English: Convicted for Caring: The Barbara Salisbury Trial [15,505]

 “One of the most common fears of the dying patient is to suffer unbearable pain. Most of the symptoms such as pain, breathlessness and nausea can now be controlled: A major aim of care is to control distressing symptoms and to maintain each patient in the maximum possible comfort”

Unfortunately there comes a point in everybody’s life where death has become inevitable. We all hope that when that time comes to meet our maker, that it will happen in a peaceful way. Death is often believed to be a painful experience, and inevitably in some circumstances it can be. For an elderly person, who is hospitalized, and who’s illness is known, there is no reason why pain should ever play a role in their departure from this life. Modern medicine has made it possible for people to die without having to worry about leaving this life in unbearable agony.

Barbara Salisbury began training to become a Nurse in the Royal Air Force in 1975. She was viewed as a very professional nurse, whose experience and knowledge was highly respected. and during her 30 year career she had nursed numerous patients with all kinds of illnesses. Barbara spent a large part of her career, nursing patients on Intensive Care Units (ITU's) across the country. One of her main skills was nursing unconscious patients. She learnt how to assess them, how to ensure their needs were being met, and more importantly how to assess if they were in pain. This knowledge was to become her downfall, and her experience to become her conviction. So just how did this experienced nurse and ward sister find herself convicted of the attempted murder of two of her patients?

May Taylor:
May was 88 years old, she had been found at her home crying for help. When she arrived at the Accident and Emergency department of Leighton Hospital, Crewe, she was deeply unconscious. Doctors examined Mrs. Taylor and a CT scan was carried out. It confirmed the worst. She had suffered a Right Parietal Intra Cerebral Hemorrhage; this is known by experts to be one of the most severe and painful strokes a person can experience. She was classified as DNR (Do Not Resuscitate) and was admitted for TLC (Tender Loving Care). Her family were informed that it would inevitably prove to be fatal and that the hospital would do their upmost to keep her comfortable and pain free. May remained unconscious; she was assessed on a regular basis. Nurses who were called to court, recalled that when they assessed her they saw no obvious signs of pain and when asked they said that they would look for grimaces, lashing out and vocal noises, to establish that she was in pain. They did not witness any such actions. She was therefore assessed to be in no pain. In time Barbara herself came to be looking after this lady, her experience told her that this type of stroke is very painful, and not only that, but as it progresses it causes the limbs to become paralyzed, which makes it harder for the patient to demonstrate pain. From her time spent working on ITU's she knew that there was one way to assess if a patient was in pain, which was not hindered by any other factors. This was to check the patients’ heart rate on movement. Barbara lifted this lady’s head off the pillow; at the same time she took the patients pulse. May’s heart rate rose and her neck stiffened. May was in pain.

On the ward round Barbara told the Doctors that Mrs. Taylor seemed “agitated on movement” The consultant and his team knew that it was highly likely that this was a result of pain caused by the brain Hemorrhage, all they could do was keep her comfortable. The Doctors prescribed the lowest dose of diamorphine to be administered by a graseby syringe driver. He chose this drug over the numerous other drugs available. Barbara completed the ward round with the consultant and his team. By the end of her shift the prescribed syringe driver was still waiting to be put up. She informed the next shift. On returning to duty some days later, Barbara found that the driver still had not been set up. She asked another member of staff if they would do it as it had not been prescribed on an as required basis, but that it should have been set up as soon as possible. This nurse was not happy as she had not nursed May before and was therefore not in a position to assess whether she was in pain or not. Barbara took the prescription and said she would do it herself. Diamorphine is a controlled drug, which requires two nurses to administer it. Barbara went into May’s room; the other nurse was with May. Barbara asked “ are you happy with this”, the other nurse agreed that she was happy and the administration was carried out. If this nurse was not completely happy for this drug to be administered all she had to say was no and the administration would not and could not have gone ahead. The Syringe Driver was reprimand with diamorphine by two other nurses. May died peacefully and pain free a few days later on March 23rd 2002. Barbara was not with May when she passed away.

Frank Owen:
Mr. Frank Owen was an elderly man of 92 years; he too was admitted to hospital following a stroke. During his stay in hospital Mr. Owen’s health was observed to be in steady decline. He was regularly refusing food and drink and on frequent occasions he was refusing medication too. Doctors sadly came to the conclusion that he had given up the will to live. Mr. Owen was eventually deemed by doctors to be for TLC only and was classified as DNR. He had reached the stage where death was inevitable and all that can be done for him is to keep him comfortable. One nurse in court, who testified against Barbara, claimed that she had a special bond with Mr. Owen; he would squeeze her hand when he wanted a cup of tea. This is the same patient who was refusing food and fluids and when he did take fluids they had to be administered by syringe into the mouth. This is also the same patient who had clubbed hands, to the extent that his relatives told medical staff that he seemed to be in pain with the slightest touch of his hands. During Frank's stay Barbara became ill whilst on duty and was herself admitted into another ward for observation. She was off duty for one week. During her time away from the ward Mr. Owen started to suffer intermittent pain and was prescribed Diamorphine of the lowest dose possible. This was administered on a number of occasions. Barbara returned to work, not knowing how Mr. Owen had declined. During her first shift back she was looking after Mr. Owen. He became a little agitated and didn’t seem to be settling. Barbara observed on his prescription sheet that diamorphine had been prescribed and observed this to be an appropriate time to give it. She sought the help of a staff Nurse on the ward. When this other nurse arrived in Mr. Owen’s room she recalled in court seeing him "moving around the bed in an agitated state". She agreed with Barbara that the drug was needed. Mr. Owen settled. After 4 hours the time came when the drug would cease to be effective in controlling pain and the choice had to be made whether to keep Mr. Owen comfortable by continuing his pain relief and administering a second dose of diamorphine, or to leave him with no pain relief and wait for his discomfort to return. Barbara knew that it was better to keep a dying man pain free rather than let him experience unnecessary distress. This is exactly the level of care the hospital policy states a dying patient will receive "to maintain each patient in the maximum possible comfort".

The same staff nurse administered the drug with Barbara. This Nurse later said in court that she did not feel the drug was needed, and that by giving the drug Sister Salisbury’s motive was more than to provide pain relief. She said she gave the drug because she felt intimidated by Sister Salisbury. Yet if she had said no to the administration, the drug would not and could not legally have been given.

In the Nursing Code of conduct, the rule book by which every nurse must obey, it states that:

"You are personally accountable for your practice. This means that you are answerable for your actions and omissions regardless of advice or directions from another professional"
1.3 Nursing and Midwifery Council Code of professional conduct.

If this nurse truly thought that by giving the second dose of diamorphine to Mr. Owen, Barbara’s intention was to murder him, all she had to say was no. And to say she felt intimidated into the administration is no excuse. Her duty was to protect the patient, from a danger she says she knew was there. Mr. Owen died on the 31st March 2002, peacefully and pain free. After his death Mr. Owen’s wife spoke to another member of staff saying “ thank you for keeping him pain free”

The untold story:
During the court case, Barbara’s defense team put it to the jury that the whole case came about from gossip which had spiraled out of control. It was clear, for whatever reason, Barbara was not liked on the ward. In a diary entry written during her first few months on the ward, she said she felt like she was walking on egg shells and that she was facing a constant battle to get the staff working as a team. The first allegations were made whilst Barbara was on holiday with her husband. The managers from the hospital whilst investigating the allegations made it clear to the ward staff that anyone who came forward with information about Barbara Salisbury would be given immunity from disciplinary action. During the trial many of the allegations, which were made against Barbara, were found to be completely false but surely this opened the floodgates. At the same time all hospital staff were told they must not under any circumstances get in contact with Barbara and Barbara was suspended from duty. Over the coming weeks Barbara would be pushed to the limit. She would find out the true level of hate the ward had for her. After a number of weeks into her suspension Barbara began to receive some distressing phone calls. They would come at any time of the day or night. Once answered the caller would listen for a while and then hang up. Barbara knew these calls were meant for her. It became such a frequent occurrence that Barbara became distressed whenever the phone would ring. The calls became so frequent and distressing for Barbara that the police became involved, they set up a logging system, which recorded all calls made to Barbara’s number.

The next attack on Barbara would shock all those who witnessed it. Barbara was at home with a number of family and friends. When her July 2002 pays lip was hand delivered. Barbara opened the pays lip and found words written on it that frightened her beyond belief. Next to her name were clearly the words KILL. This was reported to the police who began an investigation. In an attempt to keep it under wraps Barbara received a phone call from a member of the hospital management asking for it to be taken out of police hands. Pay slips were normally delivered to the wards where they would accumulate at the nurse’s station until collected by the nurses they belonged to. After this distressing event, nurses were made to pick up their pay slips from the Hospital offices. Barbara sunk slowly into a downward spiral of depression. The final insult came when the National Press arrived. They had two sources at the hospital that had informed them of the investigation into Barbara’s conduct, they knew details of the investigation that only ward staff and management knew. They delved to sickening levels by falsely informing the reporter that police were preparing to exhume bodies. At this point, Barbara had not been informed by the hospital management of why she had been suspended. She only became fully aware of the seriousness of the situation when she mistakenly received a letter from the Nursing and Midwifery Council which was meant for the detective in charge of the case. Barbara could not cope with the degree of depression she was now suffering from and she was hospitalized in Cheadle Royal Hospital in Stockport. The medical team there tried everything to lift Barbara out of this depression, but nothing succeeded. So they had to resort to extremes and twice a week Barbara was subjected to ECT. She was being electrocuted to try and lift her cloud of depression. This treatment worked temporarily, and had to be repeated regularly in order to keep up the effects. Barbara received approximately 30 treatments, which have left her with little short-term memory and little recollection of the past few years. Barbara and her family had every faith in the British Justice system. They believed that court trials were a process of sifting out the truth from the lies. How wrong they were. The prosecution barrister Mr. Robin Spencer QC had many tricks up his sleeve. He fabricated a story to fit each statement. His story made headlines. “Nurse attempts to kill patients in order to free up beds” This story was never told by any of the witnesses called to court.

In his closing speech Defense Barrister Mr. Peter Burkitt QC addressed this fabrication, he told the jury that the stories that had been fabricated throughout the trial were ingenious but were merely scraping the bottom of the barrel. Robin Spencer even delved to the extreme, of changing the allegations, whilst Barbara was herself in the witness box, knowing full well that she had to answer these allegations without being able to consult her legal team. Barbara had not been expecting this turn of events. Barbara knew she had nothing to hide and truthfully answered all questions put to her and these new allegations were proven to be unfounded. The Judge Mr. Justice Pitchford reprimanded Robin Spencer QC, for his unethical approach. Barbara and her family firmly believe that she was convicted because of a series of underhand events. Every attempt was made by the prosecution to confuse the jury. They even went to the extremes of sending the majority of the prosecution witnesses on a "witness training course" where they learnt how to become a good witness, where they were encouraged to compare their evidence with other witnesses and educated on how to deal with discrepancies in evidence. Barbara is the victim of a prejudicial system, which as she was told early on in the investigation assumed her guilty until proven innocent. The day that will prove her innocence is yet to come.

When the facts of this case are taken away from the gossip and the opinion of personal accounts it is clear that Barbara’s motive was one thing and one thing only - to provide her patients with the best possible care she could, and to keep them comfortable and pain free in their final days.

As always, stay safe !

Bird

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