“The fractures to the lower left ribs could not, of themselves, have led directly to death and there is no evidence that they indirectly led to death as there is no report of significant damage to adjacent vital organs. There is therefore evidence of 2 fracturing episodes, one at or immediately around the time of death and the other that happened within 3-4 hours of death. The earlier injury is extremely unlikely of itself to have caused death. The second, because of the degree of osteoporosis, could have been caused by overenthusiastic CPR.”
“In Professor Malcolm’s view the fractures he examined occurred within 1 hour of Bradley Hamilton’s death. Professor Malcolm would find it difficult to say that they occurred within 3-4 hours of death as he would expect to see at least some fibrin forming within 3-4 hours even with a chronic alcoholic. He suggests this time frame is ‘pure conjecture’. Prof Malcolm for his part believes that “Prof Freemont may have strayed from his area of expertise”
“The rib fractures on the left side cause a series of problems. It’s probably best to describe them as impact on the left side [inaudible]. We’ve got significant interruption of the integrity of the left side of the chest wall called flailed chest and this is well associated with very significant complications, so you are going to have interruption with the mechanics of respiration. You’ve also got the underlying damage to the spleen and the pancreas in that location which I attribute to being caused by the broadly same impacts, so that’s going to cause a bleeding in the chest cavity. Entry of essentially damaged products into the blood stream. In addition, you are going to get blood in the chest cavity which will irritate the diaphragm, and the diaphragm again is integral to respiration, so you’ve got [inaudible] potential mechanisms of death. You’ve also got the overlying large area of blood formation…of blood, erm, collection, so you’ve also got bleeding to the tissues as well.”
“A. To merely split individual components off is not appropriate. This man had very significant injuries to several structures and in isolation, the mesenteric injuries, the pancreatic and [inaudible] to a lesser degree could all have caused death in themselves. Q. And again, in isolation from those, the flail chest caused by all the fractures could have done the same. A. It could have done, yes.”
“And the simple fact of the matter is that Professor Malcolm’s evidence is that the absence of fibrin suggests injury that is either…it is certainly no more than an hour old, and in most people thirty minutes would produce it. The necessary inference from that is, we would suggest, and certainly one which open to the jury, that those serious injuries occurred after Clarke’s ultimate return, at which time Miss Morabir is not only present but has been in contact with him and immediately afterwards initiates or takes part in this proposed 999 call.”
“I don’t consider the way that the prosecution has…that the case is any different than it was when this case was opened so far as Miss Morabir is concerned, and as Mr Raggatt has said, the word “cover up” has been used more than once. I don’t consider there is any change here that justifies this matter being reopened or the jury being discharged. I say again, for the avoidance of doubt, and I ask that my reasons have the word “circumstances” written in, because that was simply a slip of the pen.”
“I am not persuaded that even on a view of the evidence most favourable to Mr Clarke, that as a matter of law the issue of causation of death arises as a question for the jury here. This man died from multiple injuries. I do not consider that cross-examination of Doctor Kolar or other evidence undermines that proposition. If a contributory factor to this man’s ultimate fate was CPR, and we are talking here as CPR realistically by the Defendant - there is no suggestion that the paramedics’ efforts [inaudible] and if the jury are satisfied that he, Mr Clarke, was acting unlawfully and with the necessary intent when he caused any non-CPR injuries to Mr Hamilton, they will on any view of the evidence agree it is a significant contribution to this death, even if not only or the main factor. In the context of this case, it could not as a matter of law in my judgment be said that the CPR injuries were so overwhelming as to make the non-CPR injuries just part of the history as opposed to an operating cause of the death.”
“1. Have the prosecution made you sure that it was a blow of some kind, or a combination of blows, from the defendant that caused the death of Bradley Hamilton? If they have made you sure, go on to the next question. If not, then “not guilty”.”
“Although, as I have directed you, all matters of fact are for you to decide in this case you have had no evidence to contradict the prosecution proposition that you can be sure that Bradley Hamilton died from multiple injuries.”
“1. Other than any injury that may have been caused by a genuine attempt at CPR, have the prosecution made you sure that the defendant caused any serious injury or injuries to Bradley Hamilton?”
“Count 1, that is the allegation of murder against Mr Clarke. To convict a Defendant of murder, you must first of all be sure that he unlawfully killed Mr Hamilton. Killed in the context of this case means that you have to be sure that Mr Hamilton died from multiple injuries, but you have no evidence, ladies and gentlemen to contradict that proposition which was put before you by the prosecution according to Doctor Kolar, so if you are sure that that is how he died, then the Defendant, Mr Clarke, will have been responsible for the death of Mr Hamilton if he caused any serious injury or serious injuries as part of those multiple injuries from which Mr Hamilton died, apart, that is from anything that he may have done in genuine attempts of CPR.”
“It starts with a note, “Although as I have directed you, all matters of fact are for you to decide, but in this case, you have no evidence to contradict the prosecution’s proposition that you can be sure that Bradley Hamilton died from his bleeding. The extent of violence used towards Bradley Hamilton by the Defendant is very much in issue between the prosecution and the defence, but it is not challenged by the defence that there was some violence used. Clearly, any injury that may have been the result of a genuine attempt at CPR is not of course unlawful, so you then move on, ladies and gentlemen, to deal with the questions in the order in which they appear.”
“Now, before I remind you of what the Defendants have said about these matters, I am going to remind you about the expert evidence in this case and there has been, as you know, quite a lot of expert evidence. There has been some expert evidence called by the prosecution. There’s been expert evidence called by the defence, and expert evidence, ladies and gentlemen, is allowed in criminal cases to provide you information and opinion which is likely to be outside your experience and knowledge, unless there happens to be a pathologist or a doctor or a specialist in bone [inaudible] on the jury, but it is within the area of expertise of the witness who is giving evidence.”
“You do not have any evidence to contradict [“the view”] that Bradley Hamilton died from multiple injuries.”
“Professor Freemont said on that, [inaudible] that with the exception of those [inaudible], all the fractures were caused, potentially have been caused by CPR.”
“The cause of the death was not natural causes. It was multiple injuries with the consequences of lots of individual things. Death was the product of those multiple injuries. He said that the rib fractures on the back, those on page 23 [inaudible] seven, eight and nine, had caused a series of problems. They’d interfered with the integrity of the proper functioning of the left chest and the underlying damage to the spleen. It produced what he called damaged products in the blood stream and had caused death in this case. Blood has gone into the diaphragm and was compromising him. There had been bleeding into his tissues. Blood loss can cause death. You don’t need to lose a lot of blood for that to happen.”
“He said, “If I considered that the fractures were two or three hours old, but there was no fibrin, there wasn’t any fibrin, that would only be possible if this man’s body had no fibrin, which would be incompatible with human life because his blood would not clot.”