Sheila was sedated

[Erik Narramore]

Paragraph 148 is the appeal judgment reciting the prosecution's case at trial!

Paragraph 87 does not confirm she was sedated.  That's just the appeal judges relying on a part of Dr. Ferguson's statement in which he gives his general view about the side-effects of a particular drug.  That does not mean she was sedated and the judgment does not confirm it.  She was skipping down Pages Lane, wasn't she?  Here is another example (of many) where Bamber has, in my view, suffered from poor legal representation.  The appeal judges aren't pharmacologists, the opinion of Dr. Ferguson should have been rigorously tested.  For one thing, it seems to me he had a vested interest in playing down Sheila's actions.  The guilt camp are taking what is said too much at face value for my liking.  I think about things for myself, I don't just treat as Gospel what people say, just because they have professional titles.

[Erik Narramore]

Haloperidol is not used as a sedative.  That's just a side-effect of taking it or having it.  The appeal judgment does not prove she was sedated and the judges do not come to that conclusion, or if they have assumed that, the assumption has been left unexamined, which is wrong.  Moreover, even if she was sedated, what exactly does that mean?  The term can mean lots of different things.  Very generally, it refers to a depressed state of alertness.  It doesn't follow that she was unable to carry out the massacre or that she slept through a massacre committed by Jeremy.

[Erik Narramore]

The Court of Appeal did not find that Sheila was sedated and there is nothing to show conclusively that she was sedated.

Furthermore, even if we say she was sedated, that does not mean she was asleep and it would still have been possible for her wake/re-awaken and carry out a massacre.

[Erik Narramore]

In their 2002 judgment, the Court of Appeal say that Sheila was "probably in a sedated state" and the drug she was on was known to have "sedative side effects at the levels prescribed".  But the judges had no expert opinion to rely on for these views.  Dr. Ferguson, in his statement of 9th. August 1985, states only that the drug would have had a slightly sedating effect, but he doesn't know what the effect was on Sheila because he had not seen her since her dose was lowered.

You have no evidence to say that Sheila was sedated, assuming you even understand what the term 'sedated' means and its significance.  Sedated does not mean asleep.  There are witnesses to Sheila's general physical state on the 7th. August 1985, but these witnesses give us conflicting accounts.

[Erik Narramore]

Haloperidol can have sedative side-effects, but there is no evidence that Sheila was sedated.  In any case, being sedated does not in itself preclude her involvement in a massacre.  It is not the same as being asleep and could mean anything from feeling drowsy and numb through to actual sleep.

Now let me continue in a bit more depth.

One problem in discussing this is that the terminology is quite confusing and even medical doctors use the terminology incorrectly or sloppily in their day-to-day work. From what I can gather, some antipsychotics are tranquilising, others are sedative in their effects.  Furthermore, antipsychotics that are tranquilising can have sedative side-effects if taken in high enough doses and/or if other factors are present.

Tranquilisation is not the same as sedation, however most run-of-the-mill medical doctors - GPs, most psychiatrists, etc. - will conflate the two terms and use sedation as a synonym for tranquilise, even though the two things are very different.  This is because the distinction isn't necessarily of great practical importance in their day-to-day work, so they forget.

Both tranquilisers and sedatives act to suppress brain activity and can result in drowsiness.  The difference is that a tranquiliser is not intended to induce the patient into the sleep spectrum and therefore will not normally be analgesic in its effect (though it can be), whereas a sedative will induce somnolence and is therefore analgesic. This distinction is quite important in the Bamber case, if you think about it.

Now let's consider the pharmacology of Haloperidol.

Haloperidol is a first-generation antipsychotic of the butyrophenone type.  This makes it a tranquiliser, not a sedative.  The whole point of Haloperidol is to antagonise certain biochemical receptors in the brain in order to suppress neural 'excitement', and thus counteract the typical symptoms of a severe mental illness such as schizophrenia.  Haloperidol is a highly effective (but also highly-dangerous) antipsychotic and is perhaps the most commonly-used drug in psychiatric emergencies - typically when somebody goes nuts and needs to be injected and then sectioned.  As such, Haloperidol is not optimum for sedation and is never prescribed or used for that purpose, as it would not make much sense.  However, it is openly acknowledged that one of the adverse side-effects of Haloperidol can be sedation.  This seems to happen when the drug is administered in high doses or where there are contraindications or other factors present.

The presumed lack of analgesic effect of Haloperidol may be of significance to us because, remember, Dr. Vanezis was of the opinion that someone incurring a .22 flesh wound to the neck would experience great pain.

However, two further significant facts need to be considered in Sheila's case:

(i). The toxicology report shows that Sheila was almost-entirely unmedicated by the point of death.

(ii). There were contraindications because Sheila took recreational drugs and the toxicology report confirms that she was taking illicit drugs up to around her death.

What we are left with is a complex picture, which I would sum up in the following way:

1. Haloperidol is not a sedative.  Dr. Ferguson uses slovenly terminology in his most important statement of 18th. September 1985, saying it has a tranquilising effect, which is correct, but then using the terms sedation/sedative, which gives an incorrect impression of the drug's effects on Sheila, implying that she was sedated and somnolent.  This is unfortunate but does not mean Dr. Ferguson was incompetent.  It is common for run-of-the-mill doctors to use the two terms interchangeably.

2. Sheila was tranquilised by Haloperidol, though the toxicology report shows that she was virtually unmedicated by the 6th./7th. August 1985.

3. Even if Sheila was in a tranquilised state at the time in question, this in itself would not preclude her participation in violence and a firearms massacre.

4. It is possible Haloperidol also had a sedative side-effect on Sheila, perhaps due to over-dosing and/or contraindications such as illicit drug-taking.  It is furthermore possible that Sheila was in a sedative state during the evening of 6th. August 1985, but there is no evidence for this.

5. Even if Sheila was in a sedative state at the time in question, this in itself would not preclude her participation in violence and a firearms massacre.

6. When a Haloperidol regime is being withdrawn or reduced, it is strongly advised that dosage is reduced gradually.  Due to an administrative mix-up between the different doctors involved, Sheila's dosage was cliffed (at Sheila's own request).  It is plausible that this could have resulted in a worsening of symptoms and behaviour.

[Erik Narramore]

Yes, the sedation theory comes under the heading of 'speculation'.  It has only gained legs because of slovenly terminology in Dr. Ferguson's witness statements, the lazy but widespread belief that somebody with impressive paper credentials must be right and should not be challenged, and the inattention of the defence, who should have instructed an expert pharmacologist or psychopharmacologist.  Sedation is possible with Haloperidol, but the idea that this was Sheila's state in this case is misinformed speculation in most cases, because most people are eliding two different neuro-pharmacological effects: in correct clinical language, tranquilisation and sedation are not the same thing.

There is absolutely no evidence whatsoever that Sheila was sedated.  It is possible that she was as a side-effect of Haloperidol, and an informed argument could be made for the notion, but we will never be sure.

Sheila was certainly tranquilised.  That is the direct effect of the Haloperidol, it's what the drug is for.

The toxicology results are not my opinion.  They are what they are.  Sheila was virtually unmedicated by the time she was shot (whether by Jeremy or her own hand) and she had traces of illicit drugs in her system, suggesting the antipsychotic regimen was contraindicated.

The fact the medication dosage was halved is hugely significant and cannot be airily brushed aside.  This was medical negligence, pure and simple.   That is tacitly admitted.  I am not stating anything controversial here.  It is established medical canon that withdrawal from antipsychotics should be gradual.  Sudden withdrawal is dangerous.  Haloperidol is a dangerous enough drug as it is.

Bear in mind these points I am submitting neither assist nor undermine Jeremy's position. 

[Erik Narramore]

The toxicology report should be interpreted in light of the surrounding facts, including the date of Sheila's last intramuscular injection and the greatly reduced dosage received on that occasion.

[Erik Narramore]

Looking at this factually, we can't say she was sedated.  Nobody can say that.  She was on a tranquilising antipsychotic, not a sedative.  The drug did potentially have a sedative effect, among its adverse side-effects, and she was contraindicated, so it is possible she was sedated and therefore somnolent to some degree.  But we can't say that she was.  When Dr. Ferguson and the appeal court say that, they are just plain wrong.

[Erik Narramore]

The Court of Appeal got their facts from Dr. Ferguson.

Dr. Ferguson was clearly wrong.  At best, he did what a lot of doctors do and conflated the concepts of tranquilisation and sedation.  The defence failed to call expert pharmacological/psychopharmacological evidence to challenge him.  Dr. Ferguson's error is perhaps understandable in that the distinction is not terribly important to the day-to-day work of most ordinary doctors, as they tend to rely on what they are told about the proper function of various drugs available for them to prescribe.

However, sedation and tranquilisation are two different things.

It's not that I think I know better than experts.  I am sure Dr. Ferguson was a very diligent doctor, and no doubt far cleverer than myself when it comes to medicine and psychiatry, but experts often get things wrong.  It is a very great mistake to rely on experts.  The function of an expert is to advise, not to decide.  You should weigh things up and decide for yourself.  But that requires you to think for yourself, which requires effort and brains, which not everybody has.

A certain Dr. Skuse averred that he could trace nitroglycerin compounds in the hand swabs of terrorist suspects.  He was an expert, but his evidence was shown to be wrong.  He took in lots of otherwise intelligent people who ought to have questioned what he was doing.  Instead, they rested on the fact that he was an expert in his field.

A certain Dr. Meadows, a very eminent paediatrician, swore blind that his statistical evidence about the incidence of infanticide was reliable.  He was wrong.  Indeed, his evidence was plainly ridiculous and could have been dismantled by a GCSE maths pupil, but it was accepted by a jury, a judge, prosecution barristers with law degrees, and appeal judges, as well as lots of other otherwise intelligent people who just treated expert 'scientific' evidence as unassailably credible.  This cost a woman years in prison.

[Erik Narramore]

Note: 'Jane', the Blue Forum user, took issue with my description 'virtually unmedicated' and posted a link to this study: https://pubmed.ncbi.nlm.nih.gov/1586270/

Below is my response.

Arguing with Jane over this or anything else was very arduous because she is highly partisan and egotistical.  She didn't come across to me as very bright and I tended to skip her posts as I found her contributions lacking in substance, but she inserted herself into an exchange I was having with the user called 'Snow'.

________________________________________________________________________________________________

I am looking at the statement of the forensic scientist Mr Allan, dated 12th. November 1985.  In regard to Haloperidol, Dr. Allan states that Sheila had 0.55 micrograms per gram in her liver and 15 nanograms per millilitre in her blood.

I say 'virtually unmedicated' in relation to her last monthly dosage of 100mg - which is a lot in comparison to what was in her by the end.  We could instead say 'low-medicated' or words to that effect, but it's just semantics.  I appreciate that 'medicated' is not a linear concept, but the effect of the drug varies according to the individual and the circumstances.  To be clear, I am simply talking about the diminishing concentration of the drug in her body in relation to the original dosage.

The link you provide is not to a full article, but to an abstract behind a paywall.  That means we don't know the context and basis of their opinion of what a low or medium or high dosage is.  Sheila's level is at the lower end of what the authors of the paper call 'medium' or 'moderate'.  Other clinicians may take the view that it is a low concentration.

It is also not clear to me whether "plasma level" is a reference to concentration of the drug or dosage.  We'd have to read the article to know.  Furthermore, the reference is to plasma not blood - not the same thing.  It is likely that a blood level matrix would render a lower concentration.  (I accept it is possible that Mr Anderson may have used a plasma matrix to measure drug concentration).

Furthermore, the abstract summary - such as is it - does not make clear what point the article is making.  It states in conclusion: "Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients."  But what does that mean?  What are 'clinical responses'?  What was the state of the patients entering the trial?  The abstract is saying that someone can be virtually unmedicated and show little difference in 'clinical response' in comparison to someone who is moderately medicated or highly medicated. But isn't that confusing on its face?  We'd have to know what they mean by "minor differences".  A minor difference to them could be a significant difference to you and me. We need to read the full article to make any sense of it.

The article also does not address the points germane to the issue presently under discussion: which are whether she was 'virtually unmedicated' and whether there is any basis for saying she was sedated, but in any event, the abstract suggests that the article is neutral on the point I make.

Sheila had her last monthly intramuscular dose on 11th. July 1985.  Again, in fairness, this was a few days later than I thought.  For some reason, I had in mind that her last dose was on the 4th. and the next was imminent.  Even so, she was approaching the end of her medication cycle.

Despite your efforts, I am still left in the same position, which is as follows:

(i). There is no evidence that Sheila was sedated.  Sheila's medication was tranquilising and is known for having a low sedative effect, though admittedly Halioperidol can have a sedative side-effect, so it is possible she was sedated.

(ii). Sheila was approaching the end of her medication cycle.  The toxicology report confirms that Sheila had a low concentration of Haloperidol in her.

(iii). The toxicology report and the surrounding facts and knowledge we have about Sheila suggest that Sheila took illicit drugs, both soft and hard.  Both Dr. Ferguson and Dr. Allan say this would have had no effect, but Mr Allan puts it in terms of the cannabis interacting with the Haloperidol, whereas Dr. Ferguson merely says that in his view the Haloperidol would not have been inhibited in its effect by the cannabis.  Neither of these experts were pharmacologists or psychopharmacologists.  Dr. Allan was a Chartered Chemist and professional toxicologist, whereas Dr. Ferguson was a psychiatrist.

[Erik Narramore]

The drop in her medication is important to consider.  Of significance also is that the drop on the 11th. July 1985 was medically negligent.

As I have stated, there is no evidence she was sedated.  Dr. Ferguson may have been of the view that she would have been, but that is just an opinion.  It doesn't mean she was (though please note, I accept it is possible she was).  What is "slightly sedated" anyway?  How do you distinguish that from being tired?  Jeremy must have been tired and drowsy after a full day at work on the farm, but that didn't stop him committing a massacre in the middle of the night - according to the courts.

I have just been trying to find a free copy of the full article that another poster linked to above about the relationship between clinical responses in psychotics and dosages of Haloperidol.  I still can't find a free copy, but I have found a report on a 1998 study by different researchers that suggests dosages above 18ng/mL are less efficacious and even counter-therapeutic.

[Erik Narramore]

Something else I forgot to mention is a phenomenon known to forensic toxicologists called post-mortem redistribution.  This is when antipsychotic drugs redistribute from the body tissues and organs into the blood after death.  Of course, we have to weigh this against the fact that Haloperidol continues to diminish according to its half-life after death.

[Erik Narramore]

The housekeeper commented that Sheila seemed normal.

Pamela did not see Sheila, she only spoke to her on the phone, and merely commented that she seemed quiet.

Haloperidol can have sedative side-effects, but there is no evidence that Sheila was sedated.  In any case, being sedated does not in itself preclude her involvement in a massacre.  It is not the same as being asleep and could mean anything from feeling drowsy and numb through to actual sleep.

[Erik Narramore]

Quotes are 'Adam' on the Blue Forum.  These people are sent to try us.

Thank you David.

Going by the WS's, authors, Bamber's appearance an hour after the massacre & the crime scene, Sheila put up no resistance.

Dr. Bradley's evidence does not lend any support to the idea that Sheila was sedated.  He says Haloperidol does have sedative side-effects, but only may do so, and then only moderately.  His trial evidence is just a recitation of conventional medical opinion.  I do agree that we can't rule out the possibility she was sedated, especially given that she was still on illicit drugs and drinking around about the same time.  Yet you have nothing conclusive that Sheila was sedated, and as I keep saying, even if she was in some sort of sedative state, that does not preclude her as the killer.  Sedation is not the same as asleep.  She could have committed the massacre while she was sedated, indeed while she was still well under the influence of the medicated tranquilisers she was prescribed.

I asked you a while ago whether the prosecution theory depends on Sheila being sedated, and you did say that it doesn't and that she needn't have been sedated at all.  This accords, I think, with the position taken by the prosecution at trial.  The prosecution made a big thing of the sedation theory, but their case didn't rest on it in so many words.  They left the question open as it wasn't essential for them to prove, and to that extent, I would agree with the prosecution at trial that, if Jeremy did this, how he subdued Sheila is another grey area in the case that can only be explained by Jeremy himself, in so far as it matters at all.

That having been noted, since this is something we are discussing, perhaps you could also explain how this all works if Sheila is not sedated?  Is it just that you think Sheila was half-asleep and taken by surprise and this made her pliant enough for Jeremy to position her and fire the first shot?  In other words, Jeremy relied on the surprise factor and Sheila not being disturbed by all the noise.

Or are you saying Sheila slept through the whole thing and was asleep even when Jeremy shot her?

Or don't you know?

Personally, my view is that Sheila was already in the main bedroom (possibly she slept there that night instead of Nevill) and Jeremy simply pinned her to the floor before she could react, but got off the first shot before she was prone.

Quote from: Adam on March 30, 2022, 12:13:PM
Sheila just said 'yes' or 'no' for 3 minutes on the phone.

Exactly the behaviour she exhibited to Dr. Illiffe in March 1985, before she was medicated.  This suggests her monosyllabic answers may have been due to mood or her underlying condition, or just general anger or sulkiness.  Often a child when angry or sulky will answer monosyllabically.  I don't wish to malign or belittle Sheila, but her condition made her in effect a ward of her parents and may have made her feel powerless as people around her discussed her and assumed to know what was best for her.

'Yes' and 'No' answers in the sense Pamela Boutflour described are not a typical sign of tiredness, I must add.  I think you are barking up the wrong tree on this point - or trying to make the evidence fit your conclusions.

Quote from: Adam on March 30, 2022, 12:10:PM
CAL got the information from Sheila's best friend. Snow66! has posted her name.

Among Carol Ann Lee's sources was Claire Powell's book from the early 1990s.  She specifically attributes it.  In any case, Sheila's dosage was dropped and nobody is suggesting Sheila could not get up on the morning of 6th. August 1985.

Quote from: Adam on March 30, 2022, 12:16:PM
Maybe CAL spoke to Michael Horsnell. She is an investigstive author.

Or maybe she has got his statement.

His WS not being online is neither here or there.

Are you serious?  If we don't have the statement, we don't know that what we're being told is a reliable account of what the witness stated.  It becomes just an author's interpretation of what somebody else has said.  Authors have agendas and debts of honour.  This is just basic stuff.

Quote from: Adam on March 30, 2022, 12:25:PM
You said Sheila may scratch or hit a fully clothed Bamber.

The evidence is Sheila's condition during his reconnaissance made Bamber not consider this a deterrent.

His appearance an hour after the massacre shows Sheila did not hit or scratch him.

Now I understand what you mean.  Of course, this is a back-to-front way of thinking you adopt.  You start from a conclusion and make the evidence fit.

I believe Jeremy did have minor injuries, to his hands if I remember rightly. Obviously those injuries weren't considered of any evidential significance as he was a hands-on farmer anyway.  He had no injuries to his face.  What does this evidence tell us?  Not much really, but if anything, it favours Jeremy and points to Sheila because she had moderately-long fingernails.  They weren't as long as people say, but they were long enough to cause injury in a struggle. If Jeremy were the killer, common-sense tells me that she would scratch him, especially on the face.  Even if he were wearing a mask, he could still be injured in this way, but maybe he did wear a mask and that was enough to avoid injury?  Or maybe she was asleep or too tired to fight?  Or, as I suspect, she was in the main bedroom and he caught her quite by surprise?  Overall, I don't know if we can conclude anything.

[Erik Narramore]

A key fact the prosecution don't mention is that, due to medical negligence, Sheila's dose was radically reduced.  This in itself is high risk.

They also ignore that sedation is merely a possible side-effect of Haloperidol.  Haloperidol is a tranquilising drug that is not intended for sedation.  There is no evidence she was sedated, though again, I accept it is possible she was.

Nobody has denied that she had Haloperidol in her but it's unclear whether a low residual concentration of Haloperidol could be sedating given that Haloperidol is not an optimum sedative. It also does seem to be the case that low doses of Haloperidol can be just as effective as high doses (though of what effect they are is unclear to me, and I need to do more research).