Psychiatrist 'could smell own guts' after stabbing

A consultant psychiatrist has told a jury that after a patient stabbed him in the abdomen with a four inch knife he could smell gut contents and saw that the blade was "smeared right up to the hilt".

Gavin Francis (aged 26) who had been diagnosed with schizophrenia was attending Doctor Michael McDonagh as an outpatient at St Patrick's Hospital.

The consultation had just ended when Mr Francis shook hands with Dr McDonagh and handed him a box of chocolates before stabbing him in the stomach.

Dr McDonagh had to undergo three hours of emergency surgery after it was discovered that the knife had entered through the front of his stomach, left through the back of it and pierced the head of his pancreas. He required 13 units of blood and spent some time in intensive care before he was released from hospital.

Doctor Patrick Plunkett said in a statement read to the jury at Dublin Circuit Criminal Court by prosecuting counsel, Mr Shane Costelloe BL, that in his opinion, prior to emergency surgery, Dr McDonagh's wounds indicated a substantial risk of death.

Mr Francis, of Earls Cliff, Ceannchor Road, Howth and who is currently a patient at the Central Mental Hospital has pleaded not guilty to intentionally or recklessly causing Dr McDonagh serious harm at St Patrick's Hospital, St Stephen's Lane, on September 19, 2006.

Mr Costelloe said there was a possibility that a special verdict would arise in which the jury would have to consider whether Mr Francis was "not guilty by reason of insanity".

He said that he anticipated that most if not all of the facts in the case would be agreed between the State and the defence teams and the jury would be left to determine only one issue: if Mr Francis was suffering from a mental disorder when he stabbed Dr McDonagh.

Defence counsel, Mr Luan O Braonain SC (with Mr Philipp Rahn BL), told the jury that he wanted to make a number of admissions on behalf of his client.

He said that his client was correctly identified as the man who stabbed Dr McDonagh, leaving him with a wound that resulted in surgery and that the attack "gave rise to a substantial risk of death".

Dr McDonagh told Mr Costelloe that he and Mr Francis had been discussing the hallucinating voices the accused had been experiencing over the previous number of weeks.

He said he altered the dosage of the medication he had been prescribing and ended the session earlier than he normally would have after he noticed that Mr Francis seemed quite distressed.

He said when Mr Francis took the box of chocolates from his rucksack he said something along the lines of "that's for two years" in reference to the amount of time he had been treating him.

He then felt a thrust to his abdomen and when he grabbed hold of Mr Francis's wrists he noticed that he was carrying a knife.

Dr McDonagh said he managed to get the knife off the accused but added that there had been no struggle. He didn't know if the knife had been dropped or if he had taken it out of Mr Francis's hands.

He said Mr Francis then became passive and offered his assistance, asking him if he wanted to use his mobile phone to call the emergency services and offering to drop to the ground.

Dr McDonagh said he escorted Mr Francis to the waiting room where the accused lay on the ground. He then sat down and waited for the emergency crew to arrive but he was too uncomfortable so he got down on to the floor.

He said that he believed that he had a good relationship with both Mr Francis and his family and he was surprised by the attack.

Dr McDonagh agreed with Mr O Braonain that there had been "communication" in the intervening period between Mr Francis and his family in relation to how both he and the accused have progressed.

He accepted that Mr Francis had been admitted to hospital three times, twice on account of self-harm episodes and he took over his care in 2004.

Dr Ross Dunne agreed with Mr O Braonain that when he arrived on the scene to assist Dr McDonagh there was a person laying face down on the floor of the waiting room.

He accepted that the man had his hands above his head which was face down and nurses had to advise him to move his head to allow him to breathe properly.

Dr Dunne further agreed that "at no stage" did this person show any sign of resistance.

The trial continues before Judge Desmond Hogan and a jury of seven women and five men.