High Court suspends nurses' registrations arising from death of elderly patient while restrained in chair

The President of the High Court, Mr Justice Peter Kelly, confirmed as appropriate the sanctions recommended by An Bord Altranais in relation to Nurse Ellen Teresa Anne Carroll, Kilmallock, Co Limerick, and Nurse Margaret Marian (Rita) Dowling, Churchtown, Mallow, arising from the incident concerning Hannah Comber at Heatherside Hospital, Buttevant, Co Cork, in June 2006.

Ms Comber, a long-term and highly dependent patient, died early on June 22, 2006, in the day room while sitting in a chair with a restraint belt, an established and approved method of caring for her when she became agitated, the court heard.

In a High Court judgment last January, Ms Justice Una Ni Raifeartaigh said it seemed Ms Comber slipped down in the chair and the restraint belt caused her to die due to asphyxiation. The accident appeared to have happened while a care assistant supervising Ms Comber was asleep, the judge said.

The assistant summoned Nurse Dowling about 5am and Nurse Carroll arrived moments later. Nurse Dowling tried to resuscitate Ms Comber using CPR before both nurses concluded she was dead and transferred her back to bed where they laid her out after changing her clothes.

No doctor or ambulance was called, both nurses went off duty at 8am and no reference was made in the handover nursing notes to the restraint belt. The notes were compiled by Nurse Carroll and Nurse Dowling was fully aware of them, the High Court said.

Because the death was unexpected, the matron on duty called a doctor who decided the matter should be referred to the coroner.

After a pathologist stated the cause of death was consistent with asphyxia, a Garda investigation was initiated which did not result in any criminal charges. A coroner’s inquest in April 2007 returned a verdict of death by misadventure.

Both nurses were later found guilty of professional misconduct by a Fitness to Practice Committee on grounds including failures to provide adequate nursing care to Ms Comber and to make a full and/or adequate record of relevant information, including the circumstances of her death.

The Committee recommended censure of them for reasons including, while the incident was serious, it was "once-off" in otherwise unblemished long careers, the lack of a stated policy in the hospital to deal with unexpected deaths and the insight both displayed about the inadequacy of the notes drawn up after Ms Comber's death.

When An Bord Altranais decided in March 2015 to impose the higher sanction of erasure of their registration, they went to the High Court where they did not challenge the findings of misconduct but appealed against erasure.

Ms Justice Ni Raifeartaigh ruled the Board had not properly approached sanction with adequate regard for various mitigating factors, including their otherwise unblemished long careers. She also noted delay by the Board in this case, that both nurses were suspended from their employment shortly after these events and had not worked since, and both suffered stress and anxiety since the death of Ms Comber.

Following reconsideration of sanction, the Board applied this week to Mr Justice Kelly to confirm sanctions of six months suspension and conditions on their registration. The conditions, applicable for two years, require both to complete a return to nursing practice course and to inform any future employer of the findings of professional misconduct and the registration conditions.

While the Board considered the misconduct at the upper end of the scale, involving failure to pass on information regarding an elderly vulnerable patient who died an unexpected death, it took into account various mitigating factors, including the 2006 incident was a once-off incident, the judge was told.

It did not consider the lack of a policy at the hospital, concerning how to deal with unexpected deaths, was a mitigating factor given both nurses had many years of experience.