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Losing Their Grip - the case of Henry Keogh - Dr Robert N Moles
Part Four - Chapter Nine – No other reasonable possibility?
Losing Their Grip - table of contents
Also by Dr Moles - A state of Injustice - Definition and Rule in Legal Theory
Keogh first approached the Medical Board of South Australia in September 2002. He complained to them about Dr Manock’s conduct in the investigation of Anna Cheney’s death and his subsequent trials.
What might have been through to be a straightforward process turned out to be both difficult and drawn out. To help explain what happened, it is useful to look briefly at the role and responsibilities of the Medical Board before we describe the developments that finally led to a hearing before the Board in November 2004.
A fundamental matter canvassed in this hearing, and basic to the whole case, was that of the role of experts and the use of scientific evidence. So in this chapter we also discuss the basis of this and look into its application to the question of sudden deaths in adults.
The Medical Board
The regulation of the practice of medicine in Australia lies with the Medical Boards. The procedures and powers of the Medical Board of South Australia were set out in the Medical Practitioners Act 1983. [1] It said that the Medical Board responsibilities were to:
“Ensure that the community is adequately provided with medical services of the highest standard;”
And to:
“Achieve and maintain the highest professional standards both of competence and conduct in the practice of medicine.”
The Act provided that a complaint with regard to unprofessional conduct may be put before the Board by the Registrar of the Board, or ‘a person aggrieved’ by the conduct of the medical practitioner.
When it receives a complaint, the Board must do one of three things:
it may reject the complaint if it considers it to be vexatious or frivolous;
it may refer the complaint directly to the Medical Tribunal for it to be dealt with there;
otherwise, it must inquire into the complaint and make a determination.
Keogh laid his complaint as a person aggrieved. Initially, Keogh sent a copy of his Second Petition to the Medical Board and asked them to investigate the matters which related to Dr Manock. However, the Board kept requesting Keogh to put his complaint in ‘proper form’. Eventually, Keogh obtained the services of a senior civil lawyer, and had his Complaint drafted with all the care requisite of a deed of conveyance. There is no requirement in the Act that this has to be done.
Keogh’s complaint was that Dr Manock’s conduct in relation
to the practice of medicine has been at relevant times:
(a) Improper and / or unethical
(b) Incompetent and / or negligent
within the definition of ‘unprofessional conduct’ contained in the Act.
He asked that the Complaint be laid before the Tribunal, ‘it being a matter of sufficient seriousness and involving significant issues of public interest such as to warrant it being referred to the Tribunal.’ That was not done.
The Medical Board said that it was not appropriate to look into any of the other cases in which Dr Manock had been involved.
The Registrar said that he did not support Keogh’s complaints; that it might be unfair to Dr Manock to have to defend himself against serious allegations some years after the actions in question; that there had been undue delay in raising these matters with the Board. Keogh said that if there had been any delay, then as the Registrar had the power to initiate a complaint, and all of the other cases which Keogh had complained about were on the public record, then surely the delay was the fault of the Registrar, not of Keogh.
At a hearing in December 2003, Dr Manock’s lawyer claimed that this action by Keogh was either frivolous and / or vexatious or, alternatively, it was being pursued for an improper purpose, being to overturn his criminal conviction. Mr Borick QC submitted that was clearly wrong. The only issue before the Board was whether Dr Manock was guilty of unprofessional conduct in relation to the practice of medicine as defined by the Act. He argued that any implications that such a finding might have in other legal proceedings was not relevant to the Board’s consideration of this complaint. The Board appeared to have accepted that submission, as it said that it would proceed to consider the Complaint.
On 16 July 2004 Mr Borick, in his address to the Board, explained to them that the Act says that the Board can appoint an investigator; demand the production of books and materials; and require people to answer their questions. The Board appeared unaware of their powers; or at least failed to exercise them.
Mr Borick also alleged that the Board had seriously and persistently misdirected itself on important matters. For instance, the Registrar said that the Board could not look at any issue unless someone complained to them about it. That is not correct. The Act enables the Registrar to act as a complainant for the purposes of bringing a matter to the attention of the Board. So, in matters on the public record such as the Coroner’s Findings in relation to the Baby Deaths Inquiry, the Registrar could have initiated a complaint to the Board in relation to it. He failed to do so.
The Board also stated that because the Registrar had not approved of Keogh’s complaint, then Keogh would have to investigate his own complaint and then ‘prosecute’ the matter before the Board. Not an easy thing to do when you are locked up in prison with no money. There is no basis for this in the Act. Indeed, it is quite contrary to the whole purpose of the Act. By behaving in that way, the Board was making itself an umpire in adversarial proceedings, when it should be the investigator in inquisitorial proceedings. It is the Board that must inquire into the matter; it is the Board that has the power to investigate. It is the Board that must safeguard the public interest.
In fact, the extensive powers given to the Board are greater than those that are given to a court or to the police. The police may put questions to someone, but that person is entitled to exercise their right not to answer. However, there is a positive duty on any person to answer a question put to them on behalf of the Medical Board. A court cannot require a person to answer a question that might be self-incriminatory - but under the Act, the Medical Board can.
Keogh’s lawyers asked the Medical Board to use their powers to obtain the toxicology records; the negatives and prints of all the photographs; the documents relating to the medical history of the deceased. The Board was also asked to interview witnesses such as those present at the post mortem, to clarify what had been done. Keogh was not provided with the materials that he sought, and as far as he knows no interviews were undertaken.
As we have previously indicated, Keogh responded in February 2004 to the Medical Board’s notice that they would conduct an inquiry, by filing with the Board the affidavits of his experts.
Dr Manock replied with the production of affidavits, dated 23 June 2004, from himself, Dr Ross James (his former co-worker and witness at the Keogh trials), and Dr Hilton Kobus (the Director of the Forensic Science Centre). Dr Manock subsequently issued a further affidavit, stating that he was mistaken in his first one concerning certain colour photographs being taken by a police crime scene photographer after the autopsy.
The formal hearing by the Medical Board eventually took place on 3-4 November 2004. However, before we go to that we must first develop some understanding of how scientists (including doctors and forensic investigators) should go about their work.
Scientific Expertise
In this case, it was alleged that Anna Cheney had drowned in a domestic bath. It was further alleged that it had been a forced drowning, and that it was Henry Keogh who had been responsible for that. The only person in a position to initiate such allegations was the forensic pathologist -- Dr Colin Manock. It was he who did the autopsy, and he was the only person capable of asserting a particular cause of death (drowning). However, he went further than that, and also made assertions in relation to the manner in which the drowning had come about. He said he had identified certain marks on the body of the deceased, which provided, according to the prosecutor, ‘the one positive indication of murder’. So, in order to evaluate the adequacy of Dr Manock’s work, we need to know something about proper standards for scientific experts.
At the Medical Board hearing, Keogh alleged that Dr Manock had propounded opinions, which he said were matters of expert and scientific validity, when he knew or ought to have known that they were not.
What then is the relevant test is for determining whether an opinion is an expert opinion?
In 1984, the test was stated by the courts of South Australia in R v Bonython as follows:
“(a) whether the subject matter of the opinion is such that a person without instruction or experience in the area of knowledge or human experience would be able to form a sound judgment on the matter without the assistance of witnesses possessing special knowledge or experience in the area: and
(b) whether the subject matter of the opinion forms part of a body of knowledge or experience which is sufficiently organised or recognised to be accepted as a reliable body of knowledge or experience, as special acquaintance with which by the witness would render his opinion of assistance to the court.” [2]
The view that, to be admissible, the expert opinion has to be deduced from a well recognised principle or discovery that was generally accepted within the relevant scientific specialty (the Frye test), has been internationally recognised. [3]
That view has been subsequently refined to allow for legitimate differences of opinion that have emerged within certain fields of expert knowledge. In the leading American case of Daubert v Merrill Dow, the US Supreme Court took the view that where opinions are held, but which have not yet had the chance to gain general acceptance, then the knowledge must have been arrived at by an appropriate and accepted scientific method. [4]
On the basis of this judgment, the factors that one must consider in identifying such expertise, are as follows.
“The principles used in the derivation of the knowledge must be testable. This means that if the knowledge is not capable of being tested (and therefore capable of being falsified, that is proved wrong if it is wrong), then whatever it is - it is not science.
The principles used must also have been tested.
The knowledge must have been subjected to peer review and publication.
It is important to identify the standards for using the method in question, and in particular, for identifying any known error rate.
It is important to consider if the method used (as opposed to the knowledge which it gives rise to) has been generally accepted.”
The Daubert judgment has been widely considered by courts in Australia and New Zealand. [5]
A mere conflict of opinion should not, in itself, determine whether any knowledge is acceptable as expert knowledge. Sometimes science may be at that stage of development where there is a legitimate and justifiable conflict of opinion.
Professor William Tilstone had been the Professor of Forensic Science at Strathclyde University, Scotland. In 1984 he came to Adelaide as Director of the South Australian Forensic Science Centre. He was Dr Manock’s boss at the time of the Keogh case. At a conference in 1986, he explained proper scientific procedures in forensic science. [6]
Tilstone defined ‘forensic science’ as the application of scientific principles to provide information to assist in legal matters. He said it involves both inductive and deductive reasoning. With regard to inductive reasoning he cited Professor Karl Popper as being the leading proponent of ‘falsification’. This concept means that scientific observations hold as hypotheses (theories) until some experiment or observation disproves them. [7] This is why the Daubert test emphasises the responsibility of any scientific expert to publish their observations (and the principles for interpreting them), so that they can be subjected to critical scrutiny. Without that, we are left with just the accumulation of untested experience.
Professor Tilstone said that whilst analysis is the foundation of forensic science, evidence is the goal. The basic obligation of the forensic scientist is to ‘gather evidence’ of what has been observed. Having done that, it can then be used as the basis for any inferences which are to be made.
He described the various functions of evidence. He said it might be used to indicate some things or eliminate others. Elimination, he said, may be done positively or by implication. He said there is an enormous gap between ‘not eliminating’ and ‘positively implicating’. When experts talk about things being ‘consistent with’ something, they really mean that they cannot eliminate the connection as a possibility. That is not the same as asserting some positive or causal relationship between them. Professor Tilstone also noted the important role of scientific evidence in corroborating other forms of testimony.
Professor Tilstone went on to discuss a well-publicised case that had occurred in the UK a few years before he wrote his article. The issues he discussed were very similar to those which arose in Keogh’s case. The following discussion of the case is taken from Professor Tilstone’s article.
In the case of John Preece in 1981 in Scotland, the victim, Helen Wills, had been raped and murdered. Her death was investigated by forensic scientist Dr Alan Clift. Some six years after the conviction of Mr Preece for her murder, Dr Clift was suspended from duties. The Preece case was appealed. The appeal judges took the view that the evidence supposedly indicating that Ms Wills had been in a lorry with Mr Preece would have proved nothing.
They said that the merely associative evidence linking Ms Wills to Mr Preece would have been inadequate to convict him -- just as the marks (if any) on Anna’s legs had no affirmative connection to Keogh. The judges said there had to be some additional incriminatory evidence to support the suspicion that Preece was implicated in some way in her death.
Dr Clift said there had been a mixture of vaginal secretions and semen. He said there were certain blood grouping reactions that in his opinion had come from the semen. The other experts at the appeal said that they did not believe Clift’s test could distinguish between the responses from semen and those from the vaginal secretions. Clift asserted that he could make those findings, on the basis of his experience. Yet he had not published or explained his method of doing this so that it could be assessed by other experts.
As Professor Tilstone said:
“Not only were none of the experts called by each side prepared to accept his [Dr Clift’s] conclusions, he [Dr Clift] received considerable criticism from the Appeal Court judges who said that, if in fact it had been such a wonderful test, why didn’t he publish it?”
Professor Tilstone went on to say:
“His [Dr Clift’s] response to all of this was that the information was there at trial but nobody asked him about any of the points which subsequently were said to be shortcomings, and in particular nobody asked him during the trial what the blood group of the deceased was, and of course the answer to the question was that the blood group of the deceased was A [the same as the accused].”
Dr Clift said that important information had been included in some of his working papers, but it had not been included in his court report. Professor Tilstone said:
“The appeal was upheld, and the judgement said many things. First and foremost, it said without a shadow of a doubt the individual forensic scientist had failed to meet the standards which the court expected of expert witnesses, and the results were not reliable.
Secondly, the court took considerable umbrage at apparent editing [by Clift of his preliminary test report], since Clift, for whatever reason, had not divulged all the tests and results in his Court Report.
Thirdly, he was roundly criticized for only presenting factual information. The Appeal Court was of the opinion that it is the duty of the forensic scientist to provide an interpretation of the findings for the Court.
Finally, the Appeal Court was not impressed by the idea that Dr Clift had used a novel and unpublished technique which he claimed could differentiate between semen and vaginal fluids. They felt it should have been published to permit peer assessment and to benefit other forensic scientists, if it had withstood critical appraisal.”
Professor Tilstone went on to discuss the case of Edward Splatt, whose conviction in South Australia had been overturned in 1984 as the result of a Royal Commission. He concluded by pointing out that:
“Finally, in regard to Splatt, the Royal Commissioner underlined the vital obligation lying on the testifying scientist to spell out to the jury, in non-ambiguous and clearly precise terms, the degree of weight and substance and significance which ought properly to be attached to the scientific tests and analyses and examinations, to which he refers. The critical responsibility which rests with the legal persons is to ask such detailed and probing questions of the scientist as are most likely to elicit such evidence. In this context, the primary responsibility must always remain with the scientist.”
A single instance of a complete failure of scientific method by a purported expert would normally justify the immediate suspension of that person from the scientific community of which they were part. It would lead to the investigation of other cases in which that scientist had been involved. This is what happened in the early 1980s in the UK with Dr Clift. [8]
Similar circumstances have arisen again in the UK with regard to Professor Sir Roy Meadow. His name has been erased from the Register of Medical Practitioners by the UK Fitness to Practice Panel after his ‘misleading’ expert evidence in the Sally Clark case referred to in the Preface. A number of cases in which he was involved have now been overturned by the UK Court of Criminal Appeal, and many more are being reconsidered.
In addition, the following finding has been handed down in relation to Dr Williams who conducted the autopsies on the babies in the Sally Clark case:
“Yesterday the General Medical Council said that Dr Williams had failed in his duty to consider all the possible causes of Christopher’s death.
It said that his post-mortem examination of Christopher was so impaired that it could not be considered reliable.
‘You failed to discharge the duties of a competent pathologist in such circumstances,’ a written judgment said. A spokeswoman for the council said that a panel had looked at whether Dr Williams was fit to practice and would decide whether he was guilty of the charge. [10]
The General Medical Council has subsequently banned Dr Williams from undertaking any Home Office [forensic] pathology work for three years, saying that his errors and omissions were ‘formidable’. [11]
As we will see later, Dr Manock admitted in his evidence to the Medical Board that he had not considered all the possible causes of Anna Cheney’s death. Clearly there are aspects of his post mortem examination in Keogh’s case which would be considered to be unreliable.
Sudden Adult Deaths
A fundamental scientific issue to be considered in relation to the Keogh case is whether it is either likely or possible that a fit and healthy person could drown in a domestic bath. In a filmed interview with Channel 7 Today Tonight, Mr Rofe stated that:
“As indeed we said, you know, a fit and healthy 29 year old girl doesn't drown in the bath. And Dr James, for example, had never come across such a case.” [12]
Just why Dr James not knowing of such a case makes it right, is not clear.
The fact of the matter is that it does happen. The following discussion gives some indication of the epidemiology (frequency of occurrence and distribution) of ‘sudden adult death’. The material also provides a statistical basis for the work reported by Professor Thomas; that adults sometimes do die suddenly and unexpectedly, even without a prior medical history. A full autopsy and toxicology investigation will often reveal the cause of death, but on occasions may not do so. However, it is wrong to suggest in those circumstances that the cause of death is ‘foul play’, without compelling evidence to that effect.
‘Sudden Death Syndrome’ - the condition in which previously fit and healthy young people collapse and die with no explanation - is the subject of international concern. Members of the European Parliament have demanded international action after hearing that each week in England alone, three previously fit and healthy young people collapse and die with no explanation. [13]
It is reported that each year in the USA about one in 200,000 high school or college athletes die suddenly, the vast majority without any prior symptoms. An example is that of David Kimani, a six-time national champion cross-country and track runner at the University of Alabama. In 2003, he left his new wife and team-mates stunned when he fell off his chair in the campus dining hall and could not be revived. With a Nike sponsorship in the offing, he had plans to race in the Olympics. He seemed to be in his prime, but he was dead at 25. [14]
It would seem that the position in Australia is no different. Dr Chris Semsarian, a cardiologist of the Royal Prince Alfred Hospital in Sydney has reported that between 20 or 30 people under the age of 35 die each year in the Sydney metropolitan area, of causes which are often cardiac-related. However, there are also situations where they die suddenly without any apparent cause. [15] The ABC TV science show, Catalyst, ran a program on sudden death on 25 November 2004. It reported that each year 100 seemingly healthy, young Australians die suddenly, without warning or obvious symptoms.
One of the most common disorders causing sudden death in people aged less than 35 years is generally an inherited cardiac disorder, hypertrophic cardiomyopathy (HCM). This means that the heart muscle is abnormally thickened. It is believed to occur in about 1 in 500 people, with most affected individuals having few or no symptoms. [16] In up to half of the people who die suddenly who are young, the first presentation of their disease is often at post-mortem. [17] Death occurs when the heart beats too fast and is unable to pump the blood adequately around the body.
A substantial proportion of patients with HCM die during or immediately after vigorous activity, but sudden death during rest or sleep is also common. [18] It is not a new phenomenon. It was originally reported in a British journal in 1958. [19]
In about a third of cases of sudden death, the problem is not HCM and the heart can look completely normal. This makes the determination of the cause of death even more difficult – a detailed examination of many sections of heart by a specialist cardiologist is required. [20]
The genetic basis for some of these problems is now beginning to be understood at the molecular level. Dr Ackerman and his team at the Sudden Deaths Genomics Laboratory at Mayo Clinic in Minnesota, have found that death by drowning in an otherwise healthy person can result from a defect (mutation) in a gene which is caused by a ‘misspelling’ in the base pairs in the genetic code. The genetic defects are undetectable with a regular electrocardiogram. Dr Ackerman says:
“On land, if you suffer from one of these genetic glitches that cause your heart to spin electrically out of control and you faint, you might wake up with bruises, but if this occurs in water, even if the heart regains control quickly, it may be too late; you’ve probably drowned. [21]
The deaths of 1,000 adults who were under 65 years of age, and who died suddenly with no previous significant disease, have been re-investigated in France. [22] The initial autopsy found no cause of death. The re-investigation found that heart diseases were the cause of death in 848 of the cases. That is, in 85% of the cases where the initial autopsy found no conclusive cause of death, a specialist investigation of the heart revealed a cardiac cause of death. This might just be a comment on the thoroughness or otherwise of the original autopsies, but nevertheless, in 152 of the autopsies, still no cause of death was found.
Sudden cardiac death among women has been investigated in the USA, where researchers looked at 244 women who died suddenly - within one hour of symptom onset. [23] Their ages ranged from 30-55 years. Most (88% )of these women, died as a result of arrhythmia, an abnormal conduction of the impulses in the heart causing abnormal rhythm, the heartbeat being too fast, too slow, markedly irregular, or ceasing altogether.
Other researchers have estimated the frequency of sudden unexpected death due to cardiac or unidentifiable causes in English adults of employment age to be 11 in 100,000. [24] This would translate to 2,200 sudden unexpected deaths due to cardiac or unidentifiable causes in adults each year in Australia.
Logic would seem to indicate that when fit and healthy adults do die, sometimes death must occur in the bath. A Japanese study of sudden death found that in 17 per cent of cases the fatal symptoms began in the bath. [25] Another Japanese study concluded that death can occur during hot bathing, as a result of decreased sympathetic tone (less nervous stimulation of the blood vessels) that develops approximately four minutes after immersion. [26]
Epileptic seizures occurring in the bath are considered particularly life –threatening. To eliminate this as a cause of death a full autopsy with toxicological studies and a detailed neuropathological (brain) examination need to be carried out. [27]
Homicide in the bath, however, is a rare event. A retrospective analysis of the deaths investigated by the Institute of Forensic Medicine of the University of Cologne from 1980 to 1993, revealed 215 fatalities in the bath tub, of which eleven (5%) were homicides. [28] These homicides, however, included people whose bodies had been placed in the bath following homicide as well as those who had been murdered in the bath. Of the eleven homicides, only one was a drowning. In another retrospective study only two homicides were found out of 36 fatalities in the bath tub. [29] In a series of 42 deaths in the bath in Copenhagen and Gothenburg from 1961 to 1969, only one homicide was encountered. [30]
A study in Hamburg of deaths from 1971 to 1988 found that 245 occurred in the bath. [31] These represented about one per cent of all autopsies. Of the 245, there were 66 were natural deaths, 76 suicides, 39 accidents, 13 homicides (5%). In 51 cases the cause of death was unclear. Of the 13 homicides, only two were committed in the bath, one by drowning a child, and one by an electric hairdryer. There were no adults who died by drowning.
From these studies, it can be seen that fatalities in the bath are not uncommon, but less than five per cent are homicides. Additionally, the homicides were usually caused by strangulation, electrocution and blunt force. It is rare that homicide in the bath occurs as a result of drowning.
Although statistics cannot be determinative of a cause in an individual case, they can provide us with a guide as to what it might be reasonable to consider in any individual case. In the light of the above information, it would appear that any reasonable forensic examiner should undertake a thorough and exhaustive examination for death by natural causes, even where the cause of death by other means is suspected.
When Dr Manock stated that, ‘I was at no time looking or thinking that the death was accidental because I could find no explanation as to why she would drown’, it would appear that the most compelling reason as to why he could find no explanation as to why Anna would drown was because he had not looked for some of the reasonable alternatives to drowning.
Perhaps one of the reasons for this could have been because of a phenomenon called the ‘satisfaction of search’. This entails a halt in the thinking processes once a possible solution to the problem has been found. Other avenues of investigation are therefore not pursued. It is a form of the tunnel vision which we referred to earlier.
In the second Keogh trial, the Prosecutor, Mr Rofe, said in his opening remarks:
“The prosecution says that murder is the only inference open on the evidence, the only explanation. Of course, to prove its case, the Crown must prove there is no other reasonable possibility – either that she committed suicide or she was killed by someone else or that she died as a result of an accident.”
Here, Mr Rofe did not even acknowledge the possibility that Anna could have died by natural causes. Any reasonable person should have considered that death by natural causes was a possibility in this case, or indeed, in any case. Certainly this possibility had not been excluded by the forensic examination.
As we have seen, various forms of heart problems are a major cause of sudden death. Other causes that have been noted in the literature include epilepsy [32], brain tumour [33], brain cysts [34], wasp and bee stings [35], insect allergy [36], achalasia (a disorder of the oesophagus and swallowing) [37], reflex vagal inhibition causing marked slowing of the heart rate [38], metabolic disorders such as deficiency of magnesium [39], neurosarcoidosis (an inflammatory condition of the brain) [40] and food (allergy) and exercise. [41]
If it were to be said that Anna Cheney did not have any diagnostic history disclosing any propensity to such conditions, one would only have to point out that many of them can give rise to a first onset in adulthood. A sudden adult death might well be the first indication that a person has such a condition.
Endnotes
[1] Although the legislation has changed since then, we refer to the provisions in force at that time.
[2] King CJ in R v Bonython, (1984) 38 SASR 45, cited by CR Williams “Evidence and the Expert Witness” in Australian Journal of Forensic Science 26 pp3-7 1994, emphasis added.
[3] Fry v United States 293 F 1013 (DC Cir 1923)
[4] Daubert v Merrill Dow Pharmaceuticals Inc 931 Fd 2d 1128 (9th Cir 1991).
[5] See for example, Osland v The Queen [1998] HCA 75 (10 December 1998). The Australian Law Reform Commission Background Paper no 6 January 1999. “Reforming the law on expert evidence” MJA 1998; 168: 53-54. ‘Forensic Sciences from the Judicial Perspective’ James Wood, Australian Journal of Forensic Sciences, vol 35 2003 pp115-132. ‘From Frye to Daubert’, David S. Bell, Australian Journal of Forensic Sciences, vol 32 2000 pp 61-64.
[6] WJ Tilstone ‘Where now for forensic science?’, Proceedings of The Australian Forensic Science Society, Volume 4, Number 1 (April 1986), pp. 12-23.
[7] Conjectures and Refutations – The Growth of Scientific Knowledge, (1963) Karl R Popper, Routledge and Kegan Paul. This issue is of particular importance to Dr Manock’s claim that his microscopical examination of tissue from the ‘thumb bruise’ failed to confirm the existence of a bruise, but did not refute it. See the discussion of this in chapter 11.
[8] M Hamer, ‘How a forensic scientist fell foul of the law’, New Scientist, 3 September 1981, pp. 575-6.
[9] Fitness to Practice Panel, Regents Place, London NW1 3JN - Professor Sir Samuel Roy Meadow, 15 July 2005
[10] Times Online May 28 2005.
[11] S Pook, ‘Jailed mother sues pathologist over withheld evidence’, 20 September 2005.
http://www.telegraph.co.uk/news/main.html?xml=/news/2005/09/20/npath20.xml.
[12] Interview by Rohan Wenn, Today Tonight television program, Channel 7 (Adelaide), recorded 27 June 2002.
[13] Mystery disease kills three young people a week - News release, 7 October 2003. http://www.carolinelucasmep.org.uk/news/SADS_07102003.html
[14] L Hoffman. The Australian - Running on borrowed time. 27 November 2004.
[15] C Semsarian. ABC Radio National, The Health Report: 5 July 2004 - Sudden Cardiac Death. ["http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1145435.htm"> http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1145435.htm]
[16] C Semarian & BJ Maron. Sudden cardiac death in the young. MJA 176 (2002) 148-9.
[17] C Semsarian. ABC Radio National, The Health Report: 5 July 2004 - Sudden Cardiac Death. ["http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1145435.htm"> http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1145435.htm]
[18] Semarian & BJ Maron. Sudden cardiac death in the young. MJA 176 (2002) 148-9.
[19] D Teare. Asymmetrical hypertrophy of the heart in the young adults. Br Heart J 20 (1958) 1-8.
[20] L Hoffman. style='font-family:"Arial","sans-serif"'> The Australian - Running on borrowed time. 27 November 2004.
[21] ‘Defects in gene called RyR2 cause malfunctions in the heart’s electrical system.’ Medical Research News, 2 May 2005.
[22] Loire R, Tabib A. “Mort subite cardiaque inattendue.” Archives Des Maladies Du Coeur et Des Vaisseaux 89.1, 1996:13-18.
[23] Albert CM, Chae CU, Grodstein F, Rose LM, Rexrode KM, Ruskin JN, Stampfer MJ, Manson JE. “Prospective study of sudden cardiac death among women in the United States.” Circulation. 2003 Apr 29;107(16):2096-101.
[24] Bowker TJ, Wood DA, Davies MJ, Sheppard MN, Cary NR, Burton JD, Chambers DR, Dawling S, Hobson HL. Pyke SD, Riemersma RA, Thompson SG. “Sudden, unexpected cardiac or unexplained death in England: a national survey.” Queensland Journal of Medicine. 2003 Apr 96 (4):269-79.
[25] Kouno A, Matoba R, Shikata I, ‘A statistical study of sudden cardiac death for past five years in Osaka medical, investigated at the Osaka Medical Examiner’s Office’, Acta Medical Legal Society (Liege), 39 (1989) 205-15.
[26] Nagasawa Y, Komori S, Sato M, Tsuboi Y, Umetani K, Watanabe Y, Tamura K. ‘Effects of hot bath immersion on autonomic activity and hemodynamics: comparison of the elderly patient and the healthy young.’ Jpn Circ J. 2001 Jul:65(7):587-92.
[27] Saxena A, Ang LC ‘Epilepsy and bathtub drowning. Important neuropathological observations’, American Journal of Forensic Medicine and Pathology 14 (1993) 125-9.
[28] Schmidt, B Madea. ‘Homicide in the bathtub’. Forensic Science International 72 (1995) 135-146.
[29] Devos Ch, Timperman J, Piette M, ‘Deaths in the bath’, Medicine Science and the Law 25 (1985) 189-200.
[30] Geertinger P, and Voigt J, Death in the bath’, Journal of Forensic Medicine 17 (1970) 136-147.
[31] Trubner K, Puschel K. ‘Fatalities in the bathtub.’ Arch Kriminol. 1991 Jul-Aug;188(1-2):35-46.
[32] Bennani FK, Connolly CE. ‘Sudden unexpected death in young adults including four cases of SADS: a 10 year review from the west of Ireland’ (1985-1994). Med Sci Law 1997 Jul;37(3):242-7.; Lip GY, Brodie MJ. ‘Sudden death in epilepsy: an avoidable outcome?’ JR Soc Med 1992 Oct;85(10):609-11.; Blisard KS, McFeeley PJ. ‘The spectrum of neuropathologic findings in deaths associated with seizure disorders.’ J Forensic Sci 1988 Jul;33(4):910-4.
[33] Opeskin K, Ruszkiewics A, Anderson RM. ‘Sudden death due to undiagnosed medullary-pontine astrocytoma.’ Am J Forensic Med Pathol 1995 June;16(2):168-71.; and also Matsumoto H, Yamamoto K. ‘A case of sudden death by undiagnosed glioblastoma multiforme.’ Nippon Hoigaku Zasshi 1993 Aug;47(4):336.9.
[34] Kuchelmeister K. ‘Colloid cysts of the 3d ventricle: an underestimated danger?’ Neurochirurgia (Stuttg) 1992 Jan;35(1):5-8..
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