“the identification of evidence of previous likely thin film bilateral subdural bleeds which occurred after having seemingly recovered from jugular venous thrombosis combined with post mortem identification of healing rib fractures of a similar age and similar non-accidental association is of significant concern of a previous non-accidental injury.”
“There are healing rib fractures on both sides of the chest described in detail by Professor Mangham. I agree with Professor Mangham that based on the findings there is evidence of at least two separate episodes of trauma, one within a period of 2-5 days prior to death and the other significantly earlier and timed at 10 days to 4 weeks prior to death. I also agree with the opinion that the various rib fractures identified in this case are indicative of side to side compression of the chest typical of forceful squeezing. In my opinion this would be at a level of force significantly in excess of what might be termed rough handling considering that there was no evidence of any underlying bone disease. As well as obvious healing fractures there were other more subtle changes that may represent further signs of rib trauma. There is no pathological evidence of any abnormality of the spine in spite of the suggestions from radiological examination. I have encountered this problem before and would regard the detailed histopathological appraisal of the bones as being the “gold standard”
“the elementary proposition that findings of fact must be based on evidence including interferences that can properly be drawn from the evidence, not on suspicion or speculation.”
“Where the prosecution is able by advancing an array of experts to identify non-accidental injury and the defence can identify no alternative course, it is tempting to conclude that the prosecution have proved its case. Such temptation must be resisted. In this as in many fields of medicine the evidence may be in sufficient to exclude beyond reasonable doubt an unknown cause. As Cannings teaches, even where, on examination of all the evidence, every possible known cause has been excluded, the cause may still remain unknown.”
“A temptation described is ever present in Family Proceedings and in my judgment, should be as firmly resisted as the Courts are required to resist it in the Criminal Law. In other words, there has to be factored into every case which concerns a discrete aetiology giving rise to significant harm, a consideration as to whether the cause is unknown. That affects neither the burden nor the standard of proof. It is simply a factor to be taken into account in deciding whether the causation advanced by the one shouldering the burden of proof is established on the balance of probabilities… a conclusion of unknown aetiology in respect of an infant represents neither a professional or forensic failure. It simply recognises that we still have much to learn and…it is dangerous and wrong to infer non-accidental injury merely from the absence of any other understood mechanism”
“The number, distribution and different ages of the rib fractures indicate that, in the absence of a plausible explanation they were due to non -accidental injury. There is no histological evidence of an underlying bone disease that might have made the bones more susceptible to fracture.”
“I can confirm that J’s bones showed no evidence of disease in particular no evidence of osteopenia.”
“1. A detailed post-mortem examination has not demonstrated morphological evidence of an underlying natural disease, congenital or acquired, or medical condition to which J’s death can be attributed. 2. Likewise, a detailed post mortem examination has not identified evidence of acute brain or other injury being the cause of death in this instance. 3. The combination of the osteoarticular and neuropathologic examination findings raises concerns regarding previous injuries; these injuries, in the absence of plausible explanation, would be due to non-accidental injury (injuries) of shaking/impact type”