Sunday, 24 June 2012

The co-proxamol (1)

Before examining the evidence relating to the co-proxamol I think it's worth reminding ourselves first of all about Dr Hunt's conclusions on the subject.

  • A green 'Barbour' waxed jacket, which was undone at the zip and buttons at the front.  A mobile telephone, pair of bi-focal spectacles, a key-fob and a total of 3 blister packs of co-proxamol (10 packs) were found in the bellows pocket on the front right panel of the jacket.  Only one co-proxamol tablet remained in its blister pack.
At the time of completing this report, I have been provided with the following verbal information by Dr Alexander Allan, a forensic toxicologist from Forensic Alliance Limited.
  • The blood sample contains the drug dextrpropoxyphene at a concentration of 1.0 micrograms per millilitre.
  • The blood sample contains the drug paracetamol at a concentration of 97 micrograms per millilitre.
  • Paracetamol is present in the stomach contents.
  • No alcohol has been detected.
In addition, I have been provided with a copy of the formal statement of Dr Allan dated 21 July 2003 (21/07/2003) and given the laboratory reference FAL-05969-03.

The levels of dextropropoxyphene and paracetamol in the blood were confirmed as above.


12. Given the finding of blister packs of co-proxamol tablets within the coat pocket and the vomitus around the mouth and floor, it is an entirely reasonable supposition that he may have consumed a quantity of these tablets either on the way to or at the scene itself.

13. The toxicology result indicates that prior to his death he had consumed a significant quantity of these tablets.  The active ingredients of co-proxamol are paracetamol and dextropropoxyphene.  The absolute levels of paracetamol and dextropropoxyphene in the blood are not particularly high and may not ordinarily have caused death in their own right.  In this particular case however, even these levels may be relevant as one must consider that dextropropoxyphene may cause death by its actions upon the heart leading to abnormalities of heart rhythm.  Such abnormalities of heart rhythm are made all the more easy to induce if there is hypotension (low blood pressure) as the result of bleeding and underlying narrowing of the coronary arteries.  In this case, both the latter factors would be operant.

14. Dextropropoxyphene is an opioid drug which is relatively rapidly absorbed into the blood following ingestion.  It has an analgesic effect and hence would be expected to deaden the perception of pain due to injury, particularly when taken in the sort of amount seen here which is above the normal therapeutic range.

25. In summary, it is my opinion that the main factor involved in bringing about the death of David Kelly is the bleeding from the incised wounds to his left wrist.  Had this not occurred he may well have not died at this time.  Furthermore, on the balance of probabilities, it is likely that the ingestion of an excess number of co-proxamol tablets coupled with apparently clinically silent coronary artery disease would both have played a part in bringing about death more certainly and more rapidly than would otherwise have been the case.  Therefore I give as the cause of death:

          1a.    Haemorrhage
          1b.    Incised wounds to the left wrist

          2.     Co-proxamol ingestion and coronary artery atherosclerosis  

The extract above is from Dr Hunt's final report of 25 July 2003.  He had made a preliminary report six days earlier on the 19th, in other words two days before Dr Allan's (first) formal statement.  In his opening statement on 1 August Hutton states:

37. A post-mortem examination was carried out by Dr Nicholas Hunt, a Home Office accredited forensic pathologist and his post-mortem report dated 19th July has been sent to me by the coroner. A toxicology report has also been sent to me by the coroner. The post-mortem report will be referred to in greater detail at a later stage in this Inquiry. However, it is relevant to state at this stage that it is the opinion of Dr Hunt that the main factor involved in bringing about the death of Dr Kelly was the bleeding from incised wounds to his left wrist. 
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Dr Hunt also states:  "It is noted that [Dr Kelly] has a significant degree of coronary artery disease and this may have played some small part in the rapidity of death but not the major part in the cause of death."   

Because he removed the three blister packs from the jacket pocket Dr Hunt ought to have considered at that time that co-proxamol might have been a contributor to the death.  Perhaps he did but on the 19th the toxicology results from Dr Allan wouldn't be to hand.  Therefore he, perhaps knowingly, produced a post mortem report that would likely have to be amended.  The subject of the production of more than one post mortem report by a pathologist is one that will have to keep for another day; here though we have the situation of Dr Hunt initially providing a report for the coroner in which he doesn't refer to co-proxamol ingestion in the "cause of death".  

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