Part 1 - Ralph Winstanley - FACTS about his death - Jan to11Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts



If you read this combined page, (made of 9 pages), from top to bottom, (reading also all the links), you will be presented with the precise reason why it can be stated that Ralph Winstanley was murdered.

It has never been stated, (in spite of much muddying of the water by Doncaster PCT), that most of the staff did any more than their job. Various professionals did less than their job. Some lied, when they were fully aware that Ralph Winstanley had not been dying. Dr David J Brown, Dr Gillian M Harding Dr Rachel Sykes and Dr Kevin Lee need to answer questions about their work during the killing of Ralph Winstanley.

The cause of Ralph Winstanley's death, was the lies deliberately told by someone who had much to gain Those lies were recorded by South Yorkshire Ambulance Service and - crucially - by on-call doctor, Dr Kevin Lee, who couldn't be bothered to meet the patient for whom he ordered 'terminal care'.

His diagnosis seems to have been made only on the lies told by a medically unqualified woman and not on the patient's medical record.

Read on - and do contact me at ralphwinstanley@yahoo.co.uk, if you have any comment or can help us to gain justice.

Table of FACTS in respect of Ralph Winstanley’s death
23Apr2004 - plus numerous supporting document abstracts

FIRST PART - 01Jan to 11Apr2004

13Jan2004
FACT: Ralph Winstanley underwent the first of two Gastroscopies/Endoscopies with Histopathies/Biopsies at the Gastroenterology Clinic, Doncaster Royal Infirmary.
Consultant Physician and Gastroenterologist, Dr Gary James Clinical Records - No 1

15Jan2004
FIRST REPORT TO GP
RE 13Jan2004
FACT: A letter was received from Outpatients– dated 13Jan2004. The full content of that letter, sent by Dr R J Atkinson, was entered in Ralph Winstanley’s GP Medical Records. It details the concerns, procedure and how the patient coped with it.
GP Medical Records abstract - Mrs Emma Briggs - No 2b

30Jan2004
SECOND REPORT TO GP
RE 13Jan2004
FACT: Contents of the Histopathology Report – dated as 13/01/2004 - were entered in Ralph Winstanley’s GP Medical Record by Mrs Josie Mace on 30Jan2004.
Dr D Brown’s name is appended to that record.
GP Medical Records - Mrs Josie Mace - No 2a

03Feb2004
FACT: Ralph Winstanley was told of the negative result during a consultation with Dr David J Brown
‘ 03/02/2004 Surgery consultation Dr D Brown
03/02/2004 Test result to pat personally re oesophageal biopsy report – nil suspicious but cannot be 100% certain if symptoms return -> review Dr D Brown’
GP Medical Records - Dr David Brown - No 2a

10Feb2004
THIRD & FOURTH REPORTS
TO GP
RE 13Jan2004
FACT: Two letters, recording the fact that no malignancy had been found, were sent, by Dr Gary James; one to Dr David J Brown and the other to Ralph Winstanley – except that both seem to have arrived at Dr David Brown’s, as both were recorded in Ralph Winstanley’s GP Medical Records. So did Ralph Winstanley ever see his copy?
Letters dictated by Dr Gary James on 30/01/2004, sent on 10/02/2004 to Dr David J Brown and to Ralph Winstanley
Consultant Physician and Gastroenterologist Dr Gary James - No 3a
Consultant Physician and Gastroenterologist Dr Gary James - No 3b

11Feb2004
FACT: On 11Feb2004 the entire contents of the letter to Dr David J Brown, (dictated 30Jan2004 typed and sent 10Feb2004), from Consultant, Dr Gary James, was entered into Ralph Winstanley’s GP Medical Record by Mrs Emma Briggs. Dr D Brown’s name is appended to this entry.
GP Medical Records abstract - Mrs Emma Briggs & Dr David J Brown - 2a

17Feb2004
Ralph Winstanley is supposed to have been present at the office of Mr Jonathan Goodwin of Bridge Sanderson Munro, solicitors, to sign a will. In fact he seems to have signed two wills on that day.

FACT: The second ‘will’ – 2 pages long, has been altered in date several times and is also signed by only one witness, Mr Jonathon L Goodwin, the solicitor
Two page ‘will’- page 1 - No 5i
Two page 'will' - page 2 - No 5ii

FACT: On page 2 of the 5-page ‘will’, Ralph Winstanley gets his own daughter’s name and that of his granddaughter, wrong. He also gets wrong the various addresses of her whole family. Yet he had visited them all at home and knew where they lived.
5 page ‘will’ - page 1 - No 4i
5 page 'will' - page 2 - No 4ii
5 page 'will' - page 3 - No 4iii
5 page 'will' - page 4 - No 4iv
5 page 'will' - page 5 - No 4v

FACT: Ralph Winstanley’s Pathology Report produced by Home Office Pathologist, Professor Helen Whitwell, shows that he had three forms of dementia at death – only two months later.
Pathology Report -page 6 - No 77vi
Pathology Report - page 7 - No 77vii

FACT: Consultant Neuropathologist, Dr Wharton, who conducted tests on 17 brain samples states that :
‘Individuals with such pathology as your father’s brain showed might well be expected to show some evidence of cognitive impairment in life,..’
Email written by Consultant Neuropathologist, Dr Wharton - 07Nov2006 - No 79

17Feb2004
FACT: Ralph Winstanley rang his daughter, Linda, and urgently arranged to meet her early that same evening. He didn’t mention a new will. She was concerned about his state of mind at that meeting – and about him driving home – so he agreed to ring her when he got back
Affidavit - abstract - Linda Kirby - re: 17Feb2004 - No 6

02Mar2004
NOTE WELL
FACT: It is recorded in Ralph Winstanley’s GP Medical Records that he had a standard chest x-ray at Doncaster Royal Infirmary. As a result of this he was to have a course of antibiotics and return in 6 weeks, (around 13Apr2004), for a follow-up chest x-ray. No follow up x-ray seems to have been cancelled or performed – or mentioned at all.
GP Medical Records - Ms Julie Watson - No 6a
GP Medical Records - Ms Julie Watson - No 6b

08Mar2004
FACT: Medical consultations in respect of Ralph Winstanley’s health were often made not with him but with Nina Clayton.
This seems to indicate that he had no control over his own medical treatment.
See various entries in GP Medical Records - below

08Mar2004
FACT: in a private telephone call, Nina Clayton spoke to Catherine Clayton, at Field Road Surgery. This seems to indicate that Ralph Winstanley was not involved in decision-making in this matter.
‘08/03/2004 Telephone encounter spoke to wife requesting advice re incontinence problems, says dribbling all the time, wanting incontinence assessment details to D/Nurses for assessment’Mrs Catherine Clayton, Field Road Surgery,Stainforth - GP Medical Records abstract - No 7


FACT: 31/03/2004 the District Nursing Records state ‘He says he has not experienced any urinary incontinence’
District Nursing Sister Julie Marshall - District Nursing Team Office Records abstract - No 8

08Mar2004
NOTE WELL
In more than 6 weeks - until he died - no appointment was made for him to see a Consultant Urologist. Why not?

RE: 08Mar2004
FACT: in another indication of this lack of control; ‘30/03/2004 person made appointment NOS Wife spoken to, not able to attend for further endoscopy – clinical diagnosis accepted -> offered full support – Dr D Brown’ This seems to indicate that Ralph Winstanley was not involved in decision-making in this matter either. Also, since Dr David Brown was involved in the ‘appointment’ on 30/03/2004, it seems obvious that he was aware that Ralph Winstanley did not have control over his own affairs.
There is nothing here to state what ‘clinical diagnosis’ was ‘accepted’.
GP Medical Records - abstract - Dr David J Brown - No 9

09Mar2004
FACT: Ralph Winstanley’s daughters, Linda and Charlotte, were informed, by Nina Clayton and her younger daughter, Rosemary Cheesman by telephone, that their father, ‘was dying’.
Affidavit - abstract - Linda Kirby - No 11
Affidavit - abstract - Charlotte Peters Rock - No 12

NOTE WELL: Following this call, his younger daughter, Linda went to see him every other day, until 26 March 2004, when she went on holiday. He did not seem to be dying. He looked remarkably physically fit for his age. Both phone calls were made on the day before his second Gastroscopy/Endoscopy with biopsies taken for histopathology. Neither daughter was aware that this was taking place.

10Mar2004
FACT: Ralph Winstanley underwent his second Gastroscopy/Endoscopy with biopsies at Doncaster Royal Infirmary.
Consultant Physician & Gastroenterologist, Dr Gary James - Doncaster Royal Infirmary - Letter of 14Mar2006 - page 1 - No 10i
Consultant Physician and Gastroenterologist, Dr Gary James - Donaster Royal Infirmary - Letter of 14Mar2006 - page 2 - No 10ii

FACT: He tolerated well, the procedure - of having a gastroscopy tube put down his oesophagus – needing no pre-medication. This - alone -shows that he was not having any great difficulty in that area – and certainly shows that he did not have terminal oesophageal cancer.
No 13 - Gastroenterology Clinic - Assessment Record - No 13

11Mar2004
THIS IS THE ONLY REPORT ON THE 2ND ENDOSCOPY. THERE IS NO REPORT ON THE BIOPSY IN GP RECORDS
FACT: The INITIAL Report, made by Staff Physician, Dr R Karwa, on 10Mar2004 – the day when the biopsy tissue was taken - is fully recorded in the GP Medical Record, on 11Mar2004 as ‘No 10a - GP Medical Record - Mrs Emma Briggs - Letter from Outpatients' - No 10a

NOTE WELL: The second Histology/Biopsy Report (of 10Mar2004) does not appear ANYWHERE in Ralph Winstanley's GP Medical Records.

FACT: The first Histology/Biopsy Report, (13/01/2004) had shown no sign of malignancy.
The second, Histology/Biopsy Report also showed no sign of malignancy (10/03/2004) as the Consultant was quite happy to state.
Doncaster and Bassetlaw NHS Trust, Consultant Physician and Gastroenterologist
Dr Gary James - letter of 14Mar2006 - page 1 - No 10i
Doncaster and Bassetlaw NHS Trust, Consultant Physician and Gastroenterologist, Dr Gary James - letter of 14Mar2006 - page 2 - No 10ii

Dr David J Brown is believed to have initialled the Pathology Services Report on Biopsies taken at second endoscopy - 10Mar2004 - No 15a
It has not been entered into the GP Medical Record, as the previous one had been. Why did Dr Brown not enter it?
Pathology Services Report on Biopsies taken at second endoscopy -
10Mar2004 - No 15a

15Mar2004
FACT: Histology/ Biopsy Results were shown as:‘Necrotic ulcer slough, inflamed granulation tissue and fragments of non-dysplastic oesophageal squamous epithelium. There is no evidence of dysplasia or malignancy. A fungal stain is negative.’
Dr Gary James states that the result was reported on 15 March 2004
Doncaster & Bassetlaw NHS Trust - Pathology Services - No 14
NOTE WELL: This is the same day on which Dr Brown recorded 'oesophageal cancer' in Ralph Winstanley's GP Medical Record.
Doncaster and Bassetlaw NHS Trust, Consultant Physician and Gastroenterologist
Dr Gary James - letter of 14Mar2006 - page 1 - No 10i
Doncaster and Bassetlaw NHS Trust, Consultant Physician and Gastroenterologist, Dr Gary James - letter of 14Mar2006 - page 2 - No 10ii

15Mar2004 & 30Mar2004
FACT: Dr David J Brown, in two entries which he personally made in Ralph Winstanley’s GP Medical Record, ( on 15Mar2004 and 30Mar2004), shows that he took two telephone calls – at least one of them from Nina Clayton - about Ralph Winstanley.
GP Medical Record abstract - Dr David J Brown - No 10a

15Mar2004
FACT: on 15Mar2004 Dr David J Brown recorded:
‘15/03/2004 Telephone call from a patient Dr D Brown
15/03/2004 Oesophageal cancer see 2nd endoscopy report Dr D Brown’
This entry proves that Dr Brown had received the 2nd Endoscopy report.
GP Medical Record abstract - Dr David J Brown - No 10a
NOTE WELL! The Report below this entry, in the GP Medical Record abstract, is NOT the 2nd Histology/Biopsy Report. It is the initial Gastroscopy/Endoscopy Report, which is made by eye rather than by the results of the biopsy.
The 2nd Histology/Biopsy Report, for biopsies taken on 10Mar2004, will have been sent from the Pathology Services, (probably on 15Mar2004), to Dr Brown. This would follow the pattern of the first Histology/Biopsy Report for the previous biopsies, which had been taken on 13Jan2004 (and which was entered into GP Medical Records on 30Jan2004)
That - GP Medical Record abstract - first Report was entered on 30Jan2004 - by Mrs Josie Mace - No 2b
and - GP Medical Record abstract - confirmed by entry on 11Feb2004 - by Mrs Emma Briggs - No 2b

FACT: This copy of the second Gastroscopy/Endoscopy Report (10Mar2004) is signed/initialled - believed to be Dr David J Brown's signature/initialling - which further seems to show that he received the Report sent by either Doncaster & Bassetlaw Pathology Services or by Dr Gary James.
That signature/initialling is believed to be that of Dr David Brown - No 15a

FACT: The report from Haematology Clinic (a different clinic to Gastroenterology) (06Apr2004), on Ralph Winstanley’s blood tests, shows that Dr David J Brown – whose signature is also believed to be appended on that Report - No 15b – signed the document above to agree that he had seen it. The signatures are the same. Yet the only common factor between the two departments is Dr David J Brown, whose patient was attending both clinics.

The next FACT shows that Dr David J Brown misreported the result for some reason.
15Mar2004
FACT: This Histology/Biopsy Report, on the samples taken on 10Mar2004 - was also negative for any malignancy.
Clinical Records of Consultant Physician and Gastroenterologist, Dr Gary James - No 14

NOTE WELL: INVESTIGATION CANCELLED(No letter of confirmation from the Consultant, Dr Gary James, was sent, because there was to be another investigation on 30Mar2004. That investigation was cancelled – by someone - and another appointment was made for 05May 2004.
Consultant Physician and Gastroenterologist, Dr Gary James - letter of 14Mar2006 - page 1 - No 10i
Consultant Physician and Gastroenterologist, Dr Gary James - letter - 14Mar2006 - page 2 - No 10ii
Ralph Winstanley was already dead before that date.

30Mar2004
NOTE WELL: RALPH WINSTANLEY WAS UNAWARE THAT HE WAS SUPPOSED TO BE DYING
FACT: on 30Mar2004 Dr David J Brown recorded:
‘30/03/2004 Telephone call from a patient Dr D Brown
30/03/2004 Person made appointment NOS Wife spoken to, not able to attend for further endoscopy – clinical diagnosis accepted -> offered full support Dr D Brown'
GP Medical Record abstract - Dr D Brown - No 10a

NOTE WELL! There is nothing to say what ‘clinical diagnosis’ was ‘accepted’ – nor that it was Ralph Winstanley who ‘accepted’ it. The note above, made by Dr Brown, makes it very clear that it was not Ralph Winstanley who made the telephone call but his wife Nina Clayton.There is also the fact, that when Ralph Winstanley was rushed into hospital on 11Apr2004 the note made on the Ambulance Record Patient Report Form states ‘Terminal CA patient unaware’.
Ambulance Record - Patient Report Form - 11Apr2004 - No 25
NOTE WELL: This makes it obvious that Ralph Winstanley’s GP had not told him - by 11Apr2004 - that he was dying. According to his records Ralph Winstanley was not dying

07Apr2004
FACT: Ralph Winstanley returned for his usual monthly check up at the Haematology Clinic of Dr Gautam Majumdar, on 05Apr2004. Following more than 6 months with no need for chemotherapy for his chronic lymphocytic leukaemia, it was felt that he should have another 5 days of chemotherapy (Fludarabine) tablets, which - according to his Consultant, Dr Gautam Majumdar - kept his CLL under ‘reasonable control’.
GP Record marked as seen by Dr David Brown.
GP Medical Record abstract - Ms Diane Wilson - Mrs Emma Briggs - Dr David J Brown - No 10b

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Part 2 - Ralph Winstanley - FACTS about his death - 11Apr2004 - 18Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts



Table of FACTS in respect of Ralph Winstanley’s death

23Apr2004 - plus numerous supporting document abstracts

Second part - 11Apr2004 to 18Apr2004

11Apr2004
FACT: Ralph Winstanley spent the hours between 9am and 3pm – on 11 April - with his daughter, Linda, going out to lunch for her birthday and appearing perfectly normal & happy. He was walking well and ate his meal with evident relish. Afterwards he was happily chatting for a couple of hours before she went away. He seemed well at that time, to his daughter.
Affidavit - abstract - Linda Kirby - No 16

11Apr2004around18.00
FACT: In a telephone call, made less than 3 hours later, by Nina Clayton to Linda Kirby, Ralph Winstanley was stated to be dying. Nina Clayton had him rushed, ‘dying and on oxygen’ into Doncaster Royal Infirmary.
Affidavit - abstract - Linda Kirby - No 17

11Apr2004 - 17.40
FACT: Ambulance Communications Record, shows that the person (a married female), South Yorkshire Ambulance Service - Communication Record Transcript - No 18
was stating – at 17.40 - that Ralph Winstanley
‘..is quite ill he has had a lot of problems breathing ……at the moment he is just getting chest pains and he can’t seem to get any breath.’
Also that he had been seen by the nurse ‘a couple of days ago’ and that ‘he can hardly walk’ and that ‘she took his blood pressure and it was very low it was 85 over 40’
South Yorkshire Ambulance Service - Communication Record Transcript - No 18

FACT: The Nursing Record shows that when his blood pressure had been taken on 8 April, by the nurse, it had been ‘100 over 57 sitting’ and ‘83 over 50 standing’
Nursing Record - 08/04/2004 - signature indecipherable - No 20

11Apr2004
NOTE WELL: The box which should be crossed if the patient is in pain has not been crossed.
FACT: Under ‘Description Given’, it states:
‘Chest Pain’ also ‘SOB’ (shortage of breath)
Under ‘Comments & Observations’ it states:
'SOB + chest pains for 2 days. Pale Resp 24 Pulse 100 SpoO2 on air 97 BP 110 systolic Patient feeling dizzy when stood up’Also
‘PMH/Leukaemia/CA? Lung?/Fluid retention stomach problem’
South Yorkshire Ambulance Service - Single Responder Form - MH No 542 - call sign DP5

FACT: He had not been short of breath nor having any chest pains when he had spent 09.00-15.00 with his daughter on that day. He had been walking well.
Affidavit abstract - Linda Kirby - No 16

11Apr2004 17.56-18.20
NOTE WELL
FACT: At top right hand corner of the Single Responder Form there are numerous boxes in which crosses need to be put, to state as clearly as possible the state of the patient.
He is marked as ‘conscious’
In respect of his airways and breathing his breathing is
‘clear’ and ‘normal’
It is noted that his circulation has:
‘radial pulse'
that his skin is ‘pale’ and ’>2Sec’
Also that he is ‘calm’
He is marked as being ‘alert’
The box, which should be crossed if the patient is in pain has not been crossed. This seems to indicate that he was not found to be in any pain.
South Yorkshire Ambulance Service - Single Responder Form - No 542 – call sign DP5 - No 22

11Apr2004
FACT: Ralph Winstanley had spent 6 hours with his younger daughter that day (9am-3pm), when she had found him to be quite well and in a happy mood. He had no chest pains. He had gone out to a pub for lunch. He certainly was not complaining of ‘stomach pain’. He ate a hearty meal. The false information, given to the First Responder, was less than 3 hours after Linda had happily left him.
Affidavit abstract - Linda Kirby - No 16

11Apr2004 - 18.01-18.10
NOTE WELL
FACT: The Single Responder handed over to the Ambulance Staff at 18.01 - who left the scene with Ralph Winstanley at 18.10.
Description given to them: ‘chest pain’
Their description of signs and symptoms:
Pre. Med History: ‘Lymphatic leukaemia Hypotension’
At time of arrival they were told:
‘PT C/o pains in stomach since yesterday, SOB and appears confused, feels generally unwell, dizzy,
and significantly –
‘Not c/o pain at moment.’
Also
‘Wife travelled with PT’
South Yorkshire Ambulance Service - Ambulance Patient Report Form - Attendent 24 - Driver 535 - No 23
South Yorkshire Ambulance Service - Ambulance Patient Report Form - Attendent 24 - Driver 535 - No 24

NOTE WELL: As the comment,'appears confused’, was also written – about the patient - it seems likely that the information gleaned by the Ambulance staff came from the ‘wife’ who ‘travelled with him’ rather than from the patient. It is difficult to see where else it could have come from.

NOTE WELL: It states – above – that he had 'pains in stomach since yesterday'.
Yet only three hours before, he had shown no sign of any pains in stomach, when he went out to lunch with his daughter. Nor did he show any signs from the time when she first arrived at the house at 09.00 until 15.00 when she left him. He ate a hearty meal – with evident pleasure.
Affidavit abstract - Linda Kirby - No 16

11Apr2004
FACT: For the 6 hours between 9am and 3pm, which he spent with Linda, he had not appeared confused. Nor had he complained about feeling unwell in any way
.Affidavit abstract - Linda Kirby - No 16

11Apr2004 - 18.01-18.31
NOTE WELL
RALPH WINSTANLEY WAS UNAWARE THAT HE WAS DYING
FACT: Written along the left hand side of the Patient Report Form are the words:‘Terminal CA Patient unaware’It is interesting to speculate where this information came from. It certainly could not have come from the patient, since the patient was stated to be ‘unaware’.The only other person in the Ambulance was Nina Clayton.
South Yorkshire Ambulance Services - Ambulance Patient Report Form - Attendant 24 - Driver 535 - No 25

FACT: There is no medical evidence for the statement,
‘Terminal CA Patient unaware’, since both Consultants, separately, agree that the patient, Ralph Winstanley, was not in any danger of dying from cancer.
Consultant Physician and Gastroenterologist Dr Gary James - letter of 14Mar2006 - page 1 - No 10i
Consultant Physician and Gastroenterologist Dr Gary James - letter of 14Mar2006 - page 2 - No 10ii
Consultant Haematologist Dr Gautam Majumdar - letter of 08Mar2006 - No 26

11Apr2004 - 18.01-18.31
NOTE WELL: RALPH WINSTANLEY WAS UNAWARE THAT HE WAS DYING - possibly because he wasn't?

FACT: At 18.31 the Ambulance arrived at A & E, Doncaster Royal Infirmary. Handing over not only the patient but also the Patient Report Form. Since the words ‘Terminal CA Patient unaware’ were written down the left hand side of this Form, that is the information which nurses and Senior Houseman, Dr Jamasp Dastur had to work from, in respect of this ‘confused’ patient . That copy of the Patient Report Form was retrieved, by Linda Kirby from A& E at Doncaster Royal Infirmary. – quite separately to the Ambulance records which also show it.
South Yorkshire Ambulance Service - Patient Report Form - No 25

11Apr2004 - 18.37
FACT: At 18.37 Triage Nurse notes state ‘no pain at present’
Doncaster Royal Infirmary - A & E Records - Michele Breeze, Triage Nurse Notes -No 27

11Apr2004 - 20.32-22.00
FACT: At 20.32 Senior Houseman, Dr Jamasp K Dastur records: ‘No pain now’.
Ralph Winstanley was kept under observation for three hours, no problems were seen; he was given one Paracetamol and then allowed home at 22.00, the same evening. Any supposed ‘chest pain’ was put down as being ‘musculo skeletal’.
Doncaster Royal Infirmary - A & E Records - Senior Houseman, Dr Jamasp K Dastur - No28

11Apr2004 - 17.00-22.00
FACT: Both daughters saw him for most of his time in
A & E, arriving at 19.00 and leaving at 22.00, as he also left. He was looking confused but stated that he wanted to go home - and that he was not in any pain. He didn’t seem to understand what he was doing there.
Affidavit abstract - Charlotte Peters Rock - No 29

13Apr2004
NOTE WELL:
Following his chest x-ray and antibiotics, of 6 weeks earlier, Ralph Winstanley should have returned for a second chest x-ray at around this date.

FACT: There is nothing in the GP Medical Records or other Records, which Ralph Winstanley’s daughters have, to indicate that he ever returned for a second chest x-ray. Why was that?
GP Medical Records - Ms Julie Watson - No 6a

14Apr2004
FACT: A letter arrived at Dr Brown’s Field Road Surgery, from Senior House Officer, Dr Jamasp Dastur, of A & E, Doncaster Royal Infirmary, confirming Ralph Winstanley’s visit to A & E, and stating that any pain, which he might have felt was only ‘musculo-skeletal’. The contents of that letter were entered into the GP Medical Record by Mrs Emma Briggs.
Dr Brown’s name is appended as having seen that entry.
GP Medical Records abstract - Dr David J Brown - entered by Mrs Emma Briggs - No30

14Apr2004
NOTE WELL: He was on Oramorph for 4 days & nights before 18Apr2004
FACT: Dr David J Brown decided to put Ralph Winstanley on Oramorph (Morphine-by-mouth) every 4 hours, mentioning ‘chest pain’ as the reason why he had been seen at A & E over the weekend. (This was a man trying to recover from chemotherapy, who needed to eat well to aid his recovery). It seems - from the record - his only presenting complaint at Dr Browns consultation was shortness of breath - not 'chest pain'. Having just completed a course of chemotherapy, wouldn't it be likely that he would have shortness of breath as his system tried to recover? Chemotherapy is designed to kill blood cells - which then have to replenish; taking up to 40 days (Fludarabine)
GP Medical Records abstract - Dr David Brown - No 31a
GP Medical Records abstract - Dr David Brown - No 31b

FACT: Ambulance and A&E records state that no chest pain was observed over the weekend either.
South Yorkshire Ambulance Service - Ambulance Records abstract - 11Apr2004
Doncaster Royal Infirmary - A & E Records abstract - 11Apr2004

FACT: It is clear from the GP Medical Record that Ralph Winstanley was not experiencing any chest pain at the time the Oramorph was prescribed
GP Medical Records abstract - Dr David Brown - No 31a
GP Medical Records abstract - Dr David Brown - No 31b

15Apr2004
FACT: At his request, Ralph Winstanley’s ex-wife, Nettie, was brought to see him, by his daughter Linda. Whilst she was there, Nettie was not left alone with him at all. Rosemary Cheesman was constantly hovering in the room, listening closely to the conversation. Ralph put his finger up to his lips at one point, to stop Nettie speaking in front of Rosemary.
(For quite some time, Ralph Winstanley had not knowingly been left alone with any of his own family – his two daughters. Now he was not left alone with his elderly ex-wife either.)
Affidavit abstract - Linda Kirby - No 32
NOTE WELL: Also see Nettie Winstanley for more information on this

16Apr2004
NOTE WELL
FACT: Urine examination revealed that there was no growth apparent in the solution. However, in spite of this, no suggestion was made that the urinary catheter could be removed. It was still in situ – for some reason - when Ralph Winstanley died.
No appointment seems to have been made for him to see any specialist in respect of his prostate or his ‘incontinence problems’, though that would normally have been expected, where a patient had needed catheterisation. Why was no appointment made for him to see a Consultant Urologist?
GP Medical Records abstract - Dr David J Brown - No 33

Part 3 - Ralph Winstanley - FACTS about his death - 18Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts

Table of FACTS in respect of Ralph Winstanley’s death

23Apr2004 - plus numerous supporting document abstracts

Third part - 18Apr2004

18Apr2004 - early Sunday morning 03.00
FACT: Nina Clayton telephoned Linda Kirby – yet again - to say that her father Ralph Winstanley was dying. Linda went across to Grange Farm, arriving at 4am
Affidavit abstract - Linda Kirby - No 34a
Affidavit abstract - Charlotte Peters Rock - No 34b

18Apr2004 - 06.18
FACT: Nina Clayton telephoned the on-call doctor service
Stating that Ralph Winstanley was ‘terminally ill, getting worse, not mobile stopped eating.’
The note was also made:
‘Wife very concerned – needing help’

FACT: About this contact Dr Kevin Lee states: ‘I was on duty at DDS on 18th April 2004 when Mrs Winstanley rang regarding her husband. The time was 06.18.
I replied at 06.40 & heard from Mrs Winstanley that her husband who was suffering from multiple terminal pathologies including Chronic Leukaemia, heart failure, stomach nodules & low protein had been seen the previous Friday by Dr David Brown his GP.
Dr Brown had given Mr Winstanley a terminal prognosis.’

ADASTRA Consultation note - Dr Kevin Lee - No 35
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 1 - No 36a
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b
NOTE WELL: ‘multiple terminal pathologies’ and ‘terminal prognosis’.
But no documentary confirmation

18Apr2004
NOTE WELL: Terminal care prescribed, patient not seen by any doctor

FACT: Dr Kevin Lee’s letter also states:
‘Mrs Winstanley reported that Mr Winstanley was distressed & had not slept well during the night.’
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 1 - No 36a
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b

FACT: On the basis of this call, with no medical confirmation of anything which he was told, Dr Kevin Lee seems to have thought it reasonable, without ever seeing the patient – to prescribe Terminal Care for the first time. Letter dated 18May2004
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 1 - No 36a
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b

18Apr2004 - 08.45
FACT: The first Nursing Sister to visit – sent by Dr Kevin Lee of Danum Doctors, who never meets Ralph Winstanley - states nothing about observing Ralph Winstanley being in any pain. She only states that he is ‘settled’. However, she does state that Mrs Winstanley tells her that:
‘her husband has settled a little but remains restless’.
Her notes make it obvious that she does not observe this for herself
Community Intervention Team Office Notes - Sister S Zadrozny - 37a
NOTE WELL: Not observed to be in pain

18Apr2004
FACT: The Community Intervention Team Dependency Scale, which must have been filled in for the benefit of other nurses, on 18 Apr2004 – when CIT nurses first saw him – states that: (in a scoring system of 1-5)
‘Personal Care – Dependent’ (5)
‘Feeding – Medium – poor appetite at the moment’(3)
‘Continence – High – catheterised’(4)
‘Mobility – Low – uses a walking stick’(2)
Nursing – medium – frequent visits (3)
Psychological health – Independent – self sufficient’(1)
‘Total scoring – 18 – medium’
which is interesting – to say the least. The total score is only 18. Total dependency – on this scale – comes in at 25+
Community Intervention Team - Dependency Scale - 18Apr2004 - No 48
NOTE WELL: No mention of patient being unable to take food or drink – or being unable to walk or bedfast

FACT: At this point on 18Apr2004, Ralph Winstanley’s psychological health is stated to be ‘independent’ and ‘self-sufficient’.
In that case, why did none of the nurses listen when he stated – on numerous occasions, over those two days, that he had no pain?Community Intervention
Community Intervention Team - Dependency Scale - 18Apr2004 - No 48

18Apr2004 - 18.37
FACT: Nina Clayton telephoned the Twilight Nurses, who contacted Danum Doctors again, stating ‘c/o started on syringe driver today. Aggitated. Trying to pull catheter out.’
Danum Doctors - ADASTRA Consultation note - Dr Kevin Lee - No 38

18Apr2004
FACT: About this contact, Dr Kevin Lee states:
‘Later the same day at 18.37 a further call regarding Mr Winstanley was received by DDS. The call was from the Twilight Nurses who had been contacted by Mr Winstanley’s family saying that he was agitated & had been trying to pull his indwelling catheter out.. Dr Bundy arranged for a prescription for Midazolam & Haloperidol to be collected.’
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b

18Apr2004
FACT: Dr Kevin Lee also states:
‘..so I spoke with the nurses as I was already familiar with Mr Winstanley’s case from earlier in the day.’
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b

18Apr2004
FACT: From the fact that he stated that he was ‘familiar’ with a patient whom he had never met, and whom no-one had observed to be in any pain, Dr Kevin Lee was happy to increase the number of drugs going into Ralph Winstanley, in this Terminal Care, and to order a second syringe driver.
Danum Doctors - Dr Kevin Lee - Letter dated 18May2004 - page 2 - No 36b
NOTE WELL: Level of ‘terminal care’ increased – but patient has ‘no pain’

FACT: During the whole of that day and the following day (19Apr2004), Ralph Winstanley kept stating to the nurse that he was not in any pain.
Letter dated 18 May 2004
4th Affidavit, abstract - 18Apr2004 - Charlotte Peters Rock - No34b

18Apr2004 - 23.45
FACT: RGN Shannon, who claims – erroneously – that she set up a second syringe-driver at this time also states, in the Community Intervention Team Office Notes: ‘Ralph settled throughout the procedure’
She makes no mention of observing him to be at all unsettled – or in any pain
Community Intervention Team Office Notes - RGN B Shannon - No 37a
Community Intervention Team Office Notes - RGN B Shannon - No 37b
NOTE WELL: No pain observed.

18Apr2004 - 23.45
NOTE WELL: RGN B Shannon, also records in the Nursing Notes, that a second syringe-driver was set up at this visit.
Nursing Notes - RGN B Shannon & C Morris - No 39


FACT: Because of other entries in the Clinical Notes File, and the Syringe Driver Form, which disprove this statement, this entry shows that the Clinical Notes File was tampered with, at this point after Ralph Winstanley had died.
Nursing Notes - RGN PA Jones - No 46a
Nursing Notes - RGN PA Jones - No 46b
Nursing Notes - Syringe Driver Form - page 1 - No 41a
NOTE WELL: First 4 entries which show only 1 syringe driver in situ until 17.00 on 19Apr2004

FACT: There is a solitary entry on an otherwise empty Infusion Check Chart, which also claims that a second syringe-driver was in place at 23.45 on 18/04/2004
Infusion Check Chart - RGN B Shannon - No 40
(This syringe is stated as having 48mm of Midazolam. When first set up, this is not possible, since some of the fluid would be in the tube and in the needle itself, so the more likely amount in the syringe would be 44mm – had one been set up at all.
Entries in the Syringe Driver Form show this pattern. Each time the syringe driver was initially set up or repositioned - it shows less than 48mm. – usually 44mm)

18Apr2004 - 23.45
FACT: The Syringe-driver Form shows quite clearly that only one syringe driver was in place at 23.45 on 18/04/2004 – and that the amount of drug followed the time-to-amount band down from
18Apr2004 - 13.20 – 42mm – first filled – R leg
18Apr2004 - 21.00 – 28 mm – checked – Right leg
18Apr2004 - 23.45 – 20mm – checked – Right leg
19Apr2004 - 09.10 – 45mm – checked – Right side chest
19Apr2004 - 17.00 – 44mm – first set up - Left upper arm
19Apr2004 - 17.00 – 44mm – checked – Right upper arm
This shows that nurses check at each visit, whatever syringe drivers are in place –and record the amount of drug remaining.
(The syringe-driver takes 48mm when full. It releases fluid at the rate of 2mm per hour. So each re-fill can last for 24 hours. Newly set up syringe drivers show less in the syringe because some of the fluid is used to fill the tube and the needle.)
Nursing Notes - Syringe Driver Form - page 1 - No 41a

Syringe-driver Form - C Walker, K Watts, B Shannon, PA Jones, J Marshall, J Marshall - No 41b

18Apr2004 - 23.45
FACT: There was no second syringe-driver available on that night, so it could not have been set up on that visit.


FACT: Ralph Winstanley’s daughter notes, in her Affidavit (presented to Coroner and Police on 27Apr2004 – before she again saw the Clinical Notes File) that “I was surprised to be told that he now had a second ‘driver’ in place on his left leg.” She had been absent from 09.30am on 19Apr2004 and had returned to the house just after midnight (00.30) on 19/20Apr2004 when she first saw it.
Affidavit abstract - Charlotte Peters Rock - No 42

18Apr2004 - 23.45
FACT: Ralph Winstanley’s elder daughter, Charlotte, remembers hearing Nurse Shannon, speaking on the phone, in the kitchen – at her 23.45 visit – 18Apr2004 - as she requested another syringe-driver by telephone and was told that none was available.

FACT: on 19Apr2004 - Ralph Winstanley’s younger daughter Linda notes in her Affidavit “With one syringe driver already in his thigh when I left to see my mother around midday, I was only away a couple of hours at the most, but dad had another syringe driver in his other thigh when I arrived back.”
Affidavit abstract - Linda Kirby - No 42a

FACT: She also notes: “Even with 2 syringe drivers in his thighs, Dad was still getting in and out of bed, standing and walking to his chair at the bottom of the bed, sitting for a while and getting up himself and walking back to his bed.”
Verbal only

18Apr2004


FACT: Danum Doctors Pharmacy Record shows that only one dose of Midazolam was prescribed on Sunday 18 April. That is enough for only one injection. It is not enough to put into a second syringe-driver. No-one else was prescribing on 18 April, since it was a weekend. No doctor from Ralph Winstanley’s GP Practice saw him until lunchtime on Monday 19 April
Pharmacy Record in respect of Danum Doctors prescribing - Weldricks, East Laith Gate - No 43

Part 4 - Ralph Winstanley - FACTS about his death - 19Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death

23Apr2004 - plus numerous supporting document abstracts

Fourth part - 19Apr2004

19Apr2004 - 08.45
FACT: Notes made by Hospice-at-Home nurse, RGN Carolyn Smith indicate that she had been informed that Ralph Winstanley had cancer of the oesophagus. She writes
‘? CA Oesophagus’
Lower down the page she notes
‘Gastroscopy March 2004; CA Oesophagus’
Hospice-at-Home - Office Notes, front page - RGN Carolyn Smith - No 44
NOTE WELL: Who told her this? Two separate Oesophageal biopsies had shown that Ralph Winstanley did not have any sign of malignancy in his oesophagus or stomach.
Doncaster & Bassetlaw NHS Trust - Pathology Services - No 1
Doncaster & Bassetlaw NHS Trust - Pathology Services - No 14
On this page, the person who referred Ralph Winstanley to her was stated as: ‘Julie Marshall’, though ‘Dr Brown’ is also noted as the doctor.
Also, notes on this page confirm that there was certainly only one syringe-driver in place at the time when RGN Carolyn Smith filled in this part of her record
‘S.D. Diamorphine + Haloperidol’
(Diamorphine and Haloperidol were both put into the same syringe-driver.)
Hospice-at-Home - Office Notes, front page - RGN Carolyn Smith - No 44

19Apr2004 - 09.10
FACT: Only one syringe-driver is shown as being refilled at this time, which shows that there was still only one syringe-driver in place.
Syringe-driver Form - RGN PA Jones - No 41a
NOTE WELL: It is certain that RGN PA Jones only checked one syringe-driver, making a note about its contents in the Syringe-driver Form. Had there been two in situ, she would have checked both – as happens in the rest of the form. Next recorded visit was not until 14.50

19Apr2004 - 09.10
FACT: Nursing Note made by RGN PA Jones makes mention of only one syringe-driver – and the fact that it is set up with Diamorphine and Haloperidol
Nursing Notes - abstract - RGN PA Jones - No 46a
Nursing Notes - abstract - RGN PA Jones - No 46b

19Apr2004 - 09.10
FACT: In her Community Intervention Team Office Notes, RGN PA Jones also makes no mention of Ralph Winstanley being observed to be unsettled, or in any pain. Her comment is that: ‘Patient appears comfortable’
These notes also contain no mention of Midazolam or of a second syringe-driver. They do mention that Ralph Winstanley is still being kept on Oramorph, in spite of his having been on Diamorphine and Haloperidol for 24 hours, both by injection and via syringe-driver.
Community Intervention Team Office Notes - RGN PA Jones - No 37b
NOTE WELL: No pain observed

19Apr2004
FACT: Enough Midazolam to fill a syringe-driver with 60mg per 24 hours, was only dispensed on Monday 19Apr2004 by Danum Doctors. The prescription was for 10 packs of 10mg/2ml – 6 of which would be needed to fill a syringe-driver to dispense 60mg over 24 hours. (A further 22 packs dispensed on 20Apr2004)
(This shows that some of the Nursing Notes are erroneous)
Pharmacy Record in respect of Danum Doctors prescribing - Weldricks, East Laith Gate - No 43

19Apr2004 - 14.50
FACT: Nursing Notes still state ‘to check syringe-driver’ – in the singular. It also states ‘Dr Sykes had visited prior to our arrival and administered Midazolam due to Ralph’s agitation.’
Had there been a second syringe-driver in place at that time, there would have been no need to ‘administer Midazolam’, because the second syringe-driver would already have contained it.
This note continues by mentioning syringe-drivers, which seems to indicate that the second syringe-driver was due to be set up at this time, by District Nursing Sister Julie Marshall, who also states that ‘Dr Sykes has now increased dosage to 40mg Diamorphine, 60mg Midazolam Haloperidol 10mg. Drugs not available at time of visit.’Because of the entry at 17.00 – see below – it seems that the paragraph above, stated to have been made at 14.50 might have been made after Ralph Winstanley died. There is also the fact that this entry begins as 19/4/04 and continues over the page as 20/4/04, then returns to 19/4/04. Whoever wrote it seems to have been thoroughly confused.
Nursing Notes - abstract - District Nursing Sister Julie Marshall - No 47

19Apr2004 - 14.50-17.00
FACT: Hospice-at-Home Nurse, RGN Carolyn Smith’s main notes, seem to have been written after 14.50 on 19Apr2004.
District Nursing Sister Julie Marshall wrote in her Nursing Note of 14.50 ‘Hospice at Home due to visit this afternoon.’
Nursing Notes - abstract - District Nursing Sister Julie Marshall - No 47

RGN Carolyn Smith writes: ‘Ralph is in terminal phase of illness.’
Who told her this?
Hospice-at-Home Office Notes - RGN Carolyn Smith - No 45

19Apr2004 - 17.00
FACT: The first record of filling two syringe-drivers is at 17.00, when District Nursing Sister Julie Marshall marks them both down on the Syringe-driver Form for the first time, recording that she fills two syringe drivers each showing 44mm.
Nursing Notes - Syringe-driver Form - District Nursing Sister Julie Marshall - No 41a

19Apr2004 - 23.20
FACT: This last Community Intervention Team Office Note states: ‘Visit as requested to check syringe-driver commenced earlier by district team.’This shows exactly when the second syringe-driver was set up. ‘district team’ refers to District Nursing Sister, Julie Marshall and her team. The ‘district team’, (consisting only of District Nursing Sister Julie Marshall, on 19Apr2004) called twice that day. At 14.50 and 17.00. So it had to be on one of these occasions that the second syringe driver to contain Midazolam, was set up. There is confirmation in the Syringe-driver Form, that it was set up - for the first time - at 17.00
Nursing Notes - Syringe-driver Form - District Nursing Sister Julie Marshall - No 41a
NOTE WELL: No pain observed

FACT: RGN J Hopkinson also agrees that from her own observation: ‘Mr Winstanley settled and pain free’.
Community Intervention Team Office Notes - RGN J Hopkinson - 2nd note - No37b
NOTE WELL: So why was his drug dose increased at13.35 on 20Apr2004, by Dr Sykes?

Part 5 - Ralph Winstanley - FACTS about his death - 20Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death

23Apr2004 - plus numerous supporting document abstracts

Fifth part - 20Apr2004

19/20Apr2004 - overnight - 22.00-07.00
FACT: Notes made by overnight Hospice-at-Home nurse make no mention of turning Ralph Winstanley every two hours – because he was still being deliberately kept bolt upright at the instigation of Nina Clayton and with the moral and physical support of the various nurses and Dr Rachel Sykes.
Nursing Notes - RGN Lorna Clark - No 49
NOTE WELL: This is where the pain began

20Apr2004 - 11.50
District Nursing Sister Julie Marshall states ‘pressure areas intact’
Nursing Notes - District Nursing Sister Julie Marshall - No 50

FACT: At this point Ralph Winstanley was still sitting bolt upright as he had been since being drugged, which rendered him too unconscious to move about.
NOTE WELL: The main pressure area, at the base of his spine was certainly not checked, or he would have had to be lain down at this time because of the building damage across the base of his spine, his buttocks and scrotum.
Nursing Notes - Patient/Carer Communication Form – filled in on 21Apr2004 by Charlotte Peters Rock - following conversation with RGN Watts at 20.15 on that day - but written about 20Apr2004 - No 51

20Apr2004 - 14.00
FACT: two different handwriting styles – one RGN Grimshaw the other DNS Julie Marshall. The first notes are not signed.
Nursing Notes - abstract -(these are the first entries under 14.00 for 20Apr2004) - RGN Sarah Grimshaw and District Nurse Julie Marshall - No 52

FACT: On the lower half of the page the second notes are entered on the wrong day for what actually happened. These notes were entered after Ralph Winstanley’s death and are pure fiction in respect of that day. They state:
‘Granuflex to obtained for next visit. Discussed with Nina possibility of having airwave mattress but due to his current condition it would be very difficult to move Ralph onto a new bed. Dr Sykes has requested Hospice at Home team to visit this afternoon to bring pressure relief cushion. Ralph positioned onto his left side.’
Nursing Notes - abstract -(these are the first entries under 14.00 for 20Apr2004) - RGN Sarah Grimshaw and District Nurse Julie Marshall - No 52

NOTE WELL:Recorded by District Nursing Sister Julie Marshall on wrong day
This could not have happened at this time on this day. See Nursing Notes of RGN Lorna Clark for 22.00 20Apr2004 to 06.00 on 21Apr2004
Nursing Notes abstract - Hospice-at-Home nightsitting nurse - RGN Lorna Clark - No 59

20Apr2004 - 11.45
FACT: DNS Julie Marshall records: 'Mr Winstanley’s daughter present at time of visit and expressed extreme concern regarding how sedated she felt Ralph was and was enquiring as to whether medication could be reduced. She believes that his pain was due to indigestion and if he was given medication for this he would not be in so much pain. I advised that I was unable to reduce the dosage without prior notification from Dr Sykes and due to the level of agitation Ralph had displayed over the weekend and yesterday I felt that he was much more settled. Explanation was given as to why syringe driver had been requested due to his condition and possible difficulties in swallowing. His daughter however felt that if he was not sedated he would be able to swallow. I have advised his daughter to discuss her concerns with Dr Sykes during her visit this morning.'
Nursing Notes (second entry re 11.45 on 20Apr2004 – after the first entry for 14.00, on that day) - District Nursing Sister Julie Marshall & RGN Sarah Grimshaw - No 52b
NOTE WELL: second notes for 20Apr2004
NOTE WELL:SERIOUS COMPLAINT RECORDED

20Apr2004 - 20.15
FACT: Possibility of a pressure relief equipment was originally brought up at 20.15, on 20Apr2004, by Ralph Winstanley’s own daughters, who - discovering the damage to his spine and insisting he was lain down - began to ask for pressure relief for him.
Nursing Notes abstract - Twilight Nursing Service - District Nursing Sister Edgecombe - 53

20Apr2004 - 20.15
FACT: Following the discovery of pressure damage - and the overruling of her decision to sit the patient upright on such pressure damage - Sister Edgecombe also made a series of inaccurate and rather nasty little observations in the Twilight Nursing Service Office Notes, stating: ‘Just for information another daughter has arrived – very demanding and complaining about previous care. I was there a long time. Obvious friction between Nina and the older daughters of Mr Winstanley (In fact the ‘older daughter’, Charlotte, had been at Grange Farm since 09.30 on 18Apr2004 – and was asking for help)
Twilight Nursing Service Office NotesDistrict NursingSister Edgecombe - No 53a
NOTE WELL: SERIOUS COMPLAINT RECORDED

20Apr2004 - 11.50 - 14.00 - 11.45 - 14.00
FACT: There is a serious duplication of the Nursing Notes on 20 April. Ralph Winstanley’s blood family believes this shows that the notes were tampered with, after Ralph Winstanley’s death, since the only possible running order – shows intention to remove the original notes. However, this does not seem to have been achieved, before the police retrieved the Notes.
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54a
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54b
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54c
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54d
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54e
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54f
NOTE WELL: The whole Clinical Notes File, which had been kept at Grange Farm was ‘missing’ from 23Apr2004 to 27Apr2004

20Apr2004 - 11.45
FACT: Note made at 11.45 on 20 April shows that a serious complaint had been made to District Nursing Sister Julie Marshall - who did not act upon it.
‘Mr Winstanley’s daughter present at time of visit and expressed extreme concern regarding how sedated she felt Ralph was and was enquiring as to whether medicines could be reduced. She believes that his pain was due to indigestion..’and
‘His daughter however, felt that if he was not sedated he would be able to swallow.’
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54d
NOTE WELL: SERIOUS COMPLAINT RECORDED

20Apr2004 - 11.45 - 14.00 - (2nd 14.00)
FACT: Notes made at 11.45 and 14.00 wander into complete fiction, in respect of assessing ‘his sacrum’ (11.45) and ‘Pressure areas assessed and graded’.
NOTE WELL: signed and dated by DNS Julie Marshall
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54e

FACT: The Initial Wound Assessment Form shows that the assessment - mentioned above - did not take place until the following day, 21Apr2004
NOTE WELL: signed and dated by DNS Julie Marshall
Nursing Notes - Initial Wound Assessment Form - District Nursing Sister Julie Marshall - No 55

FACT: The Walsall Community Pressure Sore Risk Score Calculator shows that this assessment did not take place until the following day 21Apr2004
NOTE WELL: signed and dated by DNS Julie Marshall
Nursing Notes - Walsall Community Pressure Sore Risk Score Calculator - District Nursing Sister Julie Marshall - No 56

20Apr2004 - 11.45
FACT: 11.45 ‘Unable to fully assess pressure areas to sacrum..’ and ‘Mrs Winstanley happy not to disturb Ralph..’ shows that the nurses were being led by Nina Clayton (Mrs Winstanley) and not by professionalism, since – at that time – he was still sitting bolt upright as the pressure damage took serious hold on the base of his spine – and he was being deliberately drugged unconscious, which caused him to become increasingly still.
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54e

20Apr2004 - 14.00 - (the second 14.00 in the Nursing Records on that day)
FACT: In spite of the reservations expressed by ‘Mr Winstanley’s daughter’ at 14.00, District Nursing Sister Julie Marshall writes here:
‘Visit required to increase Diamorphine to 60mg as requested by Dr Sykes following her visit.’
Nursing Notes abstract - 6 pages - RGN Dabell - District Nursing Sister Julie Marshall - No 54e
NOTE WELL: the word ‘INCREASE’
And
‘On assessing Ralph he appeared uncomfortable and leaning forward’. This shows that he was still upright at that point.
Nursing Notes abstract - 6 pages - RGN Dabell - District Nursing Sister Julie Marshall - No 54e
and
‘Ralph assisted onto his left side and made comfortable..’ is pure fiction, since he was still sitting bolt upright until 20.15 that evening.
Affidavit abstract - Charlotte Peters Rock - No 57
Affidavit abstract - Charlotte Peters Rock - No 57a
Affidavit abstract - Charlotte Peters Rock - No 57b
and
‘Ralph’s daughter concerned that it is the level of pressure which has caused Ralph to have pain and require the syringe-driver’, is yet again a complete fiction in that this note could not have been made at this time on 20 April, since the great pressure damage to the base of his spine was not discovered until 20.15 that evening, during the visit of DNS Edgecombe – see No 53 for first mention of ‘turning every two hours’.
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54e
NOTE WELL: His pain continued because no one would lie him down

20Apr2004 - 14.00 - (the second 14.00 on that day)
Another fiction: It is stated that ‘Dr Sykes had requested Hospice at Home to visit and bring pressure relieving mattress. Val Derks (Macmillan Nurse) arrived during visit with Spenco mattress. Following discussion with Val and Mrs Winstanley it was agreed not to place Ralph on mattress at time of visit’.

FACT: This could not possibly have taken place on that day - 20Apr2004 – since the damage was not discovered until later that night 20.15. This note was probably written after Ralph Winstanley died.
As an added complication RGN Val Derks, in her Hospice at Home Office Notes claims that this incident occurred on 19April2004 – which is also untrue. Most of the information which she has put down as 19Apr2004 actually took place on 21Apr2004
Hospice-at-Home Office Notes - Lead Palliative Care Nurse, RGN Val Derks - No 53b

20Apr2004
Another fiction: ‘Ralph’s daughter insistent that Ralph be lifted onto mattress but advised by myself and Val Derks that this was inappropriate as he was now laid comfortable.’
Nursing Notes abstract - 6 pages - RGN Sarah Grimshaw - District Nursing Sister Julie Marshall - No 54f

FACT: It was in fact ‘Ralph’s daughter’ who - on 21Apr2004 - seeing that a complete box mattress – rather than a ‘sheepskin’ had just been brought, who expressed the impossibility that her father could be moved, with less than 4 people to hold him and two more to change the mattresses. The interchange above, did not take place on this day, but in the afternoon of the following day, (21Apr2004) after he had been discovered to have a serious pressure wound at 20.15 on the evening of 20Apr2004 and his daughters had insisted that he was lain down. Following this he had relapsed into complete unconsciousness, where he remained until he finally died.
Affidavit abstract - Charlotte Peters Rock - No 57
Affidavit abstract - Charlotte Peters Rock - No 57a
Affidavit abstract - Charlotte Peters Rock - No 57b

20Apr2004
FACT: Pressure areas certainly could not have been checked, since he was left - unmoved and hardly moving - sitting bolt upright, in increasing pain and increasingly being rendered unconscious until Charlotte and Linda, discovering the pressure wounds, insisted that he was lain down – at 20.15 that evening, during the visit of District Nursing Sister Edgecombe (?)
(name not printed – signature unclear - previously thought to be Edgeware)
Affidavit abstract - Charlotte Peters Rock - No 57a
Affidavit abstract - Charlotte Peters Rock - No 57b
Affidavit abstract - Linda Kirby - No 58
Nursing Notes abstract - District Nursing Sister Edgecombe - No 53
Twilight Nursing Service Office Record - District Nursing Sister Edgecombe - No 53a
NOTE WELL: the building pain, from sitting upright, stopped the drugs from making him unconscious.

20Apr2004
FACT: 20Apr2004 - the Patient/Carer Communication Page was filled in, (on 21Apr2004) by Ralph Winstanley’s elder daughter, Charlotte, at the instigation of RGN K Watts, to comment on this lack of checking by the various nurses – and on the point when the pressure damage was found on 20 April
Patient/Carer Communication Form – (filled in on 21Apr2004 by Charlotte Peters Rock) - following conversation with RGN Watts at 20.15 on that day - but written about 20Apr2004 - No 51
NOTE WELL SERIOUS COMPLAINT RECORDED

20Apr2004
FACT: Sister Edgecombe (?)(previously thought to be Edgeware) notes in the Twilight Nursing Service Office records only that ‘another daughter has arrived – very demanding and complaining about previous care’ (In fact this daughter, Charlotte, had been at the house since 09.30 on 18Apr2004.)
Twilight Nursing Service Office Record – abstract - District Nursing Sister Edgecombe - No 53a
Affidavit abstract - Linda Kirby - No 34a
Affidavit abstract - Charlotte Peters Rock - No 34b
NOTE WELL SERIOUS COMPLAINT RECORDED

20Apr2004 - 20.15
FACT: Also written in the Nursing Notes ‘Nina didn’t want Ralph Disturbing.’
This refers to the fact that he was still sitting upright when Sister Edgecombe arrived – and that both she and Nina Clayton objected to him being lain down.
Nursing Notes - abstract
Nursing Notes abstract - District Nursing Sister Edgecombe - No53
NOTE WELL: It was Nina's wishes that kept him upright

20Apr2004 - 20.15
FACT: Also written in the Nursing Notes:
‘Family are turning Ralph every two hours to relieve pressure.’ Nursing Notes abstract - District Nursing Sister Edgecombe - No53

FACT: This refers to the fact that – by the time this nurse left – Ralph Winstanley had been lain down – at the insistence of his own two daughters, Linda and Charlotte – and against the wishes of both Nina Clayton (Mrs Winstanley) and District Nursing Sister Edgecombe (?)
Affidavit abstract - Charlotte Peters Rock - No 57

Part 6 - Ralph Winstanley - FACTS about his death - 21Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death
23Apr2004 - plus numerous supporting document abstracts

Sixth part - 21Apr2004

20/21Apr2004 - overnight - 22.00-07.00
FACT: Nursing Notes made by Hospice-at-Home nightsitting nurse, Lorna Clark, mention that Ralph Winstanley is now being turned every two hours – and his pressure areas checked.

FACT: Night-sit nurse states - at 22.00 20Apr2004:
‘Sacrum discoloured + L heel.’
then - at 03.00 21Apr2004
‘Pressure areas checked. Position changed. Ralph now on his L side. Both heels elevated off the bed to relieve pressure’
then - at 06.00 21Apr2004
‘Position changed. Ralph on his R side. Sacrum discoloured, heels elevated off the bed’
Nursing Notes - abstract - Hospice-at-Home nightsitting nurse - RGN Lorna Clark - No 59

21Apr2004 - 11.00
More Fiction: Nursing Notes of District Nurse, make the claim that the ‘Spenco Mattress taken back by hospice at home’
Nursing Notes abstract - District Nursing Sister Julie Marshall and RGN Sarah Grimshaw - No 60

FACT: It is hardly likely that this could have happened, since the Spenco mattress did not arrive until early afternoon of 21 April, having been requested either overnight, after the damage to Ralph Winstanley’s spine had been discovered, or earlier during 21Apr2004.
Nursing Notes - Patient/Carer Communication Form - Charlotte Peters Rock - No 51

FACT: The Spenco mattress was taken back by RGN Lorna Clark - following her third and last night-sit with Ralph Winstanley – at 07.00 on 22 April

21Apr2004 - 15.00 - 20.15
FACT: Two separate nursing notes make it clear that Ralph Winstanley was completely unconscious by this date.

FACT: 15.00 - DNS Julie Marshall writes 'No non verbal indication of any pain'
Nursing Notes abstract - District Nursing Sister Julie marshall and RGN Sarah Grimshaw - No 61

FACT: 20.15 - RGN K Watts writes 'He remains unresponsive'
Nursing Notes abstract - RGN K Watts - No 62

21Apr2004
NOTE WELL
FACT: A chart called ‘Injectable medication’ has been filled in to state that no injectable medication was ‘used at present’ , before 20Apr2004. That is patently untrue – as can be seen above and in the Document abstracts, which accompany this Table of Facts.
Injectable Medication Chart - District Nursing Sister Julie Marshall - 52a

21Apr2004
FACT: Patient/Carer Communication Page makes it clear that Ralph Winstanley’s two daughters are objecting to his treatment.
Nursing Notes - Patient/Carer Communication Form - Charlotte Peters Rock - No 51

FACT: In her Twilight Nursing Service Office Notes,
RGN K Watts has noted the concerns raised by Ralph Winstanley’s two daughters;
‘For information only:-
The elder daughter raised a lot of issues tonight regarding the care her father has received. She has documented a full communication sheet at the back of the notes which she wants answers to.
Some of the issues are:-
1 The strength of drugs are too high and knocking her father out and accelerating his death
2 He has no diet, fluids or antibiotics
3 His pressure areas are not being checked and documented properly
etc. etc. etc.
I answered all her points and gave her the reasons – but she is not happy.
This daughter did not get on with her father. The rest of the family seem happy with the care given. Thought you’d better be aware. Thanks.’
Twilight Nursing Service Office Notes - RGN K Watts - No 63
NOTE WELL: SERIOUS COMPLAINT RECORDED

21Apr2004
FACT: The notes above show that RGN K Watts also was fully aware that there was a severe problem with the treatment of Ralph Winstanley and that his own two daughters were asking for help. Nothing was done to provide this help.
Twilight Nursing Service Office Notes - RGN K Watts - No 63
NOTE WELL: SERIOUS COMPLAINT RECORDED

FACT: The ‘rest of the family’ mentioned in the notes above, were unrelated to Ralph Winstanley, except by marriage. Nina Clayton, who claimed to be his wife, also claimed that he had not lived at Grange Farm for more than 6 years.
Rosemary Alice Cheesman - Nina Clayton's younger daughter - Birth Certificate - No 64
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 1998
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 1999
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 2000
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 2001
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 2002
Electoral Returning Officer, Doncaster MBC - Electoral Return re occupants of Grange Farm, Pinfold Lane, Moss, Doncaster. DN6 0ED - 2003

Of course Nina Clayton was happy with the treatment. It was designed to kill Ralph Winstanley – when he had not been dying. She had told the lies which brought it about. They are recorded by Dr Kevin Lee and by RGN Carolyn Smith
Danum Doctors Services - Dr Kevin Lee - letter - 18May2004 - page 1 - No 36a
Hospice-at-Home Office Notes - RGN Carolyn Smith - No 45

Part 7 - Ralph Winstanley - FACTS about his death - 22Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death 23Apr2004 - plus numerous supporting document abstracts

Seventh part - 22Apr2004

22Apr2004
FACT: It is recorded in the Hospice at Home Notes:
‘Telephone call from RGN Lorna Clarke following her third consecutive night sit with Ralph – Severe family friction this morning between Ralph’s daughter Christine & his wife Nina.’
Hospice-at-Home Notes - St John's Hospice - RGN Val Derks - Lead Palliative Care Nurse - 2nd entry for 22Apr2004 - No 66a
NOTE WELL: SERIOUS COMPLAINT RECORDED

FACT: Also recorded:'Telephone call to Nina – she says Christine feels her father has been oversedated and his death accelerated.’
(note: Christine=Charlotte Peters Rock)
Hospice-at-Home Office Notes - St John's Hospice - RGN Val Derks - Lead Palliative Care Nurse - 2nd entry for 22Apr2004 - No 66b
NOTE WELL: SERIOUS COMPLAINT RECORDED

FACT: Also recorded: ‘Telephone call from Christine requesting a home visit’.
Hospice-at-Home Office Notes - St John's Hospice - RGN Val Derks - Lead Palliative Care Nurse - 2nd entry for 22Apr2004 - No 66b

FACT: Also recorded: ‘Home visit. Long talk to Ralph’s daughter, Christine. Her son was also present. Christine has contacted PCT East who are arranging the public Health Officer to contact her. She has asked for an independent Dr to visit her father. She feels Ralph Has been oversedated and that Nina has deliberately lied to the Health Professionals involved about Ralph’s condition and that this has resulted in them giving inappropriate medications. She feels any pain and distress he suffered on Sunday and Monday was due to indigestion and sore pressure areas & that he shouldn’t have been given sedation or had the Diamorphine increased. She says that Nina told the GP that Ralph was vomiting when he was only bringing up phlegm. I confirmed that I was unable to comment as I had not been involved with the situation at that point.’

What did this expert Palliative Care Nurse, do about these concerns expressed by Ralph Winstanley’s daughters? Nothing.. except she wrote them down.. and stopped the nightsitting nurse from going into the house.
Hospice-at-Home Office Notes - RGN Val Derks, Palliative Care Nurse, St John’s Hospice -2nd entry for 22Apr2004 - No 66b
NOTE WELL: SERIOUS COMPLAINT RECORDED

FACT: Roy Courts, called to the house by his mother, Charlotte, was present when Clinical Manager, Sheila Blow, arrived at the house, at his mother’s request.
He heard her state that his grandfather was definitely dying of cancer
Affidavit abstract - Roy Courts - re Thursday 22Apr2004 - No 67
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004
FACT: Hospice at Home Notes make it clear that objections are being made about Ralph Winstanley’s treatment. ‘Christine feels her father has been oversedated and his death is being accelerated’.
Hospice-at-Home Office Notes - RGN Val Derks, Palliative Care Nurse, St John’s Hospice -2nd entry for 22Apr2004 - No 66b
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004
FACT: It is recorded here that ‘She feels that any pain and distress he suffered on Sunday and Monday (18 & 19 April), was due to indigestion and sore pressure areas + that he shouldn’t have been given sedation or had the diamorphine increased’.
Hospice-at-Home Office Notes - RGN Val Derks, Palliative Care Nurse, St John’s Hospice - 4th entry for 22Apr2004 - No 66b
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004
FACT: It is also recorded here that Val Derks had been made aware that lies were being told by Nina Clayton, Ralph Winstanley’s second wife. It is also recorded what the lies were.
'She says that Nina told the GP Ralph was vomiting when he was only bringing up phlegm.'
There is nothing in the records which Ralph Winstanley’s daughters have, to show that Val Derks did anything about this information – other than recording it.. and stopping any help which might have been received from the Hospice-at-home night-sit nurse, by stopping any Hospice-at-Home nurse from going into the house.
Hospice-at-Home Office Notes - RGN Val Derks, Palliative Care Nurse, St John’s Hospice - 4th entry for 22Apr2004 - No 66b
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004 - 08.30 - 08.45 - 11.30
FACT: Nursing Notes make it clear that there was a severe problem in respect of Ralph Winstanley’s treatment. Also they state that his daughter was objecting to that treatment and had asked the Director of Public Health for help. And that she had requested a second opinion about the state of Ralph Winstanley’s health.
Nursing Notes – abstracts - District Nursing Sister Julie Marshall - 69a
Nursing Notes – abstracts - District Nursing Sister Julie Marshall - No 69b
Nursing Notes – abstracts - RGN Sarah Grimshaw - RGN Kathryn Clinton - 11.30 - No 69c
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004 - 08.30
FACT: Nursing note at 08.30 states:
‘Val does not feel it is appropriate to send a nightsitter into the home tonight due to current situation’
Nursing Notes - abstract - District Nursing Sister Julie Marshall - 08.30 - No69a
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004 - 08.45
FACT: At 08.45 District Nursing Sister Julie Marshall records that having discussed the treatment with ‘Mrs Winstanley’, she:
‘Reassured that the District Nursing Team would be visiting this morning to refill Ralph’s syringe driver.’
Nursing Notes - abstract - District Nursing Sister Julie Marshall - 08.30 - No69a

22Apr2004 - 11.30
FACT: At 11.30 nurses record that Mr Winstanley’s daughter:
‘..feels that Mr Winstanley is being given inappropriate medication at the request of other family members and she feels that a second opinion is needed from an independent doctor.’
Nursing Notes – abstracts - RGN Sarah Grimshaw - RGN Kathryn Clinton - 11.30 - No 69c
NOTE WELL: SERIOUS COMPLAINT RECORDED

22Apr2004
FACT: Charlotte Peters Rock records her attempts to get some help to her father during Thursday 22Apr2004 – following two days and nights of asking politely for help from nurses and Dr Rachel Sykes. Recording that she first discussed with her sister Linda Kirby – who agreed that she should ask for help. Following this she spoke to
Bridget Fieldhouse at Doncaster West PCT,
Mr Mike Young at Doncaster East PCT,
Dr Tony Baxter, Director of Public Health at Doncaster East PCT,
Sheila Blow, Clinical Manager, who works from Cantley Health centre.
It also records that Dr Gillian Harding - who she had been told was the 'Expert Second Opinion on the state of her father's health' - was due to contact her but did not on that day.
Affidavit – abstract - Charlotte Peters Rock - 67a
NOTE WELL: SERIOUS COMPLAINT RECORDED - to FIVE different people

22Apr2004
FACT: There is documentary proof that Dr Sykes was certain - before Ralph Winstanley finally died – that he did not have any sign of malignancy in his oesophagus or stomach. The Oesophageal Biopsy Report states: ‘There is no evidence of dysplasia or malignancy ‘
Scrawled across this report – which was faxed to Dr Bundy at 10.09 on 22Apr2004 is, ‘RSS File in Notes’.
‘RSS’ is believed to be the initialling of Dr Rachel S Sykes.
This report seems to indicate that Dr Rachel S Sykes knew by at least the morning of the day before Ralph Winstanley died - if not before that time - that he definitely did not have Oesophageal cancer. Yet she stated, several times on 23Apr2004 to both of his daughters that he was dying of oesophageal cancer. Until that day - which was the day he died - they had not been told what he was supposed to be dying of, in spite of having asked many times.
Doncaster and Bassetlaw NHS Trust - Pathology Services - Report sheet initialled by Dr Rachel S Sykes - 67b
NOTE WELL: THIS CONFIRMED TO DR RACHEL S SYKES, THAT HE DID NOT HAVE ANY SIGN OF OESOPHAGEAL CANCER

FACT:
THIS SHOWS THE PROGRESSION OF RESULTS FROM FIRST ENDOSCOPY - WITH BIOPSIES TAKEN - WHICH WAS PERFORMED IN JANUARY 2004.

ENDOSCOPY RESULTS
13/01/2004 - Endoscopy performed and Report made, on what could be seen by eye. This Report seems to have been posted either on that day or the following day.
15/01/2004 - Report entered into Ralph Winstanley's GP Medical Record by Mrs Emma Briggs. It stated:
'Biopsy vial 1 from lower third oesophagus x 6.
Gastritis (535.5) Biopsy for H pylori (unrease test)
Final disposition
Review in GI clinic in 2 weeks. i Comments
Eradicate if CLO +ve. Decide on further management on reciept of histology.'
This shows that nothing could be decided just by looking. Results depended on what the biopsies showed.
GP Medical Records abstract - Mrs Josie Mace - Endoscopy Report - 13Jan2004 - No 2b

FIRST BIOPSIES
13/01/2004, Biopsies taken at endoscopy, showed that there was no sign of malignancy in Ralph Winstanley’s oesophagus.
30/01/2004 - This confirmation was entered into GP Medical Record.
30/01/2004Consultant Physician and Gastroenterologist, Dr Gary James dictated a letter to Dr David J Brown, Ralph Winstanley’s GP – and to Ralph Winstanley - confirming the negative results.
10/01/2004 - those letters were typed and posted.
11/02/2004 - Those letters. were received at Field Road Surgery and entered in the GP Medical Record of Ralph Winstanley. They stated that more biopsies would be taken in 6 weeks time in order to confirm or deny the initial result.
Did Dr Brown give Ralph Winstanley the letter which Dr James had sent for him?
Consultant Physician and Gastroenterologist, Dr Gary James - Letter to Dr David Brown - No 3a
Consultant Physician and Gastroenterologist, Dr Gary James - Letter - No 3b
GP Medical Record - 30/01/2004, Mrs Josie Mace - 03/02/2004, Dr David J Brown - 11/02/2004, Mrs Emma Briggs - No 2a

NOTE WELL
FACT: Tests performed and Reports on Results of the first Endoscopy/Biopsies, performed and taken on 13Jan2004, were fully recorded in Ralph Winstanley’s GP Medical Record.
There were FOUR entries in total.
Endoscopy Report - 15/01/2004
Biopsy Report - 30/01/2004, 11/02/2004.
Report given to patient by Dr David J Brown - 03/02/2004.

This seems to be the pattern by which the results of medical investigations are reported and recorded, at the GP Surgery.

NOTE WELL
FACT: Only one entry about the second Gastroscopy/Endoscopy (10/03/2004), was recorded in Ralph Winstanley’s GP Medical Record. That was only about what was observed by eye.
It was not about the Histology/Biopsy Report.
Why was the Histology/Biopsy Report not shown?
If it had not been received, why did Dr David J Brown not send for that result?
Why did Dr Rachel S Sykes not send for that result on 19Apr2004 when she saw Ralph Winstanley?
GP Medical Records abstract - 11/03/2004 - Mrs Emma Briggs - Endoscopy Report only - 10a

NOTE WELL: There is one further entry, which is totally unsupported by any document or Report. That entry was made by Dr David J Brown.
15.03.2004 Surgery consultation Dr D Brown
15/03/2004 Oesophageal cancer see 2nd endoscopy report Dr D Brown

Part 8 - Ralph Winstanley - FACTS about his death - 23Apr2004

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death
23Apr2004 - plus numerous supporting document abstracts

Eighth part - 23Apr2004

23Apr2004
FACT: At 11am Ralph Winstanley’s two daughters were refused permission – for two hours - to enter the room in which he lay. During this time Dr Gillian Harding and Dr Rachel Sykes, continued to state that Ralph Winstanley was ‘dying of terminal Oesophageal Cancer’. They both stated it several times to both daughters. Dr Harding also suggested that he should also be given Hyoscine hydrobromide, to add to the load of drugs. Dr Sykes prescribed it. And it is believed, administered it. The quantity of Hyoscine hydrobromide prescribed was noted in the Medical Record.
Affidavit abstract - Linda Kirby - No 68a
Affidavit abstract - Charlotte Peters Rock - No 68b
GP Medical Record - Dr Rachel S Sykes - No 80

23Apr2004 - 11.30
FACT: Dr Gillian M Harding, made notes in the Nursing Notes:
‘Palliative medicine’
‘Patient reviewed advanced CLL & probable oesophageal ca.
Chronic ill health & recent and rapid deterioration
Unconscious for 3 days
not drinking or eating
noisy chest secretions
Hyoscine hydrobromide
(other writing at bottom of page – which can’t be read)(Then over the page)
‘My impression is that this man is dying & is in the very terminal stage.
Further investigation or treatment other than best supportive care is inappropriate '
Nursing Notes – abstract – written by Dr Gillian Harding, Lead Clinician for Palliative Care, Medical Director of St John’s Hospice - No 78a
Nursing Notes – abstract – written by Dr Gillian Harding, Lead Clinician for Palliative Care, Medical Director of St John’s Hospice - No 78b

FACT: About Ralph Winstanley’s ‘probable oesophageal ca.’. It had certainly been known since 15 March 2004 that he did not have any malignancy in the area of his oesophagus or stomach..and any GP could have checked that for herself

Consultant Physician and Gastroenterologist Dr Gary James - Letter – 14Mar2006 - No 10i
Consultant Physician and Gastroenterologist Dr Gary James - Letter – 14Mar2006 - No 10ii

FACT: Ralph Winstanley’s unconsciousness was caused by the application of Diamorphine, Haloperidol and Midazolam, prescribed by Dr Kevin Lee, who never met the ‘patient’ and continued by Dr Rachel Sykes, who had every opportunity of checking- at her Field Road Surgery - the current state of health of the patient. Dr Gillian Harding, recommended adding Hyoscine hydrobromide – in a dose which does not seem to have been recorded.
Prior to this drugging - and during the first 36 hours of it - which began on 18Apr2004, he had been walking about, eating and drinking and speaking relatively rationally.
Affidavits – abstracts – 18/19Apr2004 - Charlotte Peters Rock - No 72
Affidavits – abstracts – 18/19Apr2004 - Charlotte Peters Rock - No 73a
Affidavits – abstracts – 18/19Apr2004 - Charlotte Peters Rock - No 73b
Danum Doctors Services Limited - Dr Kevin LeeLetter – 18May2004 - No 36a
Danum Doctors Services Limited - Dr Kevin LeeLetter – 18May2004 - No 36b
Nursing Notes abstract - Dr Gillian Harding - No 78a
Nursing Notes abstract - Dr Gillian Harding - No 78b

18-23Apr2004
FACT: Ralph Winstanley was not given any diet or fluid during the time after drugs began to render him unconscious – thus unable to shift for himself. That fact is borne out by the Community Nursing Assessment sheet of 21Apr2004
‘Mr Winstanley is not currently receiving any diet or fluids’
Community Nursing Assessment Sheet - abstract - District Nursing Sister Julie Marshall - No 71

FACT: On 18Apr2004 he was both eating and drinking - with no sign of difficulty – when the first nurses arrived at Grange Farm. Until the first injections and the drugs entering his system via the first syringe-driver began to render him unconscious, he still both ate and drank with no difficulty nor any gagging nor any sickness.
Community Intervention Team - Dependency Scale - 18Apr2004 - No 48
Affidavit abstract - Charlotte Peters Rock - No 72
Affidavit abstract - Charlotte Peters Rock - No 73a
Affidavit abstract - Charlotte Peters Rock - No 73b

23Apr2004
FACT: There is no record of the amount of Hyoscine hydrobromide, injected into Ralph Winstanley, by Dr Sykes, at her last visit on 23rd April 2004.
GP Medical Record - Dr Rachel S Sykes - 23Apr2004 - No 80

23Apr2004 - 11.15
FACT: The only nursing notes of that day, after the night-sitter left and before Ralph Winstanley finally died, were written at 11.15.
There is no indication in those notes, that a nurse might have put Hyoscine hydrobromide into either syringe-driver, since they were both already refilled, by 11.20 with
1. Diamorphine and Haloperidol
2. Midazolam
as stated in the Nursing Notes of 11.15.
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - 11.15 23Apr2004 - No 70a
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - 11.15 23Apr2004 - No 70b
Nursing Notes - Syringe Driver Form - RGN Sarah Grimshaw - 11.20 23Apr2004 - No 41b
Whereas, Dr Harding’s notes, state that they were not entered until 11.30. They are within the Nursing Notes. Nurse’s notes are timed at 11.15

It is believed that the notes of Dr Gillian Harding, entered at the end of the notes of RGN Brenda Rigo – the nightsitting nurse, show that a gap had been left on that page, by the two nurses present, as Ralph Winstanley’s daughters noticed on most of the original Nursing Notes, before Ralph Winstanley died. Those gaps had been filled in when the Nursing Notes were retrieved by South Yorkshire Police.
Nursing Notes abstract - District Nursing Sister Julie Marshall - No 74a
Nursing Notes abstract - District Nursing Sister Julie Marshall - No 74b

FACT: There is no record in the Nursing Notes of the destruction of any remaining Hyoscine hydrobromide.. which leaves the supposition that it was all injected during that visit. – unless contemporaneous notes can be found, to show otherwise
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - 11.15 23Apr2004 - No 70a
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - 11.15 23Apr2004 - No 70b

FACT: Amount prescribed was '600microgrammes/ml Supply (10)1ml ampoule(s) TWO AMPOULE OVER 24 HOURS Dr R Sykes'
Only 2 ampoules are stated to need to be used over 24 hours. So if this drug was injected, who injected it, how much was used - & what happened to any which remained?
GP Medical Record - Dr Rachel Sykes - Hyoscine hydrobromide - 23Apr2004 - No 80

22/23Apr 2004
FACT: there is no indication – in the nursing record – or any other document which we have - that Ralph Winstanley was in any way distressed, either overnight or on that day, 23Apr2004, which might necessitate the use of Hyoscine hydrobromide on a man who it was obvious was now dying.
Nursing Notes abstract - RGN Brenda Rigo - nightsitting nurse - No 70
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - No 70a
Nursing Notes abstract - District Nursing Sister Julie Marshall - RGN Sarah Grimshaw - No 70b

Part 9 - Ralph Winstanley - FACTS about his death

Click for A Full Index - but stay on this page if you want to read the main facts


Table of FACTS in respect of Ralph Winstanley’s death
23Apr2004 - plus numerous supporting document abstracts

Ninth part - 20Apr2004

28May2004 - stamped as 'received 07Jun2004'
FACT: Dr David J Brown wrote a letter to Mr Jonathan Goodwin of solicitors Bridge Sanderson Munro (who are also believe to act for him), stating why Ralph Winstanley had died – and that his mental health was not impaired.
COMPARE this letter with the documented facts.
Dr David J Brown - Sent on by Mr Jonathan Goodwin - No 82

24May2004 and 01Jun2004 - stamped as 'received on 08Jun2004'
FACT: Letter from Dr Rachel S Sykes of Field Road Surgery, Stainforth
Dr Rachel S Sykes - letter - 24May2004 - page 1 - No 81a
Dr Rachel S Sykes - letter - 24May2004 - page 2 - No 81b
and
Dr David J Brown of Field Road Surgery, Stainforth
Dr David J Brown - letter 01Jun2004 - page 1 - No 83a
Dr David J Brown - letter - 01Jun2004 - page 2 - No 83b
to Mrs Liz Hedge in respect of Ralph Winstanley’s death. Dr Brown also wrote a 'Statement', which is unsigned.
Dr David J Brown -‘Statement’ - 16May2004 - 83c
COMPARE these letters/statement with the documented facts.

2005

03Feb2005
FACT: Pathology Report – stated - about Ralph Winstanley’s:
‘Stomach/Oesophagus – no sign of any malignancy – certainly not terminal malignancy.
Pathology Report - Professor Hlen Whitwell - Home Office pathologist - re Gastro-intestinal system - page 3 - No 77iii

Brain – three forms of dementia –
1. Cortical Lewy body pathology;
2. Brainstem Lewy body pathology;
3. Neurofibrillary tangle and plaque formation (Braak stage 3 out of 6)
Pathology Report - Dr S Wharton - Neuropathologist - page 6
Pathology Report - Dr S Wharton - Neuropathologist - page 7 - No 77vii

Height – Pathology Report stated 164cm
Pathology Report - page 2 - No 77ii
- or 180cm which his own family knew him to have been.
He was flat on his back as he died. His legs were out straight. He had no curvature of the spine.

Weight - Pathology Report stated 89kg
Pathology Report - page 2 - No 77ii
- or 75.8kg as his last weight check at Dr Majumdar’s Haematology Clinic (05Apr2004) had shown.
This last recorded weight had been taken on 05Apr2004 - at the Haematology Clinic of Dr Gautam Majumdar, when he was given a 5 day course of chemotherapy, which will have lasted him until 10/11Apr2004.
By 11Apr2004 he was being rushed into Doncaster Royal Infirmary for no apparent reason. From 14Apr2004 he was put on morphine - for no apparent reason - by Dr David J Brown.
From 18Apr2004 to 23Apr2004 he was dehydrated and starved. Then he died.
With that regime, how could he possibly have gained 2 stones 2 pounds in weight?

2006

Mar2006
FACT: Linda Kirby wrote to Ralph Winstanley’s two Consultants,
Consultant Haematologist, Dr Gautam Majumdar and
Consultant Physician and Gastroenterologist, Dr Gary James,
(both of Doncaster Royal Infirmary), asking about the state of Ralph Winstanley’s health when he last attended their clinics, shortly before he died
Emails


08Mar2006 - almost two years after Ralph Winstanley died.
FACT: Dr Gautam Majumdar replied - 08Mar2006stating that Ralph Winstanley’s chronic lymphocytic leukaemia was ‘under reasonable control’
letter
Consultant Haematologist, Dr Gautam Majumdar - 08Mar2006 - No 26

14Mar2006 - almost two years after Ralph Winstanley died
FACT: Dr Gary James replied stating that during the course of two extensive investigations – with biopsies taken – no sign had been found of ‘any malignancy’ in the areas of Ralph Winstanley’s oesophagus or stomach – and that he certainly did not have any terminal condition in those areas.
letter
Consultant Physician and Gastroenterologist, Dr Gary James - letter - 14Mar2006 - page 1 - No 10i
Consultant Physician and Gastroenterologist, Dr Gary James - letter - 14Mar2006 - page 2 - 10ii

FACT: Linda Kirby then wrote again to both Consultants asking whether anyone else had contacted them to ask their opinions in respect of Ralph Winstanley’s state of health., since his death.
email

29Mar2006
FACT: Consultant Physician and Gastroenterologist, Dr Gary James, replied stating that no-one had contacted him - except Linda Kirby (Not the police, nor IPCC, nor the Coroner, nor his ‘mate’ who claims to be one, nor the other NHS Trusts, nor the Health Care Commission).
letter
Consultant Physician and Gastroenterologist, Dr Gary James - email - No 75

24Mar2006
FACT: Consultant Haematologist, Dr Gautam Majumdar replied stating that all such requests had to go to Doncaster and Bassetlaw Hospitals Trust, as he was not allowed to answer. Requests were sent, but a block was put on any reply - by senior executives at the Trust. – specifically by Chief Executive, Nigel Clifton.
letter
Consultant Haematologist, target="_blank" Dr Gautam Majumdar - letter - No 76

FACT: to this day there has been no investigation of Ralph Winstanley’s death, by South Yorkshire Police Force, in spite of all the evidence which Ralph Winstanley’s family has researched and presented to that force.
Nor has this Force ever officially interviewed either of Ralph Winstanley’s two daughters, both of whom were present and trying to stop this death, during the last 6 days and nights of his life.
Detective Superintendent Robert Haworth - email - 76a

NOTE WELL: There is a query against District Nursing Sister Edgecombe’s name. It refers only to her illegible signature, which at first seems to have been Edgeworth and because there is no District Nursing Sister Edgeworth in the Register at the Nursing and Midwifery Council – it now appears to be the signature of a DNS Edgecombe. However, since her name was not also printed, I’m not certain. The name, ‘Edgecombe’, used in this CD refers only to the District Nursing Sister who visited Grange Farm during the time when Ralph Winstanley was dying. We have had absolutely no help from any source at Doncaster East PCT, Doncaster Central PCT or Doncaster and South Humber NHS Trust, in respect of who the nurses might be. (Charlotte Peters Rock)