Ben Geen was a young nurse at the Horton General Hospital in Banbury, Oxfordshire, when he was accused of the murder of two patients and the attempted murder of 16 others.  Ben was an anomaly in the busy accident and emergency department as one of the only male nurses.  However, Ben was an eager and excitable nurse, always willing to pick up overtime shifts during the busy winter months.

 

The prosecution of Ben Geen hinged heavily on the testimony of key prosecution witness and expert, Professor Alan Aikenhead. Prof Aikenhead reviewed all 18 charges against Ben Geen and without conducting any scientific analysis, and relying solely on his subjective experiences as an anaesthetist he determined that Ben Geen was the cause of the respiratory arrests that occurred during December 2003 and February 2004.

 

The  judge, in his summary to the jury, emphasised Prof Aikenhead's assertion that primary respiratory arrests — scenarios where breathing ceases first — are notably uncommon outside the operating theatre. This point was underscored by referencing the Accident and Emergency department at Nottingham, one of the nation's largest, where such incidents were described as rare, albeit without available records for citation.

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The prosecution's stance, as recounted by the judge, was firm in asserting the rarity of respiratory arrests compared to cardiac arrests. It was posited that the patients in question either experienced a complete respiratory arrest or a significant reduction in their breathing capability. In a critical segment of the summation, the judge pointed out the prosecution's claim of an unusual pattern of respiratory arrests or sudden collapses due to breathing difficulties over two months. Much was made of the fact that the incidents, they highlighted, coincided singularly with the Ben's shifts. The jury's task was two-fold: determine whether this pattern existed and, if so, confirm that it exclusively corresponded with the defendant's work hours.  What was totally lacking from the case was a single piece of forensic evidence which could show how Ben was responsible for these medical events.

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Without any physical evidence to show that Ben was the cause of the respiratory collapses, Prof Aikenhead sought to draw upon his understanding of human physiology combined with his experience as an anaesthetist.  It was the belief of Prof Aikenhead that the only possible explanation for the respiratory collapses, in so many individuals, many of whom were elderly and suffering from co-morbidities, was that Ben had administered muscle relaxants and/or sedatives, and this was the cause of the respiratory collapse.  There was no evidence to indicate that the individuals had been administered such medications.  However, there is clear evidence that the condition of many patients was impaired. 

 

In one case, an 89 year old patient was initially thought to have viral meningitis only to reveal she actually had a subarachnoid haemorrhage (bleeding in the brain).  The registrar prescribed the patient an opioid medication, pethidine, for the neuropathic  pain.  Ben Geen was responsible for administering the medication, and did so alongside another nurse.  Some unspecified time after the pethidine was administered the doctor had second thoughts and on reviewing the patient found that she was unconscious with minimal respiratory effort.  The patient recovered and later Ben Geen was accused of grievous bodily harm.  Prof Aikenhead dismissed the fact that subarachnoid  haemorrhages are linked to acute respiratory distress syndrome in up to 50% of cases, and further ignored that pethidine administration in elders is associated with myriad issues and that both the U.S and Canada have issued safety warnings regarding its use in elders.  Prof Aikenhead speculated that Ben Geen was responsible for harming the patient and must have done so through the surreptitious administration of a muscle relaxant, a benzodiazepine, or an anaesthetic.  There was no proof that any such medications had been administered.

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The jury were instructed that if they accepted the existence of an unusual pattern of respiratory arrests, they were entitled to factor this view in when deliberating on specific counts that fit this pattern, particularly when discerning if a collapse was due to natural patient conditions or unauthorised drug administration. Furthermore, if it was accepted that only the defendant was present during these events, and that this fact could influence considerations of responsibility.

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Notably, during the trial, the defence never challenged the central theme of 'pattern' put forward by the prosecution — the implication that respiratory arrests were rare and coincidentally occurred during Geen's shifts. Instead, the defence focused on providing explanations for each respiratory arrest, supported by testimony from several medical experts, including Dr Lack, Prof Amadi, and Dr Patel, countering the testimonies of the prosecution's primary experts, Prof Aitkenhead, Dr Robert Forrest, and Dr Milroy.  Neither the prosecution, nor defence made any effort to identify the cellular and molecular mechanisms that would be necessary to result in the respiratory arrests, and instead speculated on physiological symptoms which could have all number of medical antecedents.  Ultimately, the underlying biological mechanisms of these events were never explored, and the jury was left to evaluate the generalised scientific opinions of medical doctors.  Other than this speculative approach to evaluating the cases there was no forensic testing conducted to support the assertions made by the prosecution witnesses.

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The failure to identify a biological mechanism for the respiratory collapses permitted the prosecution to create a narrative that  asserted that the collapses were unusual because the treating physicians were unable to diagnose a cause at the time of the incidents.  Similarly to the Lucy Letby case, the failure of treating doctors to appropriately diagnose the patients was used as a basis for treating the events as irregular.  These failures in differential diagnosis were seized by the prosecution expert witnesses to speculate that the only possible explanation for such events could have been intentional infliction of harm.   

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On May 9th 2006, Ben Geen, at only 25 years old, was handed 17 life sentences, having been found guilty of murder on two counts, and grievous bodily harm on 15 others.  Ben was sentenced to a minimum term of 30 years.