THE presence of a controlled drug in the body of an 86 year old man required further investigation, according to the pathologist who carried out the autopsy on him after his death in a Portlaoise nursing home in August 1995.
Dr Margaret Ann Bolster, Assistant State Pathologist, was giving evidence at the reconvened inquest yesterday into the death of Mr Frank Burke, from Killamuck, Abbeyleix, at the Aisling Nursing Home on August 26th, 1995.
Dr Bolster said that while Mr Burke was terminally ill, the combination of drugs in his body accelerated his death.
Dr Bolster was giving evidence before a jury at the inquest yesterday. The County Coroner, Mr Eugene O'Connor, adjourned a previous hearing on August 8th after deciding that the proceedings should be heard by a jury.
On that occasion he announced there was a substantial conflict of evidence between the various witnesses and Mrs Philomena Gorman, the former nursing home owner.
Dr Bolster was commenting yesterday on the presence of pethidine in the blood of Mr Burke. A level of two mg of pethidine per millilitre of blood was recorded. The State Laboratory also found the same level of another drug, promazine, in Mr Burke's blood.
The therapeutic concentration ranged from 0.26 microgrammes to 0.8 microgrammes per millilitre, the inquest heard, and both drugs were present at a toxic level in the elderly man's blood.
Also detected in the gastric contents, bile and urine was the presence of dihyrochodeine (DF118).
The inquest heard that pethidine was a synthetic, narcotic analgesic which was controlled under the Misuse of Drugs Act. It was unlawful to possess it unless it was prescribed for medical purposes. In this case there was no evidence of this drug having been prescribed for Mr Burke, Dr Bolster said.
An overdosage of pethidine would result in stupor, respiratory depression and coma.
Dr Bolster said Mr Burke was in coma for approximately 48 hours before death. It would be her interpretation that the drugs were not administered intravenously but were taken orally.
She said Mr Burke was extremely ill with widespread carcinoma and congested cardiac failure with heart disease. He was terminally ill and could have died at any time. "He could have died at any time but the combination [of drugs] explained why he died at this particular time." She added: "This accelerated his death, it pushed him over the edge, the drugs played a contributory role accelerating his death."
None of the drugs was present in his body at a fatal level. She concluded that death was due to extensive metastitic prostatic carcinoma and ischaemic heart disease contributed to by the effect of the ingestion of a combination of drugs - pethidine, promazine and dihyrochodeine.
Dr Thomas Eiernan, consultant physician at the General Hospital Portlaoise, told the inquest that neither he nor his junior doctors prescribed pethidine for Mr Burke while he was a patient in the General Hospital Portlaoise.
Neither was it prescribed by Mr Burke's GP, Dr John Keating, from Abbeyleix. He said he prescribed dihyrochodeine and promazine for Mr Burke.
A nurse, Ms Sadie Phelan, from the Midland Health Board said she carried out an inventory of drugs at the nursing home. Surplus drugs were removed to the Health Board pharmacy. The drugs removed were those which were out of date and not required for the patients who were at the time in the nursing home. The out of date drugs included pethidine in injection and tablet form drugs in date included pethidine in injection and tablet form and also DF118.
Further evidence was given by Mrs Maureen Carroll, a cook who sometimes assisted with general duties in the nursing home. She arrived at work at approximately 9.45 a.m. on Saturday. She said Mrs Gorman appeared to be very jittery. She inquired about Mr Burke and was told that he had died earlier that morning at 4 a.m. Mrs Gorman said she did not want a crowd around her at that hour.
Witness was a bit surprised that the next of kin had not been contacted. She went to the office and dialled the telephone number of Mrs Kathleen Hennessy, a daughter of the deceased man, at approximately 11.45 a.m. She handed the receiver to Mrs Gorman who said Mr Burke had died at 11.30 a.m. Mrs Gorman filled in the time of death as 11.30 a.m. on his chart. Mrs Gorman rang Dr Keating and said Mr Burke had died at 11.30 a.m.
Witness felt there was something wrong.
The inquest continues today.