Suicidal man had less than five minutes' medical attention on day of fatal attempt on his own life

Cork father of two, aged 29, was heard calling for his mother in the hours before his death

Andrew Gearns' brother Evan and mother Aideen with family members attending the inquest at Cork Courthouse today. Picture: Larry Cummins

A man who was suffering distressing delusions and had approximately six risk factors for suicide was seen by medical staff for less than five minutes on the day of his fatal attempt on his own life in Cork Prison, an inquest has heard.   

Andrew Gearns, aged 29, a former engineer and a father of two from Model Farm Rd in Cork, was heard calling for his mother in the hours before his death.  

Mr Gearns had developed a drug addiction after being prescribed benzodiazepines to cope with pain following a car crash in 2016. He entered Cork Prison “at a low ebb” on September 22, 2020, and was found unresponsive in his cell on September 28, 2020, after an attempt on his own life.

Since September 27, 2020, he had suffered delusions of being “stabbed and slashed” and thought some 50 people were outside his cell trying to attack him.  

Following a phone call from Mr Gearns’ mother, who was extremely concerned about his mental state, on September 28, 2020, Mr Gearns was checked on some 13 times by prison staff between approximately 12.30pm and the time his lifeless body was found in his cell after 4pm.  

Andrew Gearns, aged 29, a former engineer and a father of two from Model Farm Rd in Cork.

However, Elizabeth O’Connell, senior counsel for the family, said that one of these checks amounted to just a one-second look through a window in his cell door and another two similar checks lasted just two seconds each.  

Cork City Coroner Philip Comyn at Cork Courthouse for the inquest into the death of Andrew Gearns. Picture: Larry Cummins

CCTV analysis showed that 12 of these 13 checks were by prison officers who were not aware of his reported previous suicide attempt or his recent diagnosis of psychosis since entering the prison.  

Although a doctor came to his door once on the day of his death, when Mr Gearns said he did not want to see him, he left without seeing the patient. The doctor was present outside the cell with a nurse for 34 seconds, according to CCTV analysis.  

However, nurse Caroline Murphy said that they had no choice but to leave, when Mr Gearns, who was lying on the bed, refused to engage with the doctor.   

Ms O’Connell said that previous concerns had been raised about adequate sharing and recording of medical information by the prison at an inquest into the death of a man who died just hours after being committed to prison. 

At that inquest in 2019, questions were raised about why medical information was not being passed adequately on to prison guards and one year later, Mr Gearns also tragically died, with similar questions again being asked about whether all the appropriate information was shared between medical staff and prison officers and gardaí, Ms O'Connell said. 

That inquest had recommended that the nurse's committal interview, conducted when a person enters prison to assess their health, would be kept under review. She said that it was “disappointing” that one year later important information such as someone’s psychiatric history was still not asked for at a committal interview.

Nurse consultant Enda Kelly agreed that Mr Gearns’ smoking heroin and taking the medications Anxicalm and Halcion before coming into prison may have affected his clinical presentation when giving his committal interview to a nurse on September 22, 2020.   

Nurse consultant Enda Kelly said Mr Gearns’ smoking heroin and taking the medications Anxicalm and Halcion before coming into prison may have affected his clinical presentation when giving his committal interview to a nurse on September 22, 2020. Picture: Larry Cummins

Mr Gearns was a new committal to Cork Prison in September 2020 at the height of the Covid pandemic and was displaying some Covid symptoms so he was placed in quarantine, which meant that he was left alone in a two-person cell for six to seven days. 

State Pathologist Dr Margot Bolster gave the cause of death as hypoxic ischemic encephalopathy due to cardiac arrest.

She said that he would have lost consciousness very quickly so would not have suffered for long.   But he would have suffered catastrophic brain damage in the process. 

The inquest, in front of Coroner Philip Comyn and a jury of four men and two women, continues.