By Sonya McLean
A manslaughter trial has been hearing evidence from various medical witnesses and emergency personnel that dealt with the deceased.
Ronan Byrne (31) is alleged to have fractured James Marren’s leg with a bat during an altercation.
A jury has heard that days after the man’s leg was put in a cast at a hospital, a blood clot developed in his leg which travelled to his heart and this clot proved fatal.
Byrne of Lohunda Downs, Clonsilla, Blanchardstown, Dublin, has pleaded not guilty at Dublin Circuit Criminal Court to the unlawful killing of Mr Marren (57) at that address on October 31, 2013.
He also denies production of a baseball bat during a dispute and assault of James Marren causing him harm at the same address five days earlier on October 26, 2013.
The court heard the defendant’s mother Mairead Byrne and Mr Marren had been in a relationship for at least 13 years.
A number of witnesses gave evidence today on their treatment of Mr Marren both on October 26 and then when he was taken to hospital by ambulance five days later.
Doctor Abdul Choundry treated Mr Marren at James Connolly Memorial hospital on October 26, 2013.
He said the patient had already been observed by the triage nurse during which time it was noted that most of Mr Marren’s vital signs were normal.
Dr Choundry said that he himself noted that Mr Marren had “alcohol on board” and the patient himself didn’t know if he had lost consciousness.
He was treated for two cuts to his head, one measuring 2cm along the back of his head and the second, which was about 4- 5 cm in length, was on the right frontal scalp.
Neither of the wounds were actively bleeding.
The doctor said Mr Marren had excessive bruising to his leg and an x-ray later confirmed that he had fractured his right upper shin.
The blood and nerve supply to the leg were both fine at the time of his examination. He later put the leg in a plaster.
Dr Choundry agreed with Padraig Dwyer SC, that immobility of a limb can lead to the possibility of deep vein thrombosis.
He said in most cases patients would be advised to use crutches and remain mobile.
He further agreed that a doctor would ensure that the plaster, once applied and dried, was neither too tight or too loose and that a patient would be told to alert medical staff if they felt any pain in their leg.
Dr Choundry accepted that monitoring of the pain in the leg is dependant on a patient being alert.
Mr Dwyer asked the doctor if a tight cast could result in a compromised blood supply.
The doctor agreed that it is possible but continued that he has never seen this in any patient in his 30 years’ experience as a doctor.
Dr Choundry said Mr Marren remained under his care after he had set the leg in plaster and that he did not see any problem with the plaster. He was discharged from hospital the following day by another doctor.
The court heard that Mr Marren was taken to hospital by ambulance five days later after emergency services responded to a call at his home.
First responders found that Mr Marren was unresponsive and lying on a mattress.
He had no pulse and was not breathing and paramedics immediately began CPR.
He was brought to hospital by ambulance while CPR continued in transit.
Doctor David Slattery told Philipp Rahn BL, prosecuting that he assisted in the treatment of Mr Marren when he arrived to James Connolly Hospital by ambulance on October 31, 2013 just before 3.30pm.
He said he had been made aware that at that point the patient had no “cardiac output” for 40 minutes. He examined him and noted that he had no pulse and his pupils were fixed and unresponsive.
Dr Slattery said Mr Marren had been intubated and chest compressions were being administered when he first examined him.
He told Mr Rahn that he continued with CPR on Mr Marren for a further ten minutes until he pronounced his death at 16.25 that afternoon.
Dr Slattery agreed with Mr Dwyer that he had to consider the potential causes of Mr Marren’s cardiac arrest while he was treating him and he believed that the plaster on his leg could increase his chance of a blood clot that could travel to his lung, which could be fatal.
He stressed that he was not a cardiologist and there were other possibilities, including a heart attack or brain injury, that could have caused the cardiac arrest.
The trial continues before Judge Patricia Ryan and a jury.