Monday, 18 June 2012

Dr Kelly's "hardening of the arteries" (1)

In his now published report of 25 July 2003 Dr Hunt describes the condition of Dr Kelly's heart at post mortem on page 8 of the pdf

Quite correctly his report uses medical terminology but at the Hutton Inquiry he presents the relevant evidence in language more suited to the layman:

Q. Can you say what significant findings you made on the internal examination?  
A. Yes, in terms of significant positive findings, there was evidence that at the time of his death Dr Kelly had a significant amount of narrowing of the arteries to his heart, his coronary arteries by a process called atherosclerosis or, colloquially, hardening of the arteries.  That was the only positive evidence of natural disease, but I could not find evidence that he had had a heart attack as a consequence of that.
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Q. And in summary, what is your opinion as to the major factor involved in Dr Kelly's death?
A. It is the haemorrhage as a result of the incised wounds to his left wrist.
Q. If that had not occurred, would Dr Kelly have died?  

A. He may not have done at this time, with that level of dextropropoxyphene.  
Q. What role, if any, did the coronary disease play? 
A. As with the drug dextropropoxyphene, it would have hastened death rather than caused it, as such.  
Q. So how would you summarise, in brief, your conclusions as to the cause of death?  
A. In the formulation, the cause of death is given as 1(a) haemorrhage due to 1(b) incised wounds of the left wrist. Under part 2 of the formulation of the medical cause of death, Coproxamol ingestion and coronary artery atherosclerosis. 

In his Opening Statement on 1st August Hutton refers to Dr Hunt's preliminary post mortem report of 19 July 2003 and says:

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."

I think that it can be agreed that what Dr Hunt wrote in his report has to be his definitive point of view and that it is perfectly sensible, even desirable, to explain that in layman's terms to an audience of non specialists if the exact sense is retained.  So far, so good.  Then, seven years later, on 22 August 2010 something quite extraordinary and unprecedented happened: Dr Hunt elaborated on what he wrote in his report and subsequently said at the Hutton Inquiry.  An article appeared in the Sunday Times that day and we read:

During the autopsy, Hunt discovered that Kelly was suffering from a severe form of coronary heart disease called atherosclerosis, although he had been unaware of this.

Two of his main coronary arteries were 70%-80% narrower than normal, creating a significant risk of cardiac arrest. "If he had dropped dead in the canteen at Porton Down [the government research establishment where he had worked] and you had seen his coronary arteries, you would have had a very good reason to believe that was the only reason he died," said Hunt.

His condition greatly reduced the ability of his heart to withstand sudden blood loss, and also made him more susceptible to stress. It also made his heart more vulnerable to a synthetic opiate in the painkiller he had taken, co-proxamol. The prescription painkiller was withdrawn in 2007 after it emerged that overdoses, either accidental or deliberate, were causing up to 400 deaths a year. It contains dextropropoxyphene, a synthetic opiate that can cause the heart to develop an abnormal rhythm, leading to cardiac arrest.

Two points worth making here: firstly it can be seen that Dr Hunt is making a lot more of the atherosclerosis seven years later, he should have made this clear at that earlier time.  Secondly, what on earth was he doing talking to the papers about this?  He is answerable to the coroner and there is no indication that he spoke to Mr Gardiner or sought his permission.  His behaviour was totally unprofessional and unacceptable.

The subject of the Sunday Times interview was raised with the Attorney General Dominic Grieve as number 74 in the Schedule 

I won't discuss the detail of 74 for the moment because the response was mainly concerned with the blood at the scene, not the subject of this particular post.  Suffice to note that it glosses over the behaviour of Dr Hunt: The interview with the Sunday Times and justification for it is a matter for Dr Hunt but there is nothing in the account that undermines the findings of the Inquiry.  Well I'm sorry but the question of justification for the interview should NOT be just casually passed over in this way.

Dr Hunt's cavalier behaviour is in stark contrast with that of the ambulance team who were interviewed by Antony Barnett for the Observer of 12 December 2004:

Dave Bartlett and Vanessa Hunt sought permission from their employer, Oxfordshire Ambulance Trust, before agreeing to be interviewed. They spoke as individuals and not as representatives of the trust.  

A further interesting point arises here.  Assuming that the Ambulance Trust had a broad idea of what the content of the interview was likely to be then that suggests that it wasn't just Vanessa Hunt and Dave Bartlett who were concerned about the conclusions of the pathologist!   

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