Justice, Italian Style

I was surprised to learn that Amanda Knox decided to return to Italy last month. After all, she’d been treated rather brutally by their justice system.

For those of you who don’t remember, in 2007 Amanda and her boyfriend, Raffaele Sollecito, were accused of murdering Amanda’s British roommate, Meredith Kercher. The two young women were college students studying abroad in Perugia, Italy. Little is mentioned of the others living in the ground floor apartment, or in other units in the building.

Amanda and Raffaele had whirlwind romantic relationship after first meeting five days before the murder. According to Amanda, she’d spent the night at Raffaele’s flat, returning to her house the next morning. She found the front door ajar, but nothing out of place in the living room or her bedroom. In the bathroom a little later, she noted a small amount of blood around the sink and a blood stain on the bathmat. She knocked on her roommate’s door, with no response. She tried opening it, but it was locked. Then she tried calling Meredith on her cell phone, but there was no answer. Worried, Amanda contacted Raffaele, who came over and tried unsuccessfully to break the door down.

The police were called, and the door to Meredith’s room was kicked in, revealing Meredith’s nude body on the floor. She had exsanguinated from a stab to the neck. A window to her bedroom had been broken by a rock and opened.

The crime was widely publicized, the press and public demanding an arrest.

Amanda was questioned and denied access to a lawyer. After enduring many hours of interrogation which included being accused, yelled at in Italian, commanded to remember meeting Patrick (a local man in whose bar she worked part-time, but who she hadn’t met despite their insistence), Amanda reflected on the horror of her roommate’s murder, and became confused. She thought she may have forgotten recent events and believed she recollected seeing Patrick murder Meredith. She and Raffaele, who was similarly interrogated, were arrested, as was Patrick. Patrick was released a short time later, having a strong alibi at the time of the crime. Amanda and Raffaele remained in prison, awaiting trial.

The press coverage in Italy and abroad was relentless. With the help of the prosecutor, Amanda was portrayed as a sex-crazed lunatic, who had killed her roommate as part of a drug-fueled sex game. The murder was described as the crime of the century. The moniker “Foxy Knoxy” was used repeatedly when referring to Amanda, reinforcing the perception that she was an evil woman obsessed with sex. The prosecutor appeared to relish his power, at one point causing Amanda additional anguish by telling her she tested positive for AIDS while in prison, when in fact she tested negative.

DNA analysis showed a small amount of Amanda’s DNA in Meredith’s room, and a small amount of Raffaele’s DNA on the piece of Meredith’s bra found forty-six days after the murder. Small amounts of DNA from two unidentified men were also found on that specimen (although that information was withheld from the jury during the trial). A knife found in Raffaele’s flat was deemed to be consistent with the murder weapon. A small amount of Amanda’s DNA was found on the knife. Testing also showed a trace amount of Meredith’s DNA on the blade.

Bloody fingerprints and large amounts of DNA from another male were found in Meredith’s room, in other places around the apartment, and “inside” Meredith (suggesting she was raped). DNA and fingerprints from the third person were tracked down to Rudy Guede, a known drug dealer and burglar who was acquainted with men that lived in Amanda and Meredith’s building. In a previous burglary, he had opened a window after breaking it with a rock. When the police decided to bring Rudy in for questioning, they found that he had left the country. They convinced a friend to Skype Rudy, finding him in Germany. During the conversation with his friend, Rudy said he was in Meredith’s apartment the night of the murder, but he didn’t do it. An unknown man entered the apartment to murder her while he was in the bathroom. He said he couldn’t identify the man, but Amanda was definitely not there.

Rudy was extradited and tried separately from Amanda and Raffaele. Throughout the case, he changed his story several times, eventually implicating Amanda to save himself. Despite that, he was convicted and sentenced to thirty years, reduced to sixteen on appeal. His guilt remains undisputed (except by himself).

Why anyone would believe Amanda and Raffaele, who had known each other less than a week, would have been involved in a dangerous sex game with the likes of Rudy, is beyond me, but that is the scenario put forth by the head prosecutor. He fed the media lies and bizarre theories of Amanda’s demonic possession, leading to her conviction in the court of public opinion long before the trial. This prosecutor, by the way, was under investigation all this time for abuse of office.

The trial of Amanda and Raffaele was a media circus. Two years after Meredith’s murder, both were found guilty. Amanda was sentenced to twenty-six years in prison, Raffaele to twenty-five.

An American journalist, Douglas Preston, had a previous run-in with the same prosecutor when he was investigating a notorious serial killer in Florence, Italy. This prosecutor detained him and had been “very abusive.” Preston claimed the prosecutor made up theories and was fixated on “satanic sex.” Because Preston disagreed with his outrageous theories, the prosecutor accused him of being an accessory to murder, interrogated him, and threatened him with a long imprisonment. The Italian journalist Preston had been working with was arrested and spent three weeks in solitary confinement until a judge ordered him released. Preston maintained that this prosecutor based the case against Amanda and Raffaele on another of his ridiculous theories.

A year after conviction, Amanda and Raffaele began the appeals process. Review of crime scene investigation films showed sloppy technique, with booties and gloves not changed appropriately. Re-examination of the forensic evidence concluded that Meredith’s DNA on the knife and Raffaele’s DNA on Meredith’s bra fragment may have been due to contamination (the knife DNA was minuscule, and the testing was done alongside fifty specimens with Meredith’s DNA; the bra fragment had been unsecured in the apartment for thirty six days before it was found).

Amanda and Raffaele’s convictions were overturned four years after the murder. Upon hearing the verdict, people outside the courtroom were furious. The prosecutor vowed to pursue what he considered to be justice. Amanda returned to her home in Seattle.

Six years after the murder, the prosecutor was successful in convincing the Italian Supreme Court to rule that Amanda and Raffaele needed to stand trial again (remember, this is not the U.S.) Understandably, Amanda didn’t return to Italy for the second trial. Instead, she had her lawyer read a statement maintaining her innocence. Raffaele testified as to his innocence. Both were again convicted, with Amanda now being sentenced to twenty-eight years and six months (longer than the original sentence). Raffaele was again sentenced to twenty-five years. Understandably, at that point Amanda said she would never go back to Italy willingly.

Finally, eight years after the murder, the Italian Supreme Court overturned both murder convictions, referring to the extraordinarily flawed investigation, the media attention pressuring law enforcement to find the guilty party, and the lack of credible biological material connecting Amanda and Raffaele to the crime.

Amanda went back to Italy recently because she wanted to speak at the Criminal Justice Festival in Modena, organized by the Italy Innocence Project (which didn’t exist when she was tried). Given the court's history of reversing itself, I assume she must have had some assurance she wouldn't be re-arrested. I hope Amanda’s presence had a positive effect on the Italian justice system.

I know we have problems here, too, but the premise of the prosecution’s case against Amanda and Raffaele appeared ridiculous from the start. Why would these two young people participate in anything, much less a sex game, with a low life like Rudy? What would be the motive for murdering Meredith? While large amounts of Rudy’s DNA were found at the crime scene, only small amounts of Amanda’s and Raffaele’s were found, consistent with contamination and/or the fact that Amanda lived in the same apartment, and Raffaele had visited there. Add to that the prosecutor’s history of abuse and bizarre theories, and there is more than a little doubt about the Amanda and Raffaele’s guilt.

Nevertheless, I was surprised to find on a recent trip to Italy that all the native Italians I asked (tour guides, mostly) appeared to agree on one thing: Amanda Knox did it. Meredith’s family also think she’s guilty. The prosecutor has been promoted. Go figure.

Did He Do It?

I recently read that Claus von Bulow died this past May 25th in his upscale London home, at the ripe old age of 92. For those of you too young to remember, von Bulow was accused of twice attempting to murder his wife Sunny, a wealthy heiress, using insulin. She recovered from the first supposed attempt which had resulted in a short-lived coma, only to fall into another coma following a second alleged attempt approximately a year later. Sunny remained comatose until her death in 2008. Sunny’s two older children (by her first husband) and her maid were certain von Bulow was responsible. He was tried and convicted of attempted murder in 1982, close to a year and-a-half after Sunny lapsed into the second coma. He was sentenced to thirty years in prison but avoided incarceration by posting a million dollars in bail pending appeal.

For the appeal, he landed the services of famed attorney Alan Dershowitz. After Dershowitz secured a new trial for von Bulow, he remained on his legal team for the second trial, raising issues not included in the first trial, and keeping other matters excluded. Dershowitz and the team were effective, as von Bulow was acquitted the second time around.

The case hinged on the fact that once in the hospital, Sunny’s glucose was noted to be low during both her comas, while her insulin level was found to be quite high. Sunny’s two older children said they discovered insulin, sedatives, and hypodermic needles in von Bulow’s possession after her comas. One of the needles was tested after Sunny’s last coma and reported to be coated with insulin, with lesser amounts of valium and amobarbital present. During both comas, von Bulow only called for medical help after a prolonged amount of time when Sunny appeared to be near death.

Looks pretty straight-forward, right? Not so fast…

Things got complicated once Dershowitz came into the picture. He found an expert to refute the presence of insulin on the syringe, saying it was a false positive. No injection site on Sunny was reported, but it is unclear that it was looked for. Sunny had been diagnosed with reactive hypoglycemia before, and Dershowitz argued that explained her low glucose and comas. He also prevented Sunny’s banker from testifying about the money von Bulow would inherit upon Sunny’s death.

A movie about the circumstances around Sunny’s comas and the legal defense, Reversal of Fortune, was released in 1990. It was adapted from a book by Dershowitz with a similar name. Von Bulow was played by Jeremy Irons, who portrayed the sardonic elitist well enough to earn the Oscar for Best Actor (beating out Kevin Costner and Robert de Niro), as well as the Golden Globe Award for Best Actor in a Motion Picture Drama (beating out Kevin Costner, Robin Williams, and Al Pacino). Sunny von Bulow was played by Glenn Close.

Alan Dershowitz wrote in his book that he was convinced of von Bulow’s innocence. Really? Oh, yeah. He was later part of O.J. Simpson’s legal defense team.

This case brings up some topics of interest when comparing true life events with fiction.

Topic One: What is too ridiculous to be successful fiction?

Many things happen in real life that are so ridiculous, a novel (a novel being fiction, for those of you who don’t know) with the same story would be sneered at. Examples of things too preposterous to write a novel about include:

1) A lying ignoramus who had declared bankruptcy for his companies multiple times is elected president of the United States.

2) The half-brother of a notorious dictator is assassinated with a neurotoxin in an airport by two women who think they are performing for a comedy prank show.

3) The world series between neighboring teams, the San Francisco Giants and the Oakland A’s, is interrupted when an earthquake occurs shortly before a game, causing the bridge connecting the cities to collapse.

4) The second and third president of the united states both died on the same day, July 4, 1826, the 50th anniversary of the Declaration of Independence.

5) The most famous pop star dies while under the care of a doctor he hired to dispense IV Propofol so he could sleep.

I could go on, but you get the point. The above list doesn’t include the numerous local stories involving strange coincidences or stupid people doing things too ridiculous to imagine.

The von Bulow story has its share of peculiar facts, and an interesting cast of wealthy and famous people. The highlights include:

1) Von Bulow’s parents were divorced. His father later married the granddaughter of famed Norwegian playwright, Henrik Ibsen.

2) Von Bulow had worked for J Paul Getty Sr. before marrying Sunny. He was rumored to have arranged parties in his apartment where Getty, in his 60’s, met women.

3) While practicing law in London (before he met Sunny), a member of von Bulow’s firm was involved in the first known case involving murder by insulin.

4) Von Bulow was friends with a man (a Lord, in fact) who later murdered his kids’ nanny in the mistaken belief she was his wife.

5) Before marrying Sunny, von Bulow had an affair with a socialite, Anne Woodward, after she’d killed her wealthy husband (she claimed it was accidental, although he was planning to divorce her over her objection).

6) A young man who lived in von Bulow’s carriage house thought he would be called to testify during the first trial, something he feared. He didn’t testify, but six months later reportedly killed himself by jumping off a bridge while wearing a dinner jacket. It was rumored that he was pushed.

7) J. Paul Getty, Jr. loaned (or gave) von Bulow the million dollars he used for bail between trials due to Getty Jr’s sympathy for von Bulow, himself having been under suspicion when his wife died in 1971 of a drug overdose (this is the same Getty whose ear was severed by kidnappers).

8) Before and during Sunny’s comas, von Bulow had a not very secret affair with a soap opera star, Alexandra Isles, who had given von Bulow an ultimatum. Ditch the wife, or she would leave him. It was thought that, although von Bulow had some money of his own, he didn’t want to divorce Sunny, preferring to get the fourteen million dollars willed him upon Sunny’s death (if they were still married). It appears that Alexandria dumped him before the first trial, probably finding a man who kills his wife unattractive. Her testimony at the first trial was unfavorable towards von Bulow. Of note, before Alexandria Isles met von Bulow, she divorced a man who later went on to marry the former wife of Dr. Raskind, who later became Renee Richards, the trans-woman professional tennis player.

9) By the time the second trial rolled around, von Bulow had a new girlfriend, Andrea Reynolds, a Hungarian divorcee who had been married to TV producer Sheldon Reynolds. While still married, the Reynolds had become friends with von Bulow after his first trial. Plans were being made for Sheldon Reynolds to be the agent for an autobiography and mini-series about von Bulow, but that fell apart when Reynolds was in London on business and read a gossip column revealing that his wife was having an affair with von Bulow.

10) After the first trial, a shady character, David Marriott, came forward to claim he had delivered needles and drugs to one of Sunny’s older children and once to Sunny herself, suggesting that Sunny had overdosed on drugs she had given herself. Although the character was disreputable, he claimed to have told a then well-respected priest (Phillip Magaldi) about the drug deliveries before Sunny’s comas. The priest confirmed his story, lending credibility to it. However, the shady character later recanted the story, claiming he’d really delivered drugs to von Bulow. There were rumors Marriott had been paid by von Bulow to concoct the story. The priest himself is noteworthy for later being charged with perjury related to the trial, subsequently being sentenced to prison for embezzling money from his parish, eventually being known to have had homosexual relationships which required money, and, (surprise, surprise) molesting children. He died of AIDS in 2008.

11) Truman Capote had claimed he knew Sunny, and she’d told him she injected herself with insulin so she could eat whatever she wanted and not gain weight (this makes no sense, although it has been reported that insulin may cause appetite suppression and therefore weight loss). He died before he could testify.

12) In 1983, the father of Sunny’s two older children, Prince von Auersperg, was in an auto accident resulting in an irreversible coma. He died in 1992.

After the trial, Sunny’s two older children sued von Bulow in civil court, he counter-sued, and they came to an agreement that he would divorce Sunny, have no claim to her money, and never speak or write of the events. He moved to England where he associated with the upper crust before dying, I assume peacefully, of natural causes.

Despite the fact von Bulow was found innocent, many consider the case to be unresolved. Had von Bulow tried to murder his wife with insulin and/or sedatives? Had Sunny’s older children planted evidence to implicate him, thinking he tried to murder their mother, but would probably be acquitted without their taking action?

Could this story have been a successful novel? I think it could have, despite the trite rich-guy-hires-expensive-lawyer-to-escape-justice theme. As long as some of the famous people and strange events were left out. Which brings me to

Topic Two: In fiction, we are satisfied in the end by knowing what really happened.

In real life, there is often no such definitive resolution. Unless one of Sunny’s two older children claims to know von Bulow was innocent but they tried to frame him because they didn’t like him, a highly unlikely scenario, we can never be certain. But I have my opinion.

Theranos

For my first blog following the introduction, I’ll go for the low-hanging fruit: Theranos.

You’re familiar with it, right?

I first heard of Theranos around seven years ago when I was getting ready for work one morning, listening to CBS Morning News. I heard something that didn’t sound right. I stopped in my tracks and backed up my TIVO. Yes, I’d heard it right. A company was being lauded for developing blood tests that could be done with blood from a single fingerstick, collected in a small tube.

Using a fingerstick instead of the traditional venipuncture (a needle in an arm vein) was supposed to make blood collection less scary and painful. Much less blood would be used. Testing would be cheaper, too. Oh, and the CEO and brains behind the whole thing was a young woman with no apparent knowledge about medicine or chemistry. On the board of the company were notable men, none of whom had any knowledge of medicine or chemistry, either. Many supposedly savvy investors had already put money into the company.

I simply couldn’t believe it. I had no idea at the time this was a big con job being pulled off by the CEO who looked like a freak to me, but I suppose was attractive to old men. I couldn’t understand it and wanted to find out more. I figured I must have been missing something.

In case you’ve been living under a rock, I will tell you now that the company was a sham and went down in flames after a reporter, John Carreyrou, wrote an expose, a book called “Bad Blood: Secrets and Lies in a Silicon Valley Startup,” which describes the myriad lies and deceit behind the initial (financial) success of the company. It’s a good read, and I suggest anyone interested pick up a copy. Needless to say, investors lost a lot of money.

However, I want to discuss a different angle. Why I initially thought it made no sense.

1. Using less blood is no breakthrough. It’s just never been a priority. Labs typically collect much more blood than needed, to allow for repeat testing when needed, or for tests added later by the ordering physician after the original results are reviewed. Most automated machines require a larger amount of blood than would be collected in a Theranos tube, because they are made to fit standard tubes which are bigger. Like changing from feet to meters, changing the machines to fit smaller tubes is possible, but not without significant cost and an awkward transition period. Of note, pediatric patient samples currently are often collected in smaller tubes and handled specially.

2. Lowering costs, I thought, was possible. But honestly, to less than half of current costs? The fees to a large measure are dictated by the price of reagents that are FDA approved, running all the controls needed, and the salaries of licensed technicians that run the tests (they are paid well, as they should be). It turns out the company was operating at a loss, burning through investors’ money.

3. Using a single tube for all tests made no sense. When you get your blood drawn, have you ever noticed that often multiple tubes are drawn? And they have different colored tops? The color of the top indicates the chemical that is present in the tube, needed for a particular test. For instance, a red topped tube has nothing added, and the blood is allowed to clot. A lavender topped tube has an anticoagulant in it, preventing the blood from clotting so a hemoglobin level, platelet count, and white blood cell count can be performed. Other types of anticoagulant (blue tops and yellow tops) are used for different tests requiring unclotted blood. A gray topped tube has sodium fluoride and potassium oxalate and is used to accurately measure glucose. I wondered how they could possibly run a large variety of tests from one tube with nothing added (answer: they couldn’t).

4. The fingerstick. This is the one that really got me. Nobody, to my knowledge, has brought this up: why would anyone want a fingerstick instead of a venipuncture? I had a fingerstick once when I was in the first grade. I found the lancet quite scary, and it hurt like a bitch. In fact, it hurt in that spot for at least the next twenty years of my life. Your fingertip has a much higher concentration of nerve fibers than the skin on your arm. Maybe some people find it less intimidating to get a fingerstick than a needle stick, but I think anyone needing a blood test more than once every few years will catch on that fingersticks are more painful.

Bottom line: Don’t trust people with no expertise like the CEO and board members of Theranos, and don’t allow anyone to invest your money if they trust people with no expertise. Getting the advice of a pathologist could have saved some investors a whole lot of money. In this case, fortunately, probably none of those who lost money were little old ladies living on a pension.

That’s my $0.02 worth on Theranos. Let me know what you think.