Chapter 6: The General Medical Council
Findings of fact: Gladys Richards (Patient E)
The findings of fact for Gladys Richards who was admitted to Daedalus Ward on 11 August 1998 were as follows (GMC100948, pp199, 229–30):
11 August 1998: Dr Barton prescribed 10 mg oramorphine (morphine oral solution) as required
- FtP found proved that the prescribing was inappropriate.
- FtP found proved that her actions in prescribing this drug were potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Gladys Richards.
11 August 1998: Dr Barton prescribed diamorphine with a dose range of 20–200 mg and midazolam with a dose range of 20–80 mg daily subcutaneously
- Dr Barton admitted that the dose ranges were too wide.
- Dr Barton admitted that the prescribing created a situation where drugs could be administered which were excessive to the patient’s needs.
- FtP found proved that the prescribing was inappropriate.
- Dr Barton admitted that her actions in prescribing these drugs were potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Gladys Richards.
Findings of fact: Ruby Lake (Patient F)
The findings of fact for Ruby Lake who had been admitted to Dryad Ward on 18 August 1998 were as follows (GMC100948, pp199–200, 230–1):
18 August 1998: Dr Barton prescribed 10 mg oramorphine in 5 ml as required
- FtP did not find proved that the prescribing was inappropriate.
- The panel noted this prescription was in response to complaints of pain by an opioid-naïve patient (GMC100948, p230). The panel said it was Dr Barton’s view this was justified as she was exhibiting symptoms of congestive cardiac failure. The panel could not be satisfied this was inappropriate.
- FtP found proved that her action in prescribing this drug was potentially hazardous.
- FtP did not find proved that the prescribing was not in the best interests of Ruby Lake.
- The panel concluded that the prescription may, by its nature, be potentially hazardous but nonetheless in the best interests of the patient and not appropriate, and that was the case here (GMC100948, p230).
18–19 August 1998: Dr Barton prescribed diamorphine with a dose range of 20–200 mg and midazolam with a dose range of 20–80 mg daily subcutaneously
- Dr Barton admitted that the dose ranges were too wide.
- Dr Barton admitted that the prescribing created a situation where drugs could be administered which were excessive to the patient’s needs.
- FtP found proved that the prescribing was inappropriate.
- Dr Barton admitted that her actions in prescribing these drugs were potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Ruby Lake.
Findings of fact: Arthur Cunningham (Patient G)
The findings of fact for Arthur Cunningham who had been admitted to Dryad Ward on 21 September 1998 were as follows (GMC100948, pp200–1, 231–2):
21 September 1998: Dr Barton prescribed diamorphine with a dose range of 20–200 mg and midazolam with a dose range of 20–80 mg daily subcutaneously
25 September 1998: Dr Barton wrote a further prescription of diamorphine with a dose range of 40–200 mg and midazolam with a dose range of 20–200 mg daily subcutaneously
- Dr Barton admitted that the dose ranges were too wide.
- Dr Barton admitted that the prescribing created a situation where drugs could be administered which were excessive to the patient’s needs.
- FtP found proved that the prescribing was inappropriate.
- Dr Barton admitted that her actions in prescribing these drugs were potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Arthur Cunningham.
In relation to seeking advice:
- Dr Barton admitted that she did not obtain the advice of a colleague when Arthur Cunningham’s condition deteriorated.