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NEWS: Clare Dyer Pathologist in Sally Clark case accused of being "slapdash" BMJ 2005; 330: 272-b [Full text]

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There is something wrong in the system

Giusto Giusti, "Tor Vergata" Rome University   (6 February 2005)

Re: There is something wrong in the system

Penny Mellor   (7 February 2005)

Unknown Knowledge

John Fryer   (9 February 2005)

There is something wrong with the system

John M N Hilton   (10 February 2005)

Re: There is something wrong with the system

Penny Mellor   (11 February 2005)

There is something wrong in the system 6 February 2005
Giusto Giusti, professor of legal medicine 00133 Rome, via Montpellier 1, "Tor Vergata" Rome University Send response to journal: Re: There is something wrong in the system	The case that was reported is an example of the growing medical – legal malpractice cases. Reasons of this fact are numerous, and go from an insufficient selection of the home office pathologists to the difficulty of answering promptly and correctly before a Court. In my opinion, however, at the base there is the practical impossibility of having a complete knowledge of forensic pathology, a good knowledge of general and special pathology, and sufficient clinical experience. Besides, the pathologist is alone when he performs his autopsy and must decide what else to do (histology, toxicology, etc. or microbiology as in this case). No person can have such an experience to make a relevant diagnosis in so different fields. The problem is important, because a wrong diagnosis of the causes and manner of death can give rise to a wrong verdict. A possible solution is to charge an ad hoc specific institution for these duties and to permit a discussion to the members of the institution, so that a collective diagnosis –not a personal one- can be made. Standard autopsy techniques and guidelines should also be available. Competing interests: None declared
Re: There is something wrong in the system 7 February 2005
Penny Mellor, Advocate Home WV9 5HX Send response to journal: Re: Re: There is something wrong in the system	I was wondering if anyone could answer a question and I shall paint the picture first: When a baby or child dies unexpectedly there is always some sort of investigation involving all the relevant bodies, including the police. At the time those agencies turn up at the home or wherever, the area becomes a potential crime scene, the baby/infant/child being the evidence. After the autopsy has been performed, many samples are sent to the pathology lab to be investigated. When a house is robbed, the police turn up and seal off the area, dusting for finger prints and bagging and tagging items they feel may be of some use in detecting who committed the crime, all of this is carried out with witnesses to the bagging of evidence and everything is listed manually stating what was found where and by which officer as it is placed into an evidence bag. That evidence is sealed in front of witnesses and then transported to a police station to remain in the evidence room under strict supervision to ensure it cannot be tampered with. In legal terms, the chain of evidence is kept intact. When samples that have been taken from a child (who is the evidence) where there is a suspicion that the circumstances of their death may not be natural, no such chain of evidence exists. For arguments sake, let us just suppose the case goes to trial or family court and the pathalogical findings are presented, how can anyone prove that those samples and findings even belonged to that child, or haven't been tampered with, the chain of evidence gets broken time and time again, if this had been the bloodied knife that killed a man, it would be inadmissable as evidence unless the protocol for obtaining that evidence had been observed. My question is simply this, as a matter of law, how did any pathological findings ever make it into any courtroom when the testing of those samples and their transportation from the body to the microscope or test tube were not overseen by the police? Competing interests: Campaigner against false allegations of MSbP etc
Unknown Knowledge 9 February 2005
John Fryer, Chemist & Researcher France Send response to journal: Re: Unknown Knowledge	The problem still exists that toxicology is unable to detect traces of many dangerous chemicals used in the home for innocent purposes. For example organophoshates much used in the home in the 1970's through to 2000 are undetectable even with proper forensic analysis after 2 days. However as far as I am aware no such toxic analysis has ever been conducted on the dead children. My email is now john.fryer@wanadoo.fr Anyone who needs more information or comment directly will be welcome. John Fryer Analytical Chemist The good news is that many of these chemicals possibly used in the Clark and other people's homes for treatment of fleas on pets have been subject to a world wide ban in 2000 after many years of safe use (industry quote). Competing interests: None declared
There is something wrong with the system 10 February 2005
John M N Hilton, Consultant in Forensic Medicine, Assoc Prof Forensic Medicine, University of Sydney NSW 2780 Australia Send response to journal: Re: There is something wrong with the system	My colleague Prof Giusti raises several points meriting response. In this day of ready telephonic communication no pathologist should ever feel he is alone. In a well conducted practice Forensic Pathologists should never feel inhibited consulting with their colleagues in their own or other disciplines and vice versa during and subsequent to the conduct of an autopsy. In Western Australia from 1972 all sudden, unexpected and "non certifiable" infant deaths were subjected to autopsy in one instuitution and as far as possible by the same pathologist or group of pathologists. This was achieved in a jurisdiction having a land mass similar to Western Europe. At the Institute of Forensic Medicine, Sydney NSW, from 1992 each and every autopsy was discussed at a combined staff meeting held at the end of the days list. In addition from 1995 each child death was reviewed by a panel consisting of all the Pathologists practising in the Institute, including the staff Neuropathologist, trainees, and later representatives of the State Government's Child Death Review Team and the SIDS Support Group. These meetings were behind closed doors. Vigorous discussion of findings and diagnoses were encouraged with frank interchange of individual views. The responsibility for the ultimate diagnosis rested with the Pathologist conducting the case. Mellor raises an interesting point of "chain of evidence". In Western Australia a member of the State Police Force, who was attached to the specialist Coronial Investigation Unit, attended the mortuary for every autopsy, participated in recording details and received and transported clearly identified specimens which were being referred on for further extra-mural testing. (This practice may no longer be followed, for a variety of reasons) In New South Wales the practice from the early 1990's was for the Pathologist, or his Technical Assistant, to retrieve samples from the body, put them in suitable, labelled containers, seal them, complete and sign a request form. The samples were then bagged and given to a courier who transported them to the relevant laboratory. Even samples to be examined within the Institute were sealed and signed for. Each movement of the sample was recorded and again signed for. It is not necessarily best practice to have the police act as couriers. Thus many of the suggestions raised by the previous correspondents have been addressed over a period of some thirty years and in different jurisdictions in the Antipodes. Lastly the recovering of one strain of an organism from multiple sites in a cadaver is dependent on a number of factors not least the death -autopsy interval. It should be noted that an achieveable best practice is for all autopsies on all infants to be treated as emergency procedures and all such investigations and their ancillary tests be performed or instituted as and when the death comes to light. This will reduce dramatically the changes wrought by autolysis and putrefaction. Competing interests: None declared
Re: There is something wrong with the system 11 February 2005
Penny Mellor, Advocate Home WV9 5HX Send response to journal: Re: Re: There is something wrong with the system	Thank you for responding Professor Hilton, it is interesting to see that various methods have been tried in the Antipodes, pity none of those methods are applied here! I didn't mean to suggest for one moment that the police are the "right" body to transport specimens, my question was rhetorical in that respect. Quite simply, just as a matter of law, I fail to understand how findings at pathology, where the chain of evidence is so compromised, are admissible in court. It simply just isn't good enough that this happens, the NHS scandals about the huge mistakes made in path labs are well documented. On the matter of immediate post mortem's being carried out on infants who die suddenly, well that's a joke in itself, the only forensic paediatric pathologist that England had has retired and paediatric pathologists are few and far between, scattered across the UK. The UK government's monetary priorities lay out in Iraq at the moment I am afraid, the NHS is a free service and as we all know there is no such thing as a free lunch!!! Children don't vote, so the priority afforded to their protection and welfare in financial terms, comes very low on the list. I won't comment about PM contamination in the Clark case as there is an ongoing PCC hearing at the GMC, however John Batt's book about the Clark's ordeal (Stolen Innocence) does clear the particular point you make up. Competing interests: campaigner against false allegations of MSbP etc