mr mcgurgan found that one nurse had added to her original account of what had happened on the ward on the morning of july 16, 2016 to state that "the cot sides were up".
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"this should not have happened and should never be allowed to happen again to another vulnerable person or their family.
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"we are glad our concerns have been addressed by the coroner's office but the western trust has a lot to answer for.
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