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Colin Norris's case to be heard by UK Court of Appeal

catsmate

No longer the 1
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I see no-one has started a thread on this case.
Norris (wiki) was convicted on four counts of murder and one of attempted murder in 2008. He is alleged to have used insulin overdoses to murder the four elderly patients at hospitals in Leeds back in 2002.

The case against him was dubious, and the verdict a majority one (the foreman has subsequently altered his view also) delivered after four days of deliberations.

For nearly ten years there have been serious doubts, specifically about the prosecution claim that such a cluster of hypoglycaemic deaths could not occur naturally and was in itself evidence of unnatural causes. This is now considered incorrect (and there were dissenting voices back in '08).
Further investigation into each death has shown logical, non-sinister causes for the deaths.
One further point was the involvement of DCS Chris Gregg in the investigation; he may have been prejudiced by his involvement in the Harold Shipman enquiry.

CCRC Referral.

Comments?
 
"Further investigation into each death has shown logical, non-sinister causes for the deaths."

If it's true that further investigation has produced evidence that each death had a logical, non-sinister cause that exonerates Norris, then his appeal should win an acquittal quite easily.
 
He applied october 2011 and this has just been accepted. Nearly 10 years, seems a very long time.
 
How common is hypoglycemia

Murderpedia link with several news stories.

A key point against Colin Norris is that he apparently predicted the death of at least one patient.

This Justice Gap link has a link to a Paul May article.
Solicitor John "Moore continued. ‘At the trial they paraded purported expert after expert all of whom advised the jury that it was very unusual to see hypoglycaemia in persons who were not diabetic.’ Moore has instructed a leading expert, Professor Vincent Marks whom the prosecution apparently had consulted in the early stages. ‘He concluded that, contrary to current standard teaching, spontaneous hypoglycaemia is common in 10% of elderly, frail, sick people especially those with low body weight and suffering from malnutrition. [He also concluded] that there was little reason that hypoglycaemia was anything other than a spontaneous response to their underlying illness.’"

I don't have a strong opinion at this point.
 
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how long does insulin persist

"Dr Emma Ward, a diabetes expert, was surprised enough by Mrs Hall's collapse into a coma that she ordered blood tests which revealed insulin levels about 12 times the norm..." Scotsman

PHYSIOLOGY 34: 198–215, 2019. doi:10.1152/physiol.00048.2018
This is well outside of my expertise, but my understanding is that insulin is normally cleared rapidly. Before I were to accept the measurement above as being accurate, I would want to know more. For example, several weeks elapsed between the patient's falling into a coma and her death. When was the blood drawn is one question.

Right now I am slightly leaning toward guilt, but I could be swayed by more information.
 
Someone please tell me they measured C-reactive protein. Vince Marks knows this very well. It's the classic way of telling whether insulin is exogenous or endogenous. It's what got Claus von Bulow I think. I remember a case being discussed at a meeting and I think Vince Marks was actually there, where they hunted high and low for a stored blood sample from a dead patient and finally found one at the bottom of a freezer that should have been emptied but hadn't been, and you know I can't remember whether they found the C-reactive protein (not guilty) or didn't (guilty) in that case.
 
Someone please tell me they measured C-reactive protein. Vince Marks knows this very well. It's the classic way of telling whether insulin is exogenous or endogenous. It's what got Claus von Bulow I think. I remember a case being discussed at a meeting and I think Vince Marks was actually there, where they hunted high and low for a stored blood sample from a dead patient and finally found one at the bottom of a freezer that should have been emptied but hadn't been, and you know I can't remember whether they found the C-reactive protein (not guilty) or didn't (guilty) in that case.
They did not. Someone in the analysis lab felt that the immunoassay method of Ethel Hall's blood sample, combined with the medical diagnosis, provided irrefutable evidence that insulin had been administered.
 
For goodness sake, how long ago was the von Bulow case? I'm sure I'm not misremembering that c-reactive protein was instrumental in getting a conviction in that one.

I'm just a poor bloody veterinary clinical biochemist, but even I could tell you off the top of my head that that's what you needed to measure, the very minute you told me that you needed to prove exogenous insulin administration. It's so neat and cool and without that this case should have been thrown out as no case to answer.

Even if you think you have some sort of super-assay that can distinguish between injected and endogenous insulin (and just how, given that most insulin is human insulin these days, do tell), surely to God you also do the time-honoured tried-and-tested test that has precedents to call up and doesn't require a major presentation of immunoassay methodology (hotly contested by the defence of course) to secure your conviction?
 
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For goodness sake, how long ago was the von Bulow case? I'm sure I'm not misremembering that c-reactive protein was instrumental in getting a conviction in that one.

I'm just a poor bloody veterinary clinical biochemist, but even I could tell you off the top of my head that that's what you needed to measure, the very minute you told me that you needed to prove exogenous insulin administration. It's so neat and cool and without that this case should have been thrown out as no case to answer.

Even if you think you have some sort of super-assay that can distinguish between injected and endogenous insulin (and just how, given that most insulin is human insulin these days, do tell), surely to God you also do the time-honoured tried-and-tested test that has precedents to call up and doesn't require a major presentation of immunoassay methodology (hotly contested by the defence of course) to secure your conviction?
Von Bülow was convicted (of attempted murder) in 1982 (his wife didn't die but was left vegetative) and acquitted in 1985 after the verdicts were quashed on appeal in 1984.
IIRR (and I'm not familiar with the details of the case) there was no indication of a cause for the high insulin level found (in a single test, no sample was retained) and much of the other condemnatory evidence was dubious at best.
 
I could be misremembering the von Bulow case, I didn't look it up. But the use of c-reactive protein to distinguish between endogenous insulin and injected insulin goes back a long way and has been used in other cases to prove or disprove murder by insulin.
 
concentration of insulin in the other deaths

I have not seen anything on the insulin levels of other patients who died. Were these levels measured, and if not, why not?
 
I have not seen anything on the insulin levels of other patients who died. Were these levels measured, and if not, why not?
In the Norris case? I'm on the tablet atm but IIRR there was only one blood sample available due to the lack of suspicion wrt the deaths.
 
Math on Trial

Yes, I was referring just to the Norris case.

I don't believe that this happened in the Norris case, but Chapter 1 of Leila Schneps and Coralee Comez's book "Math on Trial" concerns the fallacy of multiplying non-independent probabilities.
 
For goodness sake, how long ago was the von Bulow case? I'm sure I'm not misremembering that c-reactive protein was instrumental in getting a conviction in that one.

I'm just a poor bloody veterinary clinical biochemist, but even I could tell you off the top of my head that that's what you needed to measure, the very minute you told me that you needed to prove exogenous insulin administration. It's so neat and cool and without that this case should have been thrown out as no case to answer.

Even if you think you have some sort of super-assay that can distinguish between injected and endogenous insulin (and just how, given that most insulin is human insulin these days, do tell), surely to God you also do the time-honoured tried-and-tested test that has precedents to call up and doesn't require a major presentation of immunoassay methodology (hotly contested by the defence of course) to secure your conviction?

Vets are brighter than medics. The number of times I tell junior doctors that low glucose = psychpathic nurse is innumerable. You are right, but doctors see lots of diabetics, so they lose sensitivity to the fact that low glucose in a non diabetic is odd. Now most low sugars are not due to a homicidal nurse, but if you do not check protein C you will never know.

There is a difference between innocence and being able to prove guilt. Personally I believe the evidence supports guilt, whether it is guilt BARD is another issue.

ETA
C reactive protein is something completely different, it is an acute phase reactant, I assume you meant protein C.
 
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protein C and insulin

The only protein C with which I am familiar is one that works with protein S as an anticoagulant. I did just now find a few articles about protein C and insulin (link1; link2), but I am not seeing an obvious connection.
 
Vets are brighter than medics. The number of times I tell junior doctors that low glucose = psychpathic nurse is innumerable. You are right, but doctors see lots of diabetics, so they lose sensitivity to the fact that low glucose in a non diabetic is odd. Now most low sugars are not due to a homicidal nurse, but if you do not check protein C you will never know.

There is a difference between innocence and being able to prove guilt. Personally I believe the evidence supports guilt, whether it is guilt BARD is another issue.

ETA
C reactive protein is something completely different, it is an acute phase reactant, I assume you meant protein C.


Oh, you're right, that's what not doing these tests routinely, and also being retired, does to you. I got my Cs in a twist.
 
The only protein C with which I am familiar is one that works with protein S as an anticoagulant. I did just now find a few articles about protein C and insulin (link1; link2), but I am not seeing an obvious connection.


When proto-insulin is formed it folds itself up as it should do, according to the amino acid chain and the way the charges work. Then after that folding happens, enzymes chop off a bit of the chain to get the final hormone. That is C-something, Planigale is right, I had the wrong name. This is the length of peptide (actually I think the right name is c-peptide, put me to the bottom of the class) which is needed to get the protein to fold properly to the right shape, then is trimmed off as excess. Like cutting a length of wallpaper slightly too long and trimming off the extra.

If a high insulin concentration is measured, and that insulin was made by the body, you will find the equivalent amount of c-peptide kicking around if you look for it. If on the other hand the insulin was made in the laboratory there will be no c-peptide detectable in the blood sample.
 
C-peptide

Thank you. Here is a diagram showing how the C-peptide (grey) is the part of proinsulin that is proteolyzed out. Here is a 1993 article on using the ratio of insulin to C-peptide as a probe for inadvertent or surreptitious insulin administration. A measurement of C peptide would have helped this case a great deal.
 
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von Bulow case and more on C peptide/insulin ratio

"According to Dr. George Cahill, a Harvard Medical School professor who is a leading expert on blood sugar, had the Yalow test been performed on blood taken from Martha von Bulow shortly after she lapsed into her second coma on Dec. 21, 1980, her physicians and a subsequent jury would have known ''with 100 percent certainty'' the source of the insulin in her body.

"However, doctors did not perform either the Yalow test or a test to measure the blood level of an amino acid called C-peptide, which is left when insulin breaks down. Medical experts testified that there was ''reasonable medical certainty'' because of the high level of insulin and low level of sugar in Mrs. von Bulow's blood that the insulin had been injected."
NYT

"Because of the differences in half-lives, the molar ratio of circulating insulin to C-peptide is usually <1, despite equimolar secretion." link
 
Well, gimme a break, I haven't thought about this for years if not a decade or two and I got the terminology wrong (I didn't look anything up, probably should have done), but even I remembered that there's an excellent test to distinguish between endogenous and exogenous insulin, and why and how. Please tell me why nobody seems to have thought of that?
 
hardly an open and shut case

At first I thought Mr. Norris sounded like an uncaring individual at best, thereby forgetting my own rule that the prosecution can make almost anyone look bad. The Knox/Sollecito case is not the only example of this, but it is a good one.

With respect to the science, the discussion in this thread is pushing me toward saying that the evidence against him is not a slam dunk. If this case were being decided using preponderance of evidence (50.1%) as the standard, I might vote one way. Using BARD, I might vote the other.
EDT
I found a link to an article in the American Biology Teacher that goes through some of these issues using a laboratory exercise with simulated data from immunoassays. There are a few references.
 
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access and inventory

Would Mr. Norris have had access to insulin? Was the insulin inventoried, and if so, was some missing? I don't know enough about typical hospital operations, to know whether or not these are realistic questions to be asking.
 
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