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Article: Australian law on miscarriages of justice
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The Medical Board of South Australia concerning Complainant: Henry Vincent Keogh and Dr Colin Henry Manock
Affidavit of Dr Richard Byron Collins

On                             2004

I, Dr Richard Byron Collins make oath [or affirm] and say as follows:

I am a registered medical practitioner, practicing as in 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.

Now produced and shown to me and marked RBC 1 is a copy of my curriculum vitae of ** pages which is attached hereto.

I have been asked by the current legal representatives of Mr Henry Vincent Keogh to advise them in relation to the work of Dr Colin Henry Manock arising from his autopsy of Ms Anna-Jane Cheney.

I previously provided advice to Mr Michael David QC who represented Mr Keogh at his trial in relation to this matter.

I attended at the scene of the death of Ms Anna-Jane Cheney on 17 January 1995.

The following comments constitute my expert opinion in relation to this matter.

The most important observation whilst in the bathroom was the ease whereby an individual standing or leaning by the bath could slip and lose balance on the tiled floor. Such an event was also possible even when a mat was placed on the floor. The taps and water spout protruded from the wall adjacent to the side of the bath, any one of which would produce a bruise if it were struck by a falling body.

On attempting to re-enact the scenario as 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 from the leg striking the side of the bath.

It is my opinion that the bruises on the right shin could not have been produced in this manner.

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

A total of nine microscope slides and two vaginal smears were provided to me for my review. These slides consisted of two slides of heart tissue, a single slide each of lung and kidney tissue, with the remaining five slides said to be samples of tissue taken from the bruises on the legs and head.

It is my opinion that the vaginal smears are unrelated to the cause of death.

It is my opinion that this number of slides is totally inadequate to properly investigate a suspicious death.

It is my opinion that the autopsy is incomplete because there was no histological examination by Dr Manock of the brain. It is therefore impossible for him 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. It is my opinion that 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 however, is not identifiable to any significant extent in the microscope slide.

Dr Manock expressed the opinion that because there was no vomitus within the smaller airways and alveoli (lung substance) the episode of vomiting must have occurred after drowning.

It is my opinion that this assertion cannot be substantiated on the basis of a single light microscope slide which within the lung tissue contained only two small bronchioles.

I agree that the sections taken from the various bruises showed no cellular reaction to the extravasated blood.

However, it is my opinion that such a bruise could have occurred up to approximately twenty four hours prior to death, or even in the early post mortem period. Any such bruising would show a similar histological picture of no inflammation. The dating of a bruise is extremely difficult and a definite time frame is not realistic or reliable.

It is my opinion that the uncertainties of light microscope ageing are compounded due to the fact that different levels of a bruise may vary in the degree of development of the inflammatory (healing) response. The inflammatory reaction, which is the cellular infiltrate which takes place in response to the irritant effects of the extravasated blood within the tissues, varies from individual to individual, and also from area to area within the bruise.

It is my opinion that the apparent lack of an observable histological difference between the head and leg bruises does not necessarily indicate that they were produced by episodes of blunt force trauma inflicted 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.

It is my opinion that Dr Manock is wrong to suggest that just because the head bruises appeared to him to be of minor severity, they would not have caused any change in the level of consciousness.

It is my opinion that EMIT analysis of urine alone is insufficient to indicate whether drugs were present within the deceased’s bloodstream and therefore possibly affecting her conscious state.

It is my opinion that following ingestion of a drug and its subsequent absorption into the blood stream via the blood vessels in the wall of the stomach, there is a variable time delay before the parent drug or its metabolite appears in the urine as part of the excretory process. It would have been quite possible for Ms Cheney to have consumed a small quantity of a tranquiliser drug and for it to have adversely affected the central nervous system producing unsteadiness of gait particularly in combination with alcohol. If this had occurred it would be possible that it would fail to be detected in the urine.

It is my opinion that 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.

It is my opinion that the statement made by Dr Manock concerning the blood alcohol level of 0.08% is meaningless and inaccurate. Such a concentration is of sufficient magnitude to impair motor function and could contribute to poor balance. This would be especially so if it were to occur in association with psychotropic drugs. The situation would be further compounded by the slippery surface of the bathroom floor.

My opinion is one of strong disagreement with Dr Manock that any application of trauma to the head sufficient to impair the conscious state would always leave a bruise or some other “sign”. I know of no other pathologist who would express that view. There are a wide range of variables involved in the production of an area of bruising.

In relation to this autopsy, it is my understanding that Dr Manock did not examine the under-surface of the facial skin and subcutaneous tissues. It is therefore not possible for him to express an opinion as to the presence or absence of bruising in this region.

I am at a complete loss as to the reason why Dr Manock returned to the mortuary two days after the initial autopsy to further reflect the scalp. It is my opinion that this is 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 the autopsy.

His interpretation that the small bruises on the left lower leg have been caused by the application of fingers is 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 on the deceased. 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 occipital region can 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 vasodilation caused by the warm water of the bath would exacerbate any bruising which might otherwise occur. It is my opinion that it would be possible to produce minor areas of bruising with firm compression of the skin over a bony prominence such as on the front of the shin.

It is my opinion that Dr Manock is not entitled to state that the cause of death was drowning. There are no tests which can be performed on a deceased individual which are pathognomonic for the diagnosis of death by drowning. A diagnosis of death by drowning is a diagnosis of exclusion. Therefore all other possible causes, both natural and unnatural, should be properly investigated and excluded before arriving at this diagnosis as a cause of death. 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. I found no lung weights in Dr Manock’s autopsy report.

It is my opinion that massive lung oedema may also occur 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…” is descriptive but diagnostically non-specific.

A useful ancillary test in the process of deciding if a person found immersed in water has drowned is the presence of diatoms in organs on the systemic side of the circulation, for example, in the bone marrow or kidneys. This test does have a number of limiting factors which render any findings difficult to assess.

However, what can be said with confidence is 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 would appear from the evidence given by Dr Diane Forbes, the deceased’s general practitioner, that the deceased did not suffer from any apparent natural disease processes which could have caused sudden collapse and death. However, it would have been important to enquire if there had been any previous history (even in close relatives) of asthma or epilepsy.

The disease myocarditis, which is a viral inflammation of the heart, can lead to a sudden cardiac malfunction and death. However, this condition can only be diagnosed by proper microscopic examination of the heart muscle. It would appear that this has not occurred in this case.

It is my opinion that 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. A natural cause of death cannot be excluded as a reasonable explanation. Even if it were to be accepted that the deceased did drown, there is insufficient pathological evidence to indicate that it was a drowning which was homicidal in nature as opposed to one which was accidental or suicidal.

Sworn by the said

Dr Richard Byron Collins

in the presence of:

Solicitor / Commissioner for oaths

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