Chapter 6: The General Medical Council

The findings of fact for Geoffrey Packman who had been admitted to Dryad Ward on 23 August 1999 were as follows (GMC100948, pp203–4, 235–7):

26 August 1999: Dr Barton gave verbal permission for 10 mg of diamorphine to be administered to the patient

• FtP did not find that this prescribing was inappropriate.
  
• The panel noted that Professor Ford was not critical and GMC Counsel conceded in his closing submission that it may be appropriate for this head to fail (GMC100948, p236).
  
• FtP did not find that this prescribing was potentially hazardous.
  
• FtP did not find that this prescribing was not in the best interests of Geoffrey Packman.
  

26 August 1999: Dr Barton prescribed diamorphine with a dose range of 40–200 mg daily subcutaneously

• FtP did not find proved that the lowest dose was too high.
  
• The panel said that, when applying the appropriate conversion rate, the panel calculated that the anticipatory prescription did not provide for an increase in the equivalent level of analgesia provided for in the existing prescription and was not therefore too high (GMC100948, p235).
  
• Dr Barton admitted that the dose range was too wide.
  
• Dr Barton admitted that the dose range 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 Geoffrey Packman.
  

26 August 1999: Dr Barton also prescribed midazolam with a dose range of 20–80 mg daily subcutaneously

• FtP found proved that the lowest dose was too high.
  
• Dr Barton admitted that the dose range was too wide.
  
• Dr Barton admitted that the prescribing created a situation where drugs could be administered which were excessive to the patient’s needs.
  
• Dr Barton admitted that her actions in prescribing these drugs were potentially hazardous.
  
• FtP found proved that the prescribing was inappropriate.
  
• FtP found proved that the prescribing was not in the best interests of Geoffrey Packman.
  

In relation to the management of the patient:

• Dr Barton saw Geoffrey Packman on 26 August 1999 and noted that he was “not well enough to transfer to acute unit, keep comfortable, I am happy for nursing staff to confirm death”.
  
• Dr Barton did not consult with anyone senior about the future management of Geoffrey Packman, nor undertake any further investigations into his condition.
  
• FtP found proved that this was inappropriate.
  
• FtP found proved that this was not in the best interests of Geoffrey Packman.
  

The findings of fact for Elsie Devine who had been admitted to Dryad Ward on 21 October 1999 were as follows (GMC100948, pp204–5, 237–9):

21 October 1999: Dr Barton prescribed morphine solution 10 mg in 5 ml, as required

• FtP found proved that this was not justified by Elsie Devine’s presenting conditions.
  
• FtP found proved that the prescribing was inappropriate.
  
• FtP found proved that her actions in prescribing these drugs were potentially hazardous.
  
• FtP found proved that the prescribing was not in the best interests of Elsie Devine.
  

18 November 1999: following a deterioration in Mrs Devine’s condition, Dr Barton prescribed fentanyl 25 micrograms, by patch

• FtP found proved that the prescribing was inappropriate.
  
• FtP found proved that her actions in prescribing these drugs were potentially hazardous.
  
• FtP found proved that the prescribing was not in the best interests of Elsie Devine.
  

19 November 1999: Dr Barton prescribed diamorphine with a dose range of 40–80 mg daily subcutaneously

• FtP found proved that the lowest dose was too high.
  
• FtP did not find proved that the dose ranges were too wide.
  
• The panel noted Professor Ford’s view that a dose range which allowed for an increase of more than 100% was too wide; this dose range did not offend against that principle (GMC100948, p238).
  
• FtP found proved 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.
  
• FtP found proved that her actions in prescribing these drugs were potentially hazardous.
  
• FtP found proved that the prescribing was not in the best interests of Elsie Devine.
  

19 November 1999: Dr Barton prescribed midazolam with a dose range of 20–80 mg daily subcutaneously

• FtP found proved that the lowest dose was too high.
  
• FtP found proved that the dose ranges were too wide.
  
• FtP found proved 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.
  
• FtP found proved that her actions in prescribing these drugs were potentially hazardous.
  
• FtP found proved that the prescribing was not in the best interests of Elsie Devine.
  

In relation to advice:

• Dr Barton admitted that she did not obtain the advice of a colleague when Elsie Devine’s condition deteriorated.