Misinterpretation of post-mortem findings

One morning in 1993, a four-year-old girl was found dead at home in her bed. She did not have any significant history of ill health that could possibly explain her death.

During the evening and night prior to her death, she was looked after by her uncle.

The body was found facing down and the blood in her body had gravitated to the face, front of the neck and chest. At the post-mortem examination the pathologist described the accumulation of blood as multiple bruises on the anterior aspects of the neck and upper chest and multiple tiny bleedings in the face, neck and upper chest.

Her anus was markedly dilated and reported to have evidence of acute and chronic injury. The cause of death was given as cardio-pulmonary arrest due to asphyxia. Her uncle was charged with first degree murder, convicted and sentenced to life in prison. The case was reviewed 12 years after the child’s uncle had been incarcerated.

In another case, a 24-year-old young man accidentally dropped a six-month-old baby of his girlfriend on the evening of February 21, 2002.  The young man and the mother of the baby were living together, but he was not the father of the child.

That evening, the baby’s mother left her in his care as she went to buy groceries.  According to the young man, the child soiled herself and he had to give her a bath and change her diapers.

The child, however, slipped from his hands and fell and her head struck the toilet. She did not seem seriously injured.

He changed her into clean clothes, put her to bed and said nothing about what happened when her mother returned. This was perhaps the biggest mistake he was to make and regret. When the baby’s mother checked on her that evening, she seemed fine.

A short time later, she discovered that the baby did not appear to be breathing. She rushed the baby to a hospital where the baby died after attempts to resuscitate her failed. Several medics who examined the baby would later testify that her anus was dilated, indicating sexual assault and therefore that the baby had been anally raped.

The doctor who carried out the post-mortem stated that she died as a result of the Shaken Baby Syndrome, also known as the Abusive Head Trauma, a serious brain injury resulting from forcefully or violently shaking an infant or toddler repeatedly.

The doctor reported a one centimetre wound in her anus. The doctor was, however, not a certified pathologist.

The police were called to investigate this case and the young man was arrested. However, it was two days later that he told the police what had really happened. The late disclosure only served to damage his credibility.

By then the authorities believed he had raped and killed an infant. He was tried in December 2002 and found guilty.  He was convicted of capital murder and sentenced to death in a proceeding that lasted less than two days. He asked court during his trial to provide the means to hire an independent expert to review the medical findings, but his request was denied.

Inconclusive tests

The methodology for the post-conviction in case of the four-year-old included the reassessment of the scene and post-mortem photographs, microscopic slides, results of all the investigations, review of all expert opinions and preparation of additional microscopic slides from the tissue blocks.

A review of the post-mortem photographs showed that there was discolouration of the neck and face attributed to the movement of the stagnant blood due to gravity. The anus of the child was dilated, but was not bruised and did not have any tears.

When the tissues were examined under the microscope there was no evidence of injury. Neither spermatozoa nor DNA was recovered from the anal tissues.

After the review the cause of death could not be determined. It was opined that either natural or unnatural causes could account for the death, but there was no straightforward or definitive evidence for either.

The appearance of the anus was attributed to post-mortem dilatation rather than anal sexual abuse and the findings in the head and neck were attributed to the position of the child after death had occurred.  The experts who reviewed the case agreed that there was no basis for the first opinions offered in court. The little girl’s uncle was released from prison after 12 years and received financial compensation from the government to the tune of $4.25 million.  

Righting wrongs

Following this glaring miscarriage of justice, a commission of inquiry was instituted to publicly evaluate forensic pathology practice. This inquiry made a number of observations, the most significant of which was that a sophisticated and advanced criminal justice system in a first world setting failed to pick out defective medical/forensic evidence.

This failure in the criminal justice system involved all the actors including those responsible for the maintenance and oversight of standards and training in forensic pathology.

Other actors who were deemed to have failed included the coroner, the police, the prosecutors, the defence lawyers and the court itself.

With respect to the six-month-old baby, an independent analysis of the evidence was later to find that there was no sign of any tears in the child’s anus and that anal dilation in such circumstances is not out of the ordinary.

An independent pathologist also noted that there was no trace of the young man’s DNA found on or inside the baby. The pathologist was of the opinion that a thermometer inserted into the baby’s anus at the emergency room could have caused the small bruise.

According to a pathologist respected worldwide, the anus can dilate in coma or after death and anal abrasions (superficial wounds in the anus) can be due to innocent causes such as constipation, diarrhoea and rubbing up against a diaper.

The two forensic pathologists who independently reviewed the post-mortem medical examination report of the baby concluded that the baby was not sexually assaulted and that she had died of injuries consistent with an accidental drop.

The prosecution’s medical expert conceded that the medical evidence did not support a claim of sexual assault.

This information was initially withheld from the defence. The defence would later learn in January 2014 that the doctor who performed the post-mortem had looked at the tissues of the baby under the microscope and found that there was no evidence of sexual assault.

The baby’s mother testified at the trial that the young man had never changed the baby’s diapers and had never given her a bath.

This testimony was devastating as it gave the jury the impression that the young man’s actions on the night the child died were suspect.  However as it turned out the mother’s pretrial statements, which were recorded, contradicted her testimony at the trial. The mother told the authorities earlier on that the young man loved the child and that he often changed her diapers and often bottle fed her.

She stated that she was not at all surprised that the young man gave her daughter a bath. The jury never heard these pretrial statements.

The Supreme Court initially threw out the first appeal, but on April 3, 2015, the court ruled that the death row inmate could proceed with his evidentiary hearing to challenge his murder conviction. He had been in prison and on the death row for 13 years awaiting execution for a crime that probably never took place. In 2018 he was taken off the death row.

There is no doubt that the misinterpretation of medical and other forensic evidence has led to miscarriages of justice.

More often than not, this is as a result of incompetence rather than deliberate manipulation.

However the latter cannot be entirely ruled out in rogue states and police forces that have no moral spine and are eager to show results no matter the cost.