the court felt there was no doubt that the nurse should have sent an ambulance, they didn't think that it has been proven beyonf reasonable doubt that the man wouldn't have died even if an ambulance had been dispatched - this being a prerequisite to convict the nurse who faced charges of manslaughter.

The case dates back to the early hours of January 30th 2011 when the Stockholm man called SOS Alarm, a company operating emergency response services in several counties in Sweden, on several occasions, asking for an ambulance.

23-year-old Emil Linnell had been experiencing difficulty breathing and had lost consciousness several times while he spoke with the nurse on the phone.

The 52-year-old nurse, who no longer works for SOS Alarm, faced charges of aggravated manslaughter. According to Aftonbladet, he had previously been criticized for not listening enough to callers.

Throughout the trial, however, the nurse reamined adamant he was "completely innocent".

The nurse's lawyer, Björn Hurtig, said during the trial that he doesn't think that a crime has been committed.

"Of course we all realize that mistakes have been made. But I believe that you must be able to make mistakes, even if you are working at SOS Alarm," he said.

The 23-year-old man was suffering from a ruptured spleen, a condition that requires emergency care, the prosecutor concluded.

A ruptured spleen causes breathing problems and affects circulation to the extent that it can cause a loss of consciousness, as well as pain and extreme anxiety.

The case generated a great deal of interest in Sweden and prompted scrutiny of the service provided by SOS Alarm.

The National Board of Health and Welfare (Socialstyrelsen) published a report earlier in the month sternly criticising the firm for severe flaws in their judgements of ambulance call-outs.

Story continues below…

The agency has investigated around 50 cases across the country in the course of its investigations and has demanded that SOS Alarm reply by January 15th with a plan of action to address the deficiencies.

According to Aftonbladet, Emil Linnell's family have no plans of giving up the fight any time soon.

"They don't know which family they are messing with. We will not give in," Eva Vassilakis told the paper.

TT/The Local/rm (news@thelocal.se)

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Your comments about this article

14:21 November 30, 2011 by Liquidmonkey
a mistake is when u put a rip in a sweater.

THIS is denying a citizen their right to an ambulance.......... period.

the nurse made a very very very stupid decision here and should be held accountable.

if someone asks for an ambulance it should be sent, RIGHT AWAY.

if its a prank call then it can be dealt with accordingly.

better safe than sorry.

stupid emil.
14:30 November 30, 2011 by JulieLou40
I totally agree. Christ, they're soft in Sweden!!
14:42 November 30, 2011 by cogito
"... he had previously been criticized for not listening enough to callers."

No accountability. As usual.
14:50 November 30, 2011 by krrodman
The difficult question here is simply this: Where does malpractice end and criminal neglect begin?

Dr. Murray criminally administered propofol to Michael Jackson in exchange for obscene amounts of money. There was no recognized medical purpose for the medication and it was administered in a way that was outside of the standard of practice. Pretty much everyone agrees that his actions went well beyond "poor judgement" and amounted to criminal negligence.

Our hapless nurse in this case exercised extremely poor judgement, but is there any evidence of criminal neglect or intent to harm? In my opinion this case is malpractice(civil) and not criminal.


The Swedish emergency system is not designed to send an ambulance in response to every call. A nurse triages the calls and makes a determination as to medical necessity. Perhaps this is another example of socialized medicine rationing care in order to save money. In the USA we send an ambulance without question for everything from gunshot wounds to hemorrhoids. And, for better or worse, health care in the USA is the most expensive in the world.

One final thought. Does anyone know why Emil's spleen ruptured? It is very unusual for a spleen to spontaneously rupture. It can happen in cases where the spleen is massively enlarged but is very rare. More often the spleen ruptures after a traumatic injury. Does anyone know what Emil reported to the nurse? Did he injure himself or was this one of those rare events?
15:45 November 30, 2011 by Puffin
this seems to me to be a prosecutor error - the prosecution could have put a wider range of charges before the court - manslaughter was always going to be tough to prove

however negligence and occupational neglience (tjänstefel) would have given the court a chance to convict
15:46 November 30, 2011 by Åskar

If I remember correctly the emergency service gets so many false calls that they need to have a nurse filtering them. This case reminds me of the boy who cried wolf.

As for his spleen it ruptured because of a major infection and it resulted in respiration problems which is why Emil called.
16:58 November 30, 2011 by Abe L
This is the line of work in which you are NOT allowed to make mistakes. As one of the very likely outcomes is the death of a person.

As it's also a repeated case which now resulted in death, I can not other then hope this person gets life in jail without the opportunity for parole.

Most importantly as a warning to other people who held other people's lives in their hands during their day jobs. Mistakes are not an option.
17:37 November 30, 2011 by Mark S.
I recognize that the US and Sweden have different standards, but here is the part I do not understand:

"had lost consciousness several times while he spoke with the nurse on the phone. "

Is losing conciousness while calling for help not considered a medical emergency in Sweden?
21:30 November 30, 2011 by krrodman
@abe L

As a practicing physician for 30 years, I am intrigued by your claim that medical professionals are "NOT" allowed to make a mistake. If life were only so simple. The first thing we need to do is to define what a mistake is. Sounds simple, but it not so simple. We can all agree that it is an horrific mistake to cut off the wrong leg. That one is easy. What about this? Is it a "mistake" by your standards to operate on a patient with abdominal pain secondary to presumed appendicitis only to find out that the appendix was normal and the patient had pain secondary to a viral condition called mesenteric adenitis? What if I were to tell you that there is no test that can distinguish with 100% certainty between appendicitis and mesenteric adenitis? A surgeon understands that because of diagnostic uncertainty there must be "unnecessary" surgery. Is that the kind of "mistake" that you are talking about? And to take it one step further, while it is extremely rare, healthy patients die under anesthesia. So we know, statistically speaking, that at some point in time a patient will die during "unnecessary" surgery. What do you propose to do to the health care professionals involved? Put them in jail for life because "mistakes are not an option"?
21:39 November 30, 2011 by RobinHood
Fortunately, for many of the posters above, being an idiot is not a crime in Sweden. Oh to be one of them, not a mistake made between them. Perfection personified!

The criminal courts are for prosecuting criminals, not persecuting negligent nurses.

Some people here want to see the entire Swedish medical profession banged up. Every doctor and nurse ever have messed something up.
22:06 November 30, 2011 by Svensksmith
Krrodman, thanks for bringing the voice of reason and experience to these medical discussions. I would be curious to know what your opinion(s) are on:

1. Socialized medicine


2. What can be done to "fix" the high costs of medical care in the US?
00:37 December 1, 2011 by swenrika

Two wrongs do NOT make a right...

A life was lost and an incompetent nurse is blame free. Oopsie.

A court agrees that it was not that bad, go do it again i guess. Oppsie.

Not good signals being sent.
01:12 December 1, 2011 by Imperor
Privatized, gone to s h i t and no-one is responsible whatever happens. Sounds exactly like the entire health service. Way to go M!
01:39 December 1, 2011 by Keith #5083
"........ this being a prerequisite to convict the nurse who faced charges of manslaughter."..

As I understood this case as reported much earlier in the year, the deceased young man had received, on numerous occasions, medical intervention that had been inconclusive as to the cause of his problem.

Ergo, the pre-requisite condition to convict already had existed for some time. The failure of one or more or many doctors to agree a diagnosis does not release any person from the obligation to render emergency assistance.

The man may well have died even if an ambulance had been dispatched, in which case one would reasonably presume that those doctors/specialists who had seen this young man over a period of time will now themselves be charged with involuntary manslaughter!

There really is no point in consulting a qualified professional who cannot make a diagnosis until after your dead! Nor is there any point in employing emergency response personnel who cannot render assistance because you are still alive, but may be dead before you get to hospital!

This family would be well advised to set up a webpage and invite donations towards legal costs from the public. Then, since people will vote with their money, lawmakers may properly address this issue.
07:49 December 1, 2011 by Mark737408
This sort of stuff is why i fckn hate living in this fckned up country they people are just un fckn believable.
12:16 December 1, 2011 by krrodman

You asked me about socialized medicine, and the high cost of health care in the USA. Here I go: There are 2 core problems in dealing with the health care crisis. First, health care is a unique problem, especially for capitalists. In modern capitalist countries we accept that a rich person may be able to drive a Rolls Royce, while a poor person may have to drive an old clunker. While the cars may be quite different, in the end both drivers will be able to get to their destination. How do we apply these capitalist principles to health care when the cost of treating an illness like appendicitis is the same for both rich and poor? The second problem, and this applies to every country in the world, is that there is not enough money to give every citizen unlimited, timely, high quality health care. Every country rations health care in one way or another. Sweden is a perfect example. I assume you are familiar with 0-7-90-90. The goal of the Swedish healthcare system is to provide specialist care within 187 days of the identification of a problem. That would be 187 days to get a bad gallbadder removed. That would be 187 days to get a knee arthroscopy for a torn meniscus. Are you kidding me? In my opinion it is outrageous to ask a patient to wait that long for care. That said, slowing down care is the most common form of rationing. Or put differently, how many more doctors, nurses and hospital beds would be needed in Sweden if the goal were to get surgery done with 30 days instead of 187 days? And how much would that cost the system?

The USA rations differently. We have extraordinary care for the well insured. It is unlimited and timely, but very very expensive. If I were to go to the hospital today with an acute gallbadder attack, my gallbladder would be removed within 48 hours, not 187 days. Knee pain??? MRI within 1 week. Surgery within 2 weeks. Perfect, right??? Well, perfect for me because I am well insured. I get far superior care to the average Swede. BUT, not so perfect for the 30 million people without insurance and millions more with lower quality insurance. So, we spend a fortune on health care to give many people great care, but fail miserably on millions of other people. Obamacare tries to address these issues, but the unintended negative consequences are real. The plan is to insure an additional 30 million people while spending less overall on health care. And, the promise is not to reduce care to those that currently have the best care in the world. You and I both know the task is impossible. Inevitably, care will have to be rationed significantly in order to provide universal insurance.
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