Dark practices on night shift at death hospital

But an inquiry into Anne Grigg-Booth, published yesterday, paints a wider disturbing picture of night work on wards at Airedale Hospital, near Keighley, about which top management were either ignorant or did little or nothing to confront.

It found the night nurse practitioner was not alone in carrying out illegal prescribing at the hospital between the mid-1990s and her suspension in 2003. It said the conduct should have been "picked up and stopped six years earlier", well before any serious incidents took place.

But managers were quick to dismiss her as a "rogue" nurse and did not realise there were systemic failings at the organisation, wrongly believing that because it had won a string of accolades it was a successful NHS trust.

The report found Mrs Grigg-Booth was not a nurse in the mould of Grantham nurse Beverly Allitt or Colin Norris, who murdered four patients in Leeds during 2002, since her actions were "almost entirely" open.

She recorded what she was doing in clinical records and prescription charts.

Her role aimed to reduce the workload of junior doctors under arrangements in 1991 to cut their hours. It became unofficial policy for them to be allowed to stay in bed at night creating "the potential for patients to be put at risk", said the inquiry.

"Without realising it the trust board had a system in place which inadvertently put the needs of the organisation before that of patients."

It found that contrary to hospital policy, night nurse practitioners administered opiate painkillers straight into patients' bloodstreams.

They all believed they were permitted to do so and were competent to do it. Some managers knew about it but did nothing.

On some occasions Mrs Grigg-Booth went further and illegally prescribed opiates herself without permission from a doctor. Sometimes, but not always, she got a doctor to approve her actions retrospectively. Other practitioners may also have done the same but less often, the report found.

Her activities were only discovered by chance as staff were carrying out an audit of patient deaths.

The report found supervision and professional support for night practitioners was "woefully inadequate".

It said: "The night staff in particular appeared to operate in a vacuum, separated from the world of day staff, save for brief handover arrangements for continuity of patient care."

The trust's board had little idea what went on at night. It found former chief executive Bob Allen, who was in charge for 12 years until 2004, or Prof Brian Jewell, trust chairman from 1999-2005, had never visited the wards at night, while the trust's director of nursing made three visits between 1995 and 2003.

"The most striking failure was in the disconnection between what was happening on the wards at night and what the board knew. The board had no idea," it said.

"By failing to undertake any 'reality checks' at night, whether formally or informally, in effect they were only taking an overview of governance arrangements during daylight hours."

An entirely new management team has run the hospital since 2005.

Of three other night nurse practitioners investigated, one took early retirement and two others were disciplined and demoted before leaving. Their line manager was suspended in October 2004 and was later dismissed.

A senior manager, who was aware of some unlawful practice, was suspended and later resigned.

96-year-old's death sparked inquiry

Investigations into Anne Grigg-Booth were triggered by a review of the case of Annie Midgley who died in hospital at Airedale on July 22, 2002, aged 96. She had been admitted a month earlier, after a fall when she suffered a broken left hip.

The pensioner underwent surgery. Her condition deteriorated during the evening of July 21. Mrs Grigg-Booth was called and took charge of her care, giving Mrs Midgley diamorphine. Her daughter recalled: "After the sister injected my mother she became more settled and the sister left."

No doctor was called. Two hours later, her breathing deteriorated and she died.

Mrs Grigg-Booth recorded what she had done in the medical notes and the prescription charts.

The inquiry concluded: "It appears that she administered it to relieve the patient's distress in her dying hours. She would have known that to do so may hasten death."

Nevertheless, it said her prescription of the drug was unlawful and that, even though it made no difference to the patient, for Mrs Grigg-Booth it was "little short of catastrophic". Two years later she was later charged with Mrs Midgley's murder.

Widow died after lung cancer tests

Widow Eva Blackburn was admitted to Airedale Hospital in November 2001 with suspected pneumonia after complaining of shortness of breath for several days.

The 75-year-old from Haworth, who had worked as a weaver, was a lifelong heavy smoker. Medical teams carried out tests which revealed she could have lung cancer.

Her condition quickly deteriorated and despite further treatment from hospital staff, her plight worsened and she was prescribed diamorphine by a doctor as she was becoming agitated.

Shortly afterwards Anne Grigg-Booth administered the drug but her condition continued to worsen despite further treatment and her family including two sisters were called to her bedside as it became clear she was dying.

An hour later, Mrs Grigg-Booth decided to give her a second dose of the diamorphine and she died peacefully half an hour later.

In police interviews, Mrs Grigg-Booth insisted she would not have given the drug unless her patient was in pain or distress.

The inquiry team accepted this but police later charged the night nurse practitioner with Mrs Blackburn's murder.

'Few can understand trauma and distress'

Karen Hanson, was admitted to Airedale Hospital in July 2000 with an extremely painful abscess in her hip.

Then aged 28, she had given birth nine weeks previously and her baby son was lying at the bottom of her bed.

Specialists were called after she was left in enormous pain and nurses were told in very clear terms she needed regular medication.

On the night of July 20, her condition worsened and Anne Grigg-Booth prescribed and gave her morphine.

The inquiry team find this was both "unlawful and potentially dangerous" but despite it being recorded in the medical notes it was not picked up by other hospital staff.

Mrs Hanson's condition was still causing her pain and four days later Mrs Grigg-Booth gave her a second dose of the drug.

She did recover but the inquiry team say the nurse's actions, for which she was charged with two counts of administering a noxious substance with intent to cause grievous bodily harm, were both "illegal and dangerous".

Yesterday Mrs Hanson, who lives near Keighley, said: "Few can begin to understand the trauma and distress that is felt when they are the victim of a violent act from someone in a position of trust like this and which it is now clear could have been avoided. The failures on the part of the management are disturbing."

Her lawyer Simon McKay said: "This is a young woman who had given birth to a child and was assaulted by a nurse who was out of control and poorly managed."

Retired ward sister had hip infection

Retired nursing sister June Driver was admitted to hospital at Airedale in June 2000 suffering from an infected right hip replacement.

The artificial hip was removed and she was treated at the hospital until her condition suddenly deteriorated on the evening of July 23.

Anne Grigg-Booth was called to see her and a junior doctor also attended her bedside as concerns grew that she had suffered a stroke.

Medical staff continued to treat her through the night and plans were drawn up to transfer her to hospital in Leeds for further treatment.

Mrs Driver's daughter, also a nurse, was at her beside throughout the early hours but by 4am her condition had deteriorated.

The inquiry team believe Mrs Driver was administered diamorphine. It was not recorded on medical or prescription charts by Mrs Grigg-Booth although it was noted by another nurse.

Mrs Driver became more relaxed and her breathing slowed and within minutes she had died, aged 67.

Experts disagreed whether the drug hastened her death.

Mrs Grigg-Booth was later charged with her murder.