GP 'gave toxic level of sedative to profoundly disabled daughter' - trial hears
A manslaughter trial has been told that an Offaly GP gave her 11-year-old, disabled daughter a toxic level of a sedative before taking an overdose herself.
The Central Criminal Court jury was hearing the opening speech in the trial of 58-year-old Bernadette Scully.
Ms Scully is charged with unlawfully killing Emily Barut at their home at Emvale, Bachelor’s Walk, Tullamore. It’s alleged that she killed her by an act of gross negligence involving the administration of an excessive quantity of chloral hydrate on September 15th, 2012. She has pleaded not guilty and went on trial this morning.
Tara Burns SC opened the case for the State, telling the jury that the prosecution had to prove that Ms Scully had a duty of care to the deceased on the basis of being both her mother and GP, and that she was in breach of that duty.
She said the prosecution’s case was that there was gross negligence. She said that Ms Scully would have realised, if she thought about it at all, that there was a risk of harm.
She explained that Emily was born with profound physical and learning disabilities, including microcephaly and epilepsy, and that her mother had acted as her GP throughout her life.
“Emily was very well cared for at home,” she said.
She said that, two weeks before her death, Emily had a surgical procedure to replace a peg in her stomach, through which she was fed and given her medication. She was in a lot of pain and sleeping poorly following this. She said that Ms Scully was in an exhausted state as a result.
She said that on September 15th, Ms Scully sent her partner to the pharmacy for anti-depressants and sedatives. He hadn’t seen Emily before going. When he returned, she sent him out for food. He still hadn’t seen Emily when Ms Scully went to have a sleep that afternoon.
He found Ms Scully in a deep sleep around 7pm, but didn’t wake her. He checked on Emily two hours later and found her cold. He called an ambulance and both mother and daughter were taken to hospital, where Emily was pronounced dead.
“Ms Scully had taken an overdose,” explained the barrister.
A post-mortem exam was carried out on Emily and a metabolite of her prescribed sedative, chloral hydrate, was found in her blood at a level of 200 micrograms per ml. Ms Burns said that, if given at the correct dose, a level of between 10 and 20 micrograms would be expected.
“But 200 was found. You’ll hear that level is beyond the therapeutic level and within the toxic range,” she said.
Ms Burns said that Ms Scully went to a garda station a few days later and gave an account of what had happened in the early hours of that Saturday. She said that Emily was upset, crying in pain and woke at 2am and 6am. She administered chloral hydrate both times.
She said Emily had a significant fit at 11am and that she gave her chloral hydrate again.
“She accepted she gave her too much,” said Ms Burns.
State Pathologist Professor Marie Cassidy testified that she carried out the post-mortem exam. She knew that Emily was severely disabled from birth, that she was cared for at home by her mother and attended a special needs school daily.
She had been told that she was on a number of medications and that chloral hydrate was one of the medicines found at the scene.
She examined the child’s body and found that her brain showed maldevelopment. She also found that her lungs were water-logged.
Another expert examined her brain and found damage resulting from multiple seizures, along with evidence of a hypoxic episode in the six to eight hours before her death.
Toxicology tests showed that she had 220 micrograms of trichloroethanol in her blood. She said that deaths had occurred with levels of 20 to 240 micrograms.
She said there was no evidence of pressure sores or contractions of the limbs, which could occur when a patient had limited movement.
“She appears to have been very well cared for and was developing normally despite her disabilities,” she said.
She said that death was due to chloral hydrate intoxication. She explained that this was a sedative used for the treatment of epilepsy. She said that children may be given a maximum single dose and that the half life in children was 10 hours.
She said that Emily was at risk of a potentially fatal seizure at any time and that epilepsy was not excluded as a possible cause of death. However, the level of chloral hydrate in her blood was such that she gave the cause of death as chloral hydrate intoxication. Contributory factors were microcephaly, abnormality of her brain, epilepsy and acute inflammation of the lungs.
Under cross examination by Kenneth Fogarty SC, defending, she agreed that her expert colleague had found evidence of a hypoxic episode at least six hours before her death. He noted that his client had told gardai that her daughter had three seizures, at 2am, 6am and 11am
“Any one of those seizures could have resulted in the damage to the brain,” said the professor. “The seizure didn’t cause her death, but was a very significant seizure that caused this hypoxic change… That would be a major seizure.”
He asked if she could have passed away from the seizure, notwithstanding the chloral hydrate levels.
“Yes, she could have had a terminal seizure,” she replied.
She said that a seizure could cause death at the time or some time later.
She said that the waterlogging in her lungs could be due to heart failure, which could be due to the chloral hydrate but could also be due to hypoxic changes in the brain.
She was asked if chloral hydrate was taken out of the equation, was there ‘still sufficient there to cause her death’.
“Yes,” she replied.
The trial continues before Mr Justice Patrick McCarthy and a jury of seven women and five men.