Chapter 6: The General Medical Council

Part Two set out the formal findings of fact:

• The panel noted that Dr Barton had admitted to some parts of the allegations.
  
• In relation to the unadmitted parts, the panel said it had borne in mind that the burden of proof rests on the GMC and that the standard of proof in this case was the criminal standard: “namely that the Panel must be sure beyond reasonable doubt” (GMC100948, p221).
  

The findings of fact for Leslie Pittock, who had been admitted to Dryad Ward on 5 January 1996, were as follows (GMC100948, pp195–6, 222–4):

5–10 January 1996: Dr Barton prescribed diamorphine with a dose range of 40–80 mg daily

• The Fitness to Practise Panel (FtP) found proved that the lowest dose was too high.
  
• FtP did not find proved that the dose range was too wide.
  
• The panel accepted the view of Professor Ford that a dose range which allowed for an increase of more than 100% from the lowest to the highest parameter was too wide. This dose range did not offend against that principle (GMC100948, p222).
  
• Dr Barton admitted that this created a situation where drugs could be administered which were excessive to the patient’s needs.
  
• FtP found proved that this was inappropriate.
  
• FtP found proved that this was potentially hazardous.
  
• FtP found proved that this was not in the best interests of Leslie Pittock.
  

11 January 1996: a new prescription was given, the diamorphine daily dose range was raised to 80–120 mg; midazolam was prescribed with a dose range of 40–80 mg daily

• FtP found proved that the lowest doses in the ranges were too high.
  
• FtP did not find proved that the dose range was too wide.
  
• The panel accepted the view of Professor Ford that a dose range which allowed for an increase of more than 100% from the lowest to the highest parameter was too wide (GMC100948, p222). This dose range did not offend against that principle.
  
• Dr Barton admitted that this created a situation where drugs could be administered which were excessive to the patient’s needs.
  
• FtP found proved that this was inappropriate.
  
• Dr Barton admitted that this was potentially hazardous.
  
• FtP found proved that this was not in the best interests of Leslie Pittock.
  

15 January 1996: a syringe driver was started with 80 mg diamorphine and 60 mg midazolam

• FtP did not find proved that the diamorphine administered was excessive to the patient’s needs.
  
• The panel noted that Dr Barton attended the patient in person and exercised her clinical judgement. It said it could not, in those circumstances, be sure the doses were excessive.
  
• FtP did not find proved that this was inappropriate.
  
• FtP found proved that this was potentially hazardous.
  
• FtP did not find proved that this was not in the best interests of Leslie Pittock.
  

17 January 1996: the diamorphine dose was increased to 120 mg and midazolam to 80 mg

• FtP did not find proved that the diamorphine administered was excessive to the patient’s needs.
  
• The panel noted that Dr Barton attended the patient in person and exercised her clinical judgement. It said it could not, in those circumstances, be sure the doses were excessive.
  
• FtP did not find proved that this was inappropriate.
  
• FtP found proved that this was potentially hazardous.
  
• FtP did not find proved that this was not in the best interests of Leslie Pittock.
  

January 1996: Dr Barton prescribed 50 mg nozinan in addition to other drugs

• FtP found proved that this prescription in combination with other drugs already prescribed was excessive to the patient’s needs.
  
• FtP found proved that this was inappropriate.
  
• FtP found proved that this was potentially hazardous.
• FtP found proved that this was not in the best interests of Leslie Pittock.