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Sunday, 22 August 2010

The Death of Dr David Kelly


Recent media coverage in respect of the death of Dr David Kelly places the layperson in a difficulty.

On one hand, we have the respected and sensible writer David Aaronovitch in his Voodoo Histories assuring us that there is nothing to worry about. (See his Times article here for a taste of his approach.)

He is joined today by the incisive Nick Cohen, a good friend of this Blog, who emphasises the role of the media in bringing about the apparent suicide.

And that the death was a suicide is backed up by Nicholas Hunt, the pathologist who actually carried out the post-mortem examination, who is quoted as saying:

"I felt very, very sorry for David Kelly and the way he had been treated by the government... I had every reason to look for something untoward and would dearly love to have found something.

"It was an absolute classic case of self-inflicted injury. You could illustrate a textbook with it."



But.

A group of seemingly eminent medical professionals and experienced coroners have stated that there are unanswered questions about the cause of death.

In particular, they are quoted as saying:

"Insufficient blood would have been lost to threaten life. Absent a quantitative assessment of the blood lost and of the blood remaining in the great vessels, the conclusion that death occurred as a consequence of haemorrhage is unsafe."


I do not think any of their points are self-evidently fanciful or bizarre. Their backgrounds do not suggest that they are crackpot conspiracy theorists.

And to simply say there are questions outstanding, of course, is not to in any way endorse a conspiracy theory.


So what should the layperson do when faced with such conflicting information?

I would suggest the correct response is to call for a proper inquest.

The conclusions of distinguished writers such as Aaronovitch and Cohen are important, as are the quoted views of the pathologist who examined the body; but to put the question beyond reasonable doubt surely requires a public inquest by a coroner.

And it was undoubtedly a mistake for one not to have taken place.


UPDATE - the Hutton Report's detailed account of the death is here.


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17 comments:

Richard T said...

It seems to me that it was equally a mistake to have 'sealed up' the papers for 70 years with the apparent intention of protecting Dr Kelly's family. This intention seems to have been counter productive in that it has fuelled speculation about both the sad death itself and the motivation for the secrecy.

DocRichard said...

It is pretty clear from the testimony of the paramedic on the scene that the blood loss was not enough to cause death, and it is odd that Lord Hutton thought that the principal cause of death was blood loss.

"An overdose of as few as 15–20 tablets can be fatal, especially if taken in conjunction with alcohol or another CNS depressant."
http://qjmed.oxfordjournals.org/cgi/content/full/98/3/159
Death can occur within an hour.

So it is possible that he could have died of the co-proxamol overdose.

But other circumstances - his Bah'ai faith, and the lack of suicide note, and his fear of murder - still raise big question marks, and the call for a proper inquest is entirely reasonable, pace David Aaronovitch's attempts to smear the skeptics as conspiracy theorists.

Anonymous said...

1. It is not 'pretty clear' that there was "not enough blood loss" at the scene as DocRichard claims. The paramedics said they didn't see much, the forensic pathologist said he saw sufficient.
2. The Bahai faith is a red herring. Catholics commit suicide and the Bahais are much less anti-suicide than the RCs.
3. Most suicides don't leave notes.
4. If you'd read the chapter in my book on Kelly you'd know all this.
David Aaronovitch

Bertie said...

The reports in today's Sunday Times (22 August) and the details from the pathologist certainly suggest that exsanguination from a divided ulnar artery, together with heart disease was the proximate cause of death. The pathologist seems to have been very thorough

The ulnar artery (little finger side of the wrist) is often a puny thing, and may be pretty unfunctional, though the pathologist found blood clots. The multiple incisions are very typical of suicide.

I'm a bit disturbed by the pathologist's use 'textbook' to describe what was found. Too good to be true, perhaps?

DocRichard said...

David,

You seem very certain that this is suicide as a journalist. Qualified medics, on the other hand, are not so sure on the evidence available. It is anomalous that there was no full coroner's inquest at the time. Hutton was not qualified to give an opinion. Even the Nicholas Hunt, the Home Office pathologist, agrees to another inquest.

Do you agree that the call for an inquest is reasonable?

I you had read my book you would have a broad understanding of the impact of unemployment, poverty, bad housing and pollution on public health.

Richard

Anonymous said...

Doc, David Kelly died of something (tho we will probably get some theory about substitution). Isn't it overwhelmingly more likely that he killed himself than that it was (a) a bizarre accident or (b) murder? Now, it may seem vital to you that, say, co-proxamol is given a fair share of the blame, if necessary. To the journalist, in the context of conspiracy theories such as those run by Norman Baker and implied by the Mail, it isn't so significant.
David Aaronovitch

charlesbarry said...

1) DocRichard, Paramedics have as much expertise in forensically assessing the cause of death as you or I do. Their job is to administer first-aid and get patients to the hospital alive.

His faith is irrelevant, as is the other highly quoted fact that he did not leave a suicide note. (see http://www.ncbi.nlm.nih.gov/pubmed/19929155)

2) JoK, the problem with the group of 'experts' saying there are unanswered questions is that their seem not to be 'expert' in this subject.

A lady (one of the group) on Newsnight frequently asserted that the ulnar artery was totally insignificant and not possible of causing suicide. A letter to the times (http://www.thetimes.co.uk/tto/opinion/letters/article2689035.ece) by a leading hand surgeon contradicted this - he described it as "the main artery supplying the hand". He also said that age or a serrated blade could easily prevent the full clotting of the artery, causing sufficient blood loss for death.

3) People rarely seem to grasp that while Kelly died due to blood loss, slitting his ulnar artery did not kill him. His long standing heart/blood vessel illness did not kill him. His overdose of co-paraxomol did not kill him.

What killed David Kelly was the combination of the three: slitted ulnar arterty AND degradation of his arteries AND the co-paraxomol.

4) Overall, JoK, I would say this article is of a lower quality than your incisive work debunking many of the claims around Gary McKinnon. Many will note that both "theories" were peddled by the Daily Mail.

Retired said...

Charles Barry

(1)Paramedics do assess the amount of blood loss.

That he did not leave a suicide note cannot simply be dismissed as irrelevant.

Faith is relevant to determination of the likelihood of a death being suicide. (You are looking for an aberration a caricature within which the life personality is reflected. For example be suspicious of a death using a phobic method.)

(2) Is speculation. The amount of blood loss would be a fact. Outside and within the body.

(3)If he died of blood loss then it should be accounted for. I don't see that degradation of arteries is a cause of blood loss. Coproxamol in overdose would bring about respiratory depression coma cardiac arrest.

(4) All in all I don't think you made inroads on JoK's position.

J Bonington Jagworth said...

The whole thing still stinks, IMO, and I’m amazed that Mr Aaronovitch, as an investigative journalist, remains so sanguine about it. Mind you, I seem to remember him saying that he would stop supporting the Iraq War if the WMD turned out not to exist, and that didn’t happen either.

As for Dr Kelly, I am prepared to believe that his death had something to do with his heart condition, but slashing the wrong artery of one wrist would not have done it, and is hardly ‘textbook’! I also note that the painkiller packaging was found 'with the body', but if you want painkillers to work, you take them well in advance. I imagine that a careful pathologist could determine how long this was, and would know if they were taken before he went on his walk, in which case, why have the packaging on his person? It would have been difficult for him to take in the wood anyway, unless he also took a glass of water!

Furthermore, why did Charlie Falconer (Blair’s chum) prevent the normal inquest from going ahead, something that has never been done before or since for an individual death?

Finally, what could be so upsetting about the pathology that Hutton ordered the paperwork sealed? The family already believed that Kelly killed himself - if it confirms that, then why the secrecy? Hutton kept invoking distress to the family as a motive for limiting the investigation - am I unduly cynical in wondering if it was more to reduce distress to Blair and his acolytes?

brian in the tamar valley said...

Those proponents of the suicide explanation always state as matter of indisputable fact that Dr Kelly swallowed all 29 of the missing co-proxamol tablets. Ingesting 29 tablets we are told would be more than enough to kill someone yet forensic toxicologist Alexander Allan discovered that the levels of co-proxamol's components found was a lot less than what would normally be considered a fatal dose.

In a nutshell there is definite evidence of some co-proxamol and its constituents in Kelly's body. There is however no watertight evidence that all 29 tablets disappeared down Dr Kelly's throat - unless of course David Aaranovitch can prove otherwise.

We also have the statement from Kelly's friend and confidante Mai Pedersen that Kelly had a rare medical condition that made swallowing tablets virtually impossible. I understand that the co-proxamol tablets were about half an inch long which I would have thought would make them considerably bigger than most other tablets. A half litre water bottle was found next to the body. Let us suppose that the water therein was used to flush down the tablets. Well Kelly would have had only the equivalent of about one quarter of an inch depth of water in a tumbler per tablet. This assumes he managed to ensure each tablet had the same share of water, not very likely I think! And we also know that an unspecified amount of water was still in the bottle - with such a miniscule amount of water available per tablet are we to assume that Kelly wouldn't have drained the bottle?

With Kelly's aversion to tablets why would he have taken 3 blister packs with him anyway? For the suicide theory to be acceptable we need proof that Kelly took all 29 tablets otherwise it fails. From the evidence in the public domain it seems unlikely that he took 29 tablets. Perhaps I am missing something - can Mr Aaranovitch enlighten me?

Joe Otten said...

It seems to me that rather too much is made of the fact/opinion that Kelly's wounds are consistent with suicide/self-infliction.

This "consistency" is not refutation of murder, merely not a refutation of suicide. It is no evidence, in particular, against a murder, expertly committed, with the intention of faking suicide.

Retired said...

(1) Is it reasonable to suspect government involvement in the death ?

(2) If so was an inquiry held which meets the UK's signatory standards of the UN Minnesota Protocol ?

(3) In any event was the legal objective of an inquest achieved (To allay suspicion) ?

(4) The tests for safety of an inquest verdict are either

Insufficiency of Inquiry

Or Rejection of Evidence (such as inability to swallow tablets)

Or Fraud

Or Irregularity of proceedings


I would say the govt broke international protocol by setting terms of reference and imposing secrecy. And that Dr Kelly is entitled to an inquest.

The term of SEVENTY years is not plucked at random. It means the release of autopsy results would coincide with the expiry of Dr Kelly's rights to inquest. (Three score years and ten from the date of his death)

Article 6 of the ECHR does not extend the right to fair inquest.


In Inquests the matter of secret public interest custodianship powers of such as Attorney General need examination.

In 1994, I am just a layman, I argued in an application to ECHR that Inquests are part of the UK's Article 2 commitment to protect life.

Because our lives are only protected when we live in a certain knowledge of full and proper sudden death inquiry.

What I was on about was Regional Crime Squad Wales account of a secret Special Branch monitor snooping and reporting on police inquiries, especially Coroners' inquiries, touching on certain charities and organisations of govt.

One of the three suicides cited in my application was that of the Regional Crime Squad Det sgt !

Unless you can argue non judicial execution you won't get admissibility in ECHR. Hence the IRA can get its cases in but our own citizens cannot.

ObiterJ said...

I entirely agree that the proper way forward would be to hold an inquest. IMHO it should be chaired by a High Court Judge and have a jury.

The value of such a process - and, in my view, particularly the jury - was amply demonstrated when they finally got round to Princess Diana's inquest which put to rest most of the "conspiracy theories".

The 70 year ruling is concerning? I don't think that was announced by Hutton at the Inquiry but it came to light subsequently when a group of doctors asked for access to reports. I did a post on this some time ago:

http://obiterj.blogspot.com/search?q=kelly

Such a ruling lends support to those who argue that there is something to hide. The matter is now being made worse by Dominic Grieve saying that it is not a matter for him but is for the Justice Secretary. For goodness sake, they both work for the same government and could sort this out in a few days if there was a will to do so.

The whole issue of Coroners/Inquiries/Inquests continues to fester with the lack of implementation of the relevant part of the Coroners and Justice Act 2009. It appears that the coalition government has put implementation on hold even thought the present arrangements are far from satisfactory in numerous ways.

Retired said...

Thank you for publishing the above Jack.

It seems to me (a layman) that the Minnesota Protocol rationally must set either an equal or higher standard that a domestic inquest.

But de facto the outcome of the Hutton Inquiry is lower than the public rights in an ordinary inquest:

(1) That HM Coroner shall preserve as public record the inquest testimony (excepting notes addressed to HM Coroner from the decd) including autopsy report for 15 years. My advice was that even the Coroner's power to disclose only to "Properly interested parties" would never stand a challenge in court.

In the book "Death of a Rose Grower" the autopsy on Hilda Murrell was published.

(2) The legal objective of an inquest to allay suspicion is not met

(3) The Hutton Inquiry does not fulfil the tests I set out above.

One of the pre-conditions to appeal an inquest verdict is that the appelant file a copy of the inquest testimony including the autopsy report.

So Kelly's rights to inquest within seventy years are prevented. The rights of ANYONE to appeal the verdict are headed off.

What reality do we live in and is it lawful ? HM the Q at Coronation took an oath wedding the British folks. She became sole fount of justice in mercy and guarantor of rights to enjoy peace (such as right to life). Assisting her in this noble purpose INDEPENDENT of govt are various sworn folks holding Crown Authority. Judges, Coroners, Magistrates and Constables.

Balance of powers. Primacy of judiciary. The admin of justice independent of govt.

He who undermines the Queen as sole fount of justice commits treason. Tony Blair and Jack Straw aided and abetted by Hutton.

Alice said...

Possibly this comment doesn't contribute or help much, but my tuppence worth . . .

Call me a conspiracy theorist if you like, but just as you don't need to be a homeopath to know that homeopathy doesn't work, you don't need to be an specialist doctor to know that cutting your wrists doesn't work.

Even if we accept that Dr Kelly had a heart condition which would have made him an exception to the above rule, there is no reason why he would have known that or indeed taken the chance. Had he wanted to bleed to death he would have gone for his jugular vein in the neck. A doctor also knows that taking pills is incredibly messy and you are likely to just vomit them up again.

I'm not a doctor, but I live with two very experienced doctors who tell me plainly that there is nothing remotely "textbook" like about this death.

If I understand correctly, both Dr Hunt and the doctor who carried out the initial autopsy on Ian Tomlinson are currently being investigated by the GMC? Is it just me or do the powers that be prefer to use these doctors when there are reasons to be rather suspicious of the circumstances of their death?

Even if it turns out it was a suicide, the Labour government brought great suspicion on themselves by locking up the report for 70 years. One has to wonder why. Surely in, say, 60 years' time any surviving relatives would have got over his death enough that people could examine the papers. That they think we'd believe such an unlikely scenario - or that they don't care what we believe - is just typical of a government that took us to war illegally on a bunch of lies, and wanted to impose ID cards which would have required our everlasting trust in them, for their everlasting distrust in us.

I'd better stop now!

Alice said...

PS Ooops - info mix-up. I think I was wrong about Dr Hunt being investigated!

Monty West said...

I fully agree with brian in the tamar valley. Having read Norman Baker's well researched book I make the following points

Co-proxamol was responsible for many suicides in UK (5%).

David Aaronovitch should know that there is absolutely no proof Dr Kelly took 29 tablets of co-proxamol.

Only the equivalent of one fifth of one tablet was found in his stomach.

Alexander Allen, the forensic toxicologist, stated that the blood level of each of the drug's two main components was less than a third of what would be normally be found in a fatal overdose.

Plus the other points about Dr Kelly's aversion to taking tablets (these co-proximol tablets being half an inch long) combined with the small quantity of water make it highly improbable that he took 29 tablets.

Blood loss It is not clear if any analysis or measurement of the amount of blood in soil was carried out.

One of the paramedics, who had 15 years of experience and had attended dozens of suicide attempts, said, "There was a little bit of blood on the nettles to the left of his left arm. The only other bit of blood I saw was on his clothing... the size of a 50p piece."

Dr Hunt, the pathologist, did "notice an area of blood staining to the left side of the body , across the undergrowth into the soil" however he did not report even an estimate of the residual blood volume in the body (a key indicator).

Coronary artery atherosclerosis
This was mentioned in the Hutton report and on the death certificate as a contributory factor. You might think that this would have shown up in an MoD medical which Dr Kelly underwent only 2 weeks earlier in preparation for a trip to Iraq.

Kelly's own GP also seemed to know nothing about this heart condition.

One concludes the condition was very minor and so exactly how much of a contributory factor was it?

Also I fully agree with J Bonington Jagworth's points (very warm greetings, by the way, from a former HJ Back Roomer).

The whole thing stinks.