"The Advice of Just One Doctor..."

Who said Megrahi had Three Months?
July 13 2010
last edit August 8

This post will address, if not resolve, some of the confusion about just who was responsible for that controversial decision that Abdelbaset al Megrahi was likely to die within three months or less. As the span since then stretches to a year, the pressure has risen to investigate just how this decision was made in the first place.

First, the "three months" benchmark, while important, is over-stated in its importance. The rules on Compassionate Release state as one of its main criteria:
"Those suffering from a terminal illness and death is likely to occur soon. There are no fixed time limits but life expectancy of less than three months may be considered an appropriate period."
Scottish Government Website, Sept. 1 2009

That is, the "bomber" could have been sent home even without this supposedly pivotal prognosis. To actually do so would court criticism that the 3-month guideline hadn't been met, however, so it was useful in that regard.

One Doctor = Sikora
The recent slew of press reports is a little vague and confused on the number and identity of the doctors responsible for the prognosis in question. But the over-arching impression is most sources originally citing "one unnamed doctor," who later seemed to be questionable cancer expert-for-hire, Karol Sikora. He was paid by “Libyan officials,” and so, as one comment grossly summed it up, Scotland allowed “one terrorist diagnose another terrorist.”

MSNBC, July 4 2010
The doctor who said he would maybe only have three months to live now says he could live another ten years.”

CNN, July 5 2010
"... the Sunday Times said it could only find one doctor who admits giving three months to live. Dr. Karol Sikora was hired by Libyan officials, who asked him to assess the patient. He told the Times, "It was clear that three months was what they were aiming for"...

Daily Fail, 5 July
"The cancer expert who predicted the Lockerbie bomber would die within three months of his release from prison has admitted he could live for another ten years or more."

New York Daily News, July 7:
"It's bad enough that Megrahi still hasn't died. It's even more stomach-turning that the doctor who provided the convenient initial prognosis now says the released terrorist might live 10 years, maybe even 20. That's the latest word from cancer specialist Dr. Karol Sikora ..."

SF Gate, July 7:
"Megrahi's doctor [sic], Professor Sikura [sic], was the only expert who would assert Megrahi had only three months to live."

Scotsman, July 8
The senators [Schumer, Lautenberg, Menendez, Gilibrand] wrote: "The doctor responsible for the key medical opinion has told the media that not only could Mr al-Megrahi live another ten years, but that the Libyan government had commissioned the doctor to make his assessment, expressly because the Libyan government hoped for a three-month prognosis. This is outrageous."

A Panel and No Sikora
Four senators, including a Kirsten Gilibrand, wrote to the UK ambassador in DC, Nigel Sheinwald,asking for answers about what Sikora had said. NY Daily News, Mouth of the Potomac:
Sheinwald denies the physician influenced the release at all, saying a panel of doctors made the recommendation. “This group did not include Prof. Sikora,” Sheinwald wrote in a letter to Gilibrand obtained by The Mouth.

Earlier, the Scottish government had said the same thing:
"The Sunday Telegraph 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.
A [Scottish Government] 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."


One Man = Andrew Fraser and/or an Unnamed Doctor
Besides MacAskill, at least one other decision-maker in the Scottish justice system, who is in fact a doctor, did make the, or a, crucial call in all this:

Daily Record, August 26:
"Four specialists said in June and July that Abdelbaset al-Megrahi could live for up to 10 months and was not sick enough to be released.
But less than a month later,
prison service medical director Andrew Fraser told MacAskill that in his opinion, Megrahi's prostate cancer had got much worse.
He said it was now "reasonable" to predict that he would be dead within three months."

The Times, August 28 2009
"The final report on al-Megrahi's condition, which went to Kenny MacAskill, the Justice Secretary, was drawn up by Dr Andrew Fraser, director of health and care with the Scottish Prison Service."
It seems worth wondering if Andrew Fraser is that "one doctor" whose opinion was relied on. But it seems there was another one consulting, who supported or informed this endorsement.

Daily Mail,28 August 2009
"It emerged that the doctor who advised that Abdel Baset Ali al-Megrahi had fewer than three months to live was not an expert in prostate cancer.
The report to Mr MacAskill […] contains a reference to an
unnamed doctor who 'dealt with him prior to, during and following the diagnosis of metastatic prostate cancer'. It added: 'Having seen him during each of these stages, his clinical condition has declined significantly over the last week [26 July to 3 August]. The clinical assessment, therefore, is that a three month prognosis is now a reasonable estimate for this patient.'"

Telegraph, August 25
Bill Aitken, Scottish Tory justice spokesman, said: “In June and July, there was a consensus on prognosis of eight months. Where is that consensus now? ”We only have the opinion of one anonymous individual - not the range of medical experts promised.”
Dr Simpson [...said] ”Kenny MacAskill released him apparently on the advice of
just one doctor whose status is not clear and who is not named.”
Following Fraser'sreport, but just prior to MacAskill's decision, a clue emerges:
Daily Record, August 26:
On August 20, the day before MacAskill announced Megrahi's release, a cancer specialist asked by Libya to examine the bomber told the minister to make an "urgent" decision.
Professor Karol Sikora said: "We believe he has only a very short period of time to live."
Sikora said he visited Megrahi in Greenock jail on July 28, along with Professor Ibrahim Sheriff from the Tripoli medical centre and Dr Abdulrahman Swessi, Libya's consul-general in Scotland.
Telegraph, 4 July 2010
"The Scottish government insists Kenny MacAskill, the justice minister who took the final decision to release Megrahi, based his ruling on a medical report by Dr Andrew Fraser, director of health and care at the Scottish Prison Service (SPS). A spokesman said Professor Sikora’s advice to Libya “had no part to play in considerations on the Megrahi case."
A Panel With Sikora
Many sources in fact cite or collectively suggest a panel of four doctors, voting either 3/4 or 4/4 against three months, but overridden by Dr. Fraser and/or the fourth doctor.  The balance suggests Dr. Sikora was the dissenter.

At least one of these reports stands out for differing. From early April, well between "three months" and "ten or 20 years":

Scotsman, April 5 2010:
"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."

This last oddball aside, it seems Dr.Sikora was indeed the one doctor on a panel of four, once anonymous but now named, who gave Fraser a possible 3-month message. And urgently, according to the Daily Record's report. From there, of course, it had to be accepted by Fraser and reccommended in his report to the Justice Secretary. And from there, Secretary MacAskill had to make the decision  that he alone claims responsibility for - to release what he considered to be a man responsible for the murder of 270 souls.

Libya's payments to Karol Sikora do little to explain any of that. Other interests must be considered to get even the faintest understanding of how compassionate release was leveraged here. Looming above all considerations, I suspect, was Megrahi's second appeal and its ominous threat to the Scottish Justice system. Perhaps a magic ticket like Dr. Fraser proposed, with strings attached (or rather implied) by that system's guardian, Mr. MacAskill, could be used as the lever to pry that appeal away from its rightful owner. If one also considers the urgency of death some months off, and a conspicuously stalled appeal process, stretching out like a sunset shadow well past the grave, it becomes clear just how absolutely ripe the situation was to exploit this way. As Rolfe puts it:
If it was actually possible to infect someone with prostate cancer, I'd suspect Kenny MacAskill (or his predecessor, since the diagnosis was actually made in 2008) of doing just that. It's the most convenient diagnosis since Socrates swallowed the hemlock.


Charles said...

I am certain that the upper reaches of the US administration, the CIA, the FBI and Uncle Tom Cobleigh and all were delighted that Mr Megrahi was returned to Libya.

So the State Department doesn't have to answer awkward questions like "why were so few SD personnel killed on Pan Am 103, when it should have been about half full of such people". That same SD had apparently discounted the Helsinki warning by about 12 December 1988. Yet it was true and apparently few SD personnel booked after that date. Of course, we have not been told how many such officials booked onto Pan Am flights other than 103.

Hilary Clinton's erstwhile colleagues, certainly knew how to look after themselves. Not so poor dupes like Flora Swire and Helga Mosley.

Caustic Logic said...

An interesting point I can't vouch for. I can't say what people do and don't know, but matters outside dictate a certain flow anyway.The main difference you'll see person-to-person here is how much thet sufferfrom either cognitive dissonnance, or just cognitive myopia.