Since three of us wrote our letter to the Guardian on January 27, questioning whether Dr Kelly's death was suicide, we have received professional support for our view from vascular surgeon Martin Birnstingl, pathologist Dr Peter Fletcher, and consultant in public health Dr Andrew Rouse. We all agree that it is highly improbable that the primary cause of Dr Kelly's death was haemorrhage from transection of a single ulnar artery, as stated by Brian Hutton in his report.
On February 10, Dr Rouse wrote to the BMJ explaining that he and his colleague, Yaser Adi, had spent 100 hours preparing a report, Hutton, Kelly and the Missing Epidemiology. They concluded that "the identified evidence does not support the view that wrist-slash deaths are common (or indeed possible)". While Professor Chris Milroy, in a letter to the BMJ, responded, "unlikely does not make it impossible", Dr Rouse replied: "Before most of us will be prepared to accept wristslashing ... as a satisfactory and credible explanation for a death, we will also require evidence that such aetiologies are likely; not merely 'possible'. "
Our criticism of the Hutton report is that its verdict of "suicide" is an inappropriate finding. To bleed to death from a transected artery goes against classical medical teaching, which is that a transected artery retracts, narrows, clots and stops bleeding within minutes. Even if a person continues to bleed, the body compensates for the loss of blood through vasoconstriction (closing down of non-essential arteries). This allows a partially exsanguinated individual to live for many hours, even days.
Professor Milroy expands on the finding of Dr Nicholas Hunt, the forensic pathologist at the Hutton inquiry - that haemorrhage was the main cause of death (possibly finding it inadequate) - and falls back on the toxicology: "The toxicology showed a significant overdose of co-proxamol. The standard text, Baselt, records deaths with concentrations at 1 mg/l, the concentration found in Kelly." But Dr Allan, the toxicogist in the case, considered this nowhere near toxic. Each of the two components was a third of what is normally considered a fatal level. Professor Milroy then talks of "ischaemic heart disease". But Dr Hunt is explicit that Dr Kelly did not suffer a heart attack. Thus, one must assume that no changes attributable to myocardial ischaemia were actually found at autopsy.
We believe the verdict given is in contradiction to medical teaching; is at variance with documented cases of wrist-slash suicides; and does not align itself with the evidence presented at the inquiry. We call for the reopening of the inquest by the coroner, where a jury may be called and evidence taken on oath.
Public health consultant
Specialist in anaesthesiology
Specialist in trauma
Specialist in radiology
Dr Peter Fletcher
Specialist in pathology
Specialist in vascular surgery