Sick Kids witness had not told jury of taped record

The nurse at the centre of a stormy inquest involving the Hospital for Sick Children was called back to the witness stand yesterday to testify about a tape she had not previously mentioned to the jury. 

Ruth Doerksen was asked why she did not mention in her testimony last month that she had recorded a tape about her care of Lisa Shore shortly before the 10-year-old died around 7:15 a.m. on Oct. 22, 1998. 

Lisa died suddenly of respiratory and heart failure, after going to the hospital the evening before for relief of pain caused by a non-life-threatening condition. 

Doerksen was called back after nurse Sian Phillibert, her day-shift replacement, said nurses always tape summaries of treatment - including vital signs and significant changes in the patient's condition - for oncoming staff. 

Phillibert said nurses would dictate the summaries into a tape recorder. 

The tapes are reused about 12 hours later when the nursing shift is over. 

The tape is significant because Doerksen has testified she did not see a patient-care plan for Lisa, containing doctor's orders for intensive monitoring against possible deadly effects of morphine, until after the girl's death. 

Frank Gomberg, lawyer for the Shore family, pressed Doerksen as to how she could have taped the summary without first having gathered the information she needed for it from the patient-care plan. 

Gomberg confronted Doerksen, saying, ``I suggest you saw the patient-care plan between 6:15 a.m. and 7 a.m.'' 

``Mr. Gomberg, you can suggest anything you want,'' she replied. 

``I suggest that sometime after you saw that plan, you went into her room and saw Lisa dead,'' Gomberg continued. ``You went out of the room, got a corometric monitor and put it on the shelf.'' 

The emergency doctor's orders entered into the hospital's computer required nurses to hook Lisa up to a corometric monitor, which would sound an alarm if her breathing or heart rate fell below set levels. 

Doerksen previously testified she had inexplicably failed to look for the doctor's orders in the computer. 

Questioned by coroner's counsel Margaret Browne, Doerksen acknowledged that the tape would have been ``sitting in the dictation machine all day,'' on Oct. 22, 1998, when the investigating coroner was at the hospital probing Lisa's death. 

Asked whether it had occurred to her to preserve it, Doerksen tersely replied ``no.'' 

Doerksen was also questioned by jury foreperson Gail Allegri about why she did not take steps to keep the tape, which was soon reused. 

``You testified that you wanted to do everything you could to help the investigation,'' Allegri asked. 

``Yes,'' Doerksen replied. 

``(But) you let it sit there for 12 hours,'' the juror said. 

Unlike criminal trials, jurors at inquests are permitted to directly question witnesses. 

Doerksen created a stir at the inquest last month when she testified that she saw the patient-care plan two hours after Lisa died - and printed out a copy five days later - while the hospital said it was not aware of the document, and the doctor's orders it contained, until three months later. 

She said she took the printout home, where it remained until Cairns ordered her to bring it to court several weeks ago, and that she did not tell anyone that she had it. 

In light of yesterday's revelations, Coroner Jim Cairns ordered the hospital to present today all day-shift nurses on Lisa's ward who may be able to shed light on what taped information they may have heard.