Friday 6 August 2010

Medical mystery behind bomber's release

This is the headline over an article just published on the website of The Wall Street Journal, in which the medical evidence available to the Cabinet Secretary for Justice when he took his decision is described and a number of US oncologists express disagreement that it warranted the conclusion that Mr Megrahi's likely life expectancy was three months. An accompanying article headed "Lockerbie release flawed: Scotland lacked medical consensus in returning convicted bomber to Libya" can be read here.

A report on the BBC News website headed "Lockerbie bomber Megrahi's cancer not fake - Sikora" can be read here. A further article on the BBC News website headed Can you really predict a prisoner's death? deals with the cases of Ronnie Biggs and Abdelbaset Megrahi and with the general problem for doctors of attaching a period to the survival of a patient with a terminal illness.

On his valuable blog The Lockerbie Divide Caustic Logic is currently running a series on the known influences on the release decision.

41 comments:

  1. They just aren't going to let up are they?

    I've run out of nouns for them.

    You know that wee issue called Data Protection? Maybe we can use that against the Americans on the release of further medical records just as they, and the UK Government have in refusing to release certain evidence required by Megrahi's defence in the appeal? Patient confidentiality and all that.

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  2. Interesting twist and timing. I didn't read the links yet, but it's still a confused and fertile area. For the past few days I've been posting on these decisions made bit by bit "one year ago today."

    They start with the 3-moth prognosis on 3 August, and link forward from there. Did the Biggs release and parallels just now.

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  3. I see that's noted now, if not before. :) I can't guarantee my facts are right. It's complex stuff. I was impressedwith the size of the WSJ article and the fact that I'm not going to read and debunk it tonight.

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  4. So they've moved from the BP connection to the medical prognosis and the accuracy of it. The notes released by the SG include reference to the effects a return to Libya would have on Megrahi's overall health where the support, not only of his family, but external agencies could bring him more time. Anyone not see in there a hint that he might not die as soon as a loud gong sounded three months down the line? The notes state specifically that the impact on his psychological state in being around his family and being cared for by them could be significant. They also make the clear link, which most reasonable people are aware of anyway, between a person's mental state and their ability to rally when in the grip of such a disease.

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  5. The BBC articles are very fair.

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  6. The Wall Street Journal article is well researched and well thought out - and I am not surprised to see the name of Alistair MacDonald (their new UK political editor) as a contributor. Maybe the only chink in the armour of the case for Megrahi's release will be the medical report and the associated decision process based on that report. I cannot see why a doctor would not just provide an impartial diagnosis and prognosis of a patient - and if this has not happened because of outside influence then this is disappointing. However, more importantly, for such a controversial decision, which would inevitably invite much scrutiny, was there enough second and third opinion considered, or asked for by MacAskill? The WSJ has raised a fair question.

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  7. The BBC reports linked to this site show how very difficult it is to instruct someone to die at a specified time in order that the Medical Profession isn't ridiculed for getting it wrong.

    The Medical reports released by the SG on their own site also include references, as I've said above, to the positive impact a return home would possibly have on Megrahi's health and psychological well being. It is also possible he has had treatment in Libya which he had not had in Scotland (Did Rolfe previously speak about chemo on this site?)

    If the WSJ wishes to raise fair questions it really should want to talk about that pesky Appeal and the doubts raised about Megrahi's guilt and the original trial, including the US paying millions of dollars to a star witness who couldn't even identify Megrahi in court. It is not too late for the WSJ to call publicly, as certain UK publications are, for that Appeal to go ahead.

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  8. [When I read the medical report I go "EEK!" and my face makes that gesture where your mouth is drawn back by your cheek muscles denoting surprise]
    Why did Fraser write a medical report that included opinion from a party that is blatantly NOT disinterested (and write he agrees with their assessment)? Why did MacAskill accept a medical report that contained non-medical information pertaining to the PTA?
    Reference to Libyan representation (since Megrahi was not under their medical care) should not have been mentioned - it tends to detract from the objectivity of the report, because it says, "I was aware there was a big political stushie surrounding this case".
    There are too many soft facts and not enough medical facts or statistical evidence where the facts are interpretive. You should not have to dive into his case notes to find out for example, if he had treatment, what it was, what was the outcome, follow-up treatment? This is missing in what should be a summary for non-medical readers.
    Considering this was a report on the status and prognosis of a patient being assessed for compassionate release (which I believe the criterion is a life expectancy of circa 12 weeks), there is even talk of his 'longer-term psychological impact' - which doesn't sound like Fraser is decribing the last few weeks of a 'dying' man.
    Finally, although there are two urologists and two oncologists stated in the documentation there is scant mention of their opinion and therefore this can certainly be regarded as a medical report that does not contain independent opinion. I would have expected the secondary consultation to be either collated in the report (and specifically noted as such) or contained separately in an appendix (preferable).
    I find the medical report sloppy and I can see why Fraser would want to stay well away from the scrutiny of the Senate hearing.

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  9. Blogiston.........Libyan medical opinion wasn't included in the reports considered. Some medical people did, of course, have access to Megrahi but they were entitled to that. It is the case however that their assessments, their views, did not feature in reports on which Mr MacAskill based his decision.

    The views of Libyan medical people were sought independently by the media and they spoke about these views. This still doesn't mean their input was involved in the reports MacAskill had access to, so no need to Eek! NO Libyans were involved. :)

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  10. And actually Blogiston, in Scotland, and throughout the UK I believe, people do not have open access to another people's medical records and casenotes. Including Megrahi's. Such things are covered by Data Protection Law and the same sort of privilege which exists between a lawyer and a client.

    Finally Bloggy, it isn't a case of Fraser wanting to stay away from the Senate. It is a case of the Senate having no authority or jurisdiction in Scotland or the UK to support ordering anyone associated with either the Westminster or Holyrood governments to go there.

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  11. Jo G: No, they are mentioned in the medical report, section 4e paragraph 1 and section 4e paragraph 4. I don't state stuff without checking.
    The other point you defend in the medical report is one of patient confidentiality. It's not breaching patient confidentiality to explain that the prisoner has had treatment, his response to that treatment etc. I fail to see how you give an objective status of the patient's health history without including that information - considering you know the gravity of the decision that is facing your minister. This wasn't the routine release of some insignificant convict in very poor health who's release would attract little or no attention -
    MacAskill was facing the biggest decision of his career and it seems to me he was somewhat let down by Fraser's (sloppy) report.
    EEK! justified, me thinks.

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  12. Bloggy it is indeed breaching confidentiality to go further than the reports did without Megrahi's consent. It would have been against DP laws in this country. Medical Records are fully covered under those laws.

    In any case reference is made to Megrahi's progress or lack of it in the reports. The reports refer to specialists across the UK being involved and recognises that Libyan medics were present and seeing Megrahi regularly. Of course they would be. Libyan physicians were entitled to access to him. But it certainly does not say that it was they who provided the reports which MacAskill based the decision on. Mr MacAskill has made it clear since, repeatedly, that Libyan medics were NOT involved in that decision, and I believe him. Do you think for one minute he would have hoped to get away with that? It would have been absurd.

    The problem many people have here is that Megrahi did not fall over and die after three months. I would say, with respect, that people who expected this must be very stupid indeed. There is information on cancer elsewhere which will explain far better than I can the risks of issuing prognoses for this disease so unpredictable is it and so many are the factors that can knock any prognosis sideways. One of those factors undoubtedly is the mental/psychological health of the patient. Megrahi's return home could be a significant factor indeed as could the further treatment, such as chemotherapy, he may have had since.

    But here's my main point Bloggy, Megrahi has NOT suddenly been cured. He is STILL terminally ill yet to listen to some people you would actually think he had made a complete recovery. Anything to avoid addressing the real Megrahi issue which is the doubt about his conviction in the first place. If they wanted to address THAT I think I would take them a bit more seriously.

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  13. And Bloggy I do realise this "wasn't the release of some insignificant convict". For indeed this was the release of a man whose original conviction had been questioned because the SCCRC had found six separate grounds to consider it may be unsafe! So my shock and surprise, my EEKs, are in response to any honourable political/judicial establishments allowing these doubts to hang around for more than two years while they delayed repeatedly the hearing of his appeal.

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  14. This is from a news report on 6 September 2009.

    "The Scottish Government has flatly denied reports they considered the medical opinions of three doctors paid by the Libyan government in releasing the Lockerbie bomber.

    (The Sunday Telegraph had reported that the Libyans had paid for the medical advice of three doctors and "encouraged" them to form the opinion that Abdelbaset Ali Mohmed Al Megrahi had just three months to live.)

    The Scottish Government said the prognosis of the three medics - Britons Karol Sikora and Jonathan Waxman and Libyan Ibrahim Sherif - was not taken into account when Kenny MacAskill decided to free the 57-year-old on compassionate grounds last month.

    A spokesman said: "This report is false and factually incorrect.

    “The Director of Health and Care at the Scottish Prison Service drew on expert advice from a number of cancer specialists in coming to his clinical assessment that a three month prognosis is now a reasonable estimate for the patient.

    These included two consultant oncologists, two consultant urologists and a number of other specialists, including a palliative care team, who had reviewed and contributed to the clinical management of the patient.

    They did not include Karol Sikora, Jonathan Waxman or Ibrahim Sherif, whose assessments played no part in considerations – including no part in the report submitted by the Scottish Prison Service Director of Health and Care."

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  15. Caustic I've put the above comment on your own site too as it reads as if Dr Sikora's input was used in the decision to release. It was not used.

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  16. Jo G: Respectfully, I disagree. It will be interesting to see what the Senate committee make of the medical report (in September), and whether they will see it as a weakness worth exploiting along the lines I have outlined.

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  17. Even at the time, I harboured some suspicions that the prognosis might have been massaged down somewhat in order to faciliate the exercise of leaning on Megrahi to drop his appeal. The timing was rather neat. The appeal was due to come back to court in early November, under three months from all these negotiations.

    I never suspected Megrahi was manipulating anything; more that he was being manipulated. Leave the three-month progosis much later, and he might decide to chance it and stick around for the next appeal hearings. But as it was, it was implied that he'd probably be dead or at least moribund by that time, making such a gesture futile.

    I'd really like to know why everyone was so keen to get that appeal dropped, including SNP ministers who had nothing to do with the original legal shenanigens. All this, just to prevent the Scottish justice system looking bad? It already looks bad.

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  18. Blogiston, with respect, what the Senate Committee thinks is completely irrelevant. They have resurrected this issue for their own selfish reasons which are connected with the oil spill and BP. I think we all realise this. Nevertheless they are irrelevant, they have no jurisdiction here and their beloved country was behind the whole framing of Megrahi and burying of the truth in the first place.

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  19. "I'd really like to know why everyone was so keen to get that appeal dropped, including SNP ministers who had nothing to do with the original legal shenanigens. All this, just to prevent the Scottish justice system looking bad? It already looks bad."

    That is the biggest question of all. That the SNP appeared to be part of the moves to get the appeal buried brings another huge question into the equation too. They were uncontaminated by the toxic stuff associated with the trial and the decisions at Westminster to keep the truth hidden, to slap privacy certificates on certain evidence pertinent to the appeal. They had nothing to lose and everything to gain by wanting that appeal continued and doing everything in their power to ensure it did.

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  20. It seems there's some real confusion of the role of Sikora and/or other doctors. Not just here but elsewhere. Was it all Fraser's doing, or no one's, or what? I concluded that Sikora seems to be the three-month guy by some comparing sources and deducing. It might be wrong, but good enough for me at the moment. Explained here:
    http://lockerbiedivide.blogspot.com/2010/07/advice-of-just-one-doctor.html
    Thanks for the comment, Jo. I'll look it over and comment later on today. Laundry time now. :)

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  21. Hiya Caustic......from what I can find the SG declared quite firmly that the views of Sikora were not part of the "advice" taken.

    Great site incidentally: I'll be going back to read more.

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  22. Nope. Sikora's report wasn't even received by MacAskill in time to be considered. Fraser wrote the definitive report, but taking into consideration reports from a number of different consultants and other experts.

    Libya had the right to pay Sikora as a hired gun, and to submit his report to the Justice Secretary (except it was late), but the Justice Secretary would not have considered that to be part of the medical evidence he based his decision on even if it had been received in time.

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  23. Agreed Rolfe. To consider any advice from Libyan funded medics would have been quite insane.

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  24. I know this is speculative but I sometimes wonder what it must have been like for Megrahi trying to deal with the whole situation: we had the wait for the appeal going on and on: then his illness, the deterioration in his health and the sort of emotions any ordinary person must feel when facing up to cancer never mind a person locked up in prison. We then had this PTA business or the compassionate release and the prospect of having to drop his appeal in one of those options (or was he told both?). We had the uncertainty he faced about just how long he had .....and so wouldn't we also see a further deterioration in his condition under the weight of all this?

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  25. Auugh! Giant comment lost!

    Okay I'm wrong.

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  26. Finally sit down and spend a rare hour ... Rolfe, when did Dr.Sikora's report reach MacAskill? Do you have a date? I didn't know he delivered a separate report, had presumed he was included in Fraser's.

    And one important Q, who is the doctor redacted from Fraser's report? I had presumed this was Sikora, given how he's played up his role and so much media echoed that he was the responsible doctor.
    image

    I had tried to rule it out, but was unable:
    image
    Thanks.

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  27. And another part I lost, to show how confusing this is when Dr. Sikora keeps talking:
    The new WSJ article says:
    "Libya retained three doctors to examine him. Two said a three-month prognosis was reasonable and one didn't, according to Karol Sikora, the only one of the three who agreed to be interviewed. Dr. Fraser didn't consider the reports filed by these Libyan-hired doctors, the Scottish government says."

    And before we've had this:
    "Karol Sikora was one of three specialists who refused to concur with the prognosis by a prison doctor last August that Abdelbaset Ali Mohmed Al Megrahi had just three months to live when he was released last year.
    […]
    "I say he will be dead within four weeks," said Mr Sikora, the medical director of Cancer Partners and Dean of Buckingham University medical school."
    http://thescotsman.scotsman.com/scotland/Lockerbie-bomber-39will-die-within.6203241.jp

    ???

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  28. "That the SNP appeared to be part of the moves to get the appeal buried brings another huge question into the equation too. They were uncontaminated by the toxic stuff associated with the trial and the decisions at Westminster to keep the truth hidden, to slap privacy certificates on certain evidence pertinent to the appeal. They had nothing to lose and everything to gain by wanting that appeal continued and doing everything in their power to ensure it did."

    Jo, I have always thought it's very simple. The incoming minority SNP government thought it would be good politics to offer an olive branch to Labour by retaining one of their less important Ministers. They chose the Lord Advocate (not an MSP, of course). Elish Angiolini has spent every day of her working lifetime, from traineeship to the present day, in the service of the Crown Office. There was not the slightest chance that she would allow any government of which she was a member to pursue a course of action that would reflect badly on the Department to which she had devoted her life.

    Any progress on Lockerbie was effectively stymied when Alex Salmond decided, for understandable political reasons, to keep on Mrs Angiolini. It remains, in my view, the worst mistake that the SNP Government has made.

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  29. Caustic, I think the issue is that no one denies Sikora saw Megrahi, assessed him, made reports on him. Ultimately however his reports were not included with others from different medical personnel. How could they be? They could not be impartial. Doctors representing Libya did however have the right to access to Megrahi during his incarceration. Any foreign prisoner held here would have that right too.

    It doesn't mean anything in the light of MacAskill's decision. The reports by Sikora and other's on Libya's payroll did not play any part in the final decision.

    You mention the names of Doctor's being blacked out on the reports. All Doctors involved were not identified as far as I know. That was to protect their right to privacy and also to protect them from recriminations at a later date. Fraser was identified but that was unavoidable given his position at Greenock.

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  30. By recriminations incidentally I don't mean their professional reputations were being protected. I'm talking about their personal safety.

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  31. Prof B, thank you for that response. It is extremely interesting.

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  32. Prof. Black has said much the same about Eilish Angiolini in earlier posts. If I were to say anything close to what I think about that lady, it would probably be actionable.

    I have, however, always found it difficult to see how she and she alone could have been pulling the strings of MacAskil, Salmond and Sturgeon to the extent this would imply. She's not even in the cabinet. She's a Labourite. How can she have so much influence?

    Lords Advocate have been involved in this lot up to their dirty little necks. Peter Fraser, Colin Boyd, and now the Implacable Schoolgirl.

    Why?

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  33. Indeed Rolfe, tread warily. She likes to sue people and we'll only have to pay her bill for doing that to you if you upset her as she'll probably claim it out of expenses!

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  34. Rolfe, apart from being head of the Scottish public prosecution system, the Lord Advocate is the legal adviser to the Scottish Government. On matters of law that Government has to accept her legal advice or sack her and appoint someone else. The latter is what they should have done, of course, but (having broken every historical tradition by appointing her in the first place) that would have been just too embarrassing for the new government.

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  35. I remember her most unprofessional public outburst after Mr Megrahi launched a website following his release. It was almost a personal attack. It disgusted me coming from someone holding the office of Lord Advocate. Very common. Very vulgar.

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  36. "There was not the slightest chance that she would allow any government of which she was a member to pursue a course of action that would reflect badly on the Department to which she had devoted her life."

    How much of your own life did you devote to your professioin Prof B? How much of it have you devoted to since working for real justice following the Lockerbie trial?

    I don't believe you would have done that lightly. I don't think it would have given you any pleasure whatsoever that this trial was a disgrace to the Scottish Justice System. I think you also must have had to think long and hard about what you should do.

    In the end, your priority was justice and that showed great courage. Some would perhaps say no, it is easy. I don't buy that.

    You were part of the establishment and what you went on to say damaged it whether they admit that or not. It is often easier to run with the crowd, as many other legal people and politicians have, and indeed the Lord Advocate, than to say, "These are our principles and we must apply them fully at all times."

    Even if we set all of these people at the top of twenty feet ladders you will still be head and shoulders above all of them.

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  37. Rolfe, apart from being head of the Scottish public prosecution system, the Lord Advocate is the legal adviser to the Scottish Government. On matters of law that Government has to accept her legal advice or sack her and appoint someone else. The latter is what they should have done, of course, but (having broken every historical tradition by appointing her in the first place) that would have been just too embarrassing for the new government.

    Hmmm, even more embarrassing than what's going on at the moment?

    The only part of the goverment's behaviour I take issue with is the blackmailing/threatening/confusing Megrahi into dropping the appeal. That seems to have been highly ill-advised - implying to Megrahi that he had to drop the appeal to allow Prisoner Transfer to be considered, without even knowing if the Crown was going to drop its appeal against sentence, never mind knowing if the Prisoner Transfer was going to be granted.

    Even if there had been no question of compassionate release, and prisoner transfer was the only application on the table, no prisoner should be put in a position where he had to withdraw an appeal with every prospect of success, without certainty that he would not then find himself still facing a Crown appeal against sentence, and continued incarceration. If this is the quality of advice Mrs. Angiolini was giving the government, in my opinion she should have been sacked.

    Adding in the Compassionate Release, which would not have required the appeal to be dropped, her advice seems to have been to deliberately time matters so that the prisoner was not allowed to know the outcome of the Compassionate Release application before having to make the decision about the appeal. This is absolutely unconscionable in my opinion.

    If that appeal had not been dropped, by now I strongly suspect (barring further shenanigans) Megrahi would have been cleared of the crime, leaving the US senators and others nothing to bluster about bar insinuating that he was guilty anyway, which would have been easily brushed away.

    And to think that when her appointment was confirmed in 2007 I thought this was a conciliatory and statesmanlike gesture on the part of the SNP administration. It never occurred to me that the decision would eventually screw over any hope of clarity in the Lockerbie case.

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  38. Rolfe. The SNP know all that we know. In fact, that isn't true, they actually know much more.

    Angiolini isn't their boss, it is the other way around, so all along she could have been sacked if she was seen to be giving advice which was not in the interests of justice. (The advice followed, rather, seems to be to pervert the course of justice actually.)

    The Scottish Government went with it and as Prof B pointed out, they didn't have to. So they are as much part of the obstruction of justice as the rest of them. MacAskill has since called for an independent investigation into Lockerbie of course which is something. But it simply will never excuse what he was a party to last year.

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  39. I agree with you. I was just commenting on Prof. Black's apparent view that Eilish Angiolini was the entire cause of it all, and the Scottish government simply had to do what she told them to do.

    Yes, they could (and should) have sacked her, as Prof. Black points out. But they weren't innocent pawns. Kenny MacAskill is a lawyer, as is Nicola Sturgeon. When handed advice that appears to pervert the course of justice, they should be perfectly able to see that for what it is and take the necessary action.

    A little bit of embarrassment a year ago, to change nothing except allow the appeal to continue, could have avoided all the current calls such as "The Scottish ministers should be forced to resign, and then tried on corruption charges. Megrahi should be returned to prison."

    Meh.

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  40. CL, I swear I posted the dirt on Sikora in some detail in the JREF forum. I'm sorry I ever described him as a respected expert, I've learned better since.

    For example.

    http://www.dcscience.net/?p=2073
    http://www.dcscience.net/?p=1466

    You have to scroll down to get to the relevant part on both pages.

    It has been made crystal clear by the Scottish government that while Libya was entitled to pay him to give his opinion if they liked (I don't know if he even examined the patient, or if it was all done by examining the history and test results), there was never any question of his being one of the medical opinions taken into account in making the decision.

    He likes publicity, does our Karol, and he also likes embarrassing the NHS for some reason. That "he could live ten or 20 years" was quite disgraceful and simply poured petrol on the flames. He's never made it clear that his wasn't one of the opinions used by Kenny MacAskill, in fact he seems to enjoy pretending it was.

    I realise you're at a disadvantage not having direct access to the Scottish media, but this is fact.

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  41. "A little bit of embarrassment a year ago, to change nothing except allow the appeal to continue, could have avoided all the current calls such as "The Scottish ministers should be forced to resign, and then tried on corruption charges. Megrahi should be returned to prison.""

    Couldn't agree more. Which brings us back to why they did it. The Professor has pointed out she was originally a Labour appointment. Why leave her there then? Fresh pair of hands was what was needed, but then remember the uproar when she was appointed simply because she was a woman? All the talk about legal glass ceilings smashing? All the talk about progress?

    As you say, MacAskill and Sturgeon are both lawyers and they know the score. They also must have known that compassionate relief would bring them more grief than the hearing of the appeal would. The hearing of that appeal would have tarnished every Party just about except them. They could have landed damaging punches to both Labour and the Tories. And yet....? They followed Angiolini's bidding which was to protect the establishement and the Scottish Justice System and add insult to injury by even declaring the original verdict safe!

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