19.1.07

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

Update - but scroll down until you see his picture, if you want to read the dates of the killing and their linked, official records.

23 April 2016 - It is now 12 years exactly since my father, Mr Ralph Winstanley, was murdered. Murder is against the law. During that time, no criminal investigation has taken place; the people responsible have not even felt the need to move house, because they seemed to know that they would be safe, under South Yorkshire Police. What corruption has made them feel so safe?

16 October 2014 - It is instructive to note that piling lack of information on corruption and destruction of official records, Chief Constable of South Yorkshire, David Crompton is using his common purpose training to yet again, deny the South Yorkshire Police investigation which should have taken place over ten years ago.

We have spent the whole of this year, waiting as South Yorkshire Police claimed to be making up a list (for the first time in 10 years??) of the documents which they claim to hold in respect of my father's deliberate killing. That list was to have led on to a formal meeting during which we would show Inspector Vicky Short copies of documents which we believe South Yorkshire Police does not yet have, in its stripped out records.

The first 2 page list contained no more than a listing of the formal complaints which we have made over 10 years of malicious police inaction.
Asking if that was the entirety of document held by this force, I was then sent a 12 page list of documents recently gained from one Coroner... and a 7 page list of documents recently gained from another Coroner... but no list of documents originally held by South Yorkshire Police - which was the whole point of this - now pointless - exercise.


Seemingly there are no remaining documents held by South Yorkshire police, which indicates that a large number of documents have been destroyed by them. So on the basis of that destruction the chief constable has made his determination that the promised meeting will not take place is this a question of 'the blind leading the blind' or is it more a question of 'the three wise monkeys'?

What is certain is that the person/people who deliberately killed my father, Mr Ralph Winstanley, in a killing which can be shown to have taken months in the planning, had a certainty that South Yorkshire Police would only act to block investigation.. as they seem have done in respect of Orgreave, Hillsborough, Rotherham, Sheffield, Doncaster - the latter three sitting nicely with the removal of evidence in respect of sexual deviance, returned to me from Rossington Child Protection Unit, Doncaster, by a Police Inspector in 2009, since South Yorkshire Police seemed not to want such evidence.

18 April 2014 - This date marked 10 years since the final determined assault which killed Ralph Winstanley (on 23 April 2004) whose medical records and letters clearly show had not been dying. It took Nina Anna Clayton and her daughter Rosemary Alice Cheesman 6 long days and nights to achieve her greatly desired widowhood.. with the aid of the local NHS version of the Liverpool Care Pathway and the (ho-ho) 'Gold Standard'. At that time, East Doncaster PCT was Chaired by ex Hillsborough Police Superintendent Roger Greenwood.. whose chairmanship continued in one form or another until 31 March 2013.


It is interesting to note that both the Liverpool Care Pathway and Roger Greenwood have moved on, whereas, Nina Anne Clayton has felt safe in her deplorable actions.. so safe that she hasn't even needed to move house for fear of being arrested. South Yorkshire Police and Crown Prosecution Service justice?


No-one has been formally interviewed. No Crime Number has ever been issued. Because of their ongoing refusal to investigate what can be demonstrated as 'a deliberate killing', I believe the former Chief Constables of South Yorkshire Police Force, Mike Hedges, Meredydd Hughes, Interim CC Bob Dyson, and the current incumbent David Crompton, need to be taken to Court on a charge of Misconduct in Public Office - as does former HM Coroner ES Hooper - who currently resides in Cyprus as Chancellor to the Bishop of Cyprus and the Mediterranean, who has been approached about this matter.. but who does not respond.

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

11Mar2004THIS 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


























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


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  • Abide With Me (mine)
  • Dead An Buried? Ardly!
  • Director of Public Health - Dr Tony Baxter
  • If - (not by Rudyard Kipling)
  • Jayne Brown - The Cover-Up Woman
  • Practice - Field Road Made
  • Quack Quack Dr Lee
  • St John's Hospice - My Father Was Not Dying
  • Thanksgivin? Thanksgivin? Ah'll be Waitin On
  • The NHS/PCT Thinks You Should Go
  • The Palliative Gillian
  • The Power behind the Patient Dr Brown

Who was Ralph Winstanley?

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sister sites: 1.http://rwinstanley.blogspot.com 2.http://ralphwinstanley.blogspot.com 3.http://ralphwinstanley83.blogspot.com 4.http://winstanleyr.blogspot.com 5.http://ralphwinstanleyofwath.blogspot.com