A DEMENTIA patient who fatally pushed a former chairman of the GAA's Ulster Council at a specialist unit should have been given an anti-psychotic drug several times a day, an inquest heard yesterday.
John O'Reilly (83), from Camlough in Co Armagh, died from severe bleeding to the brain after he was pushed, fell and hit his head off a wall at Gillis Memory Centre in Armagh on the evening of December 4 2018.
The former Crossmaglen Rangers chairman died in hospital a week after he was pushed by a fellow patient, referred to as Mr Y, in a corridor at the 24-bed ward for people with dementia.
Medical notes showed staff at the unit had given Mr Y one milligram of a specific anti-psychotic drug, commonly prescribed for dementia patients, when they felt it was needed.
On the second day of the inquest at Armagh courthouse yesterday, a leading expert in old age psychiatry, Professor Robin Jacoby, said that Mr Y should have been prescribed 1.5 milligrams of the drug twice or three times a day to "achieve a steady state of sedation".
Mr Y was given the drug several times on an ad hoc basis following his admission to Gillis on November 30 2018.
However, Professor Jacoby told coroner Joe McCrisken Mr Y should have been on a more regular drug regime, given his history of aggressive behaviour towards his wife and staff and patients at the nursing home where he was cared for before his transfer to Gillis.
Mr Y was also aggressive to staff at Gillis and on November 30 pushed Mr O'Reilly twice in succession.
"In retrospect, he (Mr Y) should have been more carefully medicated," Prof Jacoby said.
He added: "Given the level of violence I wouldn't be worried too much about giving him a slighter higher dose".
Prof Jacoby said had Mr Y been given regular medication between November 30 and December 4 he "would have been less likely to push Mr O'Reilly".
Following the fatality, Mr Y was given two milligrams of the anti-psychotic drug twice a day at Gillis.
At the time of the fatal push, Mr Y was under one-to-one observation at the specialist unit.
Prof Jacoby was asked whether the patient should have been placed under closer two-to-one observation.
But he said the one-to-one observation was appropriate at the time.
"I'm not sure that the two-to-one observation would have prevented the accident unless the second person was shooing everyone away from him," he said.
Prof Jacoby said the fatal push could have been prevented if Mr Y had been isolated from other patients but it was reasonable that he was not cared for in isolation.
Following the push, Mr Y "went for the throat" of a nurse.
He was later sectioned on mental health grounds, was placed under two-to-one observation and was cared for away from the main unit.
The inquest heard from Professor Peter Crome, an expert in geriatric medicine.
Prof Crome said he had no issue with how Mr Y was cared for at the unit, both in terms of how he was observed and his medication.
"I don't think that at that time I would have mandated that any changes be made," he said.
The inquest also heard from a senior nurse who witnessed the fatal push and rang 999 and another nurse worked at Gillis.
Several other statements, including from a nurse who was targeted by Mr Y following the push were submitted to the inquest.
The inquest continues.
