Campbell (aka Norris) v R.

Factual and Procedural Background

The Appellant, formerly known as Colin Norris and now as Colin Campbell, was convicted on 3 March 2008 at the Crown Court sitting at Newcastle Upon Tyne of four counts of murder and one of attempted murder related to the deaths and severe illness of five elderly female patients under his care in two orthopaedic wards in Leeds hospitals. He was sentenced to life imprisonment with a minimum term of 30 years for the murders and a concurrent sentence of Imprisonment for Public Protection for the attempted murder.

His initial appeal against conviction was dismissed by this Court in December 2009. Subsequently, the Criminal Cases Review Commission (CCRC) referred the case back for appeal based on fresh expert evidence suggesting plausible natural causes for the hypoglycaemia episodes that formed the basis of the original prosecution’s case.

The appeal process has been marked by substantial delay, impacted by the illness and death of expert witnesses, applications to amend grounds of appeal, and disputes over disclosure of medical records relating to additional patients not originally charged. The Court refused applications that would have caused further delay or introduced a 'cluster argument' based on other cases of hypoglycaemia in elderly patients.

The trial evidence focused on the appellant’s alleged administration of exogenous insulin or anti-diabetic agents to elderly patients who developed sudden, severe hypoglycaemia resistant to treatment and resulting in death or serious injury. The prosecution case was supported by scientific expert and circumstantial evidence, including the appellant’s presence on shift at relevant times and his conduct. The defence denied the allegations, suggesting natural causes for the hypoglycaemia and proposing an alternative suspect.

The appeal hearing in 2025 involved extensive expert evidence from both appellant and respondent experts, including consideration of new scientific hypotheses and additional patient cases. The Court carefully managed the evidence and expert meetings to clarify points of agreement and dispute.

Legal Issues Presented

1. Whether the new expert evidence based on fresh scientific understanding and additional patient cases undermines the safety of the appellant’s convictions for murder and attempted murder.
2. Whether the appellant’s grounds of appeal, including the proposed 'cluster argument' and reference to additional patients, should be admitted and considered.
3. How to properly assess the cause of sudden severe hypoglycaemia in elderly patients: distinguishing between exogenous insulin poisoning and natural causes related to age, frailty, and co-morbidities.
4. Whether the jury directions at trial regarding the cross-admissibility of evidence and the requirement to exclude natural causes were adequate and lawful.

Arguments of the Parties

Appellant's Arguments

• New expert evidence posits plausible natural causes for the hypoglycaemia episodes in the index patients, challenging the prosecution’s assertion that exogenous insulin was the sole explanation.
• The new evidence suggests that severe hypoglycaemia can arise in elderly, frail patients as an epiphenomenon of co-morbidities and physiological decline, potentially accounting for the clinical presentations without requiring deliberate insulin administration.
• The timing and nature of hypoglycaemia onset in some cases undermine the prosecution’s case as to when insulin was administered, potentially exculpating the appellant.
• The appellant seeks to rely on evidence from additional 'extra' patients who had hypoglycaemia of natural causes to support the new hypothesis, although the Court limited this evidence to avoid a statistical 'cluster argument'.
• Argued that the jury was deprived of the benefit of evolving scientific understanding of hypoglycaemia, which could have affected their verdict.

Respondent's Arguments

• The prosecution opposes the appeal, relying on expert evidence that the index patients’ hypoglycaemia was sudden, severe, profound, and refractory to glucose treatment, consistent with exogenous insulin administration rather than natural causes.
• Respondent experts reject the appellant’s hypothesis that frailty and co-morbidities cause such severe hypoglycaemia, emphasizing the rarity of such presentations and the lack of clinical experience or literature support.
• The respondent challenges the relevance and comparability of the additional patients cited by the appellant, maintaining significant clinical differences.
• The prosecution case at trial and appeal consistently maintained that no natural explanation could account for the clinical phenomena observed, and that the appellant was the perpetrator.
• Respondent contends that the appellant’s attempt to introduce new bases for conviction is improper and that the fresh evidence does not render the convictions unsafe.

Table of Precedents Cited

Court's Reasoning and Analysis

The Court undertook a detailed and methodical analysis of the new expert evidence in the context of the original trial evidence and subsequent appeals. It recognized the complexity of distinguishing between hypoglycaemia caused by exogenous insulin poisoning and that arising naturally in elderly, frail patients with co-morbidities.

The Court accepted that the new expert evidence was credible and admissible, and that it presented a hypothesis that severe hypoglycaemia could arise naturally in such patients due to a 'tipping point' in physiological decline. However, it found that the appellant’s experts lacked clinical experience with cases exhibiting the full constellation of phenomena observed in the index patients, including the sudden onset, severity, profound nature, and refractory response to glucose treatment.

The respondent’s experts, supported by extensive clinical experience and peer-reviewed literature, maintained that the presentation of hypoglycaemia in the index cases was consistent with exogenous insulin administration and not with natural causes. The Court found this evidence compelling, especially the patterns of blood glucose response to treatment and the need for large and repeated glucose doses, which are atypical in natural hypoglycaemia.

The Court considered the additional 'extra' patient cases and found them to be clinically distinct from the index cases, particularly in terms of severity and response to treatment, underscoring rather than undermining the prosecution’s case.

The Court also reviewed the trial judge’s directions to the jury, including on cross-admissibility and the exclusion of natural causes, and found them to have been proper and clear, rejecting arguments that the jury was misled or deprived of relevant scientific knowledge.

Ultimately, the Court concluded that the new evidence did not undermine the safety of the convictions, as the prosecution’s case remained strongly supported by the clinical and circumstantial evidence, and the new hypothesis lacked sufficient evidential and clinical foundation to displace it.

Holding and Implications

The Court’s final decision is to dismiss the appeal and uphold all convictions.

The direct effect is that the appellant’s convictions for the four murders and one attempted murder remain safe and valid. The Court found no basis to overturn the verdicts based on the new expert evidence or other grounds raised. No new precedent was established; rather, the decision reaffirms established principles regarding the assessment of fresh evidence, the role of expert testimony, and the standards for safety of conviction on appeal.