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Affidavit of Dr Byron Collins (summary) - for the Medical Board of South Australia

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I am a registered medical practitioner, practicing as an independent consultant forensic pathologist. I have had considerable experience in the field of forensic pathology. I have frequently been asked to provide expert opinions in medico-legal and forensic matters.

I previously provided advice to Michael David QC who represented Keogh at his trial. I attended at the scene on 17 January 1995. The most important observation whilst in the bathroom was the ease with which a person standing or leaning by the bath could slip and lose balance on the tiled floor. It was also possible when a mat was placed on the floor. The taps and water spout protruded from the wall adjacent to the side of the bath. They would produce bruising if struck in a fall.

On attempting to re-enact the scenario described by Dr Manock it was found to be anatomically impossible for the right leg to be bent sufficiently over the body and head for it to strike the ledge behind the bath or the side of the bath. The bruises on the right shin could not have been produced in this manner.

The method of gripping the left lower leg as stated by Dr Manock would be most unusual and certainly was not the position likely to be adopted, instinctively, in a hurried attempt to drown a person sitting in the bath.

The microscope slides had been provided to review. This number of slides is totally inadequate to properly investigate a suspicious death. The autopsy was incomplete because there was no microscopical examination of the brain. It was therefore impossible to exclude cerebral conditions such as encephalitis which may have caused or contributed to the death.

The piece of lung tissue measured approximately 1.5 x 1.0 cm. This amount of tissue was grossly insufficient to assess the features likely to be found in a suspected death by drowning.

Dr Manock claimed that there was fluid within the lungs, either water or possibly pulmonary oedema. This is not identifiable to any significant extent in the microscope slide.

Dr Manock expressed the opinion that because there was no vomit within the smaller airways and lung spaces, the episode of vomiting must have occurred after drowning. This cannot be substantiated on the basis of a single microscope slide which contained only two small bronchioles.

The sections taken from the various bruises showed no cellular reaction to the leaked blood. Such a bruise could have occurred up to approximately 24 hours prior to death, or even in the early post mortem period. The dating of a bruise was extremely difficult and a definite time frame was not realistic or reliable.

The uncertainties of microscopical ageing of bruises were compounded owing to the fact that different levels of a bruise may vary in the degree of development of the healing response. The reaction takes place in response to the irritant effects of the leaked blood in the tissues. It varies from individual to individual, and also from area to area within the bruise. Any apparent lack of differences between the head and leg bruises did not mean they were produced by blows over a short space of time. The extent of an area of bruising is not always an accurate indication of the degree of force applied.

Dr Manock was wrong to suggest that just because the head bruises appeared to be of minor severity, they would not have caused any loss of consciousness. The analysis of urine alone was insufficient to indicate whether drugs were present so as to affect consciousness. There is a variable time delay before any drug appears in the urine. 

In a suspicious death, a wide ranging set of analytical procedures on various body fluids and organs such as blood, bile, urine, liver, stomach and contents must be performed. The statement by Dr Manock concerning the blood alcohol level of 0.08% is meaningless and inaccurate. Such a concentration was of sufficient magnitude to impair motor function and could have contributed to poor balance. This would have been especially so if it had occurred in association with drugs. The situation would have been further compounded by the warm bath and the slippery surface of the bath and the floor.

It is wrong for Dr Manock to say that a blow to the head affecting consciousness would always leave a bruise or some other sign. I know of no other pathologist who would have expressed that view.

I am at a complete loss as to why Dr Manock returned to the mortuary two days after the initial autopsy to further reflect the scalp. This was something which should have been done as part of the original examination in order to distinguish it from post mortem artifactual bruising or bleeding. I have seen ‘false’ bruises produced in the back of the neck after the neck structures and large blood vessels have been removed during an autopsy.

Dr Manock’s interpretation that the small bruises on the left lower leg had been caused by the application of fingers was extremely misleading and unsound. Bruising of the lower limbs is a common occurrence from day to day living and this is the most likely explanation for the bruises. If someone were trying to force an individual’s head under the water by pulling the legs up in the air, the most appropriate grip would be to encircle the ankle rather than the calf region.

No proper cause for the bruise on the head could be proposed. Post mortem bruising of this area can result from rough handling of a body in circumstances from the scene to the mortuary table. In the immediate post mortem period the dilation of the blood vessels caused by the warm water of the bath would have exacerbated any bruising which might otherwise have occurred.

Dr Manock was not entitled to state the cause of death was drowning. There are no tests which can be performed on a dead person which prove drowning. It is a diagnosis of exclusion and all other reasonable causes, both natural and unnatural, should be properly investigated and excluded before arriving at this diagnosis. In this case, Dr Manock has not fulfilled this basic requirement.

In the classic cases of wet drowning, within the initial twenty four hours after a person has drowned, it is common to find copious quantities of frothy pinkish white fluid filling the airways and exuding from the mouth; this being in association with a congested brain and wet, heavy, hyper-inflated lungs. There were no lung weights in Dr Manock’s autopsy report.

Massive lung oedema occurs in acute heart failure. Therefore, the comment by Dr Manock to the effect that ‘water could be squeezed from the cut surface of the lungs’ was descriptive but diagnostically non-specific.

A useful test in the process of deciding if a person found immersed in water had drowned is the presence of diatoms in organs on the systemic side of the circulation, for example, in the bone marrow or kidneys. However, this test does have a number of limiting factors which render findings difficult to assess. However, it can be said with confidence that Dr Manock’s search for these organisms in the lung tissue is a complete waste of time. These organs are not part of the systemic circulation and diatoms can enter the lungs during the passive movement of water within the airways after death.

It appeared from the evidence which had been given by Anna’s general practitioner that she did not suffer from any apparent natural disease processes which could have caused sudden collapse and death. However, it would have been important to see if there had been any previous history (even in close relatives) of asthma or epilepsy.

Myocarditis is a viral inflammation of the heart which can lead to a sudden cardiac malfunction and death. This condition can only be diagnosed by proper microscopic examination of the heart muscle. This has not occurred in this case.

Dr Manock’s autopsy was far from complete, particularly as the brain had not been examined. It is my opinion that a proper cause of death has not been established. Therefore, a natural cause of death can not have been excluded as a reasonable explanation. Even if it were to be accepted that the deceased had drowned, there is insufficient pathological evidence to indicate that it had been a drowning which was homicidal in nature as opposed to one which was accidental or suicidal.

Sworn and signed by Dr Richard Byron Collins.

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