Cause of death in law is key

A medical doctor, out of sheer incompetence or poor training, misled court and ultimately occasioned a miscarriage of justice when he recorded the cause of death of a young man as “cardiopulmonary arrest due to respiratory distress secondary to pus in the chest caused by lung collapse”.
The young man is reported to have been stabbed in the chest by his biological father three weeks earlier. The doctor did not make matters any better when he concluded that the death was from natural causes, since it was caused by an infection of the lung, also known as pneumonia.

Cause of death vs complications
Cardiopulmonary arrest simply means that the heart and the lungs have stopped performing their functions. This, in reality, occurs in every death; it cannot be said to be a cause of death. In the same way cardiac arrest (a heart that has stopped beating) and respiratory arrest (lungs that have stopped functioning) cannot be said to be causes of death.
Cause of death is defined as the initial injury or the immediate disease condition responsible for setting into motion other malfunctions of the body ultimately leading to the death. In this particular case, the cause of death should have been stated as a stab wound to the chest. The pneumonia was a direct effect of the stab wound. The pneumonia and lung collapse that the doctor described in his postmortem report were the subsequent events that resulted from the stab wound.

Medically, they are described as complications of the stab wound. The chest cavity is a sterile cavity and one of the complications of a stab wound in the chest is the introduction of micro-organisms that ultimately cause pneumonia and puss formation.
The judge, in this particular case, concluded that if the cause of death was pneumonia and that it was from natural causes, then that meant that any possible injuries the young man’s father may have inflicted on him did not contribute to his death. The judge, therefore, did not find any reason to place the young man’s father on his defence, as no sufficient case had been made against him to answer. The judge subsequently acquitted him.

Prosecution was also probably at fault when it failed to bring out the very strong circumstantial evidence, including the medical evidence, in this case. It was unfortunate that the prosecution did not call any of the medical personnel who attended to the patient.
The judge also said that the evidence of the investigating officer was useless; he never confirmed the injury. He could only claim that there was a bandage on the chest of the deceased and concluded the bandage invariably covered a wound. To the judge, the investigating officer’s claim that the deceased had a stab wound was, therefore, unfounded. The investigating officer did not bother to look for the weapon which was used to cause the injury.

Similar case
In yet another case, a man was stabbed in the chest and died 36 days after being wounded. However, a doctor, in a postmortem report, wrote that the victim’s death was due to pneumonia and tetanus, following a stabbing injury to the chest.
To court, this statement was considered an expression of fact. It meant that the pneumonia and tetanus followed, in point of time, the stabbing. But there was absolutely no evidence, anywhere on record, that the pneumonia and tetanus were a direct result and consequence of the stabbing. To court, it was most likely they were, but that could not exclude the possibility that the doctor might have conceded that the pneumonia and tetanus supervened independently of the stabbing. The doctor was not called to give evidence in court as he had left the country then.

Linking cause of death to an injury
Court concluded that there was a lacuna in the prosecution’s case, in that the link between the cause of death and the injury inflicted was not established, beyond reasonable doubt. This lacuna could only have been filled by calling, as a witness, another medical expert. The possibility of death having been caused by some intervening circumstance, unconnected with the stabbing, had, therefore, not been excluded in this case.
Clearly, what is apparently obvious to medical persons may not be that obvious to non-medical persons, courts of law inclusive.

Key issue
The circumstances of the case were as followings:
• The young man was healthy and had no health complaints before he was assaulted by his father
• The young man’s wife saw her father-in-law assault her husband, and although she did not see the actual stabbing, she heard her husband scream
• The young man was taken to, and admitted in hospital, with an injury to his chest that evening and subsequently transferred to a regional hospital. The young man made a statement to the police to the effect that he had been stabbed in the chest by his father
• In both hospitals, the young man was treated for chest injuries At the postmortem examination there was a scar in his chest and his lung had collapsed.