Nurse tells Mayo inquest in hindsight he would have acted differently

A Mayo nurse who was the last person to speak to Lahardane man before he went missing from Mayo University Hospital said he would have kept an eye on him if he was informed he tried to leave the hospital a few hours previously.

Evidence in the inquest of 69-year-old Patrick Rowland concluded in Swinford Courthouse this afternoon with the verdict expected to be delivered in July after the coroner, Patrick O'Connor asked for submissions on a possible verdict.

The inquest which took place over three days heard that Mr Rowland of Tobernaveen, Lahardane left the hospital in the early hours of January 17, 2023 and went out into the freezing weather wearing just his pyjamas and slippers.

He had been admitted on January 15 suffering from pneumonia and despite developing sepsis, he spent 42 hours on a trolley in the Emergency Department before he was finally given a bed in Ward B at 12.30am on January 17.

During his time on the trolley, his family became increasingly worried for his welfare claiming that he had been in a confused state and was 'raving' and telling family members he wanted to go home.

The inquest heard that at around 9.30pm on January 16 he had to be returned to the Emergency Department after leaving and telling security staff that he was going home. He also expressed his frustration and anger to nursing staff about not getting a bed and told them he wanted to go home.

Staff nurse Peter Brown told the inquest that shortly after Mr Rowland was admitted to B Ward he met him in the corridor and told him not to go too far.

“At approximately 1am Mr Rowland walked past the nurses station and I asked him if he was okay. He responded to say he was okay but couldn't sleep. I informed him he was supposed to be on oxygen but his response was there will be all night for that. I asked him not to go too far. At this time my observation was that he was alert and there was no obvious cause for concern,” he said.

When asked by Roger Murray, senior counsel for the Rowland family if he had been told that Mr Rowland had attempted to leave the hospital before being admitted to B Ward, Mr Brown said he had not. He also said he had not been informed that he had spent 42 hours on a trolley and that Mr Rowland had told nursing staff in the ED to take out his IV catheter because he wanted to go home

Nurse Brown agreed with Mr Murray that if he knew all the history regarding Mr Rowland's stay in the ED it would have raised a 'red flag' and he may have been a risk factor for absconding. He also agreed that his decision making on the night would have been different if he had this information at the time he last saw Mr Rowland.

“I'd likely have used persuasive language to get him to go back to his bed and put on his oxygen and I'd have monitored him more closely. Even if he had gone for a walk on the ward I'd have asked staff to keep an eye on him and I'd likely try to convince him to go back on the ward again,” he said.

Nurse Brown said he only had a 90 second interaction with Mr Rowland when he was admitted to Ward B but he gave no indication he wanted to leave the hospital after getting a bed.

The inquest heard that Mr Rowland left the hospital at approximately 1.10am via a service entrance in the basement of the hospital and CCTV footage showed him jumping the wall and going onto the Westport Road.

His son Cormac had earlier told the inquest visited his father in the hospital at 10.30pm on September 16 because his mother was concerned for him. He stayed with him until 12.44am on September 17 after he was given a bed. He said he just arrived at his home in Parke when his father phoned him at 1.13am telling him he was at the TF Royal Hotel across from the hospital and he was going home.

Cormac Rowland's wife Marcella then rang the hospital to ask about her father-in-law's whereabouts and it took eleven minutes before they confirmed he was not in the ward.

Nurse Brown said when he became aware that Mr Rowland had left the hospital, he went with one of the security guards to the TF to try and locate him but they failed to do so.

The inquest heard that CCTV footage showed that Mr Rowland was last seen on Newport Road at 1.32am and his slipper was later found nearby on the bank of the Castlebar River. His body was discovered on January 19 four miles downstream in Ballynew and the post mortem found he died as a result of asphyxia due to drowning.

Throughout the inquest Mr Murray questioned the care given to Mr Rowland during his time in the ED saying there were gaps in his medical records regarding the times he was given medication and when his vital signs were taken. He also said that when Cormac arrived to see his father after 10.30pm on January 16 he was never informed his father tried to leave the hospital or indicated his wish to do so.

The inquest heard evidence from nursing staff who said that on the night of September 16, the ED was packed with up to 60 patients and Mr Rowland was one of a number waiting to be admitted to a ward. While Mr Rowland's family claimed that he was showing signs of confusion, medical staff described him as 'lucid' and he did not show signs of confusion or delirium.

Jansa Jose who was the shift leader in the ED said that Mr Rowland was angry and agitated but this was not unusual behaviour for someone who had spent nearly 40 hours on a trolley and was tired.

After hearing the evidence in the inquest, Mr O'Connor asked Mr Murray and Mr Luán Ó Braonáin, senior counsel for Mayo University Hospital to make submissions on the verdict he should record and any recommendations he should make. He ruled out a verdict of death by suicide and also felt a narrative verdict would not be appropriate in this case.

Mr O'Connor asked the two men to make their submission by July 8 and he would deliver his verdict on July 22 in Swinford Courthouse.