the last days of Francesco Mastrogiovanni

a film by Costanza Quatriglio tells a terrible story, but not isolated

"87 hours" is a film by Costanza Quatriglio about the death of Francesco Mastrogiovanni, whose tragic fate resonated only slightly in the Italian press, although this kind of case is more common than one might believe. It is possible to be forcefully committed to a psychiatric hospital, detained and restrained there for days for days without family members being allowed to visit or obtain information; all this is allowed if restraint is compatible with the overall state of health and it can happen that the medical and paramedical staff ignore the patients' complaints and requests for help. This happens, and often happens in Italian SPDC (Psychiatric Service Diagnosis and Care) units . In some cases this situation leads to the death of the patient as in Mastrogiovanni's case and not only his.

Francesco Mastrogiovanni was admitted to an SPDC on the 31st of July 2009 following an Obligatory Health Treatment Order, the third after those of 2002 and 2005. This Order complies with law 180/78 which is applied when people suffering from mental illness require urgent medical treatment, refuse treatment and cannot avail themselves of care outside of hospital; it needs to be requested by the Mayor of the patient's place of residence, following a proposal by two doctors, not necessarily psychiatrists, one of whom a member of the town's Health Office and must also be approved by the area's tutelary judge. Hospitalisation lasts 7 days, may be extended and is enforced by medical personnel and members of the police.

The Italian law forbids that a person be held against his /her will in a health-care facility, except in this case. Forceful hospitalisation is generally recurred to when people are considered a danger to themselves and others, in cases of threatened suicide, damage to things and persons or refusal to communicate. In the face of a prior diagnosis of psychosis, failure to intervene may be considered "criminal desertion", so, the application of enforced hospitalisation is justified also on the very thin ridge of what may be considered psychotic behaviour.

In Mastrogiovanni's case the motives behind his forceful hospitalisation were flimsy indeed. They consisted in a fine for speeding and previous treatment which stigmatised him already as a psychotic patient. Mastrogiovanni was a militant anarchist who had known prison due to a stabbing incident involving the secretary of the Salerno branch of the right-wing FUAN movement in 1972, and in 1999 for grave resistance following a parking fine (he claimed, and the court proved him right, having been taken to the barracks and beaten); when he realised he was being sought by the police he tried to escape by taking refuge on a crowded beach. Here, he was pursued even by the Coast Guard: surrounded, he opted for hospitalisation without opposing resistance. The film by Quatriglio uses original CC camera footage from the ward, combined with the voices of witnesses. The film shows how, initially, Mastrogiovanni was free to move, to eat his meals and how restraint was triggered by his refusal to have urine tests. The nurses waited for the patient to fall sleep to tie his hands and feet to the bed. They were not untied for four days, not even to allow him go to the bathroom, while he was subjected to force feeding. The trial following his death saw doctors receive sentences from 13 months to two years and the eleven nurses of the ward sentenced to 14 or 15 months for kidnapping, fraudulent misrepresentation and death resulting from another crime.

The story of Giuseppe Casu, is that of a street vendor from Quartu Sant'Elena (Sardinia), harassed by the continuous fines for illegal trading. On the 15th of June 2006 an order of forceful hospitalisation was issued against him as a result of his reacting against the police because of an umpteenth fine amounting to 5,000 Euro for the unlicensed sale of fruit and vegetables on the street. Casu was considered psychotic due to a previous diagnosis of an unspecified form of personality disorder. In addition, the doctors felt that, as his breath smelt of alcohol and because he was agitated, that the diagnosis was "manic bipolar disorder" ; among the other sedatives he was given was a drug used for alcohol withdrawal symptoms. He was kept with his hands and feet tied to the bed for seven days. On the 22nd of June, Casu was declared dead due to pulmonary artery thromboembolism, probably caused by prolonged physical and chemical constriction. However, when the court ordered an autopsy, it was discovered that the remains of Casu had disappeared and had been replaced by those of another patient, making the investigation impossible. For these facts, the chief consultant of the Anatomopathology department was first condemned, then acquitted by the Supreme Court, while the head of the Psychiatry department was acquitted during all the three trials, and was able to move a lawsuit for defamation against the members of a committee for the defence of the rights of psychiatric patients, who have been sentenced to pay compensation. They were the only culprit in this whole affair.
Justice was done.

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