Wisbech Magistrates Court, Wisbech, Cambridgeshire
First Witness - Dr Carol Ann Walcott (statement read)
General Practitioner based in Ely Surgery. On Saturday 16 February 2008 one of her patients Phyllis Fletcher telephoned TCN complaining of breathing difficulties. Dr Ubani attended at 12:28 hrs. He prescribed simple linctus. According to NICE Guidelines if there is an exacerbation of respiratory symptoms a doctor should do the following:-
1. Increase the inhalers
2. Prescribe Prednisolone.
3. Consider nebuliser.
Dr Walcott said “the treatment given by Dr Ubani was in my opinion unusual and not effective in someone with pulmonary disease."
Second Witness – Sandra Banks (statement read)
Started suffering with severe headaches on 13 February 2008. Her headache turned into a migraine and increased in severity. By Saturday 16 February she took to her bed all day because she felt in so much pain and her migraine was intense. Her daughter, Julie Singer telephoned TCN and requested a Locum Doctor. Dr Ubani made a home visit at approximately 14:00 hrs. He administered an injection into her right buttock. Within a short time of him leaving she felt slightly better but within a few hours started to vomit violently and felt extremely unwell and could hardly catch her breath. Her partner, Mr Stephen Cowley said “Dr Ubani seemed competent but there was something about him. He was difficult to understand and spoke poor English. He also seemed to brush over Sandra’s list of medication far too quickly”.
Third Witness – Linda Bubb, partner of David Gray (Deceased)
Telephoned TCN on 16 February 2008 because David Gray was feeling unwell. Dr Ubani made a home visit. Linda Bubb said “Dr Ubani seemed a bit dithery and was muttering to himself. He was uncertain as to how much Diamorphine to give. When he pulled the ampoule out of his palliative care box it mentioned 100 mgs. I explained that Dr Hirson would give David 100 mgs of Pethidine, not Diamorphine. However, he proceeded to give 100 mgs of Diamorphine”.
Fourth Witness – Dr Richard Bernard Hirson, General Practitioner, Manea, Cambridgeshire and was David Gray’s GP said:
“I learnt of David’s death shortly before 9:00 am on 17 February 2008. I was contacted by the medical director of Sufdoc. I was informed that he received 100 mgs of Diamorphine. I was appalled and very upset to think that such an incident could happen anywhere and also to David Gray with whom I had a sound and friendly relationship”.
Fifth Witness – Trevor Smith (statement read) is employed as the Deputy Manager at TCN based in Ipswich.
He said “I received a telephone call from a clinician from Wisbech by the name of Gary. He said that Dr Ubani had updated the log as having administered a dosage of 100 mgs of Diamorphine. I am not a clinician, but I knew immediately that this would have been an overdose”.
Sixth Witness – Dr Nathaniel Cary, Consultant Forensic Pathologist
He examined David Gray’s body on 20 February 2008. When questioned by the Coroner about the administration of Diamorphine he said “in simple terms it was the wrong drug and wrong dose and 100 mgs of Diamorphine represents a substantial overdose”.
The inquest continues tomorrow.
For general enquiries contact Simeon Ling on 07841 499693 or for media
enquiries contact Jo Garner on 07717 897991or 01527 888992 email media@anthonycollins.com