Tomlinson ‘didn’t die of heart attack’

Day 14 of the inquest into the death of the newspaper seller after he was struck by police during the G20 protests in London in 2009 12.32pm: Gibbs has challenged Cary over whether this kind of damage to the liver would have allowed a sufficient bleed into the abdomen to cause his death. Cary has reasserted his evidence that he does not know whether the liver was the cause of the bleeding, but that it could have been. Cary: Could the liver ooze sufficiently to produce the sort of volume of blood that we see in the abdomen … I think that is a possibility. Gibbs. Really? Really, doctor? Cary: Yes. Really. Gibbs counters that there is “a problem” with Cary’s evidence because fatal internal bleeding could not have come from Tomlinson’s damaged liver. Cary: I’m not sure where the blood in the abdomen came from. What I do know is there is a contused liver, and it is possible that there is bleeding from a contused liver, but I am not saying that it must have done. 12.19pm: Gibbs said the CPR treatment would have been “rigorous” and lasted 30 minutes. He showed the pathologist more photographs from the examination. Gibbs: Do you still say that you can see no connection at all, even as a possibility, between the site of the damage to the liver and the chest compressions? Cary: For all the reasons I have already stated, yes … in my view, there is no connection between resuscitation and what was observed on the liver. 12.07pm: The break is over. Gibbs is asking Cary about his evidence that Tomlinson’s arm became trapped under his body after he was pushed by PC Harwood. Cary said he believed this could have caused the injury to Tomlinson’s abdomen. A screen grab from the video (below) shows this. Cary confirmed his assessment of the video was that of a “normal person” rather than that of a pathologist. Gibbs cited Patel’s evidence that ribs and liver could have been damaged by CPR treatment. Gibbs: Do you not agree that the part of the liver damaged is closer to the site of the CPR damage? Cary: No. 11.38am: The inquest is now taking a quick break. 11.37am: More on the extent of blood in the fluid found in Tomlinson’s abdomen. Patel said, in his updated view , that he believed there was more ascites (bodily fluid) than blood, but could not say more than that. A sample of the fluid was inadvertently discarded, so a lot of this is guesswork. Gibbs: Dr Patel has given an estimate, based upon texture and colour, an estimate of proportion; is that an assessment that you now accept? Cary: I think it is very difficult to make an assessment of texture … when you look at the picture, it looks to me heavily bloodstained, at the very least. 11.31am: Gibbs is asking about the extent of blood in Tomlinson’s abdomen. We have heard before how “the extent of blood” in Tomlinson’s abdomen is a point of controversy. A year after his initial report, after discovering other pathologists had concluded that Tomlinson died of internal bleeding, Patel altered his description of the level of blood in the newspaper seller’s’s abdomen in a second report. It was not three litres of blood, Patel said, but three litres of “fluid with blood” . In his report, Cary said he was “reliant” on the original findings of blood in Tomlinson’s abdomen. Gibbs: Do you now realise that that belief about three litres was wrong? Cary: I think it is more likely that this was blood and ascites [bodily fluid], yes. The pathologist went on to say he believed that there was, nonetheless, substantial bleeding. 11.27am: Ryder has finished his questioning of Cary. Patrick Gibbs QC , the counsel for PC Simon Harwood, has taken over. 11.25am: Cary is being asked by Ryder about the potential connection between Tomlinson being pushed over and any subsequent heart attack. Patel said there was a “compelling association” between the shove and the heart attack he believed Tomlinson died from, but said there could be no physical evidence of any causal link. Cary, who does not believe Tomlinson died of a heart attack, said the time link between the two (Tomlinson collapsed 150 seconds after being pushed) was as “compelling as I have ever seen”. Only members of the jury can put themselves in the shoes of the person who has the stress, if you like, to determine whether or not that stress would be the sort of thing that could stress them enough to cause a heart attack. It is useful to recap here that Ryder, the counsel for Tomlinson’s family, appears to have two arguments running concurrently: first, that Tomlinson died of internal bleeding, but second, if it is found that he did die of a heart attack, it would have been triggered by his encounter with Harwood. 11.18am: Again, when Patel found puncture wounds on Tomlinson’s legs, police asked him whether it could be a dog bite and told him there was broken glass in the area. Patel decided the injury was inconsistent with a dog bite and was likely to have been caused by broken glass. Cary has given his view: I thought it was likely to be a dog bite. You don’t get puncture wounds quite circular and deep like that, and it immediately makes you think of the canine tooth of a fairly large dog. 11.07am: Ryder is questioning other aspects of Patel’s findings. Last Tuesday, Patel said he concluded that a linear bruise on Tomlinson’s thigh was “more likely” to have been caused by falling onto an elongated object than by a baton strike. Ryder: When you saw the mark, what was your view, and we are talking about the linear mark, 14cm by 6cm on the left thigh? Cary: I thought it was a classic baton strike … indeed, I am an examiner for the Royal College of Pathologists and it is the sort of thing I would show to a pathologist taking an exam [and] I would expect them to come up with a spot diagnosis: “looks like a baton strike.” Cary said the nature of the injury was inconsistent with falling onto a linear object. 10.55am: According to Cary, this new expert report is crucial. He said it constituted new “clinical” evidence that the newspaper seller did not die of a heart attack. Cary: This is the case where there is really only one realistic possibility. Ryder: Which is internal bleeding? Cary: Which is internal bleeding. 10.52am: Cary: It doesn’t matter how you look at this case, whether you look at the heart and the coronary arteries or heart, you look at the ECG traces and clinical status, you come to the same view: Mr Tomlinson did not die due to a so-called heart attack, or arrhythmic heart attack, due to coronary artery disease. 10.49am: Judge Peter Thornton QC has asked Cary to clarify what this expert evidence now shows. Thornton: Is Dr Channer saying that a person who has had ventricular fibrillation, the wobbling of the heart [the kind of heart attack that Patel said Tomlinson died from], he will not have this kind of ECG reading? Cary: In essence, yes. 10.46am: Ryder opened with something new and potentially extremely significant. When Tomlinson collapsed, paramedics and, later, an ambulance worker, connected him to a defibrillator . This gave ECG (electrocardiogram) readings (picture the zigzag lines you see on a beeping heartbeat screen). Patel’s view was that Tomlinson died of an spontaneous arrhythmic heart attack, caused by “ventricular fibrillation” (a fast, irregular wobble of the heart). Patel conceded that he was not an expert, but said the ECG readings showed at times “chaotic” activity in the heart, which he said supported his theory. The paramedic ECG charts showed Tomlinson had something called “pulseless electrical activity” – meaning electrical activity in the heart, with no pulse and no beating heart. Another expert, Professor Kevin Channer , from the Royal Hallam Hospital in Sheffield, has produced a report on Tomlinson’s ECG chart readings. He found the ECG readings showed normal activity. Crucially though, Channer said that pulseless electrical activity was inconsistent with ventricular fibrillation (the type of heart attack Tomlinson was said to have died from) . 10.25am: We’re about to begin. Dr Nat Cary is on the witness stand. We are starting where we left off on Friday – he is being questioned by Matthew Ryder QC . 10.18am: There are some delays here this morning – legal issues that will become apparent soon. I guess we’ll be another five minutes or so. 10.14am: Day 14 of the Ian Tomlinson inquest is about to start. We have about four days of evidence left. Last week came down to two divergent medical opinions on the cause of Tomlinson’s death at the G20 protests on 1 April 2009. 1. Dr Freddy Patel, the first to conduct a post mortem on Tomlinson’s body, said the 47-year-old died of a spontaneous arrhythmic heart attack. Patel reached that conclusion through a “process of elimination” after being unable to find the source of internal bleeding into Tomlinson’s abdomen. Patel’s credibility was brought into question when it emerged that he had twice been suspended by the General Medical Council for professional misconduct and dishonesty. You can read his evidence over the last three days here , here and here . 2. Dr Nat Cary, the second pathologist to examine Tomlinson’s body, said he had died of internal bleeding as the result of a “blunt force trauma to the abdomen”. He said the way Tomlinson fell to the ground after being shoved by police officer Simon Harwood would account for that injury. A heart specialist, he dismissed Patel’s heart attack theory. Two other forensic pathologists who examined Tomlinson’s body, Dr Kenneth Shorrock and Dr Ben Swift , also found the newspaper seller died of internal bleeding. You can catch up on Cary’s evidence here and here . Ian Tomlinson Police London Protest G20 Paul Lewis guardian.co.uk

Posted by on April 18, 2011. Filed under News, Politics, World News. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.