According to the Evidence rpm-2

by Bernard Knight

Again the experienced GP hesitated before he replied. ‘I think it impossible to quantify, sir. I have been in practice for over thirty-five years and seen many patients die in similar circumstances. I think it virtually impossible to forecast when death will occur. In fact, I sometimes deprecate the too-dogmatic opinions of some of my colleagues, which can lead to distress for both patients and their relatives when their estimates prove markedly incorrect, in either direction.’

  Nathan Prideaux nodded wisely, to emphasize to the jury what a sensible fellow this witness was. ‘So you were not surprised to hear that Mary Parker had died on that day?’

  Dr Rogers shook his head. ‘Not at all, though I was sorry that it occurred when I was away on holiday – especially when I learned of the allegations that arose later.’

  Prideaux shied away from this aspect, as it was outside this witness’s sphere of knowledge. He tried another tack. ‘So why, medically speaking, would you not be surprised that this patient or any other in similar circumstances might die suddenly and unexpectedly?’

  John Rogers looked down at the front of the court through his thick glasses and saw what he correctly took to be a pathologist in the second row. ‘I expect you will get a more authoritative answer to that from other experts, sir, but as a mere family doctor I can say that a widespread cancer like that suffered by Mrs Parker can lead to a variety of fatal pathological events. She had secondary growths in her bones, her liver and her lungs. These could cause internal bleeding or clotting of the veins, which could cause sudden death by blocking the circulation in the lungs. Her liver impairment can reach a point where the whole chemistry of the body is irreparably damaged. But even apart from those specific problems, any patient with very severe disease of many kinds can just give up on life. We all have to die from something at some time – it used to be called “giving up the ghost”!’

  Prideaux felt that this rather philosophical statement was an ideal point to leave with the jury and, being a canny advocate, he knew when to stop pushing.

  He sat down with a sincere, ‘Thank you, doctor.’

  The judge asked Gordon if he wished to re-examine, but the prosecution barrister politely declined. Mr Justice Templeman offered his own thanks to the family doctor and released him from any further attendance.

  As the next witness was being called from outside the court, Moira whispered to her new friend from the solicitor’s office. ‘How did that go, do you think?’ she asked anxiously.

  Mrs Armitage, who had attended many courts with her own boss, gave a little shrug. ‘Neither helped nor hindered, really. Probably more helpful than not,’ she said. ‘It’s the next chap who might be a problem.’

  The ‘next chap’ was Dr Roger’s locum, the man who had been called to the vet’s house on the day of her death.

  Moira took an instant dislike to Dr Austin Harrap-Johnson from the moment he strutted importantly down the side of the court to take his place in the witness box. Though rather short, he stood ramrod straight to take the oath, holding the New Testament dramatically high in the air. His voice was loud and imbued with a plummy accent that went well with the Old Harrovian tie that set off his immaculate pinstriped suit. His fair hair was Brylcreemed back from his round, pink face as he attentively faced the judge to respond to prosecuting counsel’s request to state his name and confirm that he was a registered medical practitioner.

  ‘I am a Member of the Royal College of Surgeons, a Licentiate of the Royal College of Physicians and also hold the Licentiate in Medicine and Surgery of the Society of Apothecaries of London,’ he declared, inclining slightly towards the judge, as if to impress him with the notion that these qualifications were among the highest accolades in the British medical profession. In his seat on the second row of benches, Richard Pryor grinned to himself, as he knew that Mr Justice Templeman would be well aware that these ‘Conjoint’ qualifications and the LMSSA, though eminently respectable, were the basic requirements to get on the Medical Register. In fact, some medical students used them as a ‘safety net’ in case they failed the final examinations of their own universities.

  Responding to further questions from the QC, Harrap-Johnson confirmed that he had acted as Dr Rogers’ locum for three weeks at the material time and that he had attended Mrs Mary Parker during that period.

  ‘And were you called urgently to the Parker household on April the seventh this year?’

  ‘I was indeed – but unfortunately the patient was deceased when I arrived, and all I could do was to confirm the fact of death.’

  The young doctor spoke with a degree of gravitas that suggested he was used to attending the deathbeds of royalty.

  ‘You say that you confirmed the fact of death, doctor,’ said Lewis Gordon, tugging his black gown more closely across his chest. ‘But did you not certify the cause of death?’

  Harrap-Johnson shook his head gravely. ‘I did not, sir. I felt unable to do so for several reasons.’

  ‘And what were they?’

  ‘First, although I was of course fully aware of Mrs Parker’s serious medical condition, I had seen her only two days previously and considered then that she was in no immediate danger of dying. Her notes compiled by Dr Rogers indicated that her condition had not deteriorated since his last visit.’

  ‘And the second reason?’

  ‘When I attended the house, I was met by the dead lady’s sister, Miss Lupin, who immediately conveyed her concerns about the nature of the death. She told me that she was a qualified pharmacist and that she suspected that her sister had been given an injection of a toxic substance.’

  At this, the murmur of excitement that came from the public seats was almost palpable and the judge looked up sharply, a frown of annoyance on his face.

  Lewis Gordon pressed on with his questions.

  ‘This must have come as something of a surprise to you, doctor?’

  Harrap-Johnson managed to give the impression that such events were not uncommon in his practice and that he could take them in his stride. ‘Well, it was rather! But I was already uneasy about finding the lady dead so unexpectedly.’

  ‘What happened next?’

  ‘After I had done all I could at the bedside and confirmed that there was nothing to be done by the way of resuscitation, Miss Lupin insisted on taking me through to the veterinary clinic, where she showed me a large syringe still containing some liquid, a bottle labelled as potassium chloride and a carton of vials of sodium Pentothal.’

  ‘Was the defendant present when you arrived at the house?’

  ‘Not at first, sir. The housekeeper who admitted me said that Mr Parker was very shocked and was in the sitting room where she had given him strong tea, while he telephoned a funeral director to start making arrangements.’

  ‘So he was not present when his sister-in-law expressed her concerns about the nature of the death?’

  ‘No, but before I left I naturally sought him out to express my condolences and to tell him that I feared I was not in a position to provide a death certificate.’

  ‘How did he respond to that?’ asked Lewis Gordon.

  For the first time, the locum doctor looked a little uncomfortable, and Moira wondered if there had been some strong opinions exchanged at the time.

  ‘Mr Parker expressed surprise and consternation at my inability to certify the death, especially when I said that I had no option but to inform the coroner.’

  ‘Did you mention the suspicions of Miss Lupin at that point?’

  ‘I did not. I thought it was not my place to do so; that aspect was up to the coroner.’

  ‘So the possibility of some sort of poisoning was not mentioned?’

  Harrap-Johnson again looked uneasy, and Moira thought he might be recalling some terse words from the veterinary surgeon.

  ‘Not by me, but Mr Parker raised the allegations of his sister-in-law and forcefully rejected them.’

  The prosecutor did not want to go further down this path and backtracked in order to get further
details. This was boring stuff, and Moira could almost feel the restlessness of the court in having sheered away from more the dramatic revelations.

  When he came to the end of these more mundane matters, the judge offered Nathan Prideaux the opportunity to cross-examine, which he accepted with an almost casual grace.

  Leaning with one elbow on his little table, he started by investigating Austin Harrap-Johnson, rather than the facts of the case. ‘Doctor, how long have you been qualified?’

  The young man frowned; this was not what he expected – he was here to show off his forensic acumen to the court.

  ‘Three years – and ten months,’ he added defensively.

  ‘How have you been employed during that time?’

  Again Harrap-Johnson looked nonplussed.

  ‘Employed? Well, as soon as I qualified I became a house surgeon at Guy’s and then a house physician at the Royal Berkshire Hospital. Then I was called up for National Service for two years as a doctor in the Royal Army Medical Corps. Eastbury was my first locum after returning to civilian practice.’

  ‘What were your duties in the army, doctor?’

  ‘I was a Regimental Medical Officer to the Coldstream Guards. At first with the rank of lieutenant, then captain.’

  Richard again grinned to himself – he knew that RMO postings to the posh regiments usually went to those with double-barrelled names who had been to Eton, Harrow or Marlborough.

  The defence counsel nodded complacently. ‘I assume that most of those in a Guards regiment were pretty fit chaps, eh?’

  Mystified, Harrap-Johnson agreed. ‘Most of my work was dealing with injuries of various types.’

  ‘So you have had little experience of middle-aged ladies dying of cancer?’

  The discomfited doctor huffed and puffed a little, but had to agree. ‘But of course I had spent a year in two large hospitals before that – and as a student I had been trained in the full range of disease process.’

  ‘But had you even managed a case of terminal pancreatic carcinoma before?’

  Harrap-Johnson, for all his pomposity, was an honest young man and had sworn to tell the truth, so he agreed he had not.

  ‘And had you ever seen a patient with that awful disease?’ pursued Prideaux relentlessly.

  The locum wriggled a little, saying that a case had been demonstrated by a consultant at Guy’s and that he had seen other types of advanced cancer.

  ‘So doctor, it comes to this, doesn’t it?’ concluded the QC. ‘You have no personal experience of how and when a sufferer from terminal cancer of the pancreas might die. It’s right, isn’t it, that if Miss Sheila Lupin had not made her allegations about the possibility of a fatal injection, you would have taken your pad of certificates from your black bag and signed one on the spot?’

  Harrap-Johnson pulled himself up in a last-ditch expression of defiance. ‘I don’t know about that. I was still not happy about the case.’

  Nathan Prideaux gripped each side of his table and jutted his head forward towards the witness box. ‘But why not? You were quite entitled to certify, under the law which states that if a doctor has attended a patient within the previous four-teen days before death, excluding the final visit, he is entitled to issue a certificate. You fulfilled those criteria and were also locum to Dr Rogers, who had been treating Mrs Parker for many years, let alone fourteen days!’

  Deflated, Austin Harrap-Johnson mumbled something and attracted the notice of the judge, who glared at him over his half-moon spectacles.

  ‘Doctor, please speak up! The jury need to hear what you have to say.’

  Chastised, the doctor flushed and repeated what he had muttered. ‘I said that I was playing safe, my lord, given that I had only seen the lady on one previous visit.’

  Prideaux gave something suspiciously like a snort as he came to his last question. ‘Come along, doctor! I put it to you that if Miss Sheila Lupin had not made the initial accusation to you that her sister had been poisoned, you would have been happy to issue a certificate – instead of dashing off to the coroner with this hearsay claim?’

  As the flustered locum made a final half-hearted denial, Prideaux barked, ‘No further questions, my lord,’ and sat down with a flourish that suggested that the whole issue must now surely be settled.

  The prosecuting barrister declined an invitation to re-examine, and Mr Justice Templeman released the witness from further involvement. Harrap-Johnson descended from the box and walked out, covered in less glory that he had expected. Moira’s initial feelings had changed to sympathy as he looked embarrassed and deflated.

  ‘That went better for us, didn’t it?’ she whispered to Mrs Armitage, who nodded then looked at her wristwatch. ‘I expect we’ll just about get the next witness in before lunch. That lot up there are keen on their food at the judge’s lodgings.’

  She nodded at the five august personages sitting up on the high bench – Moira irreverently thought that they looked like the characters in a Punch and Judy show, dressed in their colourful outfits.

  This time, no witness was called from outside the court, but when Lewis Gordon called his name an elderly man, who was sitting at the end of the second bench furthest from Richard Pryor, rose to his feet and went towards the witness box. Moira knew from her reading of all the papers that had come to Garth House that he must be the local coroner’s pathologist. He was a thin, dried-up man of at least seventy years of age, his dark suit hanging on him, his shirt collar too large for his leathery neck.

  After taking the oath, he said in a faintly foreign accent that he was Dr Rupert Stein and that he was a semi-retired doctor, now living in Stratford-upon-Avon. Moira decided that he must be a pre-war immigrant from somewhere in Central Europe.

  Rupert Stein haltingly explained that he had retired from his hospital post as a pathologist seven years earlier, but still did post-mortems for several coroners in the Cotswold region. One of these post-mortems was on Mrs Mary Parker, though his tone suggested that he now wished he had kept well clear of such a controversial case.

  ‘On the day following the death, you performed an examination at the request of the local coroner. Did you know the full circumstances of the death before you began?’

  ‘Only in the broadest terms. I had wondered why the death of a sufferer from advanced cancer, under medical care for many months, should have been reported to the coroner.’

  The old doctor’s voice was as dry as his appearance, but he seemed perfectly alert and competent as he dealt with the questions.

  ‘And what were these “broadest terms”, doctor?’

  Dr Stein frowned and looked uncomfortable for the first time.

  ‘The coroner’s officer told me that a close relative had made an allegation that the deceased may have been given an injection of potassium chloride shortly before death. On hearing this, I considered declining to proceed with my examination, as I am not experienced in forensic procedures, but as the medical history seemed so strongly in favour of the cancer as the cause of death, I decided to carry on. I felt that any doubt could be resolved later.’

  Junior counsel then led the pathologist through his post-mortem report, detailing all the relevant findings. These amounted to a catalogue of the effects of the malignant tumour in the abdomen, which had spread widely to many of the major organs and to the bones.

  ‘Was there any additional condition that may have precipitated sudden death, doctor? Such as haemorrhage or thrombosis?’

  Rupert Stein shook his head. ‘No, I found nothing of that nature.’

  ‘Was there anything that could have substantiated this allegation of an injection of potassium chloride?’

  Again the pathologist answered in the negative, but added a caveat. ‘Of course, I would not expect any signs of that. Potassium chloride stops the heart; there are no visible manifestations.’

  ‘There was a fresh injection mark on the arm, was there not?’

  ‘Yes, but she was being given frequent intravenous
morphine,’ countered the doctor. ‘There were injection marks on both arms, of varying ages.’

  The prosecution barrister did his best to bring the questioning to an advantageous conclusion.

  ‘So the situation is this, is it not? You found no sudden pathological event that could have caused sudden death and you had no evidence to exclude potassium poisoning?’

  The old pathologist looked steadily down at the advocate. ‘That’s true, but equally I had no evidence to confirm or even suspect potassium toxicity, especially in the presence of very advanced cancer.’

  The barrister sat down and Nathan Prideaux rose to his feet at the judge’s invitation.

  ‘Dr Stein, you have really already answered all the questions I had for you, but just to summarize: this was an examination that was rather sprung on you, was it not?’

  ‘Looking back, I suppose I should have told the coroner that I would have preferred him to have sought a forensic opinion. But at the time the attitude of the coroner’s officer was that this allegation was not to be taken all that seriously. It was the day following the death and I understand that investigations had not got very far by that time.’

  Prideaux nodded understandingly.

  ‘You took no blood samples for analysis to check for potassium?’

  ‘It would have been pointless. Potassium is a natural constituent of the body and leaks out rapidly from the cells into the blood after death.’

  ‘Then, doctor, the situation surely is this – you did a post-mortem on a lady with very advanced cancer and found no objective evidence whatsoever that this was not the sole cause of death. Do you agree?’

  When the pathologist accepted this, the defence QC had one last question.

  ‘You may not be a forensic pathologist, but you have been an experienced hospital consultant for many years and must have seen many cases of advanced cancer. Given the medical history of this lady and in the light of your own findings, have you any reason to think that the cancer could not have killed her?’

  When the doctor gave a firm ‘No’ as his answer, Prideaux gathered his gown about him and sat down with a confident thump.