Sleeping pills, media report Sept. 2007 ..

Madeleine McCann 'died of sleeping pill overdose'
BY LUCY BENNETT
news.com.au
September 14, 2007 12:00AM
FORENSIC tests show Madeleine McCann died of an overdose of sleeping pills, media reports said today.
Body fluids found in the boot of a car hired by the parents of the missing four-year-old British girl 25 days after she went missing in Portugal showed she had been sedated, according to a French newspaper which said it had seen the evidence.
France Soir said DNA results of the fluids showed Maddie had swallowed enough sleeping pills to cause an overdose.
Guilhem Buttut, an investigative reporter for the newspaper, said he had seen "hard evidence" about Madeleine's death in a report now in the hands of Portuguese prosecutors, the metro.co.uk news website reported.
Buttut said toxicological tests on the liquids "proved the little girl had ingested medicines, without doubt sleeping pills, in quantities large enough to cause an overdose".
Sources close to the investigation said earlier this week that police discovered an 88 per cent DNA match to Madeleine in the boot of the McCanns' rented Renault Scenic.
It was also reported that hair was found in the boot, allegedly showing that her body had been in it.
The McCanns are reportedly planning their own independent forensic tests on the hire car.
A family friend said the car was being kept in a "safe place", believed to be a pound at Faro airport in Portugal, The Independent newspaper reported today.
The latest revelations come as Portuguese media reported that police wanted to question Madeleine's mother Kate yet again.
Sources close to the McCanns said they were not aware of plans for a second interrogation.
Police may also quiz her about her diary, which police are seeking, along with her husband Gerry's laptop computer.
There are suggestions the diary has already been seen by detectives who took photocopies but police want to examine it in more detail.
Overnight, a warrant was passed from Portuguese authorities to British police to go to the McCanns' home in Rothley, Leicestershire, as early as today.
Portuguese newspapers said yesterday that they had seen the photocopies of extracts.
Correio da Manha said Mrs McCann wrote in the diary that her children were "hysterical" and exhausted her.
It also said her husband gave her little help with family chores.
"She complains frequently that her children are 'hysterical' and speaks of Madeleine as a child whose excess activity exhausts her," the paper said.
The daily Publico said Mrs McCann's worries about her children's behaviour and her difficulties disciplining them were contained in the diary.
Social workers have also visited the MCanns to discuss the welfare of the couple's two-year-old twins Sean and Amelie.
It is standard practice for a mother or father named as a suspect overseas to have their case considered by British authorities.

Sedation

In this study we attempt to answer three questions
1 Were the twins sedated on the night of 3rd May 2007?
2 If so, were they sedated by an intruder ?
3   If so, but not by an intruder, then by whom ?


1 Were the twins sedated on the night of 3rd May 2007?

The question of sedation of the three McCann children is one which has caused problems since the very beginning.

Reported facts.
Around 10 pm 3rd May 2007 Kate McCann entered the apartment in the holiday resort and reported Madeleine missing.  The younger twins were still in their travel cots in the same room, and were asleep.

What followed is a matter of public record.   The apartment was searched, several times, by many people, the surrounding area was searched by large numbers of police and ex-pats and villagers, and huge amount of activity was directed to discovering Madeleine’s whereabouts.  All were in vain.

BUT . . . during all of this commotion  -

despite  a window and shutters having been open for an hour on a cold night,
despite  the door slamming shut,
despite  curtains blowing into the room,
despite  their mother frantically opening and closing wardrobes and cupboards
despite  their mother rushing out screaming for help,
despite  the entire Tapas 7 group searching throughout the apartment,
despite  Kate and the Tapas group shouting Madeleine’s name outside,
despite  Gerry McCann’s closing and opening the shutters multiple times
despite  Mrs Webster’s similarly attempting to open the shutters but failing,
despite  the Police investigating the scene,
despite  Gerry’s “roaring like a lion” and then prostrating himself on the floor,
despite  both parents repeating this action and wailing
despite  Kate’s checking the twins for vital signs,
despite  the twins being lifted from their cots by people not their parents, and
despite  their being carried out into the cold night air, and to another apartment.  [1.1]

Despite all of this    . . .   the twins did not wake

Kate McCann stated in 2011 that she had suspected sedation from the very first. Given the above perhaps this is understandable.     [1.2]
In her book, “madeleine’, which she described as “A Version of the Truth”, she says this explicitly.

3 May 2007   (NOTE:  this information was not released until May 2011)
p.  75  “Had Madeleine been given some kind of sedative to keep her quiet ?  Had the twins, too ?”   [1.3]
She also reported this to the Officer in the case
3 August 2007   (NOTE:  this information was not released until June 2008)
“due to which she now presumes that they were under the effect of some sedative drug that a presumed abductor had administered to the three children in order to be able to abduct Madeleine, a situation which Kate refers to being possible . .”  [1.4]

The McCanns then organised their own drug tests
24 September 2007
Forensic scientist from Control Risks take hair samples from Kate and the twins at the McCanns’ own request    [1.5]

A family member was ‘allowed’ to release this to the press.
02 October 2007
“Madeleine was drugged by her abductor”, says her grandmother    [1.6]

Gerry McCann reconfirms their suspicions
19 Nov. 2007
“Gerry McCann:  The twins were still sleeping in the their cots so . . .   we tried to leave it as undisturbed as possible, and they slept very soundly until we moved them out  their cots into another apartment . .    which does make you wonder if there was [sic] any substances used to keep them asleep.”              [1.7]

Independent witnesses report and confirm the McCanns’ suspicions
25 April 2008    (referring to early May 2007)
They also wanted to know whether the PJ had any evidence that would suggest that the person who took Madeleine had used any substance to facilitate the abduction.    [1.8]

5 Nov. 2007
Diane Webster - Fiona Payne’s mother:  “Err the twins were still asleep in the cot and I, with all the noise going on I don’t know how they slept through it which makes me think there was, they must have been err drugged with something.” . . .
Q: “So how would you imagine that they may have been drugged?”
DW: “Err by the abductor. I think Madeleine would have been drugged as well.”  [1.9]

10 April 2008
Fiona Payne: “But they were okay, I mean, they were fine, they didn’t, they were asleep, but at the time it did seem weird . . .  they didn’t wake up and, again, that was quite strange, even in the transfer and, and being handled by people that weren’t their parents, they didn’t, they didn’t wake up.”   [1.10]

Their own private detectives make a statement
11 Oct. 2009
Former police detectives David Edgar and Arthur Cowley . . . are convinced the abductor went to the family’s apartment on May 3 2007 fully prepared with sufficient drugs, probably chloroform, to knock out all three children.   The fact that Sean and Amelie, then just 18 months old, failed to wake when the alarm was raised, nor even as they were taken to another apartment in the cold night air, has persuaded the detectives that they, too, must have been drugged.  [1.11]





And just before the release of her book ‘madeleine’, Kate says she believes they were drugged.

13 May 2011
Kate McCann:  I believe kidnapper drugged my twins on the night Madeleine was taken.  Kate McCann said the kidnapper who seized Madeleine may also have drugged her other two children, as she launched a new appeal in the hunt for her missing girl today.
Mrs McCann said she had to check that twins Sean and Amelie were still breathing because they did not wake as they began a frantic search for the missing three-year-old.    [1.12]

Those then are the facts relating to the McCanns’ belief in sedation of the twins, and by extension, of Madeleine.

NOTE:
Levels of sedation are assessed according to the The Ramsay Sedation Scale. RSS. This was the first scale to be defined for sedated patients and was designed as a test of rousability. The RSS scores sedation at six different levels, according to how rousable the patient is. It is an intuitively obvious scale and therefore lends itself to universal use, not only in the ICU, but wherever sedative drugs or narcotics are given. It can be added to the pain score and be considered the sixth vital sign.
Ramsay Sedation Scale
1   Patient is anxious and agitated or restless, or both
2   Patient is cooperative, oriented and tranquil
3   Patient responds to commands only
4   Patient exhibits brisk response to light glabellar (forehead) tap or loud auditory stimulus
5   Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus
6   Patient exhibits no response     [1.13]

The twins are clearly in point 6 on the scale. They are failing to respond to external stimuli, cold, light, noise - including screaming, the inevitable jolting of the cots placed so close together in a small room during the search and window / shutter procedures, human touch, being picked up by person other than their own parents, and so on.  [1.14]


We should remember that Kate McCann and Fiona Payne are both qualified anaesthetists.  Even a non qualified parent should recognise the difference between a child which was merely asleep, and one that was sedated. or unconscious.   We return to this aspect in the third question.

So to restate the original question  -  were the twins sedated ?

The reply must surely be, that having regard to all the available evidence, we can confirm the parents’ and witnesses original and subsequent thoughts and say that on the balance of probabilities -  

the twins Amelie and Sean McCann were sedated




We now turn to the second question

2 Were the twins sedated by an “intruder”.

Medical note for non-medical readers
There are five routes for the administration of sedation.  
Injection, inhalation of gas, or by mouth are the most common three.
Absorption per rectum or per vaginam are possible, but specialised and rare.
All methods require some co-operation on the part of the patient.  

* Injection of three small children without raising the alarm is almost unthinkable.  Intra-muscular injections take between 3 and 15 minutes to work.  Intravenous injection is difficult.  (Paediatric anaesthetics is a specialised subject: finding a vein is more difficult than with an adult )
Injection of three children, in turn, in silence, is a suggestion which is difficult to accept by anyone with experience of children.

* Administration of sedative by mouth would require all three to be at least half awake, so they could sit up to drink and swallow, and in any event drugs taken in this way require time to act.   The fastest acting such drugs in regular use take around 20 minutes to begin acting.  
Each child, in turn, would need to have the drug administered.

* Anaesthetic gas requires equipment for its effective administration, and leaves a distinctive smell.  The classic “filling the room with chloroform” , or other gas exists only in Victorian novels, and in any event would overcome the intruder himself, unless he had breathing equipment, in addition to the equipment for administering to the children.  (It would incidentally also require the window and door to be shut ! )   Even properly administered gas inhalation normally requires time, measured in minutes, before sedation begins.  
Again, each child would have to be sedated in turn.

Because it has been raised, we must briefly consider the McCanns’ principal private detectives, Edgar and Cowley, and their statement that chloroform was used on all three children.   [2.1}  

Chloroform is the stuff of Victorian melodrama, and like ether has no place in modern medical practice.  It has a distinctive sweet smell that lingers for a very long time.  Inhalation of the vapour gives an ice-cold feeling that can cause immediate vomiting.   Any doctor, and indeed any O level chemistry student knows and can immediately identify chloroform.  The liquid produces burn marks on the sensitive skin round the nose and mouth,   [2.2]

What is interesting is that the McCanns have allowed this suggestion to remain in the public consciousness, and have never corrected the impression given. Even less have they specifically repudiated the possibility of the use of chloroform.    Matthew Oldfield was asked in detail about any unusual smell in the apartment when he entered.  He stated he detected nothing.   [2.3]

As on commentator has aptly said, an intruder would need nothing more than a bottle of chloroform, a rag, and a kidney dish for the vomit.   [2.4]
Given a sufficiently heavy dose a child could be unconscious in 15 seconds.
But importantly it would start to wake immediately the anaesthesia were stopped.   It would wake, cry, and probably vomit.  It would NOT remain comatose for three or more hours, then drift into normal sleep, and then wake the next morning with no after effects. [2.5]

Observation.
Jane Tanner’s description of the “abductor’ did not include anaesthetic equipment or gas cylinders, nor even a back pack in which they might be carried, and nothing was found in the apartment or the immediate surrounding area.

The “Window of Opportunity”
The window of opportunity for an intruder has been discussed in another study.   This is a straightforward assessment based on the times taken from Gerry McCann’s leaving the Tapas bar, walking to the apartment, entering, seeing the children, completing the tasks he reports, and then leaving by the patio doors.  Jane Tanner who left the table five minutes later by her own account, saw him talking to Jez Wilkins the street a few seconds before she saw the person who the McCanns now insist was the ‘abductor’ of Madeleine.  [2.6]

Allowing for the time to exit the apartment and cross the car park to the point where he was seen, gives the window of opportunity inside the apartment of around 1 minute and 20 seconds.

In that time he has to
• Enter the apartment
• Sedate all three children - in the dark
• Select Madeleine as the victim - in the dark
• Open the shutters and window   - if he used the front door to enter
• Pick Madeleine out of her bed   - in the dark
• Turn her round so that her head is now to his left, rather than to his right, which is the way he would have approached her in the bed.      
• Exit the apartment, either through the opened window and shutters, or through the front door, which he must then close silently behind him.
and then
• Walk to the left along the path in front of the apartment, walk straight ahead across the car park, and then walk to the right along the road, and cross the street in front of Jane Tanner, the father of the very child he had just abducted, and another man who has his own child in a buggy.  

We repeat, taking into account the travelling time, he has around one minute and twenty seconds in which to achieve the first seven items on the list

• No equipment or paraphernalia was found.
• There was no smell of anaesthetic gas
• Two children aged 2 years were left comatose for 10 hours
* When they woke no after effects were recorded.  [2.7]

So far as can be ascertained  -   there is NO substance or technique known to medical science which can do this.

So to restate the original question  -  were the twins sedated by an intruder ?
The answer must be, that having regard to all the available evidence, we can surely say that on the balance of probabilities -  

the twins Amelie and Sean McCann were not sedated by an intruder.

In fact the evidence and logic is such that this conclusion moves on the legal continuum a long way from merely “On the balance of probabilities” and very much further towards “Beyond a reasonable doubt”



We now turn to the third question


If the twins were sedated, but not by an ‘intruder” -
then by whom ?  
Specifically we must ask whether the parents were involved



This is a more problematic issue.  The parents clearly now accept that the twins were sedated, and if they wish to deny the second answer will have to draw on their medical and expert anaesthetic knowledge to show why that conclusion is wrong, how it might have achieved, and what substance or technique might have been used.

In the absence of such an explanation, however, it is surely justifiable to continue to examine some features of this extraordinary case.
The McCanns have wavered between initial acceptance, through a period of stout denial during which they aggressively threatened to sue, and ultimately back to a clear statement that they now believe the children were indeed sedated.

This is part of the genesis of the story.  It repeats some of what was seen earlier.

Initial recognition and acceptance
3 May 2007   (NOTE:  this information was not released until May 2011)
p.  75  “Had Madeleine been given some kind of sedative to keep her quiet ?  Had the twins, too ?”   [3.1]

5 May 2007       (NOTE:  statement dated 25 April 2008)
“They also wanted to know whether the PJ had any evidence that would suggest that the person who took Madeleine had used any substance to facilitate the abduction.”   [3.2]

3 August 2007   (NOTE:  this information was not released until June 2008)
“due to which she now presumes that they were under the effect of some sedative drug that a presumed abductor had administered to the three children in order to be able to abduct Madeleine, a situation which Kate refers to being possible . .”  [3.3]

August 2007
Q: Do you think the children were sedated?
A: There is no doubt.  (Here he told an anecdote: that Kate called a colleague of Gonçalo Amaral's in the PJ, in August, to ask them to check the twins for traces of sedation. Apparently Kate was alone when she called, and a bit upset. That same afternoon, Gerry called and cancelled the request.)   [3.4]

First denials that the parents had used sedation
August 2007
See previous entry. “That same afternoon, Gerry called and cancelled the request.” [3.5]
10 August 2007  ( or thereabouts)
Gerry:  “you know we’re not gonna comment, on anything but you know there is absolutely no way we use any sedative drugs or anything like that an’ you know we we have co-operated with the police we’ll answer any queries ermm … any tests that they want to do. . . “  [3.6]

Implied acceptance of possibility
24 September 2007
Forensic scientist from Control Risks take hair samples from Kate and the twins at the McCanns’ own request    [3.7]

2 October 2007
“Madeleine was drugged by her abductor”, says her grandmother    [3.8]

Resumed denials
20 October 2007
Scientific tests now support the denials by Gerry and Kate McCann that they ever sedated their children, it emerged yesterday.      [3.9]

25 Oct. 2007
The McCanns, of Rothley, Leics, were asked if reports that they sedated their children were true.    Cardiologist Gerry replied: "It is ludicrous. These sort of questions are nonsense and we shouldn't be giving them the time of day.   There is absolutely no suggestion that Madeleine, or the children, were drugged. It's outrageous."           [3.10]

Oct 2007
Oprah Winfrey "And then, there were the... the hurtful rumours that you drugged Madeleine or that you gave her sedatives; that you accidentally caused her... her death..."
KM: (After a long pause) "I mean we know it's all lies."
GM: "It's just nonsense you know, there's no... that people can have theories and that's all it is, there's no evidence to suggest any of that and it's absolute ludicrous, you know, and it's..."   [3.11]

Second acceptance of possibility
19 Nov. 2007
“Gerry McCann:  The twins were still sleeping in the their cots so . . .   we tried to leave it as undisturbed as possible, and they slept very soundly until we moved them out  their cots into another apartment . .    which does make you wonder if there was [sic] any substances used to keep them asleep.”              [3.12]

Independent Witnesses
25 April 2008    (referring to early May 2007)
They also wanted to know whether the PJ had any evidence that would suggest that the person who took Madeleine had used any substance to facilitate the abduction.    [3.13]

5 Nov. 2007
Diane Webster - Fiona Payne’s mother:  “Err the twins were still asleep in the cot and I, with all the noise going on I don’t know how they slept through it which makes me think there was, they must have been err drugged with something.” . . .
“So how would you imagine that they may have been drugged?”
“Err by the abductor. I think Madeleine would have been drugged as well.”  [3.14]


10 April 2008
Fiona Payne:  “But they were okay, I mean, they were fine, they didn’t, they were asleep, but at the time it did seem weird . . .  they didn’t wake up and, again, that was quite strange, even in the transfer and, and being handled by people that weren’t their parents, they didn’t, they didn’t wake up.”   [3.15]

NOTA BENE:     July 2008
Documents in the case including witness statements were released to the public.  At this point Diane Webster’s and Fiona Payne’s statements (above) became public knowledge, and may have been seen by the McCanns for the first time.

Public statements that it MUST have happened
11 Oct. 2009
Former police detectives David Edgar and Arthur Cowley . . . are convinced the abductor went to the family’s apartment on May 3 2007 fully prepared with sufficient drugs, probably chloroform, to knock out all three children.   The fact that Sean and Amelie, then just 18 months old, failed to wake when the alarm was raised, nor even as they were taken to another apartment in the cold night air, has persuaded the detectives that they, too, must have been drugged.  [3.16]

13 May 2011
Kate McCann:  I believe kidnapper drugged my twins on the night Madeleine was taken.  Kate McCann said the kidnapper who seized Madeleine may also have drugged her other two children, as she launched a new appeal in the hunt for her missing girl today.
Mrs McCann said she had to check that twins Sean and Amelie were still breathing because they did not wake as they began a frantic search for the missing three-year-old.    [3.17]



How then are we to make sense of this ?

Firstly we note that on occasion the question being asked is whether the children were sedated, but the McCanns answer a totally different one.   The parents deny sedating the children themselves, but often do not address the question of whether they were sedated by someone else.

Some forensic linguistics analysts have proffered views on why this might happen.

It is also striking that we are never told of the laboratory which performed the analysis on the hair samples, we are never shown the results, and in fact we have to turn to an Indian newspaper to find these details.  Here it is stated that a company called TrichoTest performed the analysis. [3.18]  [3.19]

And yet even then we have this strange passage,
“All the hair samples produced negative results. While this didn’t totally exclude the possibility that the children had been sedated, especially given the time that had elapsed, it meant nobody else (including the PJ and the media) could prove otherwise.”  [3.20]

The emphasis is not on the twins’ welfare or whether some noxious substance had been administered.  Kate McCann is purely concerned with whether there is sufficient “proof” against the parents.   But at the same time she is by implication admitting that the twins might have been sedated.

There are other bizarre aspects of the hair analysis.   Laboratories advertise their ability for analyse for a period of 90 days.    The McCanns’ samples were not taken until 24th September, almost six months = 144 days later. Although it is possible at that stage to test for continuous drug use, it is not believed in any event that a single dose of a drug, given in the tiny amount appropriate to a 2 year old would be sufficient for successful identification on analysis.

Kate describes the process as leaving her looking as it she had alopecia. [3.21] The laboratories state they need one sample taken from close to the scalp, no larger than “a shoelace tip”  [3.22]   Whilst this may simply be “journalistic licence” to evoke sympathy from the reader, or to add some human interest, that could be accepted if the book were not described as “very truthful”.

So we look to the statements  
Gerry McCann made three statements. 4 May, 10 May, 7 Sept. 2007
Kate McCann made two statements. 4 May,  9 Sept. 2007

In each of these in relation to the continued sleeping of the twins through the entire episode, and the possibility of sedation there is precisely  -  NOTHING.

The whole issue is simply side-stepped. Even in the book it is glossed over

p. 75   “I wandered into the children’s bedroom several times to check on Sean and Amelie. They were both lying on their fronts in a kind of crouch, with their heads turned sideways and their knees tucked under their tummies. In spite of the noise and lights and general pandemonium, they hadn’t stirred. They’d always been sound sleepers, but this seemed unnatural. Scared for them, too, I placed the palms of my hands on their backs to check for chest movement, basically, for some sign of life. Had Madeleine been given some kind of sedative to keep her quiet? Had the twins, too? It was not until about 11.10pm that two policemen arrived from the nearest town, Lagos, about five miles away. To me they seemed bewildered and out of their depth, and I couldn’t shake the images of Tweedledum and Tweedledee out of my head. I realise how unfair this might sound, but with communication hampered by the language barrier and precious time passing, their presence did not fill me with confidence at all.” [3.23]

There are some strange and worrying aspects to this extract.

The use of “wandered” as a verb of motion during this frantic phase of a search for a missing child.

On the previous and adjacent pages we find ”Yelled”, “hitting out at things”, “banging my fists on the railings”, ” running from pillar to post”, “ran back”, “dashed over”., “throwing open”  “hurtling out”  “started screaming”,” was hysterical”, “sprinted back”  and many other more intensely active verbs clearly carefully selected to give a real impression of terror, speed and urgency.   [3.24]

Here we are given “wandered into the bedroom” as the verbal phrase defining the action of the mother of an missing child checking that her two remaining children who she suspected had been anaesthetised,  were still alive  !     [3.25]



A number of other points surely present themselves for further comment.

• The strange way in which the children were lying,. Though this position is in itself not unusual, there is the fact that both were lying in the same way
• The fact that “despite the noise and pandemonium they hadn’t stirred” still less woken.
• Kate describing this as “unnatural”.
• Kate placing the palms of hands on their backs, to check for “chest movement”.
• Her chilling use of the phrase “. . .basically, for sign of life”
• Her thoughts “Had the twins too  [been given some kind of sedative]  ?”

For many people this passage will sound quite extraordinary.   Doctors, nurses, police officers, ambulance crews, fire officers, paramedics, St John Ambulance staff, and many others are taught in their basic training about the importance of rousing people.   Drunks, drug addicts, people with head injuries, and those who have suffered smoke inhalation are roused, and in some cases are to be shaken into consciousness.  Failure to rouse a patient should lead to immediate medical assistance being sought, or transportation to the nearest casualty department.

Failure regularly to rouse someone in a police cell is a very serious disciplinary offence, the penalty for which may be dismissal from the service.

But we are told that a qualified anaesthetist merely “. .  placed the palms of my hands on their backs to check for chest movement, basically, for some sign of life”.   [3.26]  


The Royal College of Nursing is quite clear about this.
In “Standards for assessing, measuring and monitoring vital signs in infants, children and young people - RCN guidance for children’s nurses and nurses working with children and young people”    

they say, very simply
Infants and children less than six to seven years of
age are predominantly abdominal breathers
therefore, abdominal movements should be counted.
They emphasise “the particular vulnerability of infants and young children to rapid physiological deterioration”  

And later discussing recovery room protocols
• following a simple procedure – vital signs should be recorded every 30 minutes for two hours, then hourly for two to four hours until the child is fully awake, eating and drinking.   [3.27]

When we add to this the curious way the children were lying, on their fronts in a kind of crouch, with their heads turned sideways and their knees tucked under their tummies.“  which clearly must restrict the abdominal breathing in a child of that age, the failure by either of the parents or the other qualified anaesthetist present to modify this posture is very difficult to understand.

Levels of sedation are assessed according to the Ramsay Sedation Scale (RSS)

1   Patient is anxious and agitated or restless, or both
2   Patient is cooperative, oriented and tranquil
3   Patient responds to commands only
4   Patient exhibits brisk response to light glabellar (forehead) tap or loud auditory stimulus
5   Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus
6   Patient exhibits no response     [3.28]

The twins are clearly in point 6 on the scale. They are failing to respond to external stimuli, cold, light, noise - including screaming, the inevitable jolting of the cots placed so close together in a small room during the search and window / shutter procedures, human touch, and then being picked out of their cots by persons not their parents, taken outdoors into the dark and cold air, into the light and warmth of a neighbouring apartment, where they are placed in different cots.

it is hard to believe that neither parent would have picked them up, but there is no evidence that they did.   It is also worthy of note that Dr. Fiona Payne was with Kate McCann at this time.  It seems no one was with the twins.

Although it is capable of interpretation this piece is placed in the narrative of the book around 11:00pm, an hour after the discovery.  It is placed between the incident when both Kate and Fiona Payne shout “something short and to the point” at Mrs Fenn, and the arrival of the police at 11:10pm.   [3.29]

Kate herself states
p. 74   “He’d  [Gerry had]  asked Fiona to stay with me.  I was in our bedroom, on my knees beside the bed, just praying and praying and praying. . . “   [3.30]

The next paragraph talks of Kate’s “sitting on the bed”  whilst Emma Knights from Mark Warner came in, and then goes on to talk about Kate’s being out on the veranda when another woman appeared, and so on.

In other words neither doctor was in the twins’ room performing any clinical checks for vital signs, or carrying out any procedures for rousing them.


Both doctors, each of whom is a qualified anaesthetist, failed to address the simplest but the most important questions.
Why can they not be roused ?  
And then -
Given that they cannot be roused, what procedure, and / or what substance has been used to sedate these two children to this extent ?  

We now know that any sedation must have been administered within 1 minute and 20 seconds, in a narrow time window between Gerry McCann’s leaving the apartment, and Jane Tanner’s seeing the abductor carrying Madeleine, so obviously the substance was extremely fast acting, and very powerful.

The two anaesthetists did not have that information, but must nevertheless have believed that sedation had occurred within the previous half hour between Oldfield’s visit and Kate’s.

So what precisely did the two qulalified anaesthetists assume had been used, and how did they suppose it had been administered ?
Why did they accept that the dosage had been exactly correct for children of this age and size ?
Was it still being absorbed and was the level in the tissues still increasing ?   Were they coming round, or were they drifting into even deeper level of unconsciousness, coma, and possible death ?
What were the likely or possible side effects - vomiting, breathing difficulties, lung congestion, ventricular or atrial fibrillation, brain damage, liver or kidney failure, or any of the many other possible sequelae that both will have studied at length and been examined on in detail.
What precisely did they identify or diagnose ?


Medical Note for non-medical readers - shortened (see earlier)

There are five routes for the administration of sedation.  
* Injection
* By mouth
* Inhalation of anaesthetic gas
being the three most usual.

Observation.
Jane Tanner’s description of the “abductor’ did not include anaesthetic equipment or gas cylinders, nor even a back pack in which they might be carried, and nothing was found in the apartment or the immediate surrounding area.

Reminder
The McCanns, and many of their Tapas7 friends are medically trained.  
Both Dr. Kate McCann and Dr. Fiona Payne are trained to a high standard in anaesthetics.  In fact both were Junior Registrars.  

Their continued insistence on sedation by an ‘intruder’ as a viable proposition, when combined with the unambiguous admission in their statements, in interviews, and in the book, of clearly defined professional negligence in their manifest failure to provide, or even consider, any form of resuscitation or aftercare, is baffling.  

But these qualified anaesthetists simply put a palm on a child’s back, or a finger under its nose, (according to Dr Fiona Payne).  There is no record of whether each child was turned, undressed and examined minutely for needle stick marks, or had its mouth, nose and throat cleared or checked for the presence of a chloroform soaked rag, had its breath smelled for evidence of drugs, gas or ketones, had its pupil response monitored, had its heart rate taken, had other reflexes tested, or was roused until fully conscious.  These would be standard procedures.

There is no record of proper and medically correct post-anaesthesia care.  None.  Nothing.

On the contrary, what evidence there is points to the twins’ having simply  been left for a considerable period unattended, and then some two hours later scooped up out of their travel cots, in the bedclothes in which they slept, and being carried, still sleeping, out into the cold night air and round to an adjacent apartment where they were again left to sleep.  [3.31]

Neither doctor performed any of the usual and medically required tests or procedures appropriate to recovery from anaesthesia.  It is a matter of record that the twins were not taken to a hospital for assessment.

On the facts therefore the doctors were in serious and negligent breach of a whole series of medical protocols for which people have been struck off the register.  [3.32]

And even more strangely, they have admitted this in statements and in the book.  They have made no attempt to suggest that they acted correctly.

If we rely purely on what they have said, we find that it is corroborated by independent witnesses, and it leads to the following conclusion -
They would be guilty of a most serious breach of professional standards, so serious that striking off the Medical Register would be appropriate.

We are given many instances in her own book of Kate McCanns’ loss of control, kicking out at inanimate objects, hitting railings with her fists, throwing herself on the floor, wailing and so on.  We are however also given clear examples where she was not acting in this way, being more calm and professionally purposeful, going out into the street to see what was happening, having a blunt discussion with a witness in the apartment above, “wandering” into the twins’ room, and ultimately “keeping vigil” in total silence for the rest of the night. [3.33]

However, it must be said
• For a normal distressed and anxious parent to behave in this way towards two apparently anaethetised children would be unforgivable.
• For an educated professional person it would be grossly negligent.
• For two qualified anaesthetists it is absolutely unthinkable.

If we find that it is indeed unthinkable, then we must wish to believe that their actions were not negligent, that they were not in breach of any protocols, and that their apparent lack of action does not bear any negative interpretation.

But for that to be true they would have to have known precisely why the twins were unconscious, what substance had been administered, in what dose, by whom, and when.

And they have always denied this.

But despite that, and to address the original question, having regard to the available evidence, we may be tempted to take the charitable view, and to conclude that, on the balance of probabilities,

the parents may have been involved in the sedation of the twins.

PLEASE NOTE: I am fully aware that this logical progression may offend, and that lawyers may wish to say it is defamatory.
If so, I not only apologise unreservedly and withdraw it, but on receipt of any compaint of defamation will immediately refer the matter to the GMC, with a view to the striking off the Medical Register of
Dr Fiona Payne and Dr Kate Healy / McCann.

The GMC is the proper authority in matters of this nature.
This is not a matter for legal argument.
It is a question of professional competence.

Searcher wrote:I have not read this before but it came up from a google search just now:

[You must be registered and logged in to see this link.]

I wonder what happened to the report, which apparently was passed to Portuguese police.
Would anyone know more?

lj wrote:What a great post PeterM