Chapter 6: The General Medical Council
Findings of fact: Elsie Lavender (Patient B)
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The findings of fact for Elsie Lavender who had been admitted to Daedalus Ward on 22 February 1996 were as follows (GMC100948, pp196–7, 224–7):
24 February 1996: Dr Barton prescribed morphine slow release tablets, 10 mg twice daily
- FtP did not find proved that this prescription was inappropriate.
- The panel said it had noted Professor Ford’s opinion that morphine slow release tablets 10 mg twice a day might be acceptable (GMC100948, p225).
- FtP did not find proved that this prescription was potentially hazardous.
- FtP did not find proved that this prescription was not in the best interests of Elsie Lavender.
26 February 1996: Dr Barton prescribed diamorphine with a dose range of 80–160 mg daily and midazolam with a dose range of 40–80 mg daily
- FtP found proved that the commencing doses of both drugs were too high.
- Dr Barton admitted that the dose ranges were too wide.
- Dr Barton admitted that the prescription was too wide and created a situation where drugs could be administered which were excessive to the patient’s needs.
- FtP found proved that Dr Barton’s actions in prescribing the drugs were inappropriate.
- Dr Barton admitted that the prescriptions were potentially hazardous.
- FtP found proved that they were not in the best interests of Elsie Lavender.
5 March 1996: Dr Barton increased the dose range of diamorphine to 100–200 mg and midazolam to 40–80 mg daily; a syringe driver was commenced containing both drugs at the lowest doses
- FtP did not find proved that the lowest dose of diamorphine was too high.
- The panel noted that Dr Barton attended the patient in person and exercised her clinical judgement (GMC100948, p223). It said it could not, in those circumstances, be sure the doses were excessive.
- FtP found proved that the lowest dose of midazolam was too high.
- Dr Barton admitted that the dose ranges were too wide.
- Dr Barton admitted that the prescriptions created a situation where drugs could be administered which were excessive to the patient’s needs.
- FtP found proved that Dr Barton’s actions in prescribing the drugs were inappropriate.
- Dr Barton admitted that the prescriptions were potentially hazardous.
- FtP found proved that the prescriptions were not in the best interests of Elsie Lavender.
The panel found in relation to management:
- FtP found not proved that Dr Barton did not perform an appropriate examination and assessment of Elsie Lavender.
- The panel noted GMC Counsel’s concession that Professor Ford found no fault in this regard (GMC100948, p226).
- FtP found proved that Dr Barton did not conduct an adequate assessment as her condition deteriorated.
- FtP did not find proved that Dr Barton did not provide a plan of treatment.
- The panel said that whether it was adequate or not, there was a treatment plan; her family were told she was on the “terminal pathway” (GMC100948, p226).
- Dr Barton admitted that she did not obtain the advice of a colleague when the patient’s condition deteriorated.
- FtP found proved that Dr Barton’s actions and admissions in relation to the management of Elsie Lavender were inadequate.
- FtP found proved that Dr Barton’s actions and admissions were not in the best interests of Elsie Lavender.