“[16] The Hospital is no longer an appropriate place for G, a 27-year-old woman. I agree with Miss Debra Powell QC, acting on behalf of the Clinical Commissioning Group (CCG), that at some point, G’s continued placement there became irreconcilable with her dignity. I would go further, in these circumstances where the parameters of her personal autonomy are circumscribed by her condition, the continued placement at the Hospital limits, unnecessarily, the small sphere of autonomy that remains available to her i.e., to be treated as the young woman she now is and not as the child she was upon admission. It is important to record that nobody, including G’s parents, has suggested that the Hospital is now the right place for her. In my judgement it is axiomatic that this children’s hospital, however great its resources and skills, is ill-equipped to meet the emotional, medical and physical needs of this young woman.”
“[72] There must be a recognition that the timescales contemplated for the future plan must be driven wholly and entirely, by a clear identification of G’s needs: it is necessary for her to readjust to life outside the hospital environment; it is important to stabilise her medically; it is essential that the relationship between the treating clinicians and the family (LF in particular) becomes fully functional; allied to this last point is the need for clear and unambiguous planning which all understand and are committed to; it must be understood, at all times, that G’s relationship with her parents is of paramount importance to her as well as to them; notwithstanding this extensive period of hospitalisation, G has enjoyed a high quality of family life which must be preserved in her new environment, recognising that this will involve significant changes for her.”
“[68] Dr D was entirely of the same view. He expressed himself in clear terms. He referred to 'the jeopardy of [G's] discharge' and to the 'extremely complex' breadth of her medical needs. He also, properly in my view, identified the importance of achieving what he called greater 'functionality' in the relationship between professionals and family. This said, he emphasised that the love and commitment of these parents requires to be kept sight of. In simple terms, in a phrase which he repeated on a number of occasions, Dr D considered that G was likely to be 'overwhelmed if she were discharged straight home'. He told me in evidence that it was important that G's team have full autonomy to deliver her care package, whilst respecting LF's practical contribution and insight. Though, I did not sense the parents were absorbing what he said, Dr D was also emphasising that G's family need to 'gain confidence in the team' in order fully to unlock their own role at home as a family. In order that both parents hear it clearly and unequivocally, I consider this perhaps more than anything else is the gateway to G's return to them. Ultimately, the decision to walk through it is theirs. I am confident that all involved with G would encourage them to do so.”
“[63] Up until this week the plan in relation to CPR as set out in the ReSPECT form was an unsatisfactory compromise, expressed in language which set out the views of the parents and the views of the hospital. It was a study in confusion. It provided no clarity for the treating clinicians and served to stifle G's voice. Indeed, I was told that notwithstanding the fact that the form was intended to communicate to the treating clinicians that CPR should not be attempted, it was more likely that the exact opposite would have occurred. It is a mark of Dr B's integrity that she should express herself with such candour, but she identifies a wholly unsatisfactory scenario. She considered that if LF had been present at cardiac arrest, he would have pressed this ambiguous document upon the treating clinicians in order to encourage CPR. That would have been painful and wholly contrary to G's interests as LF now recognises. Dr B had little doubt that LF would have persuaded the clinical team of the correctness of his view. There can be no further ambiguity in the documentation. Treatment plans are not compromise agreements; they require clarity.”
“[19] LF’s communication with the care home and its broader organisation were selective in the information disclosed, combative and directly opposed to my conclusions in the December judgment. LF’s concession was only made when the compelling evidence of his opposition to the placement made his continuing denials of it risible. Thus, the abandoned move to the care home, planned to have taken place on the8th March 2022 , can only be attributed to LF’s tactical strategy designed to sabotage it. The strategy was very nearly successful. The senior management wavered in their commitment to offer G a place. They became concerned as to how LF’s behaviour might undermine their own ability to care for G and the wider impact on other residents.”
“a. speaking to clinical staff at the Trust in a hostile and intimidating way and questioning their competence; b. questioning the competence of [the nursing home] staff when they visited [G] at the Hospital; c. writing to [the nursing home] and repeatedly to the Chief Executive of the [lead group] raising numerous alleged criticisms of [the nursing home] and its staff’s competence to care for [G].”
“d. causing journalists and a “public relations consultant” to contact the [lead group] to discuss the family’s ongoing opposition to the move to [the nursing home].”
“[43] … He admitted that he had deliberately taken [G] out of the ward on three occasions in August 2020 when he had been expressly told not to for reasons of Covid safety, and that he had returned to the ward when he was excluded. He admitted that he had sought to persuade [the CEO] to withdraw the offer of a place for [G], knowing that that was completely contrary to what the Court had determined was in [G]’s best interests. He admitted that the sending of numerous emails was designed to put further pressure on her to withdraw the place. He was driven, ultimately, to admit that he had lied in his witness statement when he claimed that he had accepted the Court’s decision that [G] should move to [the care home]. Finally, he admitted that, if he wasn’t prevented from doing so, he would continue to do whatever he could to prevent the move taking place.”
“First, the burden of proof lies with the local authority. It is the local authority that brings these proceedings and identifies the findings that they invite the court to make. Therefore, the burden of proving the allegations rests with them. Secondly, the standard of proof is the balance of probabilities: Re B (Children) [2008] UKHR 35. If the local authority proves a fact on the balance of probabilities, this court will treat that fact as established and all future decisions concerning M's future will be based on that finding. Equally, if the local authority fails to prove any allegation, the court will disregard that allegation completely… In my judgment, the same approach must surely apply in the Court of Protection where the court is carrying out a similar exercise in determining the facts upon which to base decisions as to the best interests of an incapacitated adult. Thirdly, findings of fact in these cases must be based on evidence. As Munby J (as he then was) observed in Re A (A Child : Fact-finding hearing: speculation)[2011] EWCA Civ 12 : "It is an elementary proposition that findings of fact must be based on evidence, including inferences that can properly be drawn from the evidence, and not on suspicion or speculation." Fourth, the court must take into account all the evidence and, furthermore, consider each piece of evidence in the context of all the other evidence. As Dame Elizabeth Butler-Sloss, President, observed in Re T[2004] EWCA Civ 458 ,[2005] 2 FLR 838 , at paragraph 33: "Evidence cannot be evaluated and assessed in separate compartments. A judge in these difficult cases must have regard to the relevance of each piece of evidence to the other evidence and to exercise an overview of the totality of the evidence in order to come to the conclusion whether the case put forward by the local authority has been made out to the appropriate standard of proof." Fifth, whilst appropriate attention must be paid to the opinion of medical experts, those opinions need to be considered in the context of all the other evidence. The roles of the court and the experts are distinct. It is the court that is in the position to weigh up expert evidence against the other evidence: A County Council v. K, D and L[2005] EWHC 144 Fam,[2005] 1 FLR 851 per Charles J. Sixth, in assessing the expert evidence, which involves a multi-disciplinary analysis of the medical information conducted by a group of specialists, each bringing their own expertise to bear on the problem, one important consideration - and of particular relevance in this case - is that the court must be careful to ensure that each expert keeps within the bounds of their own expertise and defers where appropriate to the expertise of others - see the observations of Eleanor King J in Re S[2009] EWHC 2115 Fam Seventh, the evidence of the parents is of the utmost importance. It is essential that the court forms a clear assessment of their credibility and reliability. They must have the fullest opportunity to take part in the hearing and the court is likely to place considerable weight on the evidence and impressions it forms of them - see Re W and another (Non-accidental injury) [2003] FCR 346. Eighth, it is not uncommon for witnesses in these cases to tell lies, both before and during the hearing. The court must be careful to bear in mind that a witness may lie for many reasons - such as shame, misplaced loyalty, panic, fear and distress - and the fact that a witness has lied about some matters does not mean that he or she has lied about everything - see R v. Lucas[1981] QB 720 . The assessment of the truthfulness is an important part of my function in this case.”
“…Common sense not law requires that in deciding this question, regard should be had to whatever extent appropriate, to inherent probabilities. If a child alleges sexual abuse by a parent, it is common sense to start with the assumption that most parents do not abuse their children. But this assumption may be swiftly dispelled by other compelling evidence of the relationship between parent and child or parent and other children. It would be absurd to suggest that the tribunal must in all cases assume that serious conduct is unlikely to have occurred. In many cases, the other evidence will show that it was all too likely.”
“[9.] … one possibility is of course that they are lies designed to hide culpability. Another is that they are lies told for other reasons. Further possibilities include faulty recollection or confusion at times of stress or when the importance of accuracy is not fully appreciated, or there may be inaccuracy or mistake in the record keeping or recollection of the person hearing or relaying the account. The possible effects of delay and repeated questioning upon memory should also be considered, as should the effect on one person of hearing accounts given by others. As memory fades, a desire to iron out wrinkles may not be unnatural – a process that might inelegantly be described as "story-creep" may occur without any necessary inference of bad faith.”
“While everyone knows that memory is fallible, I do not believe that the legal system has sufficiently absorbed the lessons of a century of psychological research into the nature of memory and the unreliability of eyewitness testimony. One of the most important lessons of such research is that in everyday life we are not aware of the extent to which our own and other people's memories are unreliable and believe our memories to be more faithful than they are. Two common (and related) errors are to suppose: (1) that the stronger and more vivid is our feeling or experience of recollection, the more likely the recollection is to be accurate; and (2) that the more confident another person is in their recollection, the more likely their recollection is to be accurate.”
“23. In O'Brien v Chief Constable of South Wales Police[2005] UKHL 26 ;[2005] 2 AC 534 the House of Lords considered the issue of similar fact evidence in civil cases, where it is contended that an individual's behaviour in other circumstances makes it more likely that he will have behaved in the manner now alleged because it is evidence of a propensity to behave in that way. Lord Bingham stated the position in this way; 3. Any evidence, to be admissible, must be relevant. Contested trials last long enough as it is without spending time on evidence which is irrelevant and cannot affect the outcome. Relevance must, and can only, be judged by reference to the issue which the court (whether judge or jury) is called upon to decide. As Lord Simon of Glaisdale observed in Director of Public Prosecutions v Kilbourne[1973] AC 729 , 756, “Evidence is relevant if it is logically probative or disprobative of some matter which requires proof …. relevant (ie. logically probative or disprobative) evidence is evidence which makes the matter which requires proof more or less probable”. 4. That evidence of what happened on an earlier occasion may make the occurrence of what happened on the occasion in question more or less probable can scarcely be denied. … To regard evidence of such earlier events as potentially probative is a process of thought which an entirely rational, objective and fair-minded person might, depending on the facts, follow. If such a person would, or might, attach importance to evidence such as this, it would require good reasons to deny a judicial decision-maker the opportunity to consider it. For while there is a need for some special rules to protect the integrity of judicial decision-making on matters of fact, such as the burden and standard of proof, it is on the whole undesirable that the process of judicial decision-making on issues of fact should diverge more than it need from the process followed by rational, objective and fair-minded people called upon to decide questions of fact in other contexts where reaching the right answer matters. Thus in a civil case such as this the question of admissibility turns, and turns only, on whether the evidence which it is sought to adduce, assuming it (provisionally) to be true, is in Lord Simon's sense probative. If so, the evidence is legally admissible. That is the first stage of the enquiry. 5. The second stage of the enquiry requires the case management judge or the trial judge to make what will often be a very difficult and sometimes a finely balanced judgment: whether evidence or some of it (and if so which parts of it), which ex hypothesi is legally admissible, should be admitted. For the party seeking admission, the argument will always be that justice requires the evidence to be admitted; if it is excluded, a wrong result may be reached. In some cases, as in the present, the argument will be fortified by reference to wider considerations: the public interest in exposing official misfeasance and protecting the integrity of the criminal trial process; vindication of reputation; the public righting of public wrongs. These are important considerations to which weight must be given. But even without them, the importance of doing justice in the particular case is a factor the judge will always respect. The strength of the argument for admitting the evidence will always depend primarily on the judge's assessment of the potential significance of the evidence, assuming it to be true, in the context of the case as a whole. 6. While the argument against admitting evidence found to be legally admissible will necessarily depend on the particular case, some objections are likely to recur. First, it is likely to be said that admission of the evidence will distort the trial and distract the attention of the decision-maker by focusing attention on issues collateral to the issue to be decided. This… is often a potent argument, particularly where trial is by jury. Secondly, and again particularly when the trial is by jury, it will be necessary to weigh the potential probative value of the evidence against its potential for causing unfair prejudice: unless the former is judged to outweigh the latter by a considerable margin, the evidence is likely to be excluded. Thirdly, stress will be laid on the burden which admission would lay on the resisting party: the burden in time, cost and personnel resources, very considerable in a case such as this, of giving disclosure; the lengthening of the trial, with the increased cost and stress inevitably involved; the potential prejudice to witnesses called upon to recall matters long closed, or thought to be closed; the loss of documentation; the fading of recollections. … In deciding whether evidence in a given case should be admitted the judge's overriding purpose will be to promote the ends of justice. But the judge must always bear in mind that justice requires not only that the right answer be given but also that it be achieved by a trial process which is fair to all parties.” 24. This analysis, given in a civil case, applies also to family proceedings. There are two questions that the judge must address in a case where there is a dispute about the admission of evidence of this kind. Firstly, is the evidence relevant, as potentially making the matter requiring proof more or less probable? If so, it will be admissible. Secondly, is it in the interests of justice for the evidence to be admitted? This calls for a balancing of factors of the kind that Lord Bingham identifies at paragraphs 5 and 6 of O'Brien. 25. Where the similar fact evidence comprises an alleged pattern of behaviour, the assertion is that the core allegation is more likely to be true because of the character of the person accused, as shown by conduct on other occasions. To what extent do the facts relating to the other occasions have to be proved for propensity to be established? That question was considered by the Supreme Court in the criminal case of R v Mitchell[2016] UKSC 55 [2017] AC 571 , where it was said that the defendant, who was charged with murder by stabbing, had used knives on a number of other occasions, none of which had led to a conviction but which on the prosecution's case showed propensity. Lord Kerr addressed this issue in the following way: “Propensity - the correct question/what requires to be proved? 39. A distinction must be recognised between, on the one hand, proof of a propensity and, on the other, the individual underlying facts said to establish that a propensity exists. In a case where there are several incidents which are relied on by the prosecution to show a propensity on the part of the defendant, is it necessary to prove beyond reasonable doubt that each incident happened in precisely the way that it is alleged to have occurred? Must the facts of each individual incident be considered by the jury in isolation from each other? In my view, the answer to both these questions is "No". 43. The proper issue for the jury on the question of propensity… is whether they are sure that the propensity has been proved. … That does not mean that in cases where there are several instances of misconduct, all tending to show a propensity, the jury has to be convinced of the truth and accuracy of all aspects of each of those. The jury is entitled to - and should - consider the evidence about propensity in the round. There are two interrelated reasons for this. First the improbability of a number of similar incidents alleged against a defendant being false is a consideration which should naturally inform a jury's deliberations on whether propensity has been proved. Secondly, obvious similarities in various incidents may constitute mutual corroboration of those incidents. Each incident may thus inform another. The question … is whether, overall, propensity has been proved. 44. … the jury should be directed that, if they are to take propensity into account, they should be sure that it has been proved. This does not require that each individual item of evidence said to show propensity must be proved beyond reasonable doubt. It means that all the material touching on the issue should be considered with a view to reaching a conclusion as to whether they are sure that the existence of a propensity has been established.” 26. Again, this analysis is applicable to civil and family cases, with appropriate adjustment to the standard of proof. In summary, the court must be satisfied on the basis of proven facts that propensity has been proven, in each case to the civil standard. The proven facts must form a sufficient basis to sustain a finding of propensity but each individual item of evidence does not have to be proved.”
“The court must try to give effect to what are here two conflicting public interests. The weight to be attached to each will vary according to the circumstances. The significance of the evidence will differ as will the gravity of the breach of article 8, according to the facts of the particular case. The decision will depend on all the circumstances. Here, the court cannot ignore the reality of the situation. This is not a case where the conduct of defendant’s insurers is so outrageous that the defence should be struck out. The case, therefore, has to be tried. It would be artificial and undesirable for the actual evidence, which is relevant and admissible, not to be placed before the judge who has the task of trying the case.”
“I know that in criminal cases the judge may have a discretion. That is shown in Kuruma v the Queen. But so far as civil cases are concerned, it seems to me that the judge has no discretion. The evidence is relevant and admissible. The judge cannot refuse it on the ground that it may have been unlawfully obtained… But, even if it was unlawfully obtained, nevertheless the judge is right to admit it into evidence and to go on with the case as he proposes to do.”
“I am the first to acknowledge that a judge … is entitled to take a proactive, quasi-investigative role in care proceedings. Equally, she will make findings of fact on all the evidence available to her, including her assessment of the parents' credibility; she is not limited to the expert evidence. I am also content to decide the question in this appeal on the basis that a judge … is not required slavishly to adhere to a schedule of proposed findings placed before her by a local authority. To take an obvious example: care proceedings are frequently dynamic and issues emerge in the oral evidence which had not hitherto been known to exist. It would be absurd if such matters had to be ignored. All that said, however, the following propositions seem to me to be equally valid. Where, as here, the local authority had prepared its Schedule of proposed findings with some care, and where the fact-finding hearing had itself been the subject of a directions appointment at which the parents had agreed not to apply for various witnesses to attend for cross-examination, it requires very good reasons, in my judgment, for the judge to depart from the schedule of proposed findings. Furthermore, if the judge is, as it were, to go "off piste", and to make findings of fact which are not sought by the local authority or not contained in its Schedule, then he or she must be astute to ensure; (a) that any additional or different findings made are securely founded in the evidence; and (b) that the fairness of the fact finding process is not compromised.”
“[44] Concern about the utility of Scott Schedules was raised on two different bases: one of principle and the other more pragmatic. The principled concern arose from an asserted need for the court to focus on the wider context of whether there has been a pattern of coercive and controlling behaviour, as opposed to a list of specific factual incidents that are tied to a particular date and time. Abusive, coercive and controlling behaviour is likely to have a cumulative impact upon its victims which would not be identified simply by separate and isolated consideration of individual incidents. [46] For our part, we see the force of these criticisms and consider that serious thought is now needed to develop a different way of summarising and organising the matters that are to be tried at a fact-finding hearing so that the case that a respondent has to meet is clearly spelled out, but the process of organisation and summary does not so distort the focus of the court proceedings that the question of whether there has been a pattern of behaviour or a course of abusive conduct is not before the court when it should be. This is an important point. Everyone agrees. [47] The Harm Panel has expressed a similar view and noted that 'reducing a long and complicated history of abuse into neat and discrete descriptions is challenging and can itself result in minimisation of the abuse' (Chapter 5.4), and that by limiting the number of allegations the court is not exposed to 'more subtle and persistent patterns of behaviour' (Chapter 7.5.1). So too did Hayden J in F v M in his Post Script.”
“…[G] arrived back from social leave and family requested for her to be hoisted to bed. X2 nurses on duty: DOC and SHCA assisted to bed. DOC asked family to leave [but] mum and dad both refused. Staff hoisted [G] to bed with no issues. All checks complete. Dad started to [ask] DOC about O2 cylinder when hoisting out. DOC respectfully said she was aware of the issue they had raised but was not going to discuss anything at [G]’s bedside. Dad said he was shocked at the lack of concern she had and again DOC said she would not discuss this at [G]’s bedside….”
“When finished EB went to fetch new suction tubing as we noticed it had been forgotten to be changed. Dad immediately asked what suction we would use in an emergency. Senior NP’s explanation was that we could reach with the suction on the wall. Dad said he felt it was unacceptable for an emergency situation and asked for proof that it could reach by giving nasal suction. Senior NP have [G] nasal suction which reached from the wall, suction tubing was then put under the chair.”
“18. At this point, [LF] told me that I had put [G]’s life at risk by transferring her back with that slight crack. [LF] was saying that it had been a safeguarding concern and asking what I was going to do about it and told me that I would need to keep the circuit as evidence. I felt very intimidated by his approach and very overwhelmed that I did not know how to respond immediately. I told him that I’d speak to the managers and come back to him. This interaction really upset me and still upsets me to this day. I would never put [G]’s life at risk. I care for all of my patients, their safety is a priority to me and I would never want any of them to come to any harm. If I had had any concerns that the ventilator wasn’t secure or that there was a risk to her life, I would not have transferred [G]. I had kept the piece and showed this to the managers and they also felt that as it needed as much force to disconnect as any other piece, my actions had not put [G]’s life at risk As a team, we decided it would be best if we put in safeguarding referral too, just to be sure, however it was unreportable as no harm had been caused and so we logged it as a Datix instead (this is the incident system we use for all of our incidents). 19. This incident was alarming for me, as [LF] or [GR] had not raised any concerns prior to the transfer and I could not understand why [LF]’s concerns were raised after the transfer and not before. If they had been raised prior to transfer, we could have addressed them then whilst there were multiple other people around. I believe he wanted to wait until I was on my own to speak to me as this made me feel especially vulnerable. I felt like if they had concerns about the transfer from ITU to [CH], they never said anything to myself or my colleagues or ITU staff beforehand.”
“GR: But [IW], he has gone to [IW] first. He never raised it with any of the staff…” “LF: … There was no – there was nothing to it. I just said I’d like to raise it and I said I came to try and see [IW].”
“[40] From February, Dr B considered that LF’s behaviour became “challenging and verbally confrontational”
“[35] …Nurse G felt he is frequently rude to nursing and medical staff including herself, either by ignoring them completely or by making sarcastic comments either to G or the staff directly. She finds him to be very passive aggressive and intimidating and has found herself avoiding having any contact with him whenever possible. Nurse G stated that she and other members of staff sometimes dread coming into work knowing they have to deal with him and several members of staff have left because of his unreasonable behaviour and the effect it has had on their mental health. Nurse G feared that if there was ever any incident involving G that his behaviour would escalate, as it has done in the past, and she would have to be the person to deal with him. Nurse G reported that he has a history of not abiding to restrictions which were put in place as a result of his actions, and this makes her nervous as coordinator of a busy HDU which cares for many sick children and their families. Nurse G recalled an incident where [LF] was banned from the unit due to an incident of poor behaviour which put G at risk, and he still secretly gained entry to the unit and security and senior management needed to be called to deal with the situation. Nurse G said many of the junior staff have similar concerns and have frequently expressed these concerns to her and other senior members of staff.”
“At the commencement of the shift that day, at around 08:15, I had spoken to the staff about the organisation for that day and [Nurse W] confirmed she would do the oxygen checks in all of the rooms on [the unit]. [Nurse W] left to do the oxygen checks with [RF], HCA, who was providing enhanced care at the time. Once the check of [G]’s oxygen was completed, [G] was left with her grandmother, CJ, and the 1:1 nurse who sat at the door outside [G]’s room when [G]’s family were present and [G] didn’t need any care. At around 10:50am, I was present in [G]’s room with the 1:1 nurse and CJ when CJ reported to me that [G]’s oxygen valve was off. I said I did not know how to explain that because earlier that morning [Nurse W] and the HCA had checked the oxygen valve was on and being delivered at 1 litre and no other staff had provided care to [G] since then. CJ immediately replied, “I didn’t do anything”
“next thing will be allegations of tampering again? Got to protect ourselves now x”
“Told dad” (i.e., about the reading) “He was not interested – his hand went to the back of the chair. Not sure if dad switched O2 off. X2 SN checked O2 on chair. Dad said O2 was it on. I quickly turned O2 on and she maintained 88o dad still not interested at this point. [G]￪ 97-98%”
“oxygen not on [G]’s chair for transfer – [Nurse W] put it on after 22 minutes”
“The written and oral evidence of [Nurse W], [B], [L] and [B] is consistent in that they had checked the oxygen was on, that morning. [L] states that the oxygen “was definitely turned on. I am certain that it was on as we had double checked it”
“[it was] definitely, definitely her position, wasn’t it?”
“I have been an employee of [CH] since July 2018, I started as a Healthcare Assistant, then Senior HCA (SHCA) before qualifying as a Registered General Nurse in April 2022. Whilst I have been both SHCA and nurse I have always been fully compliant with ventilator and tracheostomy training competencies. My current job role duties include assisting complex patients with holistic care within my level of knowledge/ skill which includes administering medications, tracheostomy and ventilator care, nutritional and hydration needs, and other clinical needs”
“The next alleged incident was on3 October 2022 , when it was reported that [G] was transferred and stable in her chair and that I then said that the oxygen valve was off and I turned it on. I was completing my daily checks at the time, and there have been numerous occasions when I have found her oxygen valve was turned off when I checked the chair. On this occasion the valve was turned off. I cannot account for why this was the case as I was not present earlier. However, the oxygen made a clunking noise when it was opened for the first time. When I asked [Nurse KP], she accepted that she had heard it and admitted this to [Nurse CS] in my presence. [Nurse CS] rudely and abruptly told [Nurse KP] to stop talking and to be quiet. The fact that there was a clunk would contradict the evidence that the oxygen was on as this sound only happens when turning the oxygen cylinder on for the first time. I note the evidence in [NS]’s statement that the “clunck” sound is made each time the cylinder is turned on. This is not correct. It is contradicted by the evidence from [Nurse CS] at paragraph 10 of her witness statement who says that the “clunk sound can sometimes be heard when the valve on the oxygen opens first”
“[SS] ’s contemporaneous account was prepared jointly with another HCA, coordinated by [Mr L], which creates some scope for confusion. She was asked questions about this statement and said it incorporated her recollections with others. This records that [CJ] declined to leave the room when requested for hoisting, but stood by the door. It also records that the O2 had been checked prior to transfer and set to 2L and that there had been “auditory confirmation [a hiss] that valves were open”
“…[O]n7 October 2022 I was doing checks in [G]’s room with [Nurse SJ], unit manager. During the morning check I saw [G]’s wheelchair and it was set up correctly with the tubing for her ventilator. The wheelchair was placed in the lounge outside of [G]’s room whilst we were getting her ready to go out with her parents who were waiting in the lounge. However, when the wheelchair was brought back into [G]’s room, we immediately noticed that the ventilator tubing was not set up correctly because the green filter that is supposed to go into the green end of the dry circuit had been attached to the clear end, and the clear end was attached to the green circuit. I cannot explain how this happened when I had seen it set up correctly before the wheelchair was placed in the lounge with [G]’s parents.”
“The only reasonable conclusion is that this excessive force was applied with the intention of damaging the flow meter”
“GR – IW your staff are not trained to [look] after her I am not speaking to you anymore and will only speak in writing (left the meeting) LF – We was told this was a specialist ventilation centre but we never wanted her to come here anywhere but here we would have went to Exeter. We know all about you and just want [G] here as she is a cash cow for the [the lead group]. We know about directors who are paid by [the lead group] and the [the Trust] tentacles spread far and wide. We know about your self cert inspections and CQC didn’t even speak to us following raising concerns IW – What do you mean? Back handers or something? LF - I didn’t; mention that why are you saying that I didn’t mention that Nurse B – I would see why IW would come to that conclusion form what you have said? LF – You would wouldn’t you. IW – What do you mean by self-cert? LF – Sorry, self-certification inspections IW – That is a measure put in place to ensure good practice for CQC inspections etc. LF - I have got everything recorded I know what goes on. IW – you do know it is illegal to record/film anyone with their consent. LF– What my daughter? CB – What about the staff you can’t do that. IW – If you want to go down that route, we can get an independent company to install CCTV in [G] rooms this would be done under BI decision and they would monitor DJ – I am sure they would be independent. Meeting ended”
“[LF] had said that [G] was dehydrated as we won’t give her enough fluids however that was proven otherwise when the consultant had done her blood gases. [G]’s sats were still dipping [LF] had moved [G]’s oxygen from 4-6 litres with no direction from any medical staff 5 minutes he went to the oxygen bottle where he asked me to check whether it was on the proceeded to tell me it was off and to put it on. I explained to [LF] that the oxygen was on 4 litres by our staff and hadn’t been touched by anyone. I felt very uncomfortable and intimidated when he singled me out by saying it's always you with the oxygen. My colleague was still in the room at this point so I had to take a minute and remove myself away from the situation as was feeling very upset and undermined and felt dad’s tone of voice was getting very aggressive. Before [LF] had arrived at A & E [CJ] had commented to hospital staff how well looked after [G] is at [the care home] and how we’ve done everything we could possibly could. Once Dad arrived [CJ]’s demeanour changed and could feel a tense atmosphere within the family dynamics.”
“About 5 minutes after that, he asked me to check that [G]’s oxygen was on and then he proceeded to tell me it was off and turn it back on. I said to [LF] that he knows it has been on at 4 litres this whole time and that no one had touched the oxygen valve except him since [G] had arrived at hospital. Also, if [G]’s oxygen had been off all the way from [the care home] up to now, she would not have survived. [LF] then said to me, quite aggressively ‘It’s always you with the oxygen’.”
“The contemporaneous note of [Nurse M] sets out that shortly before pointing out that the oxygen was not on, [LF] had turned up the O2 cylinder of his own accord [R1/A427], without the agreement or permission of the medical staff present. [Nurse M] maintained in oral evidence that she heard [LF] state: “I’m turning this up a little bit”
“abusive”, “dangerous”, “frightening”, “disgusting”