Thursday, 16 June 2011

Letter to the Coroner from Dr Stephen Frost, Dr David Halpin, Dr Searle Sennett, Rowena Thursby and Garrett Cooke dated 21 January 2004

Nicholas Gardiner
Oxfordshire Coroner                                                           
(City) Coroner's Office
New Post Mortem Suite                                                                   
John Radcliffe Hospital
Headley Way
OX3 9DU                                                                                             21 January 2004

Dear Nicholas Gardiner,
Unexamined Anomalies in the Case of Dr David Kelly
In the event that Lord Hutton, in his final report, upholds the widely disseminated theory that Dr David Kelly committed suicide, we are writing to urge you, as coroner in this case, to use your powers to re-open the inquest into Dr Kelly’s death. 
As concerned citizens, including amongst our number three medical clinicians - a specialist surgeon, a specialist anaesthesiologist, and a specialist diagnostic radiologist - we have closely scrutinised the testimonies given at the Hutton Inquiry, and consider that neither the police investigation nor the Hutton Inquiry has demonstrated with any degree of rigour, that Dr Kelly took his own life.  We contend that the possibility Dr Kelly’s death was murder dressed-up as suicide has not been sufficiently investigated, and believe that Dr Kelly’s death should be treated as suspicious until a full battery of evidence – including independently performed forensic evidence – has proved conclusively otherwise.
1) Crucial factors that appear to have been overlooked
It is the professional view of three of our writers - past trauma and orthopaedic surgeon, David Halpin FRCS, anaesthesiologist, Dr Searle Sennett, and diagnostic radiologist, Dr Stephen Frost - that the forensic pathologist in this case, Dr Nicholas Hunt, may have made a significant mistake in concluding that the primary cause of Dr Kelly’s death was as result of haemorrhage from his left wrist. They reason that it is highly improbable that Dr Kelly bled to death from a single transected minor artery.  In his testimony the toxicologist, Mr Allan, states that Dr Kelly did not take sufficient co-proxamol to cause his death.  Thus, if it is correct that Dr Kelly neither bled to death nor died from a co-proxamol overdose, then the true cause of death has yet to be determined.
Also pivotal to this case is the position in which Dr Kelly’s body was found.  As matters stand, there appears to be an assumption - re-enforced at the Hutton Inquiry by Dr Hunt – that Dr Kelly’s body was found lying flat on its back. The first two people who found the body however, state very clearly that the body was slumped against a tree.  Evidence we present in this letter (the direction of the vomit on his face was towards his ears) suggests that Dr Kelly died lying down. If his body was, in fact, found propped up against a tree, this implies that someone moved his body from a lying-down to a sitting-up position.  All witnesses subsequent to the first two, say they observed the body lying flat on its back.  If this is correct, then the inference to be drawn is that the body was moved not just once, but at least twice.
We hope you will agree that it is vital to establish:
a)      the precise means by which Dr Kelly met his death, and
b)     whether or not Dr Kelly’s body was moved.
We believe that a thorough examination of these two factors may reveal that Dr   Kelly was murdered.

2)  Medical evidence suggests Dr Kelly did not bleed to death
To the authors, it seems very surprising that Dr David Kelly, a top-rank microbiologist and world-expert in toxic substances, would choose an inept and uncertain method of suicide.  In the Columbia study done in 1998 on prison suicides by wrist-slashing* it was established that only 1 out of 275 were successful.  The Sandvik pruning knife Dr Kelly is said to have used appears to have been blunt, since according to Dr Hunt, the edges of the main wound, which transected the ulnar artery, bore notches and crushed edges.  Why would Dr Kelly have chosen to cut the deeper artery in his left wrist and with a blunt knife? 
a) Arteries would have “quickly shut down and clotted
David Halpin FRCS, a British past orthopaedic and trauma surgeon has professional surgical experience in dealing with the results of incised wounds, including some attempted suicides.  In his view, it is most unlikely that Dr Kelly bled to death as concluded at the Hutton Inquiry by forensic pathologist, Dr Hunt.

Mr Halpin states:
“As a past trauma and orthopaedic surgeon, I cannot easily accept that even the deepest cut into one wrist would cause such exsanguinations that death resulted.  The two arteries [in the wrist] are of matchstick size and would have quickly shut down and clotted.”
Our two other medical writers – Dr Searle Sennett, a specialist anaesthesiologist based in Johannesburg, South Africa and Dr Stephen Frost, a UK diagnostic radiologist - support this view. 
b) Single artery, completely severed
David Halpin, Dr Sennett and Dr Frost all agree that the fact that only one minor artery – the ulnar artery - was completely severed makes it even more unlikely that Dr Kelly could have bled to death from this wound.  Dr Sennett writes:
“A completely transected artery retracts immediately and thus stops bleeding, even at a relatively high blood-pressure, as against a partially-severed vessel which cannot retract.”
c) Blunt knife would have induced speedier clotting  
Bluntness in the knife, in Mr Halpin’s view, would have induced a swift clotting response:
“If the Sandvik knife was blunt… that would have tended to produce greater spasm of the severed ulnar artery, and that severance, being more traumatic, would have been a greater stimulus to clotting within the lumen of the vessel and in the wound itself.”
d) Ulnar artery transected, rather than radial
Dr Sennett: “In fact, it is the cutting of the ulnar artery as an apparent act of suicide which arouses one’s suspicion that the alleged suicide was not suicide at all.”
The fact that the ulnar artery was cut, rather than the radial artery, raises Dr Sennett’s suspicions, since the ulnar artery is deeper in the wrist and covered by nerves and tendons, which would require considerable force to cut.  Given Dr Kelly’s extensive scientific knowledge, it seems unlikely that he would deliberately choose to cut the deeper artery of the two; especially as the crushed edges to the wound indicate the knife he used was blunt.  It would have made more sense if he had cut the far more accessible radial artery.
e) Insufficient blood loss to cause death
There appears to be confusion and uncertainty regarding the amount of blood at the scene.  The people with the most hands-on experience of attempted and actual suicides – the ambulance crew, Vanessa Hunt and David Bartlett - make a point of telling the Hutton Inquiry that they were surprised how little blood was present for an arterial bleed, the implication being, that with so little blood around, they did not see how Dr Kelly could have died from haemorrhage.  By contrast, Dr Hunt makes great play of the amount of blood at the scene, but talks mostly of small patches and smears.  He points out a single 2 - 3 foot area of blood staining across the undergrowth and soil to the left of the body, but we are never told the depth and extent of it.  Nor are we told if it matches Dr Kelly’s own DNA and blood type.
Dr Sennett maintains that:
“For a man of the size of Dr Kelly to die from haemorrhage he would have to lose at least three litres of blood.  At autopsy, it would also be clear that the subject had bled to death because there would be very little blood in the heart and the large vessels.”
Dr Hunt does not advise us in his testimony how much blood was left in the heart and the large blood vessels.
Dr Sennett continues:
“And I might add, to bleed to death from a cut blood vessel is not as simple as it sounds because as the blood is lost the blood pressure falls, and this in turn, slows the blood loss…. It is extremely difficult to lose significant amounts of blood at a pressure below 50 – 60 systolic in a subject who is compensating by vaso-constricting (contracting the blood vessels)… although the subject may lose consciousness at this blood pressure, he may not necessarily die.”
“In fact, I suggest that it would be impossible to lose a “lethal” amount of blood from an ulnar artery which had been cut in the manner described for Dr Kelly.”
He doubts that Dr Kelly could have lost more than 500ml (one pint) of blood.
f) Livor mortis casts some doubt on Dr Nicholas Hunt’s verdict
Dr Hunt states that he found livor mortis to be a clear post-mortem feature.  But our medical writers point out, that if, as Dr Hunt claims, Dr Kelly died from haemorrhage, significant livor mortis would have been an unlikely finding. Thus we suggest that if Dr Hunt found livor mortis, it would be unlikely that Dr Kelly bled to death.
3) Evidence of co-proxamol overdose unconvincing
Three packets of co-proxamol were found in the pockets of Dr Kelly’s jacket.  Each contained a blister pack of 10 tablets.  Twenty-nine were said to be missing.  Mr Allan, the toxicologist, was not able to show however, that Dr Kelly had ingested all 29 tablets.  Co-proxamol contains 325 mg paracetemol and 32.5mg dextropropoxyphene (methadone) per tablet.  Although levels of the drug in Dr Kelly’s blood were much higher than therapeutic levels, Mr Allan concedes that the blood levels of each of these components was at least three times less than would normally be found in a fatal overdose.  All that was found in the stomach was residue equivalent to a fifth of one tablet.  If, as he claims, some of the drug was ejected in the vomit, have tests on the vomit been done?  If they have, the results have not so far been made public.  As Dr Kelly’s stomach was found to be virtually empty, and as it is evident that he had vomited or regurgitated its contents, it is even less likely that the co-proxamol could have contributed in any significant way, to his death. Mr Allan states in his testimony that there was probably insufficient co-proxamol in Dr Kelly’s body to attribute his death to an overdose.

4) Circumstantial evidence of suspicious activity on 18th July
At the Hutton Inquiry on September 16th the forensic pathologist, Dr Nicholas Hunt, was asked if significant post-mortem changes had taken place in Dr Kelly’s body.  He stated that hypostasis, or livor mortis, had taken place over the back of the body, and added:
“The significance of that is really that it was consistent with the position that his body was found in, in other words lying on his back.”
However Dr Hunt makes a false assumption.  Dr Kelly’s body was not found on its back.  The two people who first came across the body clearly state that it was slumped or sitting against a tree.  Evidence suggests that it started out on its back and that, according to the remaining witnesses, it ended up on its back.  But in between, it was slumped or sitting up. 
We will now examine and expand on what seems to have been suspicious activity taking place near at the scene of Dr Kelly’s death between 8 a.m. and 9.45a.m. on 18th July.
a)      Dr Kelly’s body appears to have moved
In their testimonies to the Hutton Inquiry, Louise Holmes and Paul Chapman, SE Berks volunteer searchers and first witnesses to the body, clearly describe the position of Dr Kelly’s body as against a tree.  Subsequent witnesses however, state that the body was flat on its back, not touching the tree.  This suggests that the body was moved from a slumped or sitting position to a lying-flat-on-its-back position, and raises the question: by whom?
b)     DC Coe with the body during the time it was moved
DC Coe appeared on the scene immediately after the two search volunteers, and prior to the arrival of PC Franklin, PC Sawyer and the two ambulance crew.  Police search team-leader PC Franklin said he had "no idea what he was doing there or why he was there”.  DC Coe was alone with the body (his two officers a short distance away) for a full half hour between the time the body was seen against the tree and the time the body was seen flat on its back, not touching the tree.
If the body positions have been reported correctly, then clearly serious questions need to be asked of DC Coe.
c) Number of officers with DC Coe  - was it 1, or  2?
Five witnesses: Louise Holmes, Paul Chapman, PC Franklin, PC Sawyer and Vanessa Hunt, all state that DC Coe was with two officers.  DC Coe himself however, states in his testimony to the Hutton Inquiry on 16th September that he was with only one – DC Shields. Is there some reason for Coe’s protecting this third individual from public scrutiny?  DC Shields was never called to the witness stand to clarify whether or not he was the only officer with DC Coe.
d)  Vomit direction indicates Dr Kelly died on his back
The streaks of vomit on Dr Kelly’s face reported by PC Sawyer and the paramedic, Vanessa Hunt, were said to run from the corners of his mouth to his ears.  Clearly if Dr Kelly had died as he was found – slumped or sitting against a tree – the vomit direction would have been down his chin towards his neck, not towards his ears.  This is another vital indication that Dr Kelly may have died lying down but was then moved against the tree. 
e)      Three individuals in dark clothing
Assistant Chief Constable Page stated in his second testimony to the Hutton Inquiry that three individuals in dark or black clothing had been seen by a member of the public near Dr Kelly’s body between approximately 8.30am and 9.30am - the time DC Coe and his associates were in the Harrowdown area.  ACC Page claims that the individuals had later been identified as police officers. But were they police officers?  Page definitely did not affirm they were DC Coe and his two men, and PC Franklin, the police search advisor, stated that he and the search team leader “were going to be the first” search officers on Harrowdown Hill that morning.
So if the three individuals were not DC Coe and his men, and not police search officers, who were they?  Given all the suspicious elements outlined above, it is surely crucial to establish their identity.

5)  Questionable forensic investigation
      a) Dr  Hunt’s inexperience
We are surprised that in a case as politically significant as that of Dr Kelly, selection was made of a forensic pathologist with only 7 years experience.  Dr Nicholas Hunt had been practising full-time pathology since 1994 and had been on the Home Office list since 2001 – about two years.  Obviously many years of experience are required to become an expert in this field.   Compare this with that of the psychiatrist, Professor Hawton, whose experience was 30 years.

b)  Dr Hunt’s speculative approach
Throughout Dr Hunt’s testimony we find a great deal of speculation – a surprising approach for a forensic inquiry. He appears to be attempting to align almost every finding with a suicide interpretation.  For instance, he mentions he found three abrasions to the left side of Dr Kelly’s scalp.  Rather than leave the reason for these abrasions open, he endeavours to make them seem perfectly normal:
“…and of course that part of his head was relatively close to the undergrowth.”
Dr Kelly was a seasoned walker, fully capable of pushing aside twigs and branches in his way – there was no reason for him to have received three abrasions from walking through a wood. Lord Hutton asks if the abrasions were consistent with contact with the undergrowth.
Hunt answers:
“They were entirely, my Lord; particularly branches, pebbles and the like.”
Hunt never tells us why Dr Kelly should be grazing his head on “pebbles.”
He next attempts to explain away a number of bruises on Dr Kelly’s body:
“There was a bruise below the left knee.  There were two bruises below the right knee over the shin and there were two bruises over the left side of his chest.  All of these were small…”
When asked how they could have occurred Hunt states:
“….some of them may have been caused as Dr Kelly was stumbling, if you like, at the scene.”
If the scenario suggested by Professor Hawton is to be believed, Dr Kelly was a man calmly looking for a place in the wood to end his life. Professor Hawton said, having made the decision, Kelly would have felt a sense of peace.  Yet Hunt maintains that Kelly was “stumbling around the wood”.
Dr Hunt continues attempting to justify his case for straightforward suicide:
“The orientation and arrangement of the wounds over the left wrist are typical of self-inflicted injury.  Also typical of this was the presence of small cuts called … hesitation marks.  The fact that his watch appeared to have been removed whilst blood was already flowing suggests that it had been removed deliberately in order to facilitate access to the wrist.  The removal of the watch in that way and indeed the removal of the spectacles are features pointing towards this being an act of self-harm.”
How does Hunt know the watch was removed whilst blood was already flowing?  We are left to assume it is because he found blood on the watch.  But blood on the watch need not mean that the watch was still on the wrist.  Blood may have splashed onto the watch after it was removed.  Moreover it need not necessarily have been Kelly who removed the watch.  Had he removed his watch it would have made more sense to do so before he started cutting.  Another party - a professional assassin intent on creating a suicide-scene - could have removed the watch.
c)  Failure to identify accurate parameters for  time of death

It seems odd that Dr Hunt, having arrived at the scene of death at midday on 18th July did not take a rectal temperature until 7.15pm that evening.  Why did he not take the temperature at the earliest opportunity?
The toxicologist, Mr Allan, informs us that he found a small trace of acetone in Dr Kelly’s blood.  Acetone begins forming once blood sugar and glycogen from the liver have been fully utilised by the body.  It is the professional view of one of our writers, anaesthesiologist, Dr Sennett, that the presence of (even a trace of) acetone in Dr Kelly’s body is an indicator that metabolism continued for a least 12 hours after Dr Kelly’s last meal.  Mrs Kelly testified that his last meal was at around 1:00 on 17th July; it is therefore highly probable that Dr Kelly was alive well into the early morning of the 18th July, probably beyond 1.00am.

Dr Sennett:

“Dr Kelly ate a couple of sandwiches, therefore he must have had no ketones when he left home. Further, it would have taken at least 12 hours (because he did not eat much for lunch) for them to return. It was impossible for him to leave home with ketones in his blood. And so he could not have died 3 hours later with any ketones in his blood.”** 

Dr Hunt suggests parameters for time of death as between 4.15pm on 17th and 1.15am on 18th July.  To someone pushing a suicide scenario these parameters are convenient.  But the presence of acetone suggests that Dr Hunt’s first – rather than last - parameter for time of death might be placed at 1.00am.  

This raises the question: if Dr Kelly arrived at the wood mid-afternoon on 17th, as the public have been given to believe, why would it take him at least 8 hours for him to begin his suicide attempt? 

d) Apparent failure to examine evidence presented by regurgitation
Several witnesses have mentioned the vomitus running from the corners of Dr Kelly’s mouth to his ears, and Dr Hunt speaks of more “around the ground”. In Dr Sennett’s professional opinion, if this had resulted from passive regurgitation (vomiting being an active process) then the material would have entered his lungs and contributed to his death by asphyxiating him.  Did Dr Hunt examine the lungs for regurgitative material?

e) Inadequate testing for poisons
Mr Allan, the appointed toxicologist, analysed blood and urine for the presence of alcohol and a range of medications and hard drugs.  Dr Hunt mentioned testing for volatile substances like chloroform, but results have not been released. As far as we have been told, no tests have been conducted for the presence of more exotic poisons like ricin or saxitoxin*** or for poisons that may be delivered transdermally.  Thus a third possible cause of death – neither haemorrhage nor co-proxamol overdose – may have been overlooked.
f)  No independent verification of blood-test results
In David Halpin’s opinion there should have been at least three sets of blood serum samples: one set allocated to the Home Office & Forensic Alliance, one set for a top-rank independent forensic laboratory in a foreign state, and one set to be kept under lock and key until the investigation is complete.

The evidence we have presented suggests strongly that Dr Kelly died neither from haemorrhage nor from co-proxamol poisoning, as maintained by the forensic pathologist in this case, and that the true cause of his death remains undetermined.  Dr Kelly’s body appears to have been moved twice, yet so far no witnesses have been cross-examined to explain the discrepancies in their testimonies.  For these reasons we feel the Hutton Inquiry has seriously fallen short of its obligation to uncover the truth. If Lord Hutton concludes in his report that Dr Kelly committed suicide, we hope you will seriously consider re-opening the inquest in order to perform a thorough and rigorous investigation in the most appropriate court, the coroner’s court.
We would appreciate it if you would acknowledge receipt of this letter, and look forward to your reply.

Yours sincerely,

Rowena Thursby                                                                                         

David Halpin   MB BS FRCS  (UK)                                               

Specialist in trauma & orthopaedic surgery                         
(Signatory to those aspects of this letter
where his name is mentioned)


Searle Sennett  BSc, MBChB, FFARCS
Specialist in anaesthesiology                                                 
Johannesburg, South Africa 

Dr Stephen Frost  BSc, MB ChB (UK)
Specialist in diagnostic radiology (Stockholm, Sweden)


Garrett S Cooke  (UK)
Computer Consultant



*Lethal versus non-lethal suicide attempts in jail   McKee G R  
William S Hall Psychiatric Institute, Columbia, SC, USA
Psychol Rep  1998 Apr; 82(2):611-4

** “Post Exercise Ketosis” by Johan Koeslag

*** “Saxitoxin – from Food Poisoning to Chemical Warfare by Neil Edwards

1 comment:

  1. Georgi Markov took really quite a long time to die of ricin poisoning. I would suggest something faster, if it was a poison. I think the key question is where he died rather than how: it could simply have been stress from whatever happened to him after he was seen to be heading towards his home. If that something was of the nature of an attempted abduction or hard interrogation, death might have happened before any third party responsible could react with anything other than a cover-up.