Showing posts with label co-proxamol. Show all posts
Showing posts with label co-proxamol. Show all posts

Monday, 25 June 2012

The co-proxamol (6)

Now I want to highlight a few miscellaneous points not covered in the previous five posts.
  • Why was one tablet left?  If Dr Kelly had managed to swallow 29 tablets with 78% of the water (assuming a full bottle to start with) then I'm sure that there was enough water left for the final tablet.
  • Why didn't Dr Kelly buy a half bottle of whisky say in the village instead of taking water with him.  Alcohol is much much more lethal in combination with co-proxamol than water.
  • The fingerprint technician (Renee Gilliland) has to record ANY marks even if they don't appear to be usable If Dr Kelly swallowed 29 tablets then one is looking at 29 thumb/finger movements to extract the tablets.  The blister packs were found in the Barbour jacket so protected from the elements.  I really can't believe that Dr Kelly would have left no marks whatsoever.  This comment needs some qualification in fact because one of the blister packs was kept for DNA testing so only two were checked for fingerprints.  In that respect 29 should be replaced by 19 ... still an unbelievable scenario.
  • Regarding the DNA testing of one blister pack Mr Green says in his report  A full STR profile matching that of Dr Kelly was obtained.  It's not inconceivable in my opinion that the pack aquired Dr Kelly's DNA through being in the pocket of his Barbour jacket.
  • Schedule of responses to issues raised number 33 concerns post mortem changes in drug levels http://www.attorneygeneral.gov.uk/Publications/Documents/Schedule%20of%20responses%20to%20issues%20raised.pdf  This is part of the response:  The number of pills ingested is only of relevance to cause of death if there were evidence to suggest that the drug was introduced into his body in some other way.  There is no such evidence.  It could also be argued that there is no evidence that the drug wasn't introduced into his body in some other way.  As previously pointed out it's possible that the damage to Dr Kelly's lip happened as a result of the insertion in his mouth of a gastric tube.  Perhaps the injury complex on the left wrist masked an injection site.  I'm not saying I have proof on any of this but it's wrong for the official response to be so dismissive.
  • In the response to issue 18 we read: Mrs Kelly stated that her husband would never take any sort of tablet, not even for a headache but that he was aware that she was prescribed co-proxamol as a painkillerSimilarly in 44 there is reference to Mai Pederson giving details to Thames Valley Police of Dr Kelly's avoidance of taking pills.  From a press article we learn that Ms Pederson has also said that Dr Kelly had in fact a physical problem in swallowing pills.  If TVP were aware of this then they are clearly guilty of covering up the fact.  Hutton should have investigated why Dr Kelly had an aversion to taking pills.  Yet again he failed to perform his task with due diligence.

Sunday, 24 June 2012

The co-proxamol (5)

The interview by Antony Barnett of the two ambulance team for the Observer of 12 December 2004 has plenty of interesting information  http://www.globalresearch.ca/articles/BAR412A.html

At one point Dave Bartlett says: I remember saying to one of the policemen it didn't look like he died from that [the wrist wound] and suggesting he must have taken an overdose or something else.

I have already mentioned number 18 in the schedule of responses to issues raised http://www.attorneygeneral.gov.uk/Publications/Documents/Schedule%20of%20responses%20to%20issues%20raised.pdf  This is part of it:


Following the discovery of Dr Kelly's body a search was made of his house.  Mrs Janice Kelly was present and was asked to show officers any medicines in the house.

Whether at that time Mrs Kelly felt there were any of her medicines missing I don't know; the only slight hint is her reply to Dingemans that she 'assumed' that the blister packs found on the body had come from her supply.

At the Inquiry there is this interesting commentary by PC Franklin responding to Mr Dingemans:


Q. When the forensic kit arrives and you start doing the fingertip search, do you start on the common approach path?
A. I actually, as police search adviser, do not do the search; that was run by PC Sawyer.
Q. You watched them all doing it for you?
A. Some of the time. As police search adviser I have to
liaise with the senior officers about the policies for the search and what we hope to get out of it, so I was backwards and forwards.
Q. What were you hoping to get out of this search?
A. We have to speak to the DCI initially and he wanted us to look for -- if again I may refer to my notes -- medicine or pill bottles, pills, pill foils or any receptacle or bag that may contain medicines.
Q. You are doing a search for that. Are you also looking for anything else?
A. Yes. The police search teams I work with would pick up anything that would be dropped by a human or out of the ordinary. Those are the items that were just specified to us, but as a search team we tend to look for anything that should not be there.

It is strange isn't it that DCI Young makes that specific point that I have highlighted.  Did DCI Young go to Harrowdown Hill via the Kelly home at Southmoor?  Assuming that he was appointed the Chief Investigating Officer by ACC Page shortly after the body discovery then it seems that it was another two and a half hours approximately before he arrived at the scene.

The co-proxamol (4)

In 2003 Mrs Kelly was taking prescription co-proxamol to relieve the pain of her arthritis.  When Dr Kelly's GP, Dr Warner, was examined by Mr Knox at the Inquiry there is this exchange:

Q. Did you ever have to prescribe Coproxamol to Dr Kelly?
A. No.



If Dr Kelly had ingested co-proxamol tablets then his wife's supply would be the most obvious source, particularly, as I understand things, co-proxamol was available prescription only.


Mr Dingemans questioned Mrs Kelly about the co-proxamol:


Q. Do you take any medicine?
A. I do. I take co-proxamol for my arthritis.
Q. I think we are also going to hear that appears to be the source of the co-proxamol that was used.
A. I had assumed that. I keep a small store in a kitchen drawer and the rest in my bedside table.

That highlighted question was one of the most disgraceful in the whole of the Hutton Inquiry!  It seems to me that Dingemans was trying to nudge Mrs Kelly towards a favourable answer, he must have known that nobody would know for sure about the source of the co-proxamol or would give evidence about that.  He should have asked Mrs Kelly whether she had noticed any missing from her supply.  She was making an assumption, not certain how much she had perhaps.

We aren't told at the Inquiry how much co-proxamol Mrs Kelly had in her home.  However the responses to issues raised schedule does have an answer at number 18 http://www.attorneygeneral.gov.uk/Publications/Documents/Schedule%20of%20responses%20to%20issues%20raised.pdf

Subsequent to the body being found there were 4x10 packs in her bedroom drawer and, in the kitchen drawer, a full box of 10x10.  One would think, assuming the removal of 3 packs in one go, that she might have noticed that amount of depletion from her stock.  Although the full pack had come from the "White Horse Medical Practice" I'm aware of the fact that she had been getting supplies of the drug from a high street chemist.  My guess is that the Medical Practice had recently set up their own dispensary, a not unusual circumstance. 

As can be seen from this witness statement dated 11 November 2003 from DC Eldridge http://webarchive.nationalarchives.gov.uk/20090128221550/http://www.the-hutton-inquiry.org.uk/content/tvp/tvp_17_0001.pdf the manufacturers of the co-proxamol were approached regarding the batch numbers of the tablets.  It looks as if DC Eldridge might well have been posing the wrong question, certainly he is quoting the "product licence" number in his statement rather than a batch number.  The subject is covered in this blog post by Dr Andrew Watt http://chilcotscheatingus.blogspot.co.uk/2010/11/death-of-david-kelly-possible-important.html

The co-proxamol (3)

The two substances that make up co-proxamol, paracetamol and dextropropoxyphene, were found in Dr Kelly's body.  Three blister packs of co-proxamol, originally ten in each pack but with just one tablet remaining were found in a pocket of the Barbour jacket Dr Kelly was wearing when the forensic specialists were at the scene.  So originally 30 tablets available, one left, that means Dr Kelly swallowed 29 tablets.  Yes?  No, not necessarily.

That the constituents of co-proxamol were found in the body is clear I believe.  At the end of his testimony at the Inquiry there is this exchange between Dr Allan and Lord Hutton:

LORD HUTTON: Mr Allan, if a third party had wanted paracetamol and dextropropoxyphene to be found in Dr Kelly's blood is there any way that the third party could have brought that about by either persuading or forcing Dr Kelly to take tablets containing those two substances?
A. It is possible, but I think it would be --
LORD HUTTON: That is the only way that those substances could be found in the blood, by taking tablets
containing them?
A. Yes, he has to ingest those tablets.
LORD HUTTON: Yes. Thank you very much indeed.



Why did Hutton stop Dr Allan answering his first question?  Then Dr Allan finishes up by telling an untruth:  The components of co-proxamol could have been injected into the body.  Alternatively the tablets could have been crushed and fed by a tube.  Dr Hunt reporting on the mouth writes:  There was a small abrasion consistent with contact against the teeth or biting of the lips on the lower lip on the lipline.  This was approximately 0.6 x 0.3 cms.  There was no significant vital reaction.  Later, at conclusion 16, is this:  The minor injury to the inner aspect of the lip is not associated with bruising nor damage to teeth and does not appear to have any well-developed vital reaction.  This sort of injury may be caused if the tissues of the mouth are bitten.  His deduction may be correct but would this injury to the lip also match the insertion of a tube in his mouth, particularly if Dr Kelly had been incapacitated.

If Dr Allan's last answer in the quoted extract above really had been correct that would have strongly enhanced the suicide hypothesis in my opinion.  Was the "suicide" faked?  If so a lot of trouble was taken over it.  

The co-proxamol (2)

In my last post I reproduced those parts of Dr Hunt's final report relating to the co-proxamol.  I also flagged up the fact that in his initial report of 19 July Dr Hunt hadn't seemingly included co-proxamol ingestion as a factor in the cause of deathWe know from a statement of forensic toxicologist Dr Allan dated 21 July 2003 that certain items from Dr Kelly's body were received at his laboratory on Saturday 19 July http://www.attorneygeneral.gov.uk/Publications/Documents/Dr%20Allan%20statement%201%20%2021%20July%202003.pdf


With the post mortem being completed at 00.15 on the 19th the fact that various items were sent to the laboratory on the same day at least shows a commendable desire to get things done.  Looking at what Dr Allan had to say at the Inquiry he did his testing that Saturday morning.   However the test results given in the 21 July report together with the testimony given by Dr Allan at the Hutton Inquiry gave cause for concern in as much that it seemed that the amount of testing was inadequate.  It wasn't until eight years later, on 9 June 2011, that it was discovered that Dr Allan produced two further reports on 18 August 2003 and 17 September 2003  http://www.attorneygeneral.gov.uk/Publications/Documents/Dr%20Allan%20statement%202%2018%20August%202003.pdf  and http://www.attorneygeneral.gov.uk/Publications/Documents/Dr%20Allan%20statement%203%2017%20September%202003.pdf respectively.  The last mentioned concerned a blood sample NCH/47 sent to the Royal Hallamshire Hospital in Sheffield and I don't know that that document is particularly relevant to possible co-proxamol ingestion.


Dr Allan's report of 18 August (the same day as the Registrar recorded the cause of death of Dr Kelly) details the examination for any contaminants in the liquid in the Evian bottle.  Dr Allan also says: The stomach contents (item NCH/49) was further analysed for dextropropoxyphene, and the vitreous humour (plain - item NCH/53) for this and for paracetamol.  The "missing" results in the 18 August report weren't discussed at the Hutton Inquiry.  There is no evidence that either Hutton or the coroner Nicholas Gardiner saw Dr Allan's second or third reports, certainly they weren't listed in the evidence tab on the Inquiry website.  This may be cock up rather than conspiracy ... perhaps it demonstrates the lack of medical background, or just a lack of concern, on the part of both Lord Hutton and Mr Gardiner.

The apparent failure to test the stomach contents for dextropropoxyphene was an issue raised with the Attorney General.  See number 25 here for the response to this: http://www.attorneygeneral.gov.uk/Publications/Documents/Schedule%20of%20responses%20to%20issues%20raised.pdf  If the 18 August statement was before the Inquiry why wasn't it listed and discussed?


Dr Allan states that he had to estimate the amount of dextrpropoxyphene in the stomach contents.  Why couldn't that have been done for his 21 July report?  Similarly the vitreous humour was among the items received on the 19th July for testing.  The lab didn't receive the decanted liquid from the Evian bottle until 25 July so some delay in that result was inevitable.  It seems ridiculous to me that the stops were pulled out to carry out some initial testing but then there was a delay of almost a month before the second report was produced.  


The question that has to be asked is whether this seemingly haphazard approach to testing and reporting in the forensic industry is widespread.


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.

Clothing
  • 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.
Toxicology                 
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.

Conclusions

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. 
               - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
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".  

Friday, 18 May 2012

Dr Kelly left one tablet and 111 ml of water

Dr Hunt gave his evidence to the Hutton Inquiry on 16 September 2003.  During the course of questioning from Mr Knox Dr Hunt reveals the discovery of the co-proxamol blister packs:

Q. What did you notice about the clothing?  
A. He was wearing a green Barbour type wax jacket and the zip and the buttons at the front had been undone.  Within the bellows pocket on the lower part of the jacket there was a mobile telephone and a pair of bi-focal spectacles. There was a key fob and, perhaps more significantly, a total of three blister packs of a drug called Coproxamol. Each of those packs would originally have contained 10 tablets, a total of 30 potentially available.
Q. And how many tablets were left in those packs? 
A. There was one left. 
LORD HUTTON: Did you actually take those blister packs out? Did you discover them in the pocket yourself?
A. Yes, as part of the search, my Lord.
LORD HUTTON: Yes, I see.


So what reason could there be to take so many but leave one?

The volume of water left in the bottle was 111 ml or 22% of the original contents.  Nearly a quarter not drunk then ... would he really have left so much?