Pathologists shed new light on Sally Clark case
http://www.100md.com
《英国医生杂志》
BMJ Clare Dyer legal correspondent
The evidence for a double homicide in the case of Sally Clark, the solicitor convicted and later cleared on appeal of killing her two baby sons, was "overwhelming," the General Medical Council was told last week.
Alison Armour, a consultant pathologist, said she did not believe that either death was natural. She would not exclude shaken baby syndrome or smothering as the cause of death of Mrs Clark抯 second son, Harry. Her first son, Christopher, had marks of violence on his body, and she would describe the cause of death as "unascertained."
Dr Armour, a consultant pathologist for Lancashire Teaching Hospitals NHS Trust and a pathologist for the Home Office, was giving evidence on behalf of Dr Alan Williams, the pathologist who carried out post mortem examinations on both babies and who is accused of serious professional misconduct (BMJ 2005;330:272, 5 Feb).
Dr Williams, 58, is charged with a series of failures in carrying out post mortem examinations two years apart on 11 week old Christopher and 8 week old Harry; in not disclosing the results of microbiology and biochemistry tests done on Harry; and in the evidence he gave for the prosecution at Mrs Clark抯 trial for murder at Chester Crown Court in 1999.
Mrs Clark served nearly three years in prison before her conviction was quashed by the Court of Appeal in 2003.
The appeal court ruled that her conviction was unsafe, because the undisclosed test results showed the presence of Staphylococcus aureus in various sites in Harry抯 body, including in the cerebrospinal fluid, raising the possibility—which had not been put before the jury—that he may have died from natural causes.
But Dr Armour and Professor Susannah Eykyn, another witness called on behalf of Dr Williams, told the GMC panel that they believed the bacteria were the result of post mortem contamination.
Dr Armour said: "Post mortem contamination is extremely common in cases such as this; and if there is no clinical evidence of infection—and by that I mean there is no evidence in the history whatsoever that the child was unwell—and histological examination does not show any sign of infection whatsoever, and the post mortem microbiological results isolate bacteria, as they frequently do, in my view these are a contaminant."
She added: "There was no evidence of meningitis. In the multiplicity of slides that Dr Williams took from his brain there was no evidence of meningitis in the sections he took from the spinal cord. There was no evidence of pneumonia in the lungs of Harry Clark; there was no evidence of septicaemia in Harry Clark; there was no evidence of illness in Harry Clark."
However, she said that Dr Williams should still have mentioned the microbiology results.
She continued: "My view, by the time Dr Williams came to do the autopsy on Harry Clark, when he had finished the autopsy on Harry Clark, the evidence that he was dealing with a double homicide in my view was overwhelming."
She added: "In a healthy child—because Harry Clark was a healthy child with no evidence of immunosuppression—I know of no infective agent that causes a death as rapidly as this."
Professor Eykyn, who held a personal chair in clinical microbiology at St Thomas?Hospital before she retired in 2002, said Harry抯 death was not consistent with death from staphylococcal infection.
"We have no evidence at all of infection, no evidence histologically, and so the only plausible explanation of this organism is that it is just around everywhere as a contaminant." S aureus was not found in his blood cultures, she noted.
The GMC panel has finished hearing the evidence, and the case was adjourned until 26thMay.
The evidence for a double homicide in the case of Sally Clark, the solicitor convicted and later cleared on appeal of killing her two baby sons, was "overwhelming," the General Medical Council was told last week.
Alison Armour, a consultant pathologist, said she did not believe that either death was natural. She would not exclude shaken baby syndrome or smothering as the cause of death of Mrs Clark抯 second son, Harry. Her first son, Christopher, had marks of violence on his body, and she would describe the cause of death as "unascertained."
Dr Armour, a consultant pathologist for Lancashire Teaching Hospitals NHS Trust and a pathologist for the Home Office, was giving evidence on behalf of Dr Alan Williams, the pathologist who carried out post mortem examinations on both babies and who is accused of serious professional misconduct (BMJ 2005;330:272, 5 Feb).
Dr Williams, 58, is charged with a series of failures in carrying out post mortem examinations two years apart on 11 week old Christopher and 8 week old Harry; in not disclosing the results of microbiology and biochemistry tests done on Harry; and in the evidence he gave for the prosecution at Mrs Clark抯 trial for murder at Chester Crown Court in 1999.
Mrs Clark served nearly three years in prison before her conviction was quashed by the Court of Appeal in 2003.
The appeal court ruled that her conviction was unsafe, because the undisclosed test results showed the presence of Staphylococcus aureus in various sites in Harry抯 body, including in the cerebrospinal fluid, raising the possibility—which had not been put before the jury—that he may have died from natural causes.
But Dr Armour and Professor Susannah Eykyn, another witness called on behalf of Dr Williams, told the GMC panel that they believed the bacteria were the result of post mortem contamination.
Dr Armour said: "Post mortem contamination is extremely common in cases such as this; and if there is no clinical evidence of infection—and by that I mean there is no evidence in the history whatsoever that the child was unwell—and histological examination does not show any sign of infection whatsoever, and the post mortem microbiological results isolate bacteria, as they frequently do, in my view these are a contaminant."
She added: "There was no evidence of meningitis. In the multiplicity of slides that Dr Williams took from his brain there was no evidence of meningitis in the sections he took from the spinal cord. There was no evidence of pneumonia in the lungs of Harry Clark; there was no evidence of septicaemia in Harry Clark; there was no evidence of illness in Harry Clark."
However, she said that Dr Williams should still have mentioned the microbiology results.
She continued: "My view, by the time Dr Williams came to do the autopsy on Harry Clark, when he had finished the autopsy on Harry Clark, the evidence that he was dealing with a double homicide in my view was overwhelming."
She added: "In a healthy child—because Harry Clark was a healthy child with no evidence of immunosuppression—I know of no infective agent that causes a death as rapidly as this."
Professor Eykyn, who held a personal chair in clinical microbiology at St Thomas?Hospital before she retired in 2002, said Harry抯 death was not consistent with death from staphylococcal infection.
"We have no evidence at all of infection, no evidence histologically, and so the only plausible explanation of this organism is that it is just around everywhere as a contaminant." S aureus was not found in his blood cultures, she noted.
The GMC panel has finished hearing the evidence, and the case was adjourned until 26thMay.