8) Cause of death violent shaking b)

Dr Z, crown forensic paediatric pathologist, (Trial 471): Nature of the subdural haematoma is not usually seen in a shaking case. ((Trial 479): Dr F, defence forensic pathologist agrees). (Trial 472): subdural is typical of impact not shaking. “Melissa death was the consequence of a process which began with a severe impact”. There was no soft tissue, ligament, muscle or fracture damage to the neck. (Trial 468): “I believe Melissa died from a head injury that was associated with impact that has led to subdural haemorrhage and the subsequent cerebral oedema on the right side”. (Trial 470): “it was indeed my first thought when I saw this impact abrasion” when asked by Mr HJ, crown prosecutor if she agrees with Dr F’s conclusion that the cheek mark was from the carpet. “Dr D crown pathologist and I both identified it as a patterned injury caused by a patterned surface”. “I recognized the textured surface of the carpet with the pattern on the cheek”. Dr F defence forensic pathologist (Trial 479) “when you get to older children, the likelihood of being able to shake a child to produce any significant injury to the brain becomes really quite remote”. (Trial 479) Shaken baby subdural are usually bilateral and thin, not unilateral and large and are caused by hypoxia (breathing lack of oxygen that Melissa did not experience). (Trial 503): tells the jury that it is his area of expertise that should give opinion of the retinal haemorrhage cause, not Dr K’s or an ophthalmologist. (Trial 506): the compression and starvation of oxygen applied only to the one eye on the same side of the brain where there was ischemia and deprivation of oxygen caused the retinal haemorrhages (Tersons syndrome). (Trial 481) There is clear evidence of impact with similar left cheek and left forehead injury. He agrees entirely with Dr Z crown forensic paediatric pathologist that both injuries are similar (both grazes caused by hitting the carpet). Dr M defence specialist paediatrician and director of the paediatric forensic service of a children’s hospital with a catchment of 6,000,000 people said (Trial 559): “I have never seen a case in shaken baby of a large mass effect subdural on one side causing pressure on the brain”. The judge got this expert to reconfirm that he sees no reason to think that repetitive rotational injury (shaking) occurred here and that the retinal haemorrhages had to be caused by pressure in the brain, despite this expert being quite clear about this previously. It was quite a drilling with the judge being well and truly clarified by Dr M that it was not shaking! The judge concluded the questioning by saying “yes, I understand”. If he did then he went against his own understanding to support Dr K. (Trial 542): “shaken baby syndrome would not enter my head as a primary diagnosis”. When discussing the brain swelling: “if it’s a primary effect it’s due to the shaking of the brain within the skull stretching the axons causing diffuse injury to the axons” (This is why Dr K insisted there was diffuse axonal injury immediately and throughout trial even when it was proven she did not have that by autopsy. It was crucial for shaken baby) or it’s a secondary effect due to hypoxia (the haemorrhage pressure preventing oxygen getting to the tissues, which in time if the pressure is not alleviated within a crucial timeframe causes ischemia). (Trial 543): Retinal haemorrhages secondary to raised intracranial pressure, which he himself had seen a case of. (Trial 550): there is nothing inconsistent with an impact. “an impact is by far and away the most likely cause for the subdural haemorrhage, no question about that. I don’t think anybody would question that by far and away”. (Trial 555): “there is absolutely no reason at all to invoke shaking”. (Trial 560): Dr M is the qualified expert to interpret the ophthalmologist’s findings. It is their role to provide the findings. Melissa’s retinal haemorrhages is a result of brain swelling putting pressure on her eye, Tersons syndrome (Trial 561): The type of retinal haemorrhages seen in Melissa’s eye is totally consistent with impact. (Trial 552): impact injury is most likely cause for all the findings. Mr HJ, crown prosecutor tried very forcefully to get Dr M defence specialist paediatrician to say that if a case presented like Melissa’s only with no impact evidence and a prior ‘unexplained’ head injury that the logical conclusion would be to assume abuse immediately. I believe he did this so Dr K could have a very respected ally. However, Melissa did have impact injury for both the inadvertently inflicted and prior explained accidental head injury. It explains why the Crown ignored the old scalp bruising found left rear at autopsy and only included the internal effects in Melissa’s head of pons beading and a small subdural. It also explains why Dr K had to have the recent impact evidence classed as bruising from the pressure monitor inserted at surgery. One of Dr K’s ‘hearsays’ to the jury was that Mr B, neurosurgeon had said to him that the obvious impact evidence underlying the outer forehead graze found at autopsy was caused by the pressure monitor. Mr B himself had never documented this or was asked it when he took the stand, nor was he the expert to determine this. (Trial 465): The three pathologists Dr D, original crown pathologist, Dr Z, crown forensic paediatric pathologist and Dr F, defence forensic pathologist, who were the experts to determine this, said the bruising was well away from the monitor and described the contact subdural. Defence specialist paediatrician Dr M agreed. Dr Z also commented that Mr B would not have reflected the scalp as she did, to determine the bruising was not separate from the monitor (Trial 465). There is not a comment to be found from Mr B, who obviously accepted it was not his area of expertise and was professional. With all the evidence it seemed Dr B was very reluctant to join in with Dr K’s vendetta and attempted to uphold his integrity. Unfortunately he did lie about not seeing the older subdural haemorrhage when he operated. A rather important omission. Only Dr K would think to dispute evidence of impact injury under the scalp immediately under the forehead graze noticed at Tauranga hospital, by saying a not yet inserted monitor caused it. Dr D, crown pathologist, said monitor was midline. “bruising is noticed adjacent to the pressure monitor. There is some further bruising of the deep scalp over the left side in a rather diffuse pattern”. A 5cm wide grayish area was present close to the olfactory bulb on the undersurface of the left frontal brain lobe. There was a separate red 1cm round area on the inner or medial surface of the left frontal brain lobe. Both these areas were suggestive of bruises”. Dr K also said at trial of Mr B neurosurgeon that he’d said the bleeding was still occurring at operation and he had to stop it. Mr B has only ever documented the opposite and said so at trial. This was to counter the evidence that two subdurals were picked up by CT scan and seen and removed at operation, so Dr K could support his story that it was acute and hyperacute detected and removed, rather than the subdural that occurred 15 days earlier as well as the later one. Despite this Dr K himself said: impact is “probably part” of the abuse; Subdural pattern very different to ‘shaking’ agreeing with Dr M, defense specialist pediatrician. (Trial 370): Significant element of rotation in a complex fall can tear a bridging vein, and that the forces can be significant but not extreme if these two conditions apply. (Trial 353, 356, 357, 366): He also said “Melissa was too old, an unusual presentation for ‘shaking’ and that it would be extremely difficult to cause a haemorrhage of this nature by shaking”. Dr S, crown forensic neuropathologist (Trial 427): “I have seen recently, an indication that it may well be that in short falls on occasion the positioning of the body as it falls will suddenly produce or rise above the levels of force at which tissue damage as this can be done”. (Trial 424): “there is a limited time period before the tissues begin to die off so that the sooner the blood clot can be removed; the more likely it is that there will not be permanent tissue damage leading to serious consequences to the brain”. “There was already tissue death by the time Melissa was operated on”. (Trial 423): “singulate hernia put pressure on the anterior arteries”. (Trial 415): “A hippocampal hernia put pressure on the mid brain stem”. “A large subdural haematoma needs to be removed to relieve the pressure on the brain and to allow for these hernias of tissue to retreat back to their normal position”. (Trial 416): “brain was still quite swollen, but with the release of pressure of the blood clot the midline structures had moved back to a more normal position. The singlulate hernia had retracted to the normal place in the brain and also the hippocampal hernia had retreated back and lay in its normal position”. (Trial 423): “widespread areas of tissue death because when the hernia from the hippocampal area was pushed down into the opening in the tentorial membrane, it had squeezed the blood vessels supplying that part of the brain stem and led to small but quite numerous areas of tissue death consistent with the pressure from the subdural clot pushing the brain tissue downward”. (Trial 422): “damage was due to poor blood flow to certain parts of the brain as a result of the brain compression from the haematoma before it was removed at operation”. Dr F, defence forensic pathologist, (M35) Melissa Sale died as a direct result of at least one and probably the combined effect of two impact injuries (prior accidental and subsequent inadvertently inflicted) to her head. There is no evidence that this impact was contributed to by an episode of deliberate shaking. (My lawyer failed to get Dr F to mention this in court which is one of the main points in which she was clearly “giving it to the crown” ) Dr G, defence ophthalmologist (Trial 532): brought up a case at trial virtually identical to Melissa’s of a child who had a low level fall, except for a few less retinal haemorrhages and that the child was operated on soon enough. The child is doing extremely well and has no after effects. Bearing in mind my confession to shaking (to get a response from comatose Melissa) was very early on; don’t you think my original charge would not have been withdrawn with conclusion of “no suspicious circumstances”, if the Crown believed the shaking was much more then that, and all the evidence supported their belief?” The manner in which I shook Melissa was with her in a sitting position with both my hands cupped over her head gripping some hair and top of ears at the top of her head, followed by more rocking rather than shaking her cradled in my arms when some of her hair came out in my hand. It was done so gently that as the evidence shows she did not get any injury as a result. This is totally different to the dramatic video Dr K showed in court of a very young infant doll with its head lolling back and forth violently, held under the armpits. Dr K told CYFS that retinal haemorrhages means ‘shaken baby’. It was this that caused them to not operate on Melissa immediately and to put her aside to die. Part of the covered up evidence and instruction my lawyer refused to bring up was that Dr K was on duty when Melissa was brought to Tauranga hospital and had conversed with staff there soon after her arrival and had given his opinion immediately (SOF version 3,19). It was the detectives excuse to arrest me by that a paediatrician of Starship had phoned them and said it was extremely violent shaken baby immediately. I asked them three times who that paediatrician was and they refused to tell me, but other documents show it was Dr K. It was covered up because the doctor immediately involved in treating Melissa was not permitted to then be a witness at trial. Dr K told the jury he heard of the case and met Melissa a couple of days later after ‘many’ experts notified him the case was suspicious and that his first assessment was when he was doing his nitpicking bodily injury examination and documentation. The judge tried very hard throughout trial to have the jury disregard strong defence points in a number of corrupt and unjust ways. He was very prejudiced. His contempt of court sidekick who tossed her head, had convulsions and verbally scoffed whenever defence experts were on the stand, has also edited the trial transcript to be more biased in the crowns favour, a number of times. At sentencing, Judge Lynton Stevens said a mitigating factor was my taking emphasis off my offending by blogging some facts. His comment was edited out of the sentencing notes. My answer to that is “when fact is thrown at fiction, the natural effect is for fiction to be downplayed”. I refuse to take responsibility/blame for what I didn’t do; only what I should.