Care mum gave to disabled daughter was '100pc-plus', manslaughter trial jury told
The trial of a GP charged with the manslaughter of her profoundly disabled daughter has heard that the mother was "very reluctant" to give her the sedative the prosecution claims caused her death.
Dr Bernadette Scully (58) of Emvale, Bachelor's Walk, Tullamore, Co Offaly, has denied the manslaughter of Emily Barut (11) by an act of gross negligence.
The prosecution alleges she gave toxic amounts of the sedative chloral hydrate to her daughter on September 15, 2012, with 10 times the therapeutic levels found in her blood.
A private nurse specialising in disabilities said Dr Scully had provided a level of care that was "100pc-plus" for Emily - who she said was one of the most profoundly disabled children she had ever attended.
Noreen Roche, with 40 years' nursing experience, visited Dr Scully's home on June 29, 2009, at the request of a solicitor in relation to a family law case and had observed her caring for her daughter and feeding her.
She observed that Dr Scully was "hassled, anxious and run off her feet" from caring for her daughter and working four days a week as a GP. Emily received 29 hours a week of care from the health service, but Dr Scully had been unsure of this continuing due to cutbacks.
Emily's disabilities were severe, Ms Roche noted in her report. She was visually impaired, her hearing was also impaired and her epilepsy was "severe and difficult to control".
She needed 24-hour, one-to-one care, Ms Roche told the court.
Emily was unable to communicate, stand, walk or sit and wore a nappy.
Her feeding needs were "most complex" and her mother cooked all organic meat and vegetables, liquidising her meals very finely while her drinks had to be thickened so that she did not aspirate fluid into her lungs.
Dr Scully wept in court as Ms Roche outlined the routine of what had been her typical day caring for her daughter. The day started at 7.30am when Emily would wake and Dr Scully would exercise and mobilise her joints, change the dressing on her feeding tube, change her nappy and brush her hair before putting her into a special chair for feeding.
Medicine would be administered into the peg tube before Emily would be carried back to her room, toileted and a lycra suit put on to straighten her body.
She would then drive her daughter to school, with Emily attending from 9.30am until 2.30pm - though Ms Roche noted that she would often not be able to attend due to illness, or might have to be taken home early if she became upset.
On her return home, she would be given a drink, which would take half an hour, toileted, and she might sleep for an hour before having physiotherapy for an hour and a half.
Ms Roche referred to the intensive exercise regime, which included Emily being strapped into a standing frame for 20 minutes.
Ms Roche noted that the child had not shown the contracting muscles that might have been seen in children with disabilities in the past.
She also said Emily had not been admitted to hospital with multiple chest infections, which was typical for a person at risk of aspirating fluids.
Dr Scully would then take Emily for a walk before returning for her meal, which would take an hour and a half. Supper would take a further hour and she would be carried into her bedroom, toileted and given a bath, which Emily enjoyed.
A 'good night' would see her waken two to three times, she said.
Ms Roche made a note that Emily suffered screaming fits and that chloral hydrate was the only medication that relaxed her and helped her to sleep "but that the mother was very reluctant to use it".
Ms Roche said that chloral hydrate was used as an anti-convulsant and that it was more frequently used in the past, but that she still occasionally saw it prescribed for children.
She said Emily was one of the most profoundly disabled cases she had come across and she had wondered if the quality of her care had assisted in her survival.
The care Dr Scully provided was "100pc-plus", she said.
Meanwhile, she said she had seen the onset of puberty in young female patients with epilepsy rendering the status of their attacks "more severe and frequent", requiring a re-evaluation of medication.
The court heard that the post-mortem report conducted by State Pathologist Dr Marie Cassidy had noted signs of early stages of puberty. Ms Roche said: "It is a big consideration to be taken into account."
The evidence in the case is now complete, with the jury told to return on Tuesday when closing arguments from both sides will be heard.