Plymouth murder trial told victim ‘may have survived’ if surgery was sooner

Two consultant neurosurgeons were called to give evidence as expert witnesses during the trial of two men accused of murdering 50-year-old Stefan Shotton, who died after suffering a brain bleed. Cowin Fuoco-Fisher, aged 25 and James Caswell, aged 28, both face trial for the murder of Stefan Shotton following an incident which took place in the early hours of May 28 last year, outside the Co-operative store in Devonport[1] Road, Stoke[2]. Mr Shotton was later taken to Derriford Hospital[3] suffering serious head injuries, including a bleed on the brain.

Despite surgery he never regained consciousness and died on June 6. On the first day of the trial[4] prosecutor Simon Jones told the jury at Plymouth Crown Court how Fuoco-Fisher of Stuart Road, Plymouth and Caswell, of Tailyour Road, Plymouth, had intended to cause Mr Shotton serious harm when they attacked him, punching and kicking him to the head in a joint attack. In answer to questions by the prosecutor Simon Jones, consultant neurosurgeon Howard Brydon said Mr Shotton did not die as a result of the head injury as he did not die of the brain injury.

However, he explained that the consequences of the head injury was swelling, which in turn led to pressure on the brain, which had a knock on effect of areas of brain tissue dying - effectively several strokes inside the brain. He said that if Mr Shotton had survived he would have done so with "significant disability".

The cause of death was pneumonia which was as a consequence of the head injury. It was previously explained that such injury could reduce ability of a person's cardiovascular system.

This was compounded by Mr Shotton vomiting and then inhaling the vomit. Asked by Mr Jones whether the pneumonia - a severe infection of the lungs - would have been prevented by earlier surgery to the brain, Mr Brennan said he did not think it would. Anna Vigars KC, for Caswell, asked defence witness consultant neurosurgeon Paul Brennan whether earlier surgery would have been possible, he replied that he would have expected neurosurgeons to have been notified immediately after CT scans had been carried out shortly after 3.30am on May 28 last year.

He said the only priority should have been to take him to theatre and remove Mr Shotton's blood clot. Asked about the prospect of survival, Mr Brennan said the pressure on the brain would have got gradually worse over the period that the blood clot was in Mr Shotton's head and as that pressure increased more brain stops working, the chances of the brain being permanently damage increased, "so the earlier the surgery is performed the more likely that any injury would be reversible and less likely that any non-survivable injury would occur". He added: "I do believe that earlier surgery would've made it more likely that he would have survived."

Regarding Mr Shotton breathing in his own vomit and the pneumonia, he said that one of the reasons patients' consciousness is to identify when they deteriorate, and they do that is because as the conscious level drops "we become more likely to aspirate, whether that's from vomit or something else". He said the fact that an intensive care doctor had recorded that this had occurred was an "important contributor as to why he subsequently developed a pneumonia. The earlier he had been prepared for theatre, the earlier his airway had been secured by being intubated the less likely he would've aspirated and I think therefore would've been less likely to sustain the severe pneumonia that he experienced".

He said the surgery, which took place at 7.15am, could have been carried out "within an hour" of the CT scan.

He accepted that without surgery he was "at high risk of death" and without anti-anticoagulant medication he was at risk of bleeding, but he insisted the risk of death from the blood clot was "the number one priority and the risk of bleeding is the secondary priority". He said: "They're both important but delaying removal of the blood clot to sort out the blood thinning problem makes it more likely that the clot will kill him." Mr Jones pointed out to the jury that both consultant neurosurgeons agreed that without surgical intervention Mr Shotton would have died on May 28 because of the effect of the head injury he had suffered.

Both men deny the charge of murder, although the court was told on the first day of the trial that Fuoco-Fisher had previously pleaded guilty to manslaughter.

The trial continues.

References

1. ^ Devonport (www.plymouthherald.co.uk)
2. ^ Stoke (www.plymouthherald.co.uk)
3. ^ Derriford Hospital (www.plymouthherald.co.uk)
4. ^ first day of the trial (www.plymouthherald.co.uk)