Chapter 6: The General Medical Council
Findings of fact: Robert Wilson (Patient H)
The findings of fact for Robert Wilson who had been admitted to Dryad Ward on 14 October 1998 were as follows (GMC100948, pp201–2, 232–3):
14 October 1998: Dr Barton prescribed 10 mg oramorphine in 5 ml, with a dose of 2.5 ml to be given every four hours as needed
- FtP found proved (in light of Robert Wilson’s history of alcoholism and liver disease) that this prescription was inappropriate.
- FtP found proved that this prescription was potentially hazardous.
- FtP did not find proved that it was likely to lead to serious and harmful consequences.
- The panel noted that the patient’s alcohol-related liver disease fundamentally altered the prescribing situation (GMC100948, p232). Although the prescription was potentially hazardous, the panel was not able to be sure that it was likely to lead to serious and harmful consequences.
- FtP found proved that this prescription was not in the best interests of Robert Wilson.
- FtP found proved that the prescribing was inappropriate.
- FtP found proved that Dr Barton’s actions in prescribing these drugs were potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Robert Wilson.
On or before 16 October 1998: Dr Barton prescribed diamorphine 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 Robert Wilson.
On or before 17 October 1998: Dr Barton prescribed midazolam with a dose range of 20–80 mg daily subcutaneously
- 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 Robert Wilson.
In relation to seeking advice:
- Dr Barton admitted that she did not obtain the advice of a colleague when Robert Wilson’s condition deteriorated.
Findings of fact: Enid Spurgin (Patient I)
The findings of fact for Enid Spurgin who had been admitted to Dryad Ward on 26 March 1999 were as follows (GMC100948, pp202–3, 234–5):
12 April 1999: 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 action in prescribing these drugs was potentially hazardous.
- FtP found proved that the prescribing was not in the best interests of Enid Spurgin.
12 April 1999: a syringe driver was started with 80 mg diamorphine and 20 mg midazolam over 24 hours under Dr Barton’s direction, but later the dose was reduced to 40 mg by Dr Q [Dr Reid]
In relation to assessment:
- Dr Barton did not properly assess Enid Spurgin upon admission.
- FtP did not find proved that this was inadequate.
- The panel noted that Dr Reid had assessed the patient shortly before her transfer, so accepted Professor Ford’s view that it was not necessary for her to investigate the cause of pain at the time of admission, but it would have been necessary at a later stage (GMC100948, p234).
- FtP did not find proved that this was not in the best interests of Enid Spurgin.