A jury could begin considering their verdict this Wednesday in the trial of Jozef Puska, who denies murdering 23-year-old school teacher Ashling Murphy by stabbing her repeatedly in the neck.
Mr Puska's defence finished their evidence on Monday having called Dr Johann Grundlingh, an expert in accident and emergency and intensive care, who said he has concerns about the reliability of Jozef Puska's alleged confession to murdering Ms Murphy.
The jury has heard that when gardaí questioned Mr Puska at St James's Hospital in Dublin two days after the murder, he told them: "I did it, I murdered, I am the murderer."
Dr Grundlingh said that Mr Puska may have been suffering from "subtle delirium" due to the effects of an operation he had the previous night to treat stab wounds to his abdomen. He said he is of the opinion that Mr Puska may not have been in a fit state to be interviewed by gardaí at that time because of the effects of the post-operative state combined with pain relief drugs that he was administered. He said he was also concerned about the effects on Mr Puska of the language barrier and his being in an unfamiliar environment in hospital.
He said Mr Puska was not assessed by a medical professional for common side-effects of those factors, which he said include anxiety, confusion, depression, irrational thinking and abnormal thinking. He said that all those factors cast doubt as to his fitness to be interviewed.
Following Dr Grundlingh's evidence, Mr Justice Tony Hunt told the jury that they have heard all the evidence on which they will decide the case using their experience and common sense and by drawing inferences without speculating.
He said that before counsels for the prosecution and defence deliver their closing speeches, the court wants to "clear our lines to avoid confusion later on" and the judge also wants to consider what he will tell the jury in his charge. He said he was therefore sending them home early on Monday. The prosecution will deliver its closing speech on Tuesday, followed by the defence closing and judge's charge. Mr Justice Hunt said he expects to hand the case over to the jury on Wednesday afternoon.
Jozef Puska (33), with an address at Lynally Grove, Mucklagh, Co Offaly, has pleaded not guilty to murdering Ms Murphy at Cappincur, Tullamore, Co Offaly on January 12th, 2022.
Dr Grundlingh told Michael Bowman SC, for the defence, that he has nearly two decades of experience in dealing with patients in intensive care and accident and emergency. In this case he was retained by Mr Puska's lawyers and was provided with all medical records regarding Mr Puska's time in hospital from January 13th to January 18th last year.
Surgery
He noted that Mr Puska had undergone surgery about 18 hours prior to the alleged confession. He also noted that Mr Puska was given 5mg doses of the opioid oxycodone on four occasions with the last dose coming at 4.05pm, a little more than two hours before the alleged confession at 6.30pm. He listed the common side effects of oxycodone as anxiety, confusion, depression, insomnia, abnormal thinking and sedation, with less common side effects including agitation, euphoria, hallucinations, depression and cognitive impairment.
The fact Mr Puska was post-operative, using an opioid painkiller in an unfamiliar environment and had difficulty in communicating with hospital staff may have "led to a degree of distress," he added. Those combined factors, he said, often form "part of a complex of confusion and other effects" that is commonly referred to as delirium.
He said there was no evidence that doctors or other medical staff were asked to carry out a test to assess Mr Puska's fitness to be interviewed. In his time on wards, Dr Grundlingh said that before deciding whether a person was fit to be questioned regarding a murder offence he would carry out a formal assessment of the patient's capacity.
The assessment would involve communicating information to the patient to see if they can retain the information, weigh it up and come to a decision and if they can communicate that decision effectively. "If they can do these four things convincingly, then they have the capacity to make a decision," he said.
He said he would also consider whether the patient was suffering from confusion, pain or other distress before deciding whether they were fit to be interviewed. In Mr Puska's case, he said there was "no overt evidence of confusion or delirium" but Mr Puska was not assessed and no medical practitioner was consulted about his fitness to be interviewed. He said the various factors raise concerns about the reliability of his statement to gardai.
Under cross-examination Dr Grundlingh agreed with prosecution counsel Anne-Marie Lawlor SC that his evidence is that there is a "question mark" over the confession, that it is "speculation that there could be an issue". He further agreed when Ms Lawlor said: "We are in the realm of the possible, it could be possible and that is the height of what you can offer us."
The trial continues in front of Mr Justice Hunt and a jury of nine men and three women.
