After two closing speeches this morning, the court had a short break, before returning at midday for Mr Josh Normanton’s closing speech for Karen McGhee. He started by telling the jury that in early 2019 Ms McGhee was a recently trained nurse and that he wanted to open his speech by having a think about nurses and what they do, their motivations and what their job involves.
In our country we clearly have a respect for them, but rarely a respect that translates into a desire to be a nurse, generally represented by the line “I could never do what they do”.
Mr Normanton told the jury that you have to be a particular type of person to go into nursing, that they don’t do it for the money, or the reputation because the doctors get that.
You do it because you’re someone where in your heart is a selfless desire to help people. Karen McGhee has that desire, she’s never lost it, she still has it.
Mr Normanton told the jury that the job of nursing involves hard work “much of it beyond us”. He said that their work was sometimes fulfilling, and we’d all like those moments, but some moments which were really touch.
Whorlton Hall had a good amount of really tough. When managers leave you to deal with everything.
Mr Normanton referenced Karen McGhee being injured, spending all night in hospital, before coming back the next day “or there would be no nursing care” and she had patients to look after.
Our* submission to you is the three incidents which form Counts 8, 9 and 20 are not ill-treatment of patients at all, nothing could be further from the truth.
They are examples of a nurse doing her level best to deal with tough situations Whorlton Hall would throw at you. Examples of a nurse trying to manage risk based on what she knew at the time.
One has to note ladies and gentlemen of the jury, they’re examples of conduct about which the prosecution have provided not a shred of evidence as to why Karen McGhee was ill-treating patients when she attended those events.
Mr Normanton told the jury that the prosecution could have comments from a nurse or doctor commenting on Karen McGhee’s conduct, saying that was wrong for these reasons. Or something from a MDT meeting discussing restraint and saying why it was wrong. Mr Normanton said that it was for the prosecution to show the jury so that they are sure that Karen McGhee took an “obvious leave of absence from her duty to caring”.
If you’re not sure she ill-treated, or think another explanation possibly for what happen, then your duty is to acquit her.
You’re not here as a Professional Standards Tribunal checking whether absolute best practice has occurred.
It’s not a lapse of professionalism, a case of a wrongly spoken word, they’re saying this woman who has committed herself to helping others has ill-treated those in her care, the very opposite of what we expect a nurse to do.
Mr Normanton told the jury that the mere existence of this allegation had ended her career “at least for now”. He said that in considering whether the prosecution made them sure, the jury will wish to consider Karen McGhee’s evidence and what she said in the witness box, which he said was consistent with both interviews where she gave answers to the police.
It’s not for her to prove anything, is for the Crown to prove its case.
Mr Normanton told the jury that what they’d find interesting, if not striking, was that Karen McGhee was used as an example of good behaviour, that Ms Richardson highlighted her please and thank you, highlighted that she was repeating for Patient 1, and she asked Karen McGhee if she would have done what other’s did.
Mr Normanton said to the jury that Karen McGhee had explained that she had experience of talking to Patient 1 about the need to have male staff working with her, but the prosecution say you can’t accept that.
Where is the evidence that any part of what Karen McGhee has said is wrong? Where is the nurse or doctor, if the prosecution are right, saying you just couldn’t say this to Patient 1, you couldn’t do that?
I remind you it is for the prosecution to make sure you’re sure, to prove its case.
Mr Normanton asked the jury where is the evidence to explain why the conduct they see on those videos must be ill-treatment. He asked them to then think of Karen McGhee’s explanation and what evidence is there that the prosecution have undermined her case. He told the jury that they say the documentation supports what Karen McGhee is saying, “still you are invited to reject her explanation”.
You may wish to keep in mind what you know about Karen McGhee … What you might view as a sanity test, stepping back, reflecting for a moment. Does she really fit the mould of someone who would criminally ill-treat those in her care?
This is a woman who her entire life has wanted to be a nurse.
Other healthcare professionals in the references you heard spoke of her as a quiet, thoughtful person … they spoke of her kindness and her empathy.
Mr Normanton said that the evidence they’d heard included “blink and you’ll miss it moments, that supported that description”. He said it was something you don’t see in a court room very often. He referenced when Karen McGhee spoke about the improvement in Patient 1 and how she was able to leave Whorlton Hall and move closer to home.
It was not so much what Ms McGhee said, it was the way she said it, her face lit up, it made her happy to think of Patient 1 going somewhere closer to home.
What’s interesting you may think is she’s just happy for Patient 1, not withstanding all that’s happened since, the ruination of her beloved career, her inability to face the world after the Panorama programme, this criminal trial. What does that say to you about Karen McGhee?
Mr Normanton told the jury that Karen McGhee had faced and overcome great adversity in becoming a nurse, initially unable to follow her career because of he dyslexia, then she was a single parent to two children “children with respectful careers”, he mentioned how she’d supported one of her children with their health challenges.
Mr Normanton told the jury that despite her dyslexia Karen McGhee had pursued a degree, struggling at university but succeeding. He said she’d worked through injuries, stepped in when others were ill, she had come back after completing a 12 hour shift to “shop someone off to hospital”, she’d rung around agencies and managed staff.
She shouldered responsibilities that managers at that place should have.
Mr Normanton said that Karen McGhee had called out bad treatment, and he asked why anyone would go through all of that entire history, to just throw it away and intentionally ill-treat the very people she was dedicated to looking after.
All evidence, you may think, completely undermines the allegation she’d ill-treat anyone.
Mr Normanton told the jury that the allegations against Karen McGhee were a mistake.
Reading between the lines the prosecution have lost sight of the evidence and why she acted. To some extent she’s been lumped in in this case.
Mr Normanton suggested that any time Patient 1 was told about male carers had become ill-treatment, or any time Patient 4 had been told his belongings would be removed.
Will be obvious to you people have different reasons for doing things, different knowledge, different objectives, part of the reason his honour directs you to consider each defendant’s case individually.
Mr Normanton said that even if there was a culture of treating patients at Whorlton Hall a particular way, there was not a shred of evidence Karen McGhee was about it. He said there was no video about her.
Mr Normanton told the jury that Counts 8 and 9 relate to Karen McGhee turning up in response to a restraint, and referring to the fact within that men would be needed to support Patient 1 at some point. He told the jury they may think it is important to establish what was going on with Patient 1 and her views on male staff at the time, but he said what Karen McGhee knew about it “is really important”.
If the evidence is she knew no more than was Patient 1’s preference, if it couldn’t be accommodated and Patient 1 could handle it and talking to Patient 1 about that was appropriate, my submission is it couldn’t be anywhere close to ill-treatment, it was appropriate care.
Mr Normanton told the jury that in Patient 1’s Positive Behaviour Support Plan it was “striking” there was no reference to Patient 1 being placed with men, or that she could not be supported by men.
There’s a very brief line on the first page about preference for female staff but it doesn’t link into her care.
Mr Normanton discussed more of the documentation relating to Patient 1. He told the jury that there was no information from previous placements about Patient 1 being affected by male carers and no reference at all to male carers in her previous careplan. He said that “hidden in the detail” of her psychology report was a reference to men, not emphasised elsewhere. Mr Normanton also said that document made comment about the level of comprehension Patient 1 had “may lead you to the conclusion she was someone who could be spoken to and reasoned with”.
Mr Normanton told the jury about the evidence Karen McGhee had given, that she took the time to get to know Patient 1 and would say to her when it was necessary for men to be on her shift and Patient 1 was fine. Mr Normanton said that it was necessary to place Patient 1 with men, because of staffing issues “where nurses were left with no choice” but also on occasions when Patient 1 became violent it “was necessary to keep everyone safe, staff included, to place her with the most experienced and strongest support workers”. Mr Normanton told the jury that happened and the prosecution doesn’t suggest it was wrong for it to happen, it was the reality of care and set out in Whorlton Hall policy.
Mr Normanton read an extract from the policy to the jury. He then told them that the evidence “shows nurses had not identified any problem with Patient 1’s behaviour linked to men in January 2019, they didn’t know it was an issue”. Mr Normanton told the jury that Olivia Davies had noticed Patient 1 was distressed by men, as mentioned in her video diary entry of 29 January 2019, which was 5 days after the final allegation concerning Karen McGhee.
Her evidence, Olivia Davies’ evidence, was she did not report that issue in an observation record. She spoke at length to her producers, but did not report it.
What’s the significance of that ladies and gentlemen of the jury? Beyond debate about journalistic ethics, failure to report something meant the nurses were simply not informed … Karen McGhee did not know there was an issue, linked to her behaviour, causing her distress.
You might conclude there was evidence other staff knew, but where is the evidence Karen McGhee knew?
Mr Normanton told the jury that Ms Davies had given evidence she spoke to senior support workers and to a nurse about it, later in February.
All that you may think, meant nurses in January did not know it was a serious issue.
You may think is relevant to whether Karen McGhee knew anything was wrong in speaking to Patient 1 about men on 11 or 24 January.
Mr Normanton told the jury that Patient 1 on both occasions had attacked female staff, and that Karen McGhee came at a point where there is no evidence she knew what had happened, other than that Patient 1 was at a tertiary level and was being restrained.
Let’s say you were faced with situation ladies and gentlemen of the jury where Patient 1 has repeatedly attacked staff, and you had more senior stronger staff available, what would you do?
Mr Normanton told the jury members that this was an example of the hard choices the nurses faced in this environment. He said that the issue seemed to be that it was communicated to Patient 1 during the course of a restraint “such an allegation is made in complete ignorance of the need to communicate with Patient 1”.
Mr Normanton suggested to the jury they may think it entirely reasonable and proper in the circumstances to say to Patient 1 that she will put men on. Mr Normanton also told the jury that “it seems also to help Patient 1 understand how things will play out if she continues to attack members of staff”. He said to not communicate that to Patient 1 was “an example of how these allegations ignore the reality of the job faced by nurses at Whorlton Hall”.
Mr Normanton told the jury that it may have struck them that the allegations against Karen McGhee are completely at odds to what she is seen doing in videos caring for Patient 1, repeating, deep breaths, talk to Karen, commenting on her nails to distract her.
Mr Normanton told the jury there were two things he wanted to deal with relating to Patient 1. One is Count 9, he said you could hear that there were two conversations going on at once.
You have to be sure Karen McGhee participated in that conversation, you may find it difficult to do that when evidence shows she was focused on Patient 1 at that point.
Mr Normanton said they’d played the video in their evidence and whatever the jury made of the conversation about Waqa, it had nothing to do with Karen McGhee.
Then ladies and gentlemen, the possessed comment in Count 9 … one of the very few times Karen McGhee was mentioned in my learned friend’s speech for the prosecution, was her comment that Patient 1 appeared possessed.
Mr Normanton told the jury that it was a brief statement immediately after the restraint begins.
Wonder if someone in your charge was writhing on the floor, ladies and gentlemen of the jury, scratching at staff, screaming in a deep way, attacked staff, I wonder if an inappropriate thought might flick across your mind…
No evidence Patient 1 heard it. It was not said to her. We say it was a brief professional lapse.
We say reliance on it shows how tenuous the case is. Brief lapse of professionalism made by a nurse who is human, and let’s be honest, very junior. Such mistakes say nothing of how she cared for her patients.
Mr Normanton said that it may be due to inexperience, the heavy duty job and Karen McGhee’s problems with confidence. He suggested that might be the explanation for a brief lapse of professionalism “rather than some evil plan to ill-treat patients”.
You may take comfort in her ability to identify where she fell short, and reflected on them.
Mr Normanton then turned to Patient 4 and told the jury what happened before 25 January 2019 “before getting into reasons Karen McGhee acted in the way she did and the issue of whether it could be ill-treatment or not, whether she knew it was ill-treatment or not”.
Mr Normanton said there was a preliminary issue to deal with in Count 20 and the conduct is she instructed the removal of personal possessions from Patient 4.
You may be forgiven on looking at the video, is not her who issues the instruction, is Ryan Fuller, all she does is very briefly agree items should be removed.
If the conduct alleged is not really established in evidence, when that happens finding must be not guilty.
Even if it is made out, what she does is not ill-treatment. She’s explained to you what was going through her mind, another occasion of something regrettably had to happen time after time.
Mr Normanton told the jury that when Patient 4 posed a risk his things were removed and that was appropriate because one of his characteristics was to cause damage ‘is just a sad fact of the way in which he was”. Mr Normanton referenced the Cygnet records of when he’d had property removed until he returned to baseline and reminded the jury of some examples.
It may seem to you, the evidence of her knowledge of previous incidents, what she knew about Patient 4 and how to manage his risk, is completely disregarded in making allegation against her.
Mr Normanton told the jury that the way of managing risk for Patient 4 previously was to remove items from his room, and that was “another example, we say, of the harsh realities of caring for Patient 4 disregarded in making the allegation against Ms McGhee”.
It’s said its punishment, all seems to hang on tone of voice taken from another support worker. You have to decide whether Karen McGhee’s motivation was to punish, antagonise Patient 4, and then decide whether it is ill-treatment.
Mr Normanton told the jury that when Ms Banner came downstairs with Patient 4’s belongings, Karen McGhee “makes sure that she doesn’t walk past him, why if she’s setting out to punish him?”. Mr Normanton reminded the jury it was for the prosecution to prove it’s case.
How have the prosecution explained away that complication in its case to you?
In one stage she’s said to be punishing him and within minutes her actions prevent him being distressed.
The case brought against Ms McGhee on this count is a nonsense, certainly sufficient to cast doubt you can be sure it’s ill-treatment.
Mr Normanton told the jury that Karen McGhee spoke to Patient 4 during this and that she was obviously firm, he told the jury that he submits being firm with someone who is constantly being violent “is real care”. He referenced Ms Richardson’s example in her closing speech of nurses dealing with drunk people in A&E and asked the jury to consider how firm they are required to be.
Nurses dealing with drunk ppl in A&E, have to be firm, have to be no nonsense… are they ill-treating those drunk people? When they say I’ll have to get security if this behaviour continues? Are they ill-treating or being firm?
It will be obvious to you part of being a good nurse is sometimes recognising you have to be no nonsense.
[The sound started dropping out at this point so I missed a few bits, apologies].
Mr Normanton told the jury they have a sense of the amount of restraints of Patient 4 going on at that time.
Testament to Karen McGhee’s character is that she still acts as a nurse during this incident, whatever she thinks of Patient 4’s behaviour, she stops Ms Banner, she does something else, as she approaches, she pulls down Patient 4’s top, to preserve his dignity. How is that consistent with setting out to ill-treat this person, and not really giving a toss about him, which is what is said?
Mr Normanton concluded by telling the jury that it was proper treatment.
Proper treatment, warts and all, by a nurse trying to manage a difficult situation, as best she can, to keep Patient 4 and others safe. If you can’t exclude that as a possibility then you should acquit her.
Will be obvious to you there’s a great deal at stake for her … we know you’ll consider the case against her carefully. Simply ask you to do that fairly and we ask you to acquit her.
*Mr Normanton has been assisted throughout the trial by his junior, Mr Jenkins