A surgeon told a murder trial today that two wounds found in the deceased’s heart during autopsy, presumed to be caused by a stabbing, were actually caused by him and a colleague.
Dr Michael Tolan of St James’ Hospital in Dublin was giving evidence to the Central Criminal Court in the trial of a Ballyfermot man, accused of the 41-year-old’s murder.
Darren Rogers (aged 21) of Elmdale Park, Ballyfermot, Dublin, has pleaded not guilty to the murder of Thomas Farrell of Cherry Orchard Avenue, also in Ballyfermot, on November 27, 2003.
On the sixth day of the trial, Dr Tolan told a jury of seven men and five women, that he and his surgical team operated on Mr Farrell, a stab victim, on the night of November 26, 2003.
They found a wound to the man’s lung, which they sutured. They checked the heart, which was free of injury and sent the patient to intensive care.
When asked by defence counsel, Fergal Kavanagh SC, why the suturing of the lung was not noted in the post-mortem report, Dr Tolan replied: "I can’t explain why."
In her testimony yesterday, State Pathologist Dr Marie Cassidy noted that out of two wounds to the heart and one to the lung, only one of the punctures to the heart had been stitched.
The surgeon said that a few hours after this surgery the patient’s blood pressure dropped dramatically and the surgeons decided to re-open him.
They did this for three reasons, he said: to rule out the possibility of massive bleeding, to make sure they had not missed a wound in the pericardial sac around the heart and to carry out a cardiac massage.
He said they used a scissors to open the pericardial sac and blood gushed out from, he presumed, the right atrium.
He assumed that this was a result of the scissors cutting not only the sac, but also the right atrium.
There would usually be enough space between the sac and the atrium to make an incision without cutting the heart and to place a hand inside to carry out cardiac massage.
However, he said, the atrium was under such pressure from the amount of fluid the patient had received that it was pushed up against the pericardia, and the thickness of its own wall was much reduced.
Dr Tolan said they stitched up the heart, and his explanation for this not being recorded was that he and his colleague "must have omitted to do the operation note".
Mr Kavanagh SC put it to the surgeon that because the patient was lying on his side when he first saw him that he did not notice the victim had been stabbed in the back.
He suggested that they opened Mr Farrell, saw one wound to the pericardia, stitched it and closed him, missing the other one and the wound the lung.
He argued that the team only noticed these wounds in the second surgery. To back up his theory, he pointed out that the entrance wound to the back had not been stitched up.
Dr Tolan said: "If you had any wound to the pericardia, it’s incumbent on you to examine the whole heart.
"You wouldn’t suture one wound and leave another one beside it," As for the stab wound being stitched up, he said small wounds were often not stitched to prevent infection.
They healed themselves.
Earlier, an accident and emergency doctor from the hospital told the court he removed two litres of blood from Mr Farrell’s chest cavity, when he was brought in by ambulance.
Dr Abdul Jabaar said the patient was unconscious, his pupils were dilated and he was not responding to any stimuli, something he described as "a bad sign".
The doctor could hear air entering the left side of the patient’s chest, but not the right, and that is when he decided to insert a drainage tube.
As Mr Farrell had lost about one third of his blood through this drainage, Dr Jabaar and his team gave him three litres of saline fluid and three units of blood.
He did not respond to the fluid and his blood pressure was dropping, indicating internal bleeding.
Dr Jabaar ordered an x-ray, which confirmed his fears, and the cardio-thoracic team was notified for immediate surgery.
While on the six-minute journey to theatre, Mr Farrell’s pulse disappeared, and he received CPR on the trolley while it was moving.
CPR was continuing as Dr Tolan’s team began to open the patient’s chest, the court was told.
Dr Tolan was due to be the last prosecution witness in this case, but after his cross-examination today, Anthony Sammon,SC, for the state, applied for a transcript of his evidence to be made available to Dr Marie Cassidy, whom he wishes to recall.
Ms Justice Elizabeth Dunne has agreed to the first request and instructed for Dr Cassidy to be "on standby" this morning, in case she allows her to be recalled.