SINGAPORE: After an Institute of Mental Health patient (IMH) splashed urine on his colleague, a nurse sprayed hand sanitiser in the vulnerable victim's face, before punching him during a ruckus in the day lounge.
Muhammad Ihsan Mahmud, 32, was given nine weeks' jail on Monday (Jan 18) for one count each of voluntarily causing hurt to a vulnerable victim and using criminal force against him. A third charge was considered in sentencing.
The court heard that the Malaysian national began working at IMH in April 2016 and was a staff nurse at the time of the incident on Dec 8, 2019.
Ihsan was on the morning shift with two colleagues that day - 60-year-old health attendant Sadasivam Kannan and 24-year-old staff nurse Iylia Muhammad Afiq Nor Effendi.
The IMH patients, including the victim - a long-term patient at IMH since 2005 who suffers from schizophrenia - were scheduled for haircuts that morning. At about 10.30am, the victim was moved to the day lounge after his haircut.
In the lounge, he was toying with another patient's urine receptacle before he splashed some urine on an attending nurse, who told Ihsan what happened before going to take a shower.
After hearing what had happened, Ihsan approached the 58-year-old victim and splashed hand sanitiser in his face while the latter was restrained to a wheelchair.
The victim raised his arms to shield his face and later wiped the liquid off with his shorts. After this, he picked rubbish off the floor while Ihsan tended to other patients.
A few minutes later, Ihsan walked past the victim and sprayed hand sanitiser in his face, catching him off-guard. The victim could not shield his face in time and rubbed his eyes while Ihsan walked away to continue his tasks.
A few minutes later, while securing the restraints for another patient, Ihsan tried to hit the victim with his elbow, but the latter dodged the hit.
He later sprayed the victim's face with hand sanitiser a third time for no apparent reason, intending to annoy him. After this, the victim began to create a disturbance in the day lounge.
Ihsan, Mr Kannan and Mr Iylia tried to convert the victim's one-point restraint into one with three points, but this agitated the victim.
Ihsan punched the victim twice in his eye region before continuing to secure his restraints. The victim remained aggressive and started kicking the nurses, but eventually was subdued after the three men held him down.
Ihsan kicked the victim while his colleague fixed the restraints around his forearms. His actions were caught on closed-circuit television footage, and Mr Iylia later discovered bruising around the victim's right eye.
He administered an ice pack on the victim, while Ihsan reported the injuries to IMH management, prompting IMH to lodge a police report.
The victim was taken to Singapore General Hospital with bruising over his face and a fractured toe.
Deputy Public Prosecutor Phoebe Tan asked for 10 weeks' jail, saying that Ihsan had breached the trust and duty of care owed to the victim, who was vulnerable because of his psychiatric condition.
Ihsan's actions also undermine public confidence in the administration of healthcare services in Singapore, she said.
While he had pleaded guilty, all his actions were captured on CCTV footage, she pointed out.
I DID NOT EXPECT THIS TO HAPPEN: ACCUSED
In mitigation, Ihsan said he worked as a nurse to earn a living to support his family in Malaysia and did not expect this to happen.
"I do not want to create any trouble while working here," he said through an interpreter, adding that he has three children, one of whom is a special needs child.
"My wife has been suffering from depression after the birth of my daughter and her condition is getting worse," he said. "From Jan 8, 2020, I have been unemployed and I'm thankful for my friend who has been helping me in my needs and also giving me shelter."
He apologised and asked for leniency, saying that his family was on its own as his father-in-law was warded for heart complications and his father was unwell in Penang.
The judge said nothing in his family circumstances justifies a lower sentence, agreeing that the public disquiet caused was an aggravating factor. However, he gave some weight to the fact that Ihsan reported the victim's injuries.
For voluntarily causing hurt, Ihsan could have been jailed for up to two years, fined up to S$5,000, or both. For using criminal force, he could have been jailed for up to three months, fined up to S$1,500, or both.
As the victim was vulnerable and incapable of protecting himself from abuse due to his mental infirmity, the maximum sentences for both offences could have been increased for up to one-and-a-half times.
PATIENT SAFETY IS TOP PRIORITY: IMH
IMH said in a statement on Monday evening that it has safety measures and procedures in place to ensure patients recover in a safe environment. Any injury that is unexplained is also “thoroughly investigated”.
Wards are equipped with CCTV cameras and staff members work in teams. These staff members are trained to observe and monitor the patients under their care for any change in behaviour and to look out for any injuries as sometimes patients may fall or injure themselves, said IMH.
Following the incident, IMH said it further reinforced to staff members its culture of accountability and reporting issues so that steps can be taken to address them early.
More frequent reviews were also held to discuss difficult cases in the ward. Additionally, nursing management staff members join the ward nurses and patients in their weekly community meetings to understand issues and listen to feedback from patients directly.
IMH said it apologised to the affected patient and his family after the incident and “provided support”. The patient has also recovered from his bruises and is still being cared for in IMH for his mental health condition.
Two other staff members were also investigated in relation to this incident, said IMH. The outcome of these investigations is still pending. These staff members are also no longer employed by IMH.
“IMH would like to reiterate that patient safety and well-being are a top priority at the hospital. We will not tolerate any acts of inappropriate behaviour against patients. Perpetrators will be swiftly dealt with and reported to the police,” said the institute.