Psychiatric nurse sues over fatal incident at hospital

A  psychiatric nurse has sued the Southern Health Board over an incident which took place at Cork University Hospital on April 21st, 1994. The incident involved a disturbed patient in the psychiatric unit who collapsed and died, allegedly after being physically restrained by the nurse and other staff.

Mr Pat Healy claims that, being ignorant of proper restraint techniques, he had placed his body across the patient's trunk while the man, who was in his 30s, was lying face down. The patient was pronounced dead about an hour later. Mr Healy said he learned the patient died due to asphyxiation, having ingested his own vomit.

Mr Healy (39), Portaferry, Co Down, claims he never received training in appropriate restraint procedures and that the health board was negligent, had exposed him to injury and failed in its duty of care.

He claims he suffered and continues to suffer post-traumatic stress disorder, anxiety and depression as a result of the incident. He also claims he sustained minor physical injuries. As a result of the incident, he claims he was unable to return to work and has retired. He moved to Northern Ireland from Cork in the summer of 1995.

The health board admits the patient died but denies the claim that he collapsed under restraint, apparently vomited, suffered asphyxia or cardiac arrest. It also denies that Mr Healy suffered the physical or psychological injuries alleged and pleads that if he did, these were caused or contributed to by his own negligence in that he refused to avail of the board's offer of professional psychiatric care.

Opening the case before Mr Justice O'Donovan, Mr John O'Mahony SC, for Mr Healy, said there is a technique known as De-escalation, Control and Restraint (DCR) for dealing with violent patients but Mr Healy had never received any training in that from the health board or while training as a nurse.

The DCR technique involved trying to talk the patient down and, where that failed, using control and restraint techniques involving sufficient staff to control the patient. Where a patient was brought down, the technique involved not putting the person face down and keeping their airways open.

However, at the time of this incident, the patient was placed face down and, in total ignorance, Mr Healy had put his weight across the trunk of the patient. The patient had vomited, inhaled that vomit and died.

Counsel said the nurses involved knew nothing of the appropriate procedures and what was done was "brute force". Mr Healy was of considerable weight.

Mr O'Mahony said they were also contending the patient had not been given the appropriate level of medication which would have helped to tranquillise him. His side would be calling experts to say the procedure adopted was unacceptable and placed the patient at an unnecessary risk.

In evidence, Mr Healy said he had received no training in dealing with violent patients and only became aware of the DCR technique from experts in this case.

He said the patient had a significant record of violence towards himself, other patients and staff.

The patient was transferred to the Cork University Hospital psychiatric unit on April 13th, 1994. Before then, he had been in a secure unit and a special nurse was allocated to him.

Mr Healy said he and another male nurse came on duty about 7.17 p.m. on April 21st, 1994. There were also three female staff on duty. The patient had come to them and said he ingested antiseptic soap and wanted to be pumped out. He had run away from them but they managed to bring him back to the unit without using physical restraint. He ran away again and was found in the hospital church, where he had vomited on the altar.

They again persuaded the patient to come back to the unit but while they were talking to him in the "quiet room" and waiting for a doctor, the patient lunged at the other male nurse. Mr Healy put his arms around the patient and pulled him back and they both fell over. The patient managed to run out of the room but other staff helped get him back in and on to the floor.

The patient was lying face down and Mr Healy and the other male nurse were trying to keep him in that position. They asked for help. The patient was very strong and was trying to lift them off the ground. They were exhausted. The patient was given an injection of Largactyl, a tranquilliser, but it had no immediate effect. Mr Healy said he was lying diagonally across the patient's chest, back, bottom and lower limbs while the other nurse was holding the patient's shoulders and arms. About 8.25 p.m., security staff arrived and helped them hold the patient. A doctor also arrived.

Mr Healy said the other male nurse then said the patient was having a fit. A crash team was called and was there in minutes. Mr Healy said he took no further part in the situation. The patient was pronounced dead at 9.22 p.m.

The case was adjourned to today.