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Nurse who dismissed concerns about health of man who cried out ‘I’m dying’ guilty of poor professional performance

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Edwin Lara. Photo: Steve Humphreys

Edwin Lara. Photo: Steve Humphreys

Edwin Lara. Photo: Steve Humphreys

A nurse who "dismissed" colleagues' concerns over the declining health of a man who cried out "I'm dying" has been found guilty of poor professional performance.

A fitness to practice committee heard distressing evidence during their inquiry, including details of the final hours of a diabetic patient, who, despite serious concerns, an ambulance or doctor was not called by the nurse caring for him.

At the conclusion of an inquiry on Monday, the Nursing and Midwifery Board of Ireland (NMBI) upheld five of six allegations against nurse Edwin P Lara.

They related to his care of two unnamed patients during one night shift at the San Remo Nursing Home in Bray, Co Wicklow, on February 25 and 26, 2019.

Mr Lara was found to have demonstrated poor professional performance and breached the professional code of conduct.

The committee found he failed in his care of Resident A, a 77-year-old man with type two diabetes — by not testing his blood sugar levels every 10 to 15 minutes and by, not providing him with sufficient rapidly absorbable carbohydrates and failed to provide adequate care by not contacting emergency services.

The same night, Resident B, an 89-year-old woman, sustained a fractured hip following a fall.

The committee found Mr Lara failed to provide adequate care by not ensuring she was assisted by two staff members going to bed, and also failed to assess her injuries appropriately and failed to contact emergency services.

The committee heard Resident B was "screaming with pain" after the fall, but concerns raised by a health care assistant were dismissed.

The committee accepted the evidence of a healthcare assistant who said Mr Lara responded to her fears the woman had broken her hip by saying she was fine and he would give her a painkiller.

In relation to Mr Lara's treatment of Resident A, who had "dangerously low" blood sugar, committee chair Prof Colm O'Herlihy said the registered nurse's "interventions were clearly insufficient".

"You did not dispute evidence that you failed to test blood sugar every 10-15 minutes as directed by policy."

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Prof O'Herlihy said the evidence established that two readings were taken, one at 6.55am, showing Resident A had a blood sugar level of 1.9, and another at 7.27 am, showing a reading of 2.2.

"Your own account was Patient A was given Angels Delight, half a glass of apple juice and a limited amount of sugary tea. The limited blood sugar readings thereafter demonstrated that your interventions were clearly insufficient, as (Patient A) blood sugar remained well below three.

"These readings reflected a medical emergency, not an upward trajectory as you suggested," said Prof O'Herlihy.

The committee also found it ought to have been obvious to Mr Lara that Resident A was seriously ill and deteriorating, and by not contacting emergency services, he was guilty of poor professional performance.

"Resident A's presentation was clearly very poor. He was passing black stools suggesting possible internal bleeding.

"You were the registered nurse on duty and had overall responsibility for his care, and you also had to listen to the concerns of other health professionals on duty with you.

"The evidence established that you took a dismissive approach towards concerns of staff members and should have sought outside help," Prof O'Herlihy said.

The inquiry had previously heard that at around 9am on February 26, Resident A took a turn and became unresponsive.

The day staff called an ambulance, but he was pronounced dead at 9.35am. The post-mortem examination found he died from presumed cardiac arrhythmia due to severe coronary artery disease. The cause of death does not relate to the allegations faced by Mr Lara.

Mr Lara was also found to have failed to assess Resident B for injuries after a fall in accordance with procedures.

In an Incident report, Mr Lara recorded the 89-year-old had "no injury apparent". However, the woman was subsequently diagnosed with a fractured hip.

Prof O'Herlihy said the committee accepted the evidence of a healthcare assistant who described Resident B as "screaming in pain".

The committee also upheld a complaint he failed to contact emergency services or a doctor afterwards, despite this being suggested by a healthcare assistant, which he dismissed.

A full report of the committee's findings, including recommendations of sanctions against Mr Lara, will now be prepared for the board of the NMBI.


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