I thought it was a simple accident. I thought forgiveness would be easy. I was wrong.
As the judge walked in we all rose. Today Andrea would speak. We had nervously anticipated this moment for a long time, but before that, the prosecution wanted to clear up the blood sample issue and explore morphine. They didn’t want to leave any stone unturned.
They called a forensic scientist who works in toxicology to take the stand. Toxicology is the area where they examine traces of drugs, alcohol and chemicals in the blood. Andrea’s blood sample was denatured, which means that instead of being in a liquid form; it had turned into a paste. A denatured sample can still be used to accurately determine what drugs are present; however, the exact concentration of the drugs is only an estimation. That means that in these instances, the estimations are conservative. Her blood contained Oxazepam (Serepax) and Diazepam (Valium), drugs used for anxiety and insomnia. She also had 0.3 mg per litre of morphine in her blood.
The prosecution then called Professor White, a pharmacologist, to the stand. He outlined the possible side effects of morphine to include drowsiness, sedation, impaired thinking and ability to concentrate. Andrea had told a doctor who attended her in the trauma room that she was taking a daily dose of 1000mg of MS Contin (an oral slow release morphine) and morphine injections at a dose of 30mg, two to three times a day, or as required. The injections were a ‘top up’ for breakaway pain when the MS Contin wasn’t enough. Professor White noted that these kinds of doses were “extreme”, and normally prescribed for terminally ill cancer patients. He said the normal recommended therapeutic range for MS Contin was 30 to 120mg per day.
The defence argued that Andrea has been taking this medication for a long time and has developed a tolerance to morphine; this included a tolerance to the side effects. Professor White responded that their prescriber should warn patients of the side effects and that the patient is not a reliable observer of the degree of impairment they are experiencing.
The prosecution further argued that if doses are increased, the tolerance to side effects is altered and the person is most likely to experience more pronounced side effects for up to two weeks. Given that Andrea had access to rapid onset injections, her dose could easily be increased. This, taken in conjunction with the Oxazepam and Diazepam, significantly increased the risk of side effects.
After lunch, Andrea was called to the stand by the defence. We leaned forward, straining to hear her every word as school excursions trickled in and out. Kids were being kids, they were noisy and disruptive. Why would they care what she had to say? I was getting increasingly agitated by their noise and turned around and told them to shut up. It was rude, but I didn’t care.
We learnt that Andrea is 41 years old and had been working as a nurse since 1985. She is an agency nurse and works three nights a week. The night before the accident she started work at 10:15pm, and finished at 7am in the morning. She had also worked night shift on the previous night. During the day in between she had slept well.
Andrea told the court that she’s had trouble with her knees since 1982. Between 1982 and 2001, she had up to 30 operations on her left knee and 10 operations on her right knee from at least five different orthopaedic surgeons, who had all failed to fix her problem. As a result, she experiences excruciating pain and often has to walk on crutches.
As her requests for pain medication increased, her GP referred her to a pain specialist. Around the time of the accident, if she weren’t working, she would take 500mg MS Contin in the morning and then 500mg of MS Contin at night. Andrea said that on the days she was working night shift she wouldn’t take the evening dose. On the day before the accident, 10 March, she only took a dose of 500mg in the morning. She noted that her knees were not terribly bad at the time. In regards to the injections, Andrea said that she never took them at night if she was working. She only used the injections on her days off as a breakthrough medication if she had severe pain. Andrea also stated that she did not take any Serepax or Valium around the time of the accident.
Under the care of the pain specialist, Dr Buttfield, Andrea had been taking that level of morphine for four years. The dose did increase to 1200mg around the time of the accident because her knee pain was dramatically increasing, however, she couldn’t recall when exactly. Andrea stated, “I believe the MS Contin had absolutely no effect on me whatsoever working. I didn’t feel any euphoria; it didn’t make me feel tired at all. I felt fully alert. I didn’t feel any fatigue at all. I did my work well, I was alert, cheerful, happy.”
The defence asked, “In terms of your ability to drive a motor vehicle, were you aware of any effects of the MS Contin that you were taking throughout the time leading up to the accident whilst under the care of Dr Buttfield, aware of any effects of the MS Contin on your ability to drive?’ Andrea answered, “No, none at all. May I just say, if I had noticed anything I wouldn’t have driven.”
The defence lawyer was young and seemed more inexperienced than the prosecution; he flustered easily and was constantly re-arranging his robe, which was slipping messily from his shoulders. He asked Andrea, “Throughout the time that Dr Buttfield had been responsible for your morphine-based analgesia, has he ever provided you with any advice or direction about driving whilst taking that medication?” Andrea answered, “I do recall asking him. I’m sure (I) once asked him if driving was okay and he didn’t mention that driving – it would impair my driving at all, so I had – no-one told me not to drive.” The defence further asked, “Did your GP give you any advice about driving whilst taking the morphine based analgesia?” To which Andrea replied, “No”. “Did any other Doctor?” “No.”
Unfortunately when Andrea was asked directly about the details of the accident, it seemed as though she read straight from a statement. Her answers sounded wooden. I felt like they weren’t “giving” us anything. She said: “The drive home was unremarkable. From what I gather I can remember the lights at Airport Road and the intersection to the airport. I don’t actually remember the accident as such. I just remember someone pulling me out the car, the airbag had deployed, someone telling me, I think, that I’d had an accident, getting me over to the side of the road, sitting me on the kerb and I didn’t look at the accident, I didn’t even know where the accident had occurred at the time or if I’d hit anything or what I’d hit.”
Then the strangest thing happened. The defence asked her if she thought she had a seizure, she replied no. He then asked if she thought she fell asleep at the wheel? She said no. He then asked his own witness, “If you didn’t have a seizure and you didn’t fall asleep, do you know why the accident happened?” I thought it was a great question, but the prosecution cried “objection” and accused the defence of cross-examining his own witness! The lawyers argued back and forth that it was merely speculative and didn’t count. Andrea seemed to believe her story, and it seemed that she had no idea what happened. In any case, it seemed as though the defence’s argument had just fallen over.
The prosecutor began his cross-examination; he’s intimidating, moving slowly in an assured manner, speaking deliberately and thoughtfully. He focuses on the morphine and why she thinks it’s not right to take it at work. I’m slightly mystified, wouldn’t you need more pain relief when you are working because of the stress on the knees? Andrea’s adamant that if her knee were so bad that she required injections she would have cancelled her shift. She is also adamant that she doesn’t suffer any side effects of the morphine. The accident occurred on a Thursday; Andrea said the last time she had an injection prior to the accident was on the weekend.
It was as though the prosecution were circling her, waiting to go in for the attack. It was actually amazing to watch, a real time drama unfolding before our eyes. This prosecutor oozed competence and was amazing at his job; the way he phrased questions and led her to the space where she said what he needed her to say, it was an art form. I’d hate to be married to one of these guys, you would never win!
He is super intelligent and knowledgeable about so many facets of life. He has to be, to be able to ask the necessary and intelligent questions to people ranging from pharmacologists to toxicologists. The prosecutor honed in on the handbag, asking her why she asked for it. He asked her if it was because there was a syringe in it?
I feel so confused, it’s hard to take it all in. The situation has done a 180-degree spin, and I never expected it to pan out this way. I don't know what to think of her. All the evidence is pointing towards my worst fears. She “is” at fault and she “is” to blame, and she should be punished. I’m beginning to think that perhaps she killed my Dad because she took a shit load of morphine and made the choice to drive. I feel like she should have known better.
Just when we thought our jaws couldn’t drop any lower to the ground the prosecution raised another nail biting point. This is complicated, but it’s important that I get my head around it, I need to simplify it. Earlier the prosecution had hinted that Dr Buttfield, Andrea’s pain specialist, was known to the medical board for over-prescribing. The judge didn’t allow the thread of questioning because it was irrelevant, but it’s now becoming more relevant.
The accident happened on 11 March 2004. On 17 February 2004 Andrea went to the doctor and got a 30-day prescription of injections (at three a day), and a supply of MS Contin at 1000mg a day. She then went back to the doctor on 2 March 2004 and he gave her another 10 days worth of injections (at three a day) and another 30 days supply of MS Contin at a level of 1200mg a day.
It seems excessive. She said that perhaps she lost the packets. My instincts about her are falling in a messy heap. I had wanted to believe Dad’s death was something of pure fate, rather than personal fault. It had seemed easier to cope with. I needed her to be an angel.
Now I’m concerned with the bigger questions, who are all these people doped up to the eyeballs on prescription medication driving weapons of mass destruction, one droopy eyelid away from killing our sisters, mothers, husbands, children? Who are these doctors that are handing out pills and what are they thinking? Pills for depression, pills for pain, pills for anything and everything - this is a modern day epidemic. Why can't people look at themselves honestly, do something about their problems, get over their shit and become better people?
What a fxxk up, and my Dad is dead.
Written on 16 May 2006
Over 7 years since incident
Tags:
Morphine, valium, serapax
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