A MAN who threw himself into the river Liffey was seen at Dublin’s Beaumont Hospital twice in the weeks prior to his suicide attempt and on each occasion was sent home, a Medical Council fitness to practise inquiry heard yesterday.
Prof Patricia Casey, a consultant psychiatrist at Dublin’s Mater hospital, told the inquiry of these presentations by the Eritrean asylum seeker at Beaumont as it continued an investigation into seven allegations of professional misconduct against a GP trainee who admitted the man to the Mater’s psychiatric unit on April 13th, 2008.
The man had been taken to the hospital’s emergency department the night before, after he was pulled from the river. Within hours of admission to the psychiatric unit he was found hanging in a shower. He died two weeks later.
The GP trainee, Dr Samuel McManus (31), is accused of altering the patient’s medical notes after the man’s suicide attempt. It was discovered he had crossed out the words “high” and “risk” in the phrase “high suicide risk” and added the word “attempt”. He also entered “denied” beside “suicide ideation”.
Prof Casey told the inquiry she received a telephone call at home about the patient on the morning of Sunday, April 13th. She was told his suicide attempt had arisen in the context of him receiving a recent diagnosis of HIV. She advised he needed to be admitted.
She spoke to Dr McManus, a senior house officer, after midday and he told her the patient was not suicidal at that time. But she was contacted again after 4pm and told the man had been found hanging and was being resuscitated. She went into the hospital.
She said the next day a nurse drew her attention to alterations to the patient’s medical notes.
She raised the changes with Dr McManus. She said she did not discover additional changes to the notes until a couple of days before the man’s inquest in 2009. These were where the term “high suicide risk” had been altered. These, she said, “suggested an attempt was being made to undermine the level of risk the gentleman was posing when he was seen”.
Psychiatrist Dr Siobhán Barry, the independent expert called by the Medical Council, said it was not unusual for entries in medical notes to be made retrospectively when people were busy.
In her view, the changes made no material difference to the patient’s treatment. She said she would have expected an alteration such as the one to “high suicide risk” to have been timed and dated. She believed the patient was a high suicide risk.
Simon Mills, counsel for Dr McManus, applied for the case to be dismissed. He said Dr Barry had not indicated that anything Dr McManus did amounted to a serious falling short of the standards and therefore he could not be found guilty of professional misconduct. Dr McManus admitted making the changes and never attempted a cover-up, he said.
Kevin Cross, legal adviser to the fitness to practise committee, said in his view Mr Mills’s application should be granted. After a short adjournment, its chairwoman Dr Deirdre Madden said the committee would like to hear the evidence being called on behalf of the doctor. The case continues today.