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[This version of the document has been set up by Dr Robert N Moles]
Re: Dr. Manock: Ian Maddocks’ further reflections (21.12.04)
As I understand it, the Board is asked to consider a complaint that Dr. Manock was guilty of unprofessional conduct in his work as a forensic pathologist in relation to the death of Ms. Anna Jane Cheney.
I was surprised that the final presentation on behalf of the complainant (December 17, 2004) covered a total of 20 ‘particulars’ held to indicate unprofessional conduct. These extended into many circumstances not directly relevant to the matter of professional standards and conduct.
I refer to certain of these ‘particulars’ as set out by Counsel for Keogh
*2. 3. That Dr. Manock did not for some time after the death visit the scene of that death. The counsel for the complainant seemed to imply that Dr. Manock was lying in his account of having requested police assistance to visit the scene and not receiving that assistance. But no independent evidence concerning this matter has been presented, and the suggestion that the Board should have gone out to get such evidence seems to me to ask of the Board a responsibility that properly belongs to the court.
Dr. Manock’s counsel has asserted that it made no difference when such a visit was made, and unless major structural alterations were made to the dwelling it is difficult to envisage what difference could arise. It is presumably a police matter to make prompt and exhaustive study of a crime scene, and to bring in the forensic pathologist if some circumstance suggests the need for immediate study by him. This presumably did not occur, and that Dr. Manock did not see the scene of the death until some weeks had elapsed has no bearing on whether his conduct was unprofessional.
4. That Dr. Manock formed his conclusion regarding the cause and manner of death before receiving toxicological evidence.
Toxicology when received made no difference; presumably if it had made a difference it would have been used in a reconsideration of the cause and manner of death prior to Dr. Manock’s final report.
5.6. No record was kept by Dr. Manock of conversations with police officers. If that is anyone’s responsibility, perhaps this belongs to the police officers?
7.8. Similar complaint that no record kept of Coronial office matters.
9. That photographs were not examined before coming to a final hypothesis on cause and manner of death. These recorded what had already been examined by Dr. Manock, and provide only a visual record of what was already in the examination notes.
10. Dr. Manock did not review all witness statements before reaching his conclusion. Again, if any further evidence had arisen suggesting a need to change his hypothesis that would presumably have been done; no such evidence has been suggested.
11. The Medical History of the deceased was not examined in detail. Dr. Manock had a communication from a GP and this assured him that no alternative relevant pathology had been known. Review of the full notes (much later) suggests that nothing important was missed. And the examination by Dr. Manock did not reveal any pathology prompting him to seek a more detailed review of the medical history.
12. Adequate tissue samples were not taken. Experts have suggested that more samples should have been available than were taken at this examination. None, however, have suggested any positive evidence, from the tissue samples that have been available, that the sampling was likely to have missed something important.
*13. 16. Dr. Manock is accused of having failed to consider that bruises might have been incurred port-mortem, and having misled the jury in one or both trial proceedings by referring to a bruise on the left leg, and in another context stating that the mark “was not a bruise”. It seems quite clear to me that Dr. Manock recorded a description of marks on the body at the time of his examination, and these were also made the subjects of photographs made subsequently. Both the description and the photographs show a mark which can be interpreted as a bruise. A histological section, taken from the area of that mark, failed to show extravasation of red cells consistent with a bruise. But that does not discount the appearances described and photographed, since there is no evidence as to the adequacy of the sample used for histology. Absence of proof on the basis of that histology, is not proof of absence of a bruise.
*15 That Dr. Manock did not offer in court all the evidence available from his examination but limited himself to replying to questions asked of him as an expert witness. Further, he made no attempt to correct a statement made in Parliament by the Attorney-General that he knew to be erroneous.
The first part appears to me to be a matter of court protocol or tradition, and not a matter that concerns whether the expert witness is acting professionally. On the second part I am not aware that the Board has been asked to consider the Attorney-General’s statement, and doubt if this is a responsibility for the Board.
17.18. The complainant takes up the statement by Dr. Manock “that at no time was he looking or thinking that the death was accidental”, holding that it was Dr. Manock’s responsibility to outline any hypothetical alternative reasons for the death and indicate why they were to be discounted.
This does appear to me to be a quite serious reflection on Dr. Manock’s approach to his work. A scientific approach to such a situation would be, having framed a hypothesis, to seek to disprove it, and in doing so to consider all feasible alternative hypotheses.
However, the sequence of events as presented to the Board, suggests that this body was brought to autopsy as an accidental death, and Dr. Manock proceeded with his examination (on a busy Sunday morning) focussing first on satisfying himself that the cause of death was drowning (and finding no evidence for an alternative mechanism for death in that examination). Only after completing his examination did he refer the matter back to the police, indicating his suspicion that this was not accidental, drawing upon the finding of marks that suggested the body had been forcibly held.
In final presentations to the Board on December 17, counsel for the complainant drew upon only a few items from the many listed above to argue for a charge of unprofessional conduct. They were the ones starred *, in the list above, plus:
The interpretation of a sentence by Professor Cordner (acknowledged by all parties as a credible and important expert) “I don ‘t really think so… .. in that respect this autopsy is OK” The complaint suggests that a “serious misquote” occurred in interpreting the final part of that statement as indicating that the entire examination was satisfactory, when what was meant was that the record of examination was sufficient to enable another pathologist to later form an independent opinion about a bruise.
The meaning of the statement would have to be clarified by Professor Cordner, and, if important, should have come up in cross-examination at the two trials that were held. I suggest that it is not for the Board to make its own interpretation.
Much of the wealth of words that the Board has faced in its hearings of this matter seem irrelevant to the charge of unprofessional conduct, and may indicate that the team representing the complainant have another agenda, and are using the hearing before the Board to sharpen some further approach, possibly to seek yet another trial.
Unprofessional Conduct
Whether Dr. Manock was unprofessional in his conduct depends not on the above arguments, but on the manner and process of his forensic examination and whether it was consistent with practice at the time and of an acceptable standard.
The issues that are of most relevance to the Board’s consideration of Dr. Manock’s conduct of the forensic examination are:
1. The adequacy of examination as indicated by the recording of findings at the time.
2. The taking of adequate tissue samples from relevant organs, bruises, body fluids for histological and toxicological examination
3. The ordering of adequate photographic records of major findings
1. The adequacy of examination. Dr. Manock has submitted notes made at the time that are brief, even cursory, hardly appropriate to a possible case of homicide. He indicated the practice of writing organ weights on a whiteboard with gloved, blood-stained hands, and dictating other comments for transcribing at the conclusion of the examination. His account of the erasure by another person of the weights recorded in this case is a matter of concern — both because it lacks credibility (how was it that the lung weights were retained?), or because it speaks of primitive facilities or inadequate procedures/supervision of staff.
2. Experts have attested that standard practice in 1994 would have expected more tissue samples and specimens for histological and toxicological examination.
However there has been no suggestion that the few samples taken pointed in any way to another explanation than drowning as the cause of death. Toxicology sampling was apparently adequate, and the tests performed were comprehensive, revealing no alternative cause for death.
The autopsy record demonstrates bruises and some credibility must be attached, I believe, to Dr. Manock’s description of their appearance, brief though that description was. He recognised bruises. Only one biopsy was taken from the lateral line of three (or four) ‘finger’ marks, and the one biopsy from the medial side contained no skin and showed no extravasation of blood consistent with a bruise. I conclude, however, that this specimen was poorly sited or deficient in its preparation, and absence of proof does not constitute proof of absence.
3. The photographs taken of the marks found on the left leg show the marks revealed by Dr. Manock’s notes. They are not in colour, they are not accompanied by negatives (said to have been ‘lost’) or a satisfactory description of the manner of their taking. The above points — 1, 2, 3 - suggest a lack of attention to detail or a slack discipline within the culture of the Unit.
Another issue concerning Dr. Manock‘s professional conduct is whether his interpretation of the manner of death was fanciful, or was proposed in non-scientific ways that gave it undue influence in the trials. It is clearly expected of a forensic pathologist that the forensic examination be used to suggest how death might have occurred. Whether Dr. Manock‘s suggestions were fanciful seems to me to be a matter for a court to determine, not the Board. if the necessary evidence concerning circumstances leading up to the death, depth of water, posture in the bath, resuscitation attempts, etc. were not clarified in the trials, it does not behove the Medical Board to enter into those matters.
I believe that the Board should find that the procedure by which Dr. Manock conducted that autopsy did not fulfil the standards expected of such an examination in 1994.
The Board can note, however, that it heard no evidence that Dr. Manock’s findings were incorrect or open to any convincing interpretation different from his own.
The Board has concluded that the standards of practice at the Forensic Pathology Laboratory in 1994, revealed during the hearing, were unsatisfactory. Because Dr. Manock was then the Director of that service, he must accept a major part of the responsibility for this.
By his own account, Dr. Manock has not sought to maintain his personal knowledge and practice up to date through regular continuing education. Taking into consideration the age and retired status of Dr. Manock, the Board should require that he now agree not to undertake any role in forensic pathology other than as an assistant to a qualified pathologist, and under that pathologist’s supervision.
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