Christopher

Evidence at trial in respect of Christopher

Prosecution evidence: General
17. Christopher was born on 22 September 1996. According to Kimberley Fleming, a colleague, the appellant had initially been shocked at the pregnancy, but when she brought Christopher into the surgery she glowed and was over the moon. He was a healthy baby and details were given of his regular routine checks. On 3 and 4 December 1996, the appellant and her husband stayed at the Strand Palace Hotel, London, where Christopher suffered a nosebleed. On the day before his death, the appellant had taken Christopher to a mother and baby group, where she appeared as a normal, happy, caring mother.
18. On the day of Christopher's death, 13 December 1996, the appellant was at home with Christopher while Mr Clark was at an office Christmas party. She called an ambulance at 9.35 p.m. and it arrived two minutes later. Mr Bell, a paramedic, said that they could hear the appellant very distressed inside, but she was unable to open the door because it was locked. Eventually, a neighbour brought a spare key. Later, the appellant said that her husband had taken the key with him. Mr Cooper, the ambulance driver described the appellant as very distressed, crying and screaming. She was in the kitchen with Christopher, who was very pale, cyanosed, cold and quite rigid. Resuscitation was attempted, but there was no respiration and no pulse. The appellant was on the verge of hysteria and kept asking if the baby was dead. She told him that she had found the child in a cot upstairs, but she did not say when. The appellant went in the ambulance with them to hospital. In the ambulance, Mr Bell was prevented from putting Christopher on a ventilator because the appellant was so distressed. At the hospital, the appellant continued to be distressed and Mr Clark was contacted.[JA12] .
made her feel quite uncomfortable. She was worried that the news had not really sunk in. Staff Nurse Cobbett described how the appellant said that her husband would blame her and would not love her any more.
20. Mr Clark arrived about half-an-hour later, and at 11.50 p.m. Dr Cowan spoke to them both. The appellant gave a patchy account because she was upset. She said that Christopher was snuffly, but had been active, had taken a feed at 7.30 p.m. and had been sitting in a bouncy chair. Dr Cowan noticed the discrepancy between this and Dr Douglas's note that he had been put in a Moses basket, but the appellant was very distraught at the time. The appellant declined the chance to see Christopher and became even more hysterical. Mr Clark did see Christopher.
21. During her examination, Dr Cowan had not detected any external injuries and it was possible that some damage might have been caused as a result of vigorous resuscitation attempts. Dr Cowan had also seen the pathology reports by Professor David. When she saw some of the results from an analysis of Christopher's blood, some of the figures (including sodium and glucose) seemed strikingly abnormal[Note14] .
22. At 1.37 a.m. the police were notified of the death and Sergeant Marshall attended at 1.42 a.m., by which time the Clarks had left the hospital. He saw the body, which had no visible marks. He completed the formalities and on the form for the Coroner's Office he stated that the baby had been found blue in a bouncy chair. Two officers recovered a bouncy chair from the Clark's home. It was later destroyed, but had been similar to that recovered after Harry's death.
23. Christine Hurst, from the Coroner's Office, discussed what had happened with the appellant, who told her about the nosebleed [JA15] and said that Christopher had been sniffly. Further tests had to be done before the cause of death could be given and the inquest was adjourned to allow the funeral to take place.
24. The appellant's arrest and police interview in 1998 are considered below in the context of the evidence relating to Harry.

Prosecution evidence: Medical
25. Evidence was given for the Crown by: Dr Williams, a consultant histopathologist and very experienced forensic pathologist who conducted the post mortem on Christopher on 16 December 1996; Professor Sir Roy Meadow, Emeritus Professor of Paediatrics and Child Health at St James' University Hospital in Leeds, with a specific interest in child abuse[JA16] Professor Green, a consultant pathologist at the Home Office; and Dr Keeling, a consultant paediatric pathologist.
26. At the time of the post mortem Dr Williams was suspicious of the cause of death because of bruises he saw on the body[Note17] , and arranged for a senior officer to be present. He took photographs and made a diagram of the external injuries. He noted the bruises and torn frenulum as worrying features, but at the time he could not exclude the possibility that these were caused by resuscitation attempts. In the absence of any other evidence, he concluded this must have been a natural death. He so informed the police. He explained that there was pressure to state a cause of death so that a funeral could take place and he gave the cause as lower respiratory tract infection, which was his best opinion at the time.[JA18] Following Harry's death, Dr Williams reconsidered his findings and changed his opinion: his current view was that there were no significant features of such an infection. He consulted Professor Green.
27. In relation to the lungs, examination of the slides revealed extensive bleeding, both old and fresh. Dr Williams had not initially noted it as significant because at the time it was a non-specific feature. The effect of research since 1997 was that iron in the lungs and haemorrhaging was highly suggestive that the child had been smothered. He agreed that it was not a specific marker, but rather should prompt a critical evaluation of the cause of death. The findings were consistent with smothering, but alveolar haemorrhage was not in itself a diagnostic or specific indication of smothering. He also found a diffuse amount of macrophage in the lungs. He said that whether in suffocation cases blood found in the lungs was focal or patchy rather than diffuse depended on the mechanism for suffocation and the time it had taken. In his view, the old bleeding in Christopher's lungs was not consistent with a nosebleed nor could a nosebleed explain the haemosiderin found. In any event, it was uncommon for babies [Note19] to suffer spontaneous nosebleeds. The doctor said that the blood samples taken at hospital were useless to interpret anything present in the biochemistry at time of death. He was recalled twice to deal with the analysis in more detail and maintained that the chemistry of blood after death was so unreliable as to be of no diagnostic value. He did not accept the basis of Professor David's suggested possibility for haemosiderosis.
28. Dr Williams concluded that the findings in the lungs were consistent with repeated hypoxic episodes, such as might be caused by traumatic asphyxia or obstruction of the upper airway and the injury to the frenulum could be interpreted as the mouth having been obstructed or smothered. His conclusion now was that Christopher had died from smothering and he was no longer of the opinion that his death had been natural.
29. Professor Meadow, Professor Green and Dr Keeling all agreed that that there was extensive fresh and old bleeding in Christopher's lungs. A spontaneous nosebleed in such a young baby would be very serious, but there was no sign of any disease. In any event, it was unlikely that the blood in the lungs resulted from the nosebleed or coughing blood from the lungs. Professor Meadow described the finding as an important indication of previous smothering. Professor Green said that the amount of bleeding crossed the threshold to require further investigation. Dr Keeling said that it was an important marker for further investigation[JA20] . She could find no natural explanation and would not have signed this as a cot death. Professor Meadow dismissed the possibility of haemosiderosis and said that it would have been unwise to rely on blood samples where the timing could not be established.
30. Dr Williams gave details of the bruises, which bore no obvious pattern to link them to smothering. Although the bruises were not seen by hospital staff, he was satisfied they had been caused before death. He had not undertaken a histological examination of the bruises because there was nothing else suspicious and he was in no doubt that they were bruises. Professor Meadow, Professor Green and Dr Keeling were also of the opinion [JA21] that the bruises could only have been caused during life and were unlikely to have resulted from resuscitation.
31. In relation to the frenulum, at the time Dr Williams could not exclude the possibility that the small split and slight bruising was a result of resuscitation attempts, but following Harry's death it became more significant. He had not realised that Christopher had been cyanosed when the ambulance men arrived and he concluded that there could not have been any blood pressure at the time to cause that bruising. He would not have expected any damage to the frenulum during a competent attempt at intubation of a child. It was his opinion that the injury was evidence of suffocation or smothering. Professor Meadow, Dr Keeling and Professor Green said the injury to the frenulum was unlikely to have been from resuscitation. Professor Meadow's and Dr Keeling's evidence suggested it was a sign of abuse, consistent with smothering.
32. Professor Meadow also gave evidence about research into children being smothered, including covert surveillance of mothers and their children in hospitals. In relation to "shaken baby syndrome", there was no knowledge of the precise mechanism used. He had published a paper identifying recurrent features in sudden infant deaths previously thought to have been natural: (1) previous unusual episodes; (2) inconsistent accounts between parents; (3) timing, most natural sudden deaths occurring between midnight and 11.00 a.m., although they may also happen during the day and evening, which was the most common time for unnatural deaths; (4) in unnatural deaths, the baby is often seen to be completely well and to have taken a feed, but is then found dead between half an hour and three hours later; (5) smothering could often be combined with other abuse; (6) it was possible for no signs of smothering to be found by medical staff or on autopsy.
33. In conclusion, Professor Meadow considered that Christopher's death was not from lower respiratory tract infection, nor could it be classified as SIDS. In his opinion, it was not a natural death. Professor Green considered that there was no evidence of natural disease, although he could see why at the time lower respiratory tract infection had been suggested by Dr Williams. He felt it was extremely likely that the death was other than natural. He would have given cause of death as unascertained. Dr Keeling considered that this was not a SIDS case and she was unable to find a natural explanation for the death. In her opinion the cause of death was unascertained, which meant that it might not have been natural.

Defence evidence: General
34. The appellant gave evidence of her background, her marriage in 1990 and the move to Wilmslow in 1994. At the beginning of 1996, the couple talked about having children. She would ideally have liked to have waited a few years because of her career change, but in view of her age they decided to start a family. She was shocked, but delighted, when she became pregnant soon afterwards. Christopher was born healthy. Her husband worked long hours and played sport at weekend, but was very supportive. Nevertheless, she was understandably tired. Christopher received regular visits from the health visitor, Pamela Greaves, who said he was a lovely responsive baby. The appellant was very careful with him and there was a bond between them.
35. Concerning the nosebleed at the Strand Palace Hotel, she said she had been out shopping for an outfit for Christopher's christening with a friend, Mrs Cox. She had fed him before she left and, according to her, took the mobile telephone with her in case she was needed. When she returned, her husband was worried because Christopher had had a nosebleed. Her account of what her husband told her was broadly consistent with his evidence. Her husband left shortly after her return and she and Mrs Cox had lunch in the room. She did not remember having a discussion with her husband about taking Christopher to a doctor. He had never had a nosebleed before, but it seemed unimportant. She mentioned it informally to her doctor the following week. The appellant denied that she had tried to smother Christopher at the Strand Palace Hotel or made any traumatic contact with his nose. Mrs Cox confirmed that Mr Clark told them about the nosebleed and having spoken to a doctor. Louise Priest and Grace Lee, friends of the appellant, each saw Christopher at the hotel in London on different occasions and he appeared bright and well. The appellant told each of them about the nosebleed.
36. The appellant said that on 13 December 1996, her husband was at his firm's Christmas dinner. She had had a bath, with Christopher in the bathroom in his bouncy chair because he had a snuffle and the doctor said the humidity would be beneficial. She breast fed him at about 7.30 p.m., changed him and put him in the Moses basket beside the bed. She had told Dr Cowan that he had been in his bouncy chair earlier, but the doctor had not asked her where she had found him when he died, and in interview she had been advised by her solicitor not to say anything. When Christopher was in the Moses basket, she watched television and went downstairs to make a cup of tea. When she went back upstairs, she noticed that Christopher was a "dusty grey colour" and she knew something was wrong. She picked him up and dialled 999.
37. She ran downstairs with the baby. The front door was bolted as they rarely used it and it required different keys for the locks. The spare keys to the side door were still with a neighbour, who had looked after their cats, and she could not find her own set. Later, she found them in a different part of her handbag. When the ambulance arrived, she was locked in until the neighbour arrived with the spare keys. The appellant could not remember snippets of what had happened after that. When she told Dr Cowan that Christopher had been in the bouncy chair, she had been completely hysterical. The next day, she had the first of many conversations with Mrs Hurst from the Coroner's Office, because they wanted to know why Christopher had died. She denied harming him in any way and had no idea how he came by his injuries.

Defence evidence: Medical
38. Expert evidence for the defence was given by: Professor Berry, a paediatric pathologist specialising in sudden and unexpected infant deaths; Dr Rushton, a consultant paediatric and perinatal pathologist; Professor David, a consultant paediatrician; Dr Whitwell, a senior lecturer and forensic pathologist; and Professor Luthert, a pathologist specialising in eyes.
39. As to the bruises, Professor Berry, Dr Rushton and Professor David said that visual diagnosis of bruises could be mistaken. The photographs were poor quality and no microscopic sections had been taken to confirm the existence or age of any bruising. It was agreed that if these were bruises, they must have been caused shortly before death. Professor David added that there was no significant pattern and the bruises had not been seen at the hospital.
40. As to the frenulum, the tear had not been confirmed histologically. Professor Berry, Dr Rushton and Professor David felt that it was possible but unlikely that such an injury would result from resuscitation. Each agreed that if there was bruising, the injury to the frenulum and bleeding in the lungs, it suggested asphyxia.
41. As to the lungs, Professor Berry and Dr Rushton said that haemorrhage in the lungs was a marker for, but not diagnostic of, the possibility of asphyxiation. They each excluded the possibility of idiopathic pulmonary haemosiderosis. The old blood could have been due to the nosebleed, although that would have been unusual in a baby of this age. It was also consistent with smothering, but by no means conclusive. Professor David found the blood test results to be abnormal and raised the possibility of haemosiderosis. A Canadian expert, Professor Cutts, had produced a paper, which showed similar levels of iron in the lungs of SIDS babies and those who had died from haemosiderosis. Professor David accepted that other classic signs of that rare disease were absent, but the possibility could not be discounted. Suffocation was also a possibility.
42. In conclusion, Professor Berry would have given the cause of death as unascertained, and in his view the post mortem was not sufficiently thorough to document the possible injuries that might indicate a pattern of care of the child. Dr. Rushton, if he had to give a cause of death, would have said unascertained.

[JA12] Are these not the natural reactions of any mother whose child has suddenly died for no apparent reason?