An all-powerful nurse who may have murdered up to 20 patients with painkilling drugs was allowed to flout rules at will by incompetent hospital bosses, an official report revealed yesterday.
Anne Grigg-Booth intimidated colleagues and was 'effectively in charge of the hospital' during early hours when few doctors were about and target-obsessed managers had no idea what was going on.
The night nurse practitioner was charged with the murder of three elderly patients after illegally prescribing and injecting powerful painkilling drugs as if she was a qualified doctor.
But police believe she may have killed many more during her 25 years working at Airedale General Hospital in Keighley, West Yorkshire.
Grigg-Booth also faced an attempted murder charge and 13 counts of unlawfully administering poison to 12 other patients but was never brought to trial because she died from a drink and drugs overdose at her home in 2005 at the age of 52.
Management of the hospital was also condemned by the inquiry findings. A 'club culture' existed in the senior hospital ranks and protected authority figures such as Grigg-Booth from criticism.
The fear is that other members of the nursing staff may have been 'bullied' into adopting her bad habits and followed her instructions to give banned injections.
Grigg-Booth herself treated management 'with contempt' and was 'not subject to effective supervision'. Policies designed to act as safeguards were ignored and patients placed at risk as a result.
The nurse was suspended and police called in after a routine audit identified malpractice by Grigg-Booth in January 2003.
She was later charged with murdering June Driver, 67, Eva Blackburn, 75, and 96-year-old Annie Midgley. She was also accused of attempting to murder Michael Parker, 42.
However, police said these were 'specimen' offences and the extent of her total criminal behaviour could have been far greater.
Five years ago she was branded the 'Angel of Death' after being accused of being a hospital serial killer.
But the independent inquiry came to a very different conclusion.
The report concluded Grigg-Booth was 'not a Beverley Allitt' [the nurse who murdered four children in hospital in the early 1990s]. 'We think it is unlikely that she deliberately set out to harm patients,' the report stated.
But it added: 'She was utterly convinced of her own clinical prowess; we have no doubt that on occasions she went well beyond the boundaries of acceptable nursing practice at that time and beyond the boundaries of her own clinical understanding.'
She was recognised as a 'hard working, experienced and caring nurse who could be relied on in a crisis' yet she broke the law by prescribing 'opiates' herself without checking with doctors and broke hospital rules by giving the dangerous drugs 'intraveneously' and on the 'verbal orders' of doctors.
Although in some cases where patients died Grigg-Booth failed to complete the paperwork detailing her actions, the inquiry found she recorded most of what she did in charts and files, suggesting she was not intent of killing patients.
Night nurse practitioners were introduced to reduce the workload of junior doctors. Grigg-Booth was the most senior and powerful of the four NNPs at Airedale. All the NNPs, as well as other doctors and nurses, misunderstood the rules and believed they had greater authority in respect of the use of painkilling drugs than they actually did.
But Grigg-Booth believed she was in control of the rules after dark. Indeed, all junior doctors on induction days were given the booklet A Guide for Staff who Work at Night which was written by Grigg-Booth herself.
An indication of her attitude towards consulting doctors can be found in the booklet. It reads: 'There are many occasions when we "cross the fine line or grey area" between nursing and medical duties, but will only do so in the interests of effective patient care.'
The offences she was charged with occurred between 2000 and 2002. By July 2002 she had become an alcoholic, the report revealed.
She also rumoured to be addicted to painkilling drugs herself.
She frequently attended the casualty unit as a patient and told the nurses to have diamorphine ready. On one occasion she even injected herself and on another her husband, also a hospital nurse, pressurised medical staff into giving her medication.
The inquiry team found a ' combination of individual and systems failure.' Two other NNPs were disciplined and downgraded, another took early retirement, a manager was sacked and another manager resigned.
They refused to given an opinion as to whether Grigg-Booth would have been convicted by a jury had she not died. Eddie Kinsella, a member of the inquiry team, said Grigg-Booth 'shouldn't be demonised' for her actions as she 'reasonably believed' she was acting legally in the way she did her job, but there was 'confusion' about what senior nurses were allowed to do.
However, he added: 'We don't diminish the gravity of what took place.'