an Tomlinson inquest – Friday 8 April 2011

Full coverage of day nine of the inquest into the death of Ian Tomlinson, who was struck by a police officer at the G20 protests

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• Paul Lewis
• guardian.co.uk, Friday 8 April 2011 10.01 BST
• Article history

A picture shown to the Tomlinson inquest jury of the newspaper vendor near a police van before he was knocked down by a riot officer at the G20 protests. Photograph: City of London coroner's court/PA
9.58am: Welcome to day nine of the Ian Tomlinson inquest, which we're expecting to focus on more medical evidence.
If you are catching up, the most widely reported evidence came from Kamran Saleem, a charity manager who saw Tomlinson fall to the ground a few minutes after, and 100 yards down the road from, being struck by PC Simon Harwood. Saleem told the jury he overhead Tomlinson tell another bystander: "They got me, the fuckers got me." His full statement was:
I think when somebody went to help, he said something along the lines of – I think it is in my statement – "They have got me, the fuckers got me", and then I think somebody asked him if he wanted an ambulance. He said: "No, they got me," or something ... It was probably quieter than normal, but it was kind of like an anger, it was like: "They got me," but probably more surprised than anything else.
10.00am: There was also evidence from protesters who went to Tomlinson's aid, which you can read here (pdf).
The last witness to take the stand yesterday was Dr Vasserman, Tomlinson's GP. He said Tomlinson was a chronic alcoholic, had an enlarged spleen and liver and suffered from a condition called periphery neuropathy, which affected his nervous system and made him generally unsteady on his feet. He had been taken to hospital ten times in the two years leading up to his death after falling over while drunk, he said. Next up this morning will be Dr Paul Ugwu, the last GP to examine Tomlinson, followed by ambulance and hospital staff.
10.14am: Proceedings have started. The first witness is Dr Paul Ugwu, one of Tomlinson's GPs. He saw the newspaper seller on four occasions prior to his death on 1 April 2009.
10.25am: As with Tomlinson's other doctor, Dr Ugwu gave evidence about the father of nine's problem with alcoholism and health.
He says the newspaper seller was keen to take part in detoxification programmes to overcome his alcoholism, and was on a lot of medication. The coroner thanks the doctor for his "short and sweet" testimony, and he leaves the stand.
10.38am: Next up: Karen Miskowvicz, a paramedic team leader for the London Ambulance Service.
11.01am: Miskowvicz told the jury that she attended what she was told was a cardiac arrest.
Tomlinson was lying on his back on Cornhill, being treated by police medics. There was no pulse, and he was not breathing. When she attached a defibrillator at 19.37pm, she said the readings on the screen indicated a "known cardiac arrest rhythm". But there were two other possible causes for the readings – a "blood clot" blocking proper circulation, or massive internal bleeding. CPR treatment was carried out.
11.21am: Matthew Ryder QC, the counsel for Tomlinson's family, has begun questoining Miskowvicz.
He clarified with the paramedic that when she said she was called to deal with a cardiac arrest, that was not the result of any diagnosis. Miskowvicz agreed:
That was, I guess, suspected when members of the public call and say it is a cardiac arrest ... it is difficult to know whether it is or not until we arrive on scene.
(The jury heard on day one that, whether Tomlinson died of a coronary heart disease or internal bleeding was likely to be one a point of "controversy" in the inquest.) The paramedic also reiterates that the no pulse can be a result of internal bleeding.
11.33am: Miskowvicz says her colleagues were unable to get intravenous access (needles into Tomlinson's veins to administer drugs).
Questioned by Ryder, she confirms that it can be difficult to find veins when there is not enough blood in them due to blood loss or low blood pressure. Again, she confirms that there were a number of problems she could rule out, but two that she couldn't – that Tomlinson was suffering from hypovolemia (internal bleeding) or that he had a thromboembolism (blood clot). Ryder has finished questioning.
11.43am: The hearing is being adjourned for a quick break.
12.08pm: The jury has come back.
Before we adjourned, a juror asked about a possible delay in the arrival of the ambulance. Judge Peter Thornton QC, who is sitting as the deputy assistant coroner, has stated that there is "no criticism" of police medics, paramedics, ambulance staff, doctors or members of the public who went to Tomlinon's aid. He said:
There is no criticism of any of them, either in terms of their arrival or in terms of the nature of the treatment and procedures which are carried out. None of this is an issue. The reason for our listening to these witnesses, whether they are read to you or come live to the witness box, is that this is all part of the medical narrative from the time of Mr Tomlinson's collapse in Cornhill and may be relevant later when the cause of his death is more closely considered.
12.39pm: Darren O'Rourke, another paramedic, was unable to get a needle into Tomlinson's veins to administer drugs.
He believed the vein had "shut down" or collapsed, which was unusual and caused him to assume there was possibly internal bleeding. He said there was also a "movement" around Tomlinson's abdomen "suggesting there was some sort of problem going on". O'Rourke had never seen a movement of this kind in a patient suffering a cardiac arrest. (Quick aside here: it might seem like an obvious point, but the jury has been reminded that "cardiac arrest" means only that the heart has stopped. All deaths involve eventual cardiac arrest, and the point of contention in this inquest is likely to be the cause of that cardiac arrest – coronary heart disease or internal bleeding.)
12.52pm: Ryder takes over questioning the paramedic. We have returned again to how paramedics found it impossible to get a needle into any of Tomlinson's veins, which was unusual.
Ryder: You explained in some detail the difficulty in trying to gain any form of intravenous access to Mr Tomlinson? O'Rouke: That's correct. Ryder: And that caused you to believed there had been some sort of collapse in the vein? O'Rourke: That's correct, yes. Ryder: And then in an answer to a question to Ms Hewitt, she was taking you through your statement, I think you said: 'This led me to assume there was an internal bleed that was causing the patient's circulatory shutdown'.
The paramedic confirms that his view at the time was that internal bleeding was a "likelier" cause of the cardiac arrest.
1.03pm: The inquest has adjourned for a lunch break – remember, you can email questions or contact me via Twitter (@paul__lewis).

1.07pm: Here's a lunchtime summary:
Paramedics who treated Tomlinson after his collapse said they arrived to discover his heart had stopped and he had no pulse. In a potentially important development, they said they were unable to to get needles into any of his veins to administer drugs. One paramedic assumed this meant that Tomlinson was suffering from internal bleeding.
1.56pm: The judge has decided (on the most glorious day of the year) that today's hearing would have an unusually short – 45-minute – lunch break. So we're back.
The next witness is David McNally, who was also working as a paramedic on the day Tomlinson died.
2.20pm: McNally took over Tomlinson's care when he was placed in the ambulance.
He repeats that there was no pulse, but indications of what is called "pulse-less electrical activity". He took the patient to the Royal London hospital.
2.40pm: A final paramedic, Matthew Thomas, gives evidence.
He says he was also aware during resuscitation that there was "pulsating" in Tomlinson's abdomen area. He said he assumed this could have been "blood passing through a vessel" in the stomach.
2.59pm: The next witness is Dr Gareth Grier, the consultant on duty in the emergency department at the Royal London hospital. He said Tomlinson appeared to be "lifeless" when he was wheeled into the resuscitation room.
The doctor recalled that intravenous access was gained without particular difficulty (this contrasts with the evidence given by paramedics, who said earlier that they could not get needles into Tomlinson's veins, prompting some to assume he was suffering from internal bleeding (ee posts 12.52pm and 11.33am. He said:
Obviously we were in a warm room with lighting and so on, so that was better and may have made it easier to find a vein. I think it was quite a senior person responsible for the intravenous access, as in a senior doctor.
3.20pm: Dr Grier states that Tomlinson was officially pronounced dead at 20.10 (that is 50 minutes after the father of nine's encounter with PC Simon Harwood on Royal Exchange Buildings, and 48 minutes after he collapsed around 100 yards away).
The court has taken a quick adjournment.
3.50pm: Ryder questioned Dr Grier on the topic of getting intravenous access (a needle into a vein).
The doctor has said that, according to his notes from the day, there was no evidence of a problem getting a needle into Tomlinson's vein once he reached the hospital (again, that contrasts with the experience of a number of paramedics, who tried but failed when Tomlinson was on the street, leading them to assume that he could be suffering from internal bleeding). Patrick Gibbs QC, the counsel for PC Harwood, took a similar line of questioning:
Gibbs: If there had been a particular problem, would you have recorded that on the form? Grier: Yes. I think if there had been a problem in the emergency department with obtaining IV access, I would have made some note about that. Gibbs: In fairness to those who had tried earlier, is it generally easier in a hospital environnment to get intravenous access than on the street. Grier: Yes.
4.00pm: Doctor Grier has finished giving evidence.
4.09pm: Judge Thornton has wrapped things up for the week. He said that, despite very long evidence from one witness (PC Harwood), the inquest was on schedule and would not be sitting on Monday:
So please do not come in on Monday. There will probably not be anyone here.
The judge said the inquest would "move into the area of pathologists" next week. He reminded jurors that they should not conduct any additional research on the internet, and wished them a good (and long) weekend. I'll be back on Tuesday, too.
4.15pm: SUMMARY Paramedics and doctors have told about their failed attempts to resuscitate Ian Tomlinson in the hour after his collapse near the Bank of England. The judge told the jury on the ninth day of the hearing that there was "no criticism" of the emergency services, but said their evidence could prove important in later deciding his cause of death.
Background: On the opening day of the inquest, the judge said the medical cause of death would be an issue of "controversy". Dr Freddy Patel, the first pathologist to conduct a postmortem, concluded Tomlinson died of a heart attack as a result of coronary hearth disease. Two subsequent pathologists, Dr Nat Cary and Dr Kenneth Shorrock, said he died of internal bleeding. The evidence of the paramedics was that they were unable to get intravenous access (a needle into a vein). They could not be sure of the cause of his condition, but that led at least one to assume he was suffering from internal bleeding (see post 12.52pm). However, a doctor at Royal London Hospital said there was no problem gaining intravenous access (see post 2.59pm). On Tuesday Dr Freddy Patel will give evidence. See you then.