Ref: A00-300995 Case No. 871626 Macpherson II
Volume V, Pages 35-47, Thursday 15th June, 1989
(In the presence of the jury)
MR. TEMPLE: My Lord, I am about to call the medical evidence as
far as the Crown is concerned in this case.
STUART JOHN CARNE: Sworn
Examined by Mr. Temple
Q. What are your full names? A. Stuart John Carne.
Q. What are your qualifications and professional appointments,
please? A. I am a Bachelor of Medicine and Surgery, a
Member of the Royal College of Surgeons, a Licentiate of the
Royal College of Physicians. I am President of the Royal
College of General Practitioners; I have a Diploma in Child
Health and I was Chairman of the Secretary of State Advisory
Committee (inaudible). I served as chairman or member of
numerous advisory committees to the Department.
MR. JUSTICE MACPHERSON: You are a general practitioner, are
you? A. Yes, my Lord. I am a general practitioner in
Shepherd's Bush.
MR. TEMPLE: With particular reference to this case, would you
confirm that during the course of the morning of Friday,
15th May 1987, you had occasion to see this defendant at
Paddington Police Station? You again saw him during the
course of the evening of that same day? A. May I use my
notes?
Q. Is the position that you kept notes of your examination on
each occasion? A. I did.
Q. Were the notes compiled when the events concerning the
examination and any conversation you may have had were fresh
in your memory? A. They do.
MR. JUSTICE MACPHERSON: Yes, you may use them. A. I did see
Mr. Koupparis at 11.25 in the morning of the 15th, and again
at 7.20 in the evening.
MR. TEMPLE: Can we first of all deal with the morning visit,
11.25, as we know at Paddington Police Station. What was
said to you by the defendant? A. That he had an injury to
his head. He had pain and swelling on the right side of his
face. including cheek and eye and also (inaudible) right eye.
Then he told me about a recent eye medical problem, a bleed
into the eye which had been treated at Moorfields about ten
days before that.
Q. That was what he was telling you. Did you have occasion to
examine him physically? A. I did.
Q. Your conclusions? A. Can I take them in order because they
are in the order I examined him, which is not necessarily a
logical sequence? His right thumb and elbow were sore when
I touched them and also the right shoulder, his right foot,
ankle and shinbone were all giving him great pain. He had
what is known as an adicentrum(?) [sic] of the right eye. That is
a condition with which he may have been born. It is
irrelevant to the present situation but it produces a change
in the pupil. I couldn't see any evidence of seepage into
the eye but I did suggest that arrangements be made to take
him to the eye hospital to have a check in case I had missed
any. I found no evidence of injuries to the face, arms legs
or elsewhere.
MR. JUSTICE MACPHERSON: He was complaining of pain in a number
of places but you found no evidence of injury anywhere?
A. That is right, my Lord, and during the examination he
gave me some further medical history about his previous
medical treatment. He told me that he was dependent on
nicotine and was taking about one gramme - milligramme of
pure nicotine every hour.
Q. One milligramme? A. Yes, my Lord.
MR. TEMPLE: When he said to you that he was taking nicotine in
that quantity, how did you interpret that? In other words,
what was the source of the nicotine? A. I was forming an
opinion about his mental state and this was consistent with
the opinion I was forming about his mental state.
Q. Did he actually use the phrase to you, "I am dependent on
nicotine"? A. Yes. I wouldn't swear to the words "I am",
but "dependent on nicotine" was certainly said.
Q. What did you interpret that to be when he said nicotine?
A. I would normally assume this to be obtained from smoke or
chewing. It is also available in this country as a chewing
gum but Mr. Koupparis was trying to tell me he was getting
nicotine in a pure form.
Q. Was it he who was giving you that figure of one milligramme?
A. It was.
MR. JUSTICE MACPHERSON: Is there such a thing as nicotine in
pure form? A. There is not to the best of my knowledge in
this country but I wouldn't like to say what the situation is
in other countries. He also claimed he was suffering from
withdrawal from medication, a drug called Xananax [sic].
MR. TEMPLE: Would you tell us a little about the properties of
that particular drug; what it would generally be prescribed
for? A. Xananax [sic] is one of the benzodiazepine group of
drugs, Valium, Librium, Mogadon, nitrazepam, all that group
of drug, and benzodiazepines and Xananax [sic] is one of that
group.
Q. In layman's terms, what would a doctor tend to prescribe
Xananax [sic] for? A. It is used for the treatment of anxiety
and should only be used for short periods.
MR. JUSTICE MACPHERSON: Would we call it a tranquiliser [sic]?
A. Yes, my Lord, we would.
Q. It is not a sleeping drug? A. To someone who has never
taken it before it would act as a sleeping drug but its
action is such that once you have been taking it for a while
it no longer has a sleeping effect and is taken by day.
MR. TEMPLE: We had got to the stage where he said to you that he
was suffering from withdrawal of Xananax [sic]. Did he give you
any further information as to how he had been taking it and
if so, in what quantity? A. He told me he was taking two
divided doses, half a gramme twice a day, and he had none
since the night before his arrival at the police station.
Q. That dose about which he was telling you, does that compare
with the recommended dose? A. That is within the range of
the recommendation.
Q. During the course of this morning examination, did he give
you any indication that he was taking any drug other than
the two he mentioned, Xananax [sic] and nicotine? A. No, the
other was reference to the blood pressure, nothing else about
drugs.
Q. If he had mentioned to you that he was taking other forms of
drugs, would it have been your practice to make a note of it?
A. It would.
Q. So much for the morning examination. You were telling us
that you just wanted to be absolutely certain you missed
nothing with regard to the eye and requested that he be taken
to Moorfields? A. I am not sure if it was Moorfields, but
there is a much nearer eye hospital; he may have gone there.
Q. Did you see him again at 7.20 that evening? A. I did.
Q. Was that again at Paddington Police Station? A. It was.
Q. What occurred during the course of this second visit?
A. In fact, he had been, not to Moorfields, but to Western
Opthalmic [sic] which is near Baker Street Station, opposite
Marylebone Station. The doctor there found no evidence of
any new bleeding into the eye. He told me his condition was
described as vitreous floaters, which is a condition in the
eye where little bits of the tissue in the eye drop off and
float around and you catch sight of them.
Q. Can we summarise it in this way: did it have any major
significance to your examination? A. It had no
significance at all. It is nothing, most of us have them
but we ignore them.
Q. More important, did you make a note as to his mood, and if so
how did you describe it? A. I made a note saying, "Is in a
very elated mood and he makes certain requests of me. He
wanted tranquillisers, cigarettes and oranges, orange juice",
and I made a comment as to my provisional diagnosis.
Q. I want to ask you about your provisional diagnosis in a
moment. Before I do so, obviously it goes without saying
you qualified it by "provisional diagnosis". Did you feel
that you personally had had sufficient time to make any fixed
and certain diagnosis? A. I had drawn sufficient
conclusions; had he been a patient of mine in the practice I
would have wanted a psychiatrist to confirm or deny my
impression.
Q. May I just ask you your provisional conclusion? A. That
he was suffering from what is medically called "hypomania".
This is a condition the reverse of depression and many people
with depression also have hypomania and they go up and down.
Q. "Hypo" is that Latin for "below"? A. Yes.
Q. I am corrected, it is Greek. A. I apologise too.
MR. JUSTICE MACPHERSON: It is the only Greek I know; "hypo" is
"under", "hyper" is "above".
Q. What we are looking at here in general layman's terms,
hypomania, below mania? A. Yes.
Q. A medical condition known as "mania", in simple layman's
terms, what are we looking at? A. Someone who believes
themselves capable of doing the impossible.
Q. Hypomania below that. Again in layman's terms, how would
you describe hypomania? A. Someone in that condition but
not as florid.
Q. Just to conclude so far as you are concerned, was the
position that you did not give him any treatment? A. I
gave him no treatment.
MR. TEMPLE: You will appreciate that the Crown are calling
specialist doctors to deal with the mental condition and I
need not trouble you further with regard to these matters.
CROSS-EXAMINED BY MR. BECKMAN
MR. BECKMAN: The almost penultimate answer, I do not know
whether someone can give it to me.
MR. JUSTICE MACPHERSON: About hypomania?
MR. BECKMAN: Yes.
MR. JUSTICE MACPHERSON: Someone in that condition, in the
condition of mania, but not as florid.
MR. BECKMAN: So far as hypomania is concerned, you say many
persons suffer from that. Did you see many people suffer
from something --- A. No, I said many of those who suffer
from depression also have periods of hypomania. I was not
talking of ordinary people.
Q. Looking at your notes you say this: that your view was his
behaviour needs assessment? A. That is correct.
Q. Your view was this: it could be acute hypomania or the
effects of drugs? A. That is correct.
MR. JUSTICE MACPHERSON: The effect of drugs or the withdrawal
from drugs.
MR. BECKMAN: Your Lordship ---
THE WITNESS: He could have been taking drugs of which I was not
aware which could produce this effect. It is unlikely
taking drugs for an ordinary medical condition would produce
this state unless he was specifically having treatment for
hypomania. If he - the usual treatment is a pill called
lithium. If he were taking lithium regularly, if he stopped
lithium then the hypomania would as it were escape and he
would be showing signs of it.
Q. Your preliminary view was it could be (meaning a possibility)
acute hypomania or the effect of drugs, and one could add
this: and/or withdrawal from a drug or drugs? A. From
drugs specifically for hypomania, not withdrawal from the
several drugs of which he had told me.
Q. So when you say "withdrawal from or the effect of drugs", are
you only referring to drugs you were told about at that time
or are you anticipating he may have taken other drugs?
A. Let me explain a little; if he had been taking
amphetamine, known in the street as "speed", Dexedrine and
that sort of thing, that would have that effect. He had not
told me about this and I had no reason to believe he was, but
it was a possibility.
Q. Leaving aside what it was, am I right - I want to see if the
proposition is right, and I suspect we are agreeing - when
you use the example of speed, I take it when you say "or the
effect of drugs" and we have added "or possible withdrawal"
symptoms, that you say that because he may have been under
the influence or withdrawal effects of some drug or drugs
which he had not told you about, whatever they are? A. Yes.
Q. And that was a sensible assessment for you to make from that
position? A. I think it was a reasonable assessment.
Q. A reasonable assessment. There may have been other drugs and
I take it that because of his very condition, however caused,
that what he said would not necessarily at that time be
accepted by you as reliable? A. Correct. Not untruthful
but not reliable.
Q. Exactly, that is what I am after. In other words, not
necessarily dishonestly lying but just not reliable because
of the condition that he was in, which was caused by one or
other of those methods? A. That is correct.
Q. Now, may I take it from there. It is right, is it not, that
the reason why, from your pinpoint (sic) you did not - you
added this joinder "or was because symptoms of either can
be seen"? A. Not quite. My preference from a diagnostic
point of view was for hypomania but the use of Speed-like
drugs in that part of London is so common that I could not
exclude the possibility.
Q. I take it that the way in which you were deciding the matter
is if it were very important to get a precise diagnosis you
would - whether for the purpose of law or any other purpose -
treatment, medication - go to the best experts for them?
A. Correct.
Q. You would search - from the viewpoint of his mental state you
would go to a psychiatrist? A. Yes.
Q. From the viewpoint of the possible effect of specific drugs -
there may have been other drugs - it would be right to say
you would go to a psycho-pharmacologist? A. Not
necessarily. I am regarded in the courts as an expert on
some of the tranquillisers.
Q. I am not referring just to tranquillisers, I am talking about
total expertise over the whole range of drugs and their side-
effects and otherwise, not just Speed but all sorts of drugs.
A. Within limits yes, though I have been called as one of
the so-called experts in that field.
Q. Who is the leading expert on psycho-pharmacology?
A. Malcolm Lader, I believe.
Q. And after he, or perhaps parallel with him? A. You are
asking me to guess what is in your hand. I know Malcolm
Lader, he and I work together.
MR. JUSTICE MACPHERSON: It can probably be more easily done
because I think one is in Mr. Beckman's hand. Who do you
say?
MR. BECKMAN: I was hoping to get them out of the doctor's hand.
(To the witness): A lot of books have been written by
Dr. Ashton? A. The fact I don't know his name does not
mean he is not a highly distinguished doctor.
Q. I am glad she is not here to hear you get her sex wrong. I
do not know whether you know, but it is right she has written
a lot of authoritative books on the subject. A. I don't
recollect the name but if I saw the work I would recognise
it. Malcolm Lader is a professor in the University of
London.
Q. I think Dr. Ashton comes from Newcastle. A. Professor
Rawlings' department.
Q. Professor West, you would regard him as a good psychiatrist
from Cambridge? A. Again I do not know. He may well be an
excellent psychiatrist, but I do not know him.
Q. Dr. D'Orban? A. Again not the name. I know from where ---
MR. BECKMAN: He is about to follow you as a psychiatrist.
MR. JUSTICE MACPHERSON: He is a consultant at the Royal Free.
A. Again, there are numerous consultants, my Lord.
MR. BECKMAN: So I take it in your case, Dr. Carne - it is not to
belittle you at all, on the contrary it is to compliment
you - you are a general practitioner but with particular
expertise in certain spheres? A. Yes.
Q. Would it be of any assistance to you - I apologise you have
not been shown it earlier - to see, or would you rather leave
that to the psychiatrist, Dr. D'Orban, to see the reports of
Professor West and Dr. Ashton? A. That is entirely up to
the Court. I am not sure whether it would assist. I am
quite happy to assist the Court in any way I can.
MR. BECKMAN: My Lord, I do not think I can take that any further
as Dr. D'Orban is an expert. My Lord, I do apologise, I had
asked matters to be served yesterday but unfortunately
communications broke down and they were not, so if it is felt
doctors, before leaving, should see the reports they can.
MR. JUSTICE MACPHERSON: I am not sure about that. You are
going, I suppose, to suggest to him in a sentence or two what
they say and see whether he can comment on it?
MR. BECKMAN: No, my Lord, I would have done it in another way.
First of all, we were calling Dr. D'Orban first. He is a
psychiatrist who I rely on for the expertise, without any
disrespect to Dr. Carne.
MR. JUSTICE MACPHERSON: I think what I am going to suggest, if
he will do so, is that Dr. Carne should wait during
Dr. D'Orban's evidence, then he can be recalled and make any
comment on what you have elicited from him.
MR. BECKMAN: And perhaps not only that, he could have a copy of
the reports I am about to refer to and look at them. One is
very long, the other very short.
RE-EXAMINED BY MR. TEMPLE
Q. My Lord, may I ask one question by way of re-examination?
(To the witness): Do you remember telling us your preference
so far as diagnosis was concerned was for hypomania? A. Yes.
Q. Why? A. He was so (inaudible) in his behaviour. He took
command of the situation. As a hypomanic, were he in this
court he would in fact be instructing everybody here what to
do in a very pleasant way, as though it was his drawing room.
MR. JUSTICE MACPHERSON: Dr. Carne, would you kindly sit
somewhere where you can easily hear Dr. D'Orban?
(The witness withdrew)
MR. TEMPLE: May I say I have in my hand a message to the effect
that Dr. D'Orban's secretary did not pass on the message. He
is on his way. May I make it abundantly clear that no fault
can be placed on anyone responsible for warning the witness.
MR. JUSTICE MACPHERSON: Fate is not kind to us, ladies and
gentlemen. It does not mean the medical evidence will extend
into tomorrow, so we will have a break.
MR. TEMPLE: Once again I find myself apologising to both your
Lordship and the jury.
MR. BECKMAN: I have also a request: I have not been able to
have any expert witness by my elbow. I am doing it after
discussion and preparation. I mention that because one
normally has it at one's elbow.
MR. JUSTICE MACPHERSON: It would help me, if there is a possible
cause to rise, if I could see the medical reports.
MR. BECKMAN: They should have been served on everyone yesterday.
MR. JUSTICE MACPHERSON: They have not filtered up to me.
Perhaps they can be brought to me.
MR. BECKMAN: They will be, my Lord.
(The trial was adjourned for a short time)
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