MDU 100001-0001

X’~ I1 NESS 8TA I ]’-,MEN 1

STATEMENT OF ; IOBHAN MARIE COLHNS

AGE: ~, \,ER 18

This Statement c~msisting of ./0 pages signed by m..,

" ,- b; true m the best o I’ m?,, knowledge and

be" " " ~ ~ake ii Mmwing tl~at if it is tendered in evidence I shall be :~ to prosecutio~ ifi
’i~Iv:
¯ ha

have wi I fUlty stated in it anyfl~ing which I tm~w to be false or do not believe to be trt~e,

DATED {!1is day of December 2007

Code A a

J OBHAN COLLINS

i
llllli

1 am a Registered General Nurse having qualified in Lfinmet:ick in I98; ,. From 1987 to 1994 ]
worked as an RGN at the IJmmerick Regiona! Hospital From July 1994 until October 11995 1
carried :out agency work: with the Crown Nursing Agency, I also worked as a D Grade Nurse at
the Queen A lexandra Hospital in Portsmouth:normally working on Big Ward, a general medical
ward.

From October 1995 1 was employed by the Fareham and (~-tL~v,~pO~ t r lmm y Cam ~ q}]S Trust as a D
RtJN,~’,vorkmg
Grade ..... ’ ’ ....
at St ’
Christopher’s t:toSp]tal, Fareham. \~}~ilst at St Cihristopher’s, in 1996
I applied tbr and was accepted as an E Grade
’ " ~
R~.JN.

.......
Clold l ell l l~ .......

SlgTle~ i ....... 9immssed ....... i i"

t. ......................................................... a
 MDU 100001-0002

2
S £AI LMEN f O1 S! 3I.$HAN MARIE COLLI[NS

AGE: OVER 18

Ii~ November I99~’ I then commenced working as ap, l~ Grade R(~N on Dyrad Ward, at ~t~e
(kisport War Memorial Hospital At tha~: time, Dryad Ward was a eontimfing care ward

comprising of 20 t~eds :t~.~r elderly patients. Foul: of the b~ ds x< ~.~e fol ~esF~tv. ~m e..

tn /uly :9003 I moved from Dryad Ward to Sulta~ Wara ~t the: Gosport Wm Mmnocml Hospital,

a:~ an Ii! Grade RGN.. i resigned fi’oin this posit~on i~: Mai:ch 2ti)06 ~b~ fair, ily reasor~s, although it
is my intmliior~ to return to nursing shotdy, tliis tilne at Alverstoke l:Iousc, a local nursing iiome.

I t.,.d~:e~,e ~.a~ d~,. Go:spoi:t War Memorial Hospital was [:m~

~ i a’: :’ d~e, First ’Ac ~ld War, and ~ha-I a
~ ~’tcr
section .of it is st.iiJ;~,.,v~,¥n,4,:
~’~ by the comn~tmity. Ast tmderstand it,. the Hosp~ta! ~s now run :by two

p~imarv care mm~s,

.....the Fareham at~d Gosport PCT~. and the East
’ Hami.shu~e
~ :" P(..~I,
’ .... The Hospital
[s essenhally ’~-" ho.spit:als, i~
¯ a c.ottage hospital, although it does rather more that~ most co:{ta~e
partiCt~la.r [~1 re[¯a:tion ~o
-~ I.a/hatr~’
"’ " :,’cx eatc,
......

R,A:at~,a.. tended to be concertmd that patients fi:om (. ospmt au.d the. suu~ undmg ¢..rcas should be

nearby where they could visit them, which was more difficult if ff~ey were admkted to [~ospital in
Pottsrr~otith. i tc{[ ~hat )~er Um~,., patterns w0m:e being ttansIL*tted to D, ad Ward in a co,t~di~.~on b~
w[iid~ they¢ were more acuteD:
. i~l. ’~"- ,~ ..... mcr,~asmg
1. h~a ~,roduced : .... "" dema~~ds o~ the nursing, staff. The

problem on Dryad Ward was ~?ot so much tile quan~ky o.f patients, but rather their needs, hi my
view, over the period of time I worked on Dryad Ward, tile needs of those admitted increased

sigMfiCmatty. Unfortunately,. there was m~ increase i:n the; n-t~mbers of m~rsing staff to

accommodate that need,

....... admitted to Dryad Ward were transferred t>om Acute Units,

A lot of’ the patients who ~,e~e
mainly at the Queen Alexandra Hospital, I wouM estimate tha~ during the time 1 was there
approximately 60% of the patients admitt:ed to the Ward woMd have had major medical issues

that i~ ttie short or k.mg term would become terminal,

AS I recMl it, while il worked on Dryad Ward tl’~ece was m~.t a~ h~crease in bed occupancy ..... fl~at
remabied abo~!t the same over the period, but [ am cor~schms that the turnover of patients

1. . . . C;Si A. . . .
’. .................................................. }’’’"’’-’"
i [,~,,~
 MDU 100001-0003

3
STATEMENT OI 5IOBHAN MARIE (~OLHNS

AGE: OVER 1.8

increased significantly. Patients were transferred fi’om the Queen A|exm~dra Hospital in order to
a]!eviate the demand [br acute beds [n some instances, patie~ts were transferred who ~hen
developed more problems and ended up being moved back to the Queen Alexandra Hospital, 1
am cor~scious that ~his ix a situatim~, whic}~ exists in all hospitals h~ terms of the demand for beds,
The staff at the Queen Alexandra Hospital were trying to do their best with the resources
available to them, However, [ was unhappy with the trar,,sfer of some of the patients to Dryad
Ward i~ that their needs were too great, In an ideal position, they should ~ot have been
transferred. This became quRe a demarlding situation for the staff on Dryad Ward,

While or, Dryad Ward t wot~]d t.tsua~Iv work on the sight shii-L Ordinarily, [ would work three
nights or:~e week. m~d two nights fl~.e next, However, I also liked to work on days m o~d~:4, to see
the difl)rence, and to be involved in the routine of working days. Accordilagl.y ] would urJ:dertakc
’"
a. measure of day work. winch might
~ ~an~e ..,.n very., little i~ one m.oirth through to 10 or 20
"’ -" t~"~,
hours in another.

The medical i,~put on Dryad Ward was provided by a col~suitant who carried om one ward rotund
a week, with tt~e remaiJ~ing care being unde~aken by Dr Barton, as tl~e part time Clin;ical
Assistant, [understood that she was in cfaarge of fl~e day, to-day ~m.~A:cal
" ’ care, dealit~g with acaie
pa:Oblems as fliey aw:se; 17n. the same way in whict~ tI~ere was n:o increase i~ nursing staff over the
timev,~he~* I was on Dryad Warvt similarly there wasno i~crease ’m medical’
’.-, s~tall, dul mg the" !.ram’’
~:’* .....
Dr Baao.n was Clinical Assistgmt [ recall that Dr Barton IeR in about 1999 or 2{)0:0; St~e was
rep!aced by another staff: grade doctor i n el<le~ily medicine, I°mt this time the a:ppoi:n(ment Was IMt
tlm~.~, w~t ~ tl~e doctor woddn~, from 9;00a,!n, through to 5:00p;m. cacti weel~day,

I anticipate that the Consultants lind t 00% trust in Dr Barlon and riley did not {:gel the need to
oversee a k~t of her work, Tlieir mair., inpt~t would be in tl-~e next ~el;.~ in the patient’s care, i~a
terms of deciding whetl~m {he patient should be transferred to a nursing home, or kept on the
Ward, ift i!e: !,atiem sho~fld go to rehabil~tat:ion c,r shoald go home tbra period,

f cga;A
,. .
!
Witnessed, ....... i
i
¯ ....
i
 MDU 100001-0004

4
g I A FEM[EN I Ot SIOB!{IAN MARIE LOLI,,INS

AGE: OVER 18
............... --’rr ............................. ""rr ...... ::: ......

~JiSfiartoti was the C!imeal Assistant for both Dryad and Daedelus Wards. She would come [o

Dryad Ward between 7’’0,,~ m’~d 7:30mn~, each weekday: My. Sl~iJ{:~g did nol~ l]Ilisli L’iatiI ,’7145; wIiei:i ]

was workiiig nights, and I woukt tl~erefbre see her most mornings, She would normally speak to
Sister Gill i:{amb!ii~, who was the Clinical Manager on Dryad Ward, to receive h~tbrmafi0n about

’:, :"+,,. patient~,..

:~ and howd~eir, conditions might have varied overnight,.. On occash?t~s, however, she

wouid speak to me about tt~e patients. Dr Bartm~ wouki then go to s{:e each of the pafie~ts o~

l)ryad Ward. individuMlyL Silt dealt with reLY acute problems that had arisen overnight, A nurse
would accompany l~er whe~ stie went: round to see eaCt~ of the patients, and from time to time I
acted in this capaciw. Th+s was something 1 had not seen before in my nursing experie:nce, and I

thought i~ was very tliorough, Dr Barton didtl:t simply deal witla the problem at: the desk, but was
concerned to see each patient, t:o speak with them and a,~k how: they felt. Having attended the

pai:ients on Dryad Ward, :,he would then go to l)aedelt, s ~ard, before leavi]~g to go to her own

..~eneral pi~actic.~ surgery

. at about 8~ :+~ Oa+m,

I tended to have more co!’d.ac.t with Dr Barton when i was or~ day duty:: :ald~ougf~ there: were. also

mat~y occasions when [ was on night duty when [ would speak to Dr Barton the telepl!one ill

order to seek her guidarlce about a pattern:t;

Having aee~ a!i of the patients on both wards: each morning, Dr Bar{m} would then regtflarly
return to the Ho.spi~.al at: lunchtime in .,~de~ -to see patients again then: if necessm’y, to clerk in
pal:++ents ~+ he mmight ha:re been admitted in me mc rning, and to See re{atives who mimht be m~xio~:ts
to +.ti;scuss issues witl~ her, h~: practice, flHs mem~:t shie was there at: [unch t:ime or~ tnost weekdays,

I)r Barton would also return to the Hospital in tile e.verfings to see patients, to clerk them in and to

see relatives as necessary, altl~:o!!g:~i th~s tended to be less frequenti

If a new patient had been transfErced to Dryad Ward and needed to be clerked in: we wotiid
"
usually leave a message at Dr Barto~ ~ Surgery so that she was aware of the need to ~ttend to
2j +} +~j
+

cierk in the patient. Usua{ty Dr Barto~ wouM then attend to take cart of this, tl~ough on

occasions one o f her part~:~er’ s would at:tend in her place,

. . . . . . Cocle A. . . . . . ........................................... i

.... i Code A i i
 MDU 100001-0005

5
S1 AI EMIk.NT OF SIOBHAN MARIE C .)]LLINS

AGE: OVEI~ 18

I wo~dd say that in liindsight, the nm~sh!g record keepim::’ c,~ Dryad Ward was minimal, ’]’his was
partly d u~’ ~o the
.... ....
l:act that there was not tim same emphasis th~n as: now in ~’eiation t:a file
..........
importance oi! recol:dkecping, l-{owever, it: also J;~.sult,,J largely fi’om the Net that there was a
Very significant demand o~. our time in terms of:the care reqtfired fc, i~ patientS, and O{]r " ’t+’
WFI .~,e!:t

work s:~e.red in consequence, _I did not -feel that we had enough dine [o put more into the
nursing records. If.l had wt!itten mot:e by way of entries iiil a patient’s records, I woi.!ld simply m~t
have had the opporbmity t.o deliver the actual care.

In hindsight, Dr Barton’s h~put into the medical records could have beerJ greater, l:n my view, her
i@ut ia meetiag with patients and her actual patient cor~tacl was excellen.t. In consequence, what
Dr Barton wrote in the leco~ds was corlcise, It could have been more in depth, but she was under
eve~ greater co~tstrah~:ts in terms of her time d~an the aursi~lg sta-fi:, and her recordkeepirlg
suffered accordingly, } [owever: I never saw a situation in which patieat safety orthe quality of
care was compromised by the fact that Dr Barton!s ~.otes were more limited,

la my view. I)r Barton did. not have sufficient consulta~t input, ~ot in the sense tl~t she d.id not
know what to do, but simply in terms of demands o~ her time. These demm~ds were very high,

i always tibund Dr Bartor~. to be very approachable, When I needed m col] her, even o~ of hours,

.r
I felt able to do this. l:f a patient became acutely ill, if they became distressed or they were. in
pain, ][ was aware that I could telephone her fbr advice, We generally Pelt able to contact l)r
Barton duri~g waking he urs --- in tf~e ma~-~ up to about 10:00p,m, il" we: felt that something could
be dealt with over the phor~e with the patient not actually t~eeding to be seen by a doctor. From
time. to dine k was necessary ~o contact a. doctor dm’ing the night, at~d if Dr Ba.r~o~ was on duty
we would contact he.r. l f, however, She was not on @ty, we would telephone the dt, ty doctor.

Over the period of time l was o~. Dryad Ward, the Const~ltants responsible for the Ward changed
fieqt~enfly I recall that Dr Lord, I)r Reid and Dr Logan were a{/ consultants who had
responsibifit y for Dryad Ward, but there were the others also. It seemed to me that no sooner had
a coasultam l<ound their fbet it°Jail riley then moved on, The Consultants must have been aware of

S edi Code A ., . .... r--c-6-a;-A-. .

,
 MDU 100001-0006

6
STA 1 EMENT (H! SI[OI~HAN MARI[E COLLIN,.

AGE: OVER 18

the problem of the significant demar~d o:n nu:rsing and medical [Jme brot!ght; aboti[ by [l~c
significant medical needs of the patients; and the way ill which these needs and the depe~dency
of patients i~creased overtime. In: my view morn doctors wc),e certainly !:equired to Covet! Dryad
and Dacdelus Ward.< and probably more nurses, although NVQ trained carets would certainly
i~ave eased the burden or., the qualified rmrses, enablh~g us to carry out other responsibilities,

I ,:~d !~,.t )~..,s~ the need k.~r extra stall m mb~,rs v~,~th at~,~, at t~ t[osp,,aI, [ [dt tha~ the quaiity
~>f ca-,e we were nil able ~.; deliver was excellent, However, iii consequence of the delivery ol!
that care, tl~e recordkeeping suffered. Had die quality of care been compromised. I would have
raised ~he marmr.

When the Commission =br Healt;mar<. improvement carried out its iiwestigatim~: of the Hospital,
the [nvestigator.~ spoke to a number of memoers of the Nursi~g S[aff, bul .I believe that these
we~:e individuals wito were randomly picked from each ward, and 1 was not picked~ and so did
not speak to any of the Investigators: i think:all of the t..mnca!
~’~ .... Managers spoke m htves~igators,

FoWowing ~he Commission ~.br lk..altacme Improvement Report concerning the Hospital,
different criteria: i!br admissioi~s were put in place: althougl~ my perception was tha~ tt~¢
dependency of patients did no.~. reduce, Ammgemen{s for drug prescribing c~mnged, and
Consultant visits imp~!oved. ! cannot recall now that there was any increase in tl~e number c)l"
medical o:r nursing staff.

I would say that. I)r Barton ,xas a very kind individual, and a clinician who was germine!y
interested in the wellbeing of her patients. She always treated them with respect: and I never
heard a~y paiiet~t eomp]a:in abo~.it ]~e:r it)any way. She was approachable, an~
always put patien~ we!-/~-n’e first. 1 cannot recall at~yo~e making criticisms of her during my time
at the Hospital I four~d that ! never! had any problem get~i~!g hold of her when I called: ~md she
was always qm,,~
" ’*" 1 ~a.pp~~
" , tob:e contacted. Dr Barton seemed very co~?scientiouso Sh.e was always
very plea~am, al~d was respectfu! :of th~ views of nurses,

.i- ....................................... i

-c6ae--A-. . . . . . . Wi n , s d ..... Code A ........

 MDU 100001-0007

STATEMENT ()F SIOB}IAN MAIUI,~ (_OLL][NS

AGE: OVER 18
................................................................................................2~ ...............

Having undet~.ake:n day d~lty or. a not infrequent basis, I. was present fi’om time to time when Dr
BaJt~.n""
~ would carry, out an initial assessmcn~ of a patient tbllowi~_ their admission. I have o17
course seen many doctors carrying out such initial assessments or clerking in of patients in my
career as a nm’se, h~ my vmw. Dr l~mt:on’s initial assessment was qt6te thocough. She wotdd
usually ~.a::.-¢
’y ou{ a full top to toe examination. I dkl not feel that she missed anything of
significance. Basic measurements, including the taking oi the patient’s pulse, blood pressure and
respiration and temperature ;.votdd be carried out. by the Nursing Staff. Dr Bartor~ would review
the measuremems al~d there would always be a communication belwom’~ her al’~d the Nursim~g
Stalk Any problems initially observed by the Nursing Staff were communicated to her, and she
would take them ,::m board alqd invesfigae accordingly. Patienf. medical records would tlsLia.ily
accompany the 1.atJcnt, " ~ ~ ,-, from time to. time they.. were not available. Dr Babe, on would
,, ’- . a,thct@,
review the rv.co~d,.,, and could focus her examination with the benefit of them. The assessment of
a paient would co.at.imm over a day or so tf,) ensure tiaat everything ~. ,.........
,~,.d0’’~.~.~, to k~ow about the
palient was available, For example, blood and m’ine tests might be undertaken,

Whe:n I first arrived at D~’yad Ward a practice was ill operation whereby, in addition to the
presci:ibing of a patient’s regular drugs, drugs might also be prescribed [br a patient in
anticipation. Ira patieni was deteriorating, Dr Barton might prescribe some drugs to be used ira
patient’s condition later required it. This was a!a arr:a~gemer~t to prevent, a. patient ha.ring to wait
a ntmqbc.r- of ]iourS in on]er l~)r a duty doctor to coin{: arid review them and then prescribe the
necessary medications. It was quite apparent to: me that ttais arra~agement was based :on a ~’eat
eien~ent of: trust arid a good rapport which existed between the Nursiag Stag and Dr Ba~m~,
whereby slie knew that the drugs would not be used inappropriately.

The drags ~.~sed c,n th is basis were usuaIiy Diamorphine and Midazolam. These drugs were used
in a syringe driver ordinarily when a patient was no longer able to swallow. Up to that pointi ilTa
pafien!, might require opiate medication for pain relief, we would tend to use Oramorpl~, a,~ oral
mo~hine prepara,ion. Dr Barren would usually prescribe the drugs on this basis in a relatively
wide dose range, so that the medication could be increased if necessary withe ut having to wait for
a doctor to atte:nd,

-l*
Slgne~a [
. . . . . C6-d-6--A. . . . . i..... , ,, c;iiaAi
\~ itnessed, ....... j
i .............................................
 MDU 100001-0008

8
S.[AIEM.I~NI O1~ SIOBI:IAN MARIE (:OLLINS

AGE~ OV~R 18

Some patients were on!y prescribed their regula.." medica:fim~., a.~d: would not ~ed to ha:w drugs
prescribed on this anticipatory basis, However, a lot of patients had many ailments and were
qtfiie !ll. [his form of prescribing was ur<le~aken for those patients who we:re perceived t:o be
ten!~ina!iy ill, In!s m!ght be apparer~t, o~l admlasmn. }-lc~w.~, it might also be instituted if a
d~.t,,rt J~a:,,~d and ff, ey wm’e then perceived to be termi,~aliv ilI. The ~:atim:ale
was thai patiems shou!d ~wt suffer needlessly, and that medication Should be available rapidly in
ti~is way if necessary.

t’171 eor~sid~-’~red tim{ a p~t~

a’ ~n
~ ~ req u ired such medication wh ich h ad been .prescribed on .,,
t hi ~ bas i s by
....
~m~c,n,.
Dr ~ or i~decd an incre:a8<: was reqtlire& i would ordinari,iv telephone her to a~}s,s:]
’~ ~ l~lo~" if
this arose durit~g waking horn, s, Siinilarly if Dr Bartot~ was on d~v, and d~e issue arose m ,h<.
middle of the night, i would Mso ~:aet able to tornact her, However, if the isstie arose during tim
nght and: Dr Barton was not on dt~ty, I did not contact the Duty l.)octor. Ratheri IwouM review
the positior~: witl~ a nurs:ing colleague, of file same or ~.,:,ieater seaiorkv,, We-would assesa the
position together, and so the
: ’ dcc.ts~c
~’" " ~ n would then be taken by two senior nursing staff members.
Ill was :tmcertain about something I would ask Gd.l ,lamblm., my Ma!~ager, ~~i
~ ;........
...............................
C°de._..A........"itt~e
Night Sister.

Whm~ initiating the medication prescribed in fli~is way~ we would always start at the lowest dose
in the range prescribed by, Dr Barton, m~[ess {he ~aUe~:t
*~" " had Mreadv~ been rec.e;b/ing similar
medication. Accordh~gly, if the patien!, had been receiving quantities of opiates~ it might be
necessary to adll:~.
" l:n;v "~ a higher quant.,~
~ste~: " Pv of Diamorphine t!ian the lowest dose stated in the
rm~ge,~. in order to produce:: {i~e app.ropriate equlvale~t,

The~
.......
Con~utta.nts :responsible ...... " " of the practice of prescribi~g
for Dryad V~,ard must have been awm:e
drugs in tibia way. It was there for everyone to see on the medical i!ecords, which ",votIld be
x
i:eviewed when tt~e Con,;ultants carried out their Ward Rourids each week, However, I never
heard any., expre:.’sinn,.,
.... ..... from Consultants about the operatio ~ of this poli;cy,
o f dis".,~.uiet. or concern............
I think fl? e C c nsut rant s m a5 also: Iiave op¢’.rated tl~is system of prescribing or~ occasiom Ha.d I had

........c6;aeA i
. . . . . . . . . . . . . . . . . . . .. .. .. .. ..... . . .C. . . . .ode
. . . . . . . . . . . . . . .A
.......
 MDU 100001-0009

9
S.t ATI~.M~N~ {~}ti SIOBHAN MARIE COLL1NS

AGE: OVER 18

an y ca acorn myself I woul d ce r~aln] y la ave t~lt ab I e to say so, l-Iowever, i n my view ii. was qu i te
an @propriate and efficie~t system Co~:~sMering tI~e reso~rces we:had available, [ wm~ld accq~t
fl~at it was not perfect, !n theory there was the potential tbr someone to be started on a very high
(!ose w~hh’, ti~e sigr~i~c,ant: range wMch was ustmlly prescribed, li!k.w~ever, ~his was not a :real: ri;sk
as there wasa complete understandh~g witli everyone tlmt a patient would nat be started on a very
high dose, ~mless as t have, indicated there was a specific rcasoii t~k~r th~s irl terms of ti~e
medieatio~ tiiey were already receiving. A 1! of the nurses Im.ew how: the system was supposed to
work:, and we were all profession:Is who worked in a professional marme~:, [ never saw a
situa’don in whidi ~iiis system of prescribing compromised patient Safety or the quality el" care:

I conskle.red that [ had appropriate relevant experience in th.e treatment of p~[tients with such
drugs fi:om my previous: e×pe,,~ienCe as a nurse, and th.rot~gh specific training, lrt particular, ha
February 1998 i7 spent a day and a half at the Rowans 1 {ospice, a local hospice, which provided a
~.D tlmrough course in the use of syringe drivers, conversion rates, the compatibility of drags,
and tl~e use of opiams and benzodiazipi~es: inelu(tlng {he effects of such drags :in the body, i~:
particular for patim~ts whose l~ealth is Compromise& [ believe that most o[’ nay colleagues had
Similar trainina,
,, and from my ex"er: .......... they all had a tholxmgh k~mwledge of: the retevant
,;, .~. , :,~,,.,:v,
isstms,

From my experie~me, i ~ever felt t!~at vhat Dr Bm~.on had prescribed for a patient was
inapproprb:~te. It wasn’t always necessary to use the: medication, The: patient’s condition might
improve, or ~l’~ey migl~t pass away before t t.,c
:" - medication was aer(ually required, W:e would o~ly
consider tl~e admhfistradon of such medication or i~s increase when the: patient showed signs of
significant pain or discomfort; It. was !mr lli-I!.lstJ.a] for a patie~t: to have, tb!" example, a f!’ac,tured
’ ~
fei’llLiF, and s~mh patients will inevitably’ experience s ~ om~....degree::
..... of pain and &scomtort on being,.
moved or {~med, but this c;ou[d be transieet a:~d might seato down, Sud~ patiet}ts wog!ld not
receive Diamorphine in consequence, We would give !~hem moderate pain relief, for example,
paracetamo[ or somctl.mg siig!~tiy stronger, a~:d usua!!y i~ adva~ace of their being moved The
adrn~nistra:tkm of" I)iamo,’~pifine: was o~ a completely d:i!’t;st:ent basis, and was considered o~fly
where mere was indications: of conti,qum~s and quite severe pain and dis{!:esS, and when the, patient:

i. . e anna i
si ,¯ o . . . . . . . . . . . . . . . . . . . . . . . . . . j ..........
, .
[ ........................................... i
’9,.:i{nessed................. l Code A [
 MDU 100001-0010

i0
S I A 1 E5.’.ILN3 ().~ SI[OBI:t[AN ..~I~-YRIIE COLIANS

AGE: OVI.~;R 18

was Unable t0 t-eke oral pi!eparatio~l~,;i I be ie,ze fi!om: m)! experier~cc and training as a nt~rse I wa:~
able to dis~ii~guish betwee~ pair~ wlfich might be transient and limited, and pain a~J distress
wl~ich was s igrtii~C~mtand coiitir!tii!!g.

I am aware that ti’on~ time to time [)r Barton would record in the medical records <~[ am ]~at~pyjbr

~.~t~’.si,.~g .t.,~.,:{~)to c~)o@irl~ ~’Jeaf~5 ;~. ] was consciot~ th.at [)r l:-~arton knew/t~a~ the nursing staff were
competer~t to make the assessme~t of dearth. She would usually write this in the notes when she
felt that a patien*, was terminally ill

I am r~ot aware of ~my concerns being expressed on the part o17 consultar~.~s aboat Dr Bartor~.
whether this be in relatio~ to general iss,~es relath~g to care, her prescribing, or her not.e keepi,~g.
Similarly [ am not aware of anyone else expressing any such concerns, I certain.ly did not have
an}.’ s,,~ch concern~ about Dr Barton for my own t>,a~..

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