Colleague admits she should have reported Mulholland

A nurse has admitted at Dublin Circuit Criminal Court that she should have immediately reported her colleague to her superiors after she saw her use excessive force to inject an unprescribed drug to a patient.

Ms Sharon Baxter agreed with defence counsel, Mr Giollaiosa O' Lideadha SC, in cross-examination, that it was her duty to have reported her concerns. She said she had not yet been disciplined by An Bord Altranais, but she expected to hear from it after the trial.

Ms Baxter also agreed with Mr O' Lideadha that her colleague who is on trial for assaulting elderly patients should not have been working unsupervised due to lack of training and alleged "problems".

She said that if the accused had previously been dismissed from another hospital due to inexperience and lack of knowledge she shouldn’t have been working as a night duty nurse.

Ms Noreen Mulholland (aged 35), now living in Park Road, Portadown, County Armagh and previously of Runabeg Close, Kildare, has pleaded not guilty to four charges in relation to two elderly patients at Naas General Hospital in 2003.

Ms Mulholland denies assault causing harm to Mr John Gethings (aged 77), Baltinglass, County Wicklow and to intentionally or recklessly administering a substance to him knowing it was capable of interfering substantially with his bodily functions and that she did so without his consent on March 1, 2003.

Ms Mulholland also denied assaulting Mr Seamus Doherty (aged 80) causing him harm and intentionally or recklessly administering a substance to him knowing it was capable of interfering substantially with his bodily functions and that she did so without his consent between June 18 and 19, 2003.

Ms Orla Crowe BL, prosecuting, has told the jury that Mr Gethings died on March 2, 2003 but emphasised that it was not the State’s case that Ms Mulholland was responsible for his death.

Ms Baxter didn’t accept a suggestion from Mr O' Lideadha that she accompanied Ms Mulholland to the treatment room and filled out Mr Gethings’ prescription chart while the accused drew Serenase into a syringe to give the patient.

She told Mr O'Lideadha she didn’t know that Ms Mulholland hadn’t completed her year long contract with Blackrock Hospital because she was dismissed after a senior found her lacking in experience.

Ms Baxter replied that she wasn’t aware that Blackrock Hospital superiors said they wouldn’t have been happy to allow Ms Mulholland to work night duty, that they were concerned about her attending patients without supervision, that she didn’t have a significant knowledge of pain relief drugs and that she had poor attention to detail.

"She shouldn’t have been on duty if she had all those problems. She should have been on a mentor programme or a training programme," Ms Baxter replied.

Ms Baxter couldn’t answer a further suggestion from Mr O' Lideadha that if she had known about these criticisms on March 1st, 2003, her "take" on what happened that night would have been different. "I can’t answer that question. All I can say is if those criticisms are true she should not have been working at all."

Ms Baxter accepted that her first statements given to the hospital and her first garda statement didn’t include the allegation that the initials "IM", used to indicate an intra muscular injection, didn’t appear on Mr Gethings’ prescription chart, and agreed she first mentioned it when gardai showed her the patient’s chart and she noticed that "IM" was written in a different ink to the rest of the prescription.

She also agreed she told gardaí that Ms Mulholland had said she would have to give Mr Gethings something to keep him quiet and that this was probably true rather than what she had said to the jury which was that the accused said she would have to give the elderly man "something to shut him up".

Ms Baxter rejected defence counsel’s suggestion that she was mistaken when she said Ms Mulholland had used a white needle to inject Mr Gethings and that she didn’t have the ideal viewing position to see the needle used if she had been attending to the patient.

Dr Joan Power, a clinical physician, told Ms Crowe that on February 23, 2003, she prescribed Serenase in tablet form for Mr Gethings.

Dr Power described it as an anti-psychotic drug that when prescribed in very small doses can help agitated elderly patients settle during the night and allow them to sleep. She said she wrote on Mr Gethings’ chart that the drug was to be taken once at night if he was having a sleepless night.

She said she didn’t, to her knowledge, indicate on the chart that the drug could be given as an intra muscular injection because the dose was very low and too low a dose to be given as an injection.

She later saw from Mr Gethings’ chart that he had bad night on February 28 and had been given Serenase in tablet form at 10 p.m. She also noted he was given a second dose via an intra muscular injection but there was no note on his chart that a doctor had reviewed his prescription to allow this second dose.

Dr Power explained that if a doctor had made an addition to the prescription chart he or she should have initialled and dated the change clearly. If a major change was made the prescription should have been completely rewritten.

Dr Power agreed with Mr O' Lideadha that "IM", denoting an intra muscular injection, was written on Mr Gethings’ chart in a different coloured ink beside the prescription she had made out for it in tablet form.

She accepted it was possible that a doctor could have, as an afterthought, taken a different pen out of his pocket after writing a prescription and made an addition to it without having initialled it.

"This can happen", said Dr Power, "but it should not happen. Any changes should be clearly dated and initialled."

The trial continues before Judge Frank O’Donnell and a jury of six women and six men.