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“I’m Not Dead Yet!” Forensic Pathology in the Living.


by Stuart Hamilton MB, ChB, BMSc(Hons) FRCPath MFFLM. Everyone “knows” what forensic pathologists do. We examine dead people, chase criminals,interview suspects, and become involved in complex love triangles with a zookeeper attempting to poison a rival with tiger bile and an alcoholic detective with a broken marriage but a good heart.

Except we don’t. We do examine dead people, quite often. We write reports, a lot. We give evidence in court, also a lot.

Forensic pathologists are considered to be experts (in the true legal sense) in determining medical causes of death, and in homicides a recent ruling would suggest that we are the experts1.

But that means that we look at injuries. Thousands of injuries. We are very good at offering expert opinion on the nature and likely causation of injuries. Injuries are largely the same in the living in the dead. A bruise is a bruise, a patterned abrasion is a patterned abrasion.

Forensic Pathologists are used to giving evidence, considering possibilities, and understand the precise implications of a given phraseology. We are painfully aware (spoiler alert) that people don’t always tell the truth, even when attending hospital or talking to police officers. That is even if the person isn’t so inebriated that they can’t recall what happened. 

All too often I’m instructed in a case to discover that the prosecution “expert” is a doctor who’s seen a patient in the Accident and Emergency Department and has said that the injuries are “consistent with the account”. Or even more often written by a doctor who didn’t see the patient, or photographs of the patient, and is working from the medical records.

Let’s deconstruct that for a moment. I’m not for one minute criticizing the excellent work done in our emergency departments every day. I couldn’t do that job and I admire those who have the ability and dedication so to do. But someone’s liberty may be at stake.

Doctors in A & E have to assess patients quickly for life-threatening injuries or those that need treatment. By and large, they aren’t trained to record all findings in “forensic detail.” Even if they were they wouldn’t have time to do it.

There is a definition for “consistent with” in the Istanbul Protocol2, which is “the lesion could have been caused by the mechanism/pathology described, but it is non-specific and there are many other possible causes”. It should be readily apparent that this means that something may have happened that way. But “may” is a long, long way from “did.”

The forensic pathologist has the luxury of time to consider the injuries, and the expert will be given a wealth of material relating to the alleged offence that isn’t available when someone lands in hospital bleeding.

So what do you get from us? A detailed report, detailed consideration of the relevant accounts, and a person trained to stand up in court and defend their position. All too often inexperienced middlegrade doctors are stood up to give evidence and then get savaged by a well-briefed barrister supported by an expert passing notes from behind.

So what would I need to give an opinion?

The simple answer to that is “whatever you have”. Witness statements, defence case statement, medical records, ambulance records, but most importantly photographs. Ideally photographs will be taken of the injuries by a Crime Scene Investigator or Police Photographer in good lighting with a scale on each injury to indicate size and taken in such a way that the location on the body can be readily identified. This is, of course, an ideal situation. All too often we get a blurry image taken on an officer’s Blackberry device, but we’ll work with what we get

As an anecdote, I gave evidence in an alleged rape where the “other expert” when confronted by my report backed down, said “I’ve only been doing this two weeks and I’m not really an expert”, and that was that. That’s not to say my report was amazing, it was fairly standard, but such is the power of the trained expert.

I can’t always say that we will support your case, we are “independent experts to the court” after all, but at worst you’ll get a reasoned explanation why the client’s account doesn’t hold water.

I suspect that most people reading this work for the defence, and I certainly do a lot of defence work in this arena, but we can also do prosecution reports. I recently gave prosecution evidence in a successful attempted murder conviction.

So even if your client isn’t dead, someone like me may be useful!

Take Home Messages

• Pathologists can give expert opinion in the causation of injuries in the living as well as the dead.

• Balanced expert assessment of injuries involves examining all accounts, not just what the complainant says.

• Pathology evidence can be useful both to prosecution and defence in Offences Against the Person cases.

• Good quality photographs are the best thing for the expert to see, along with relevant statements and medical records.

1. Clarke & Anor, R v [2013] EWCA Crim 162.
2. The Istanbul Protocol [Sect V, D, 187, A-E], United Nations: Geneva, 1999.

Stuart Hamilton is a Home Office Registered Forensic Pathologist. He undertakes forensic autopsy examinations and expert interpretation of injuries in the living with associated expert evidence in courts. He has been consulted at both national and international levels.

Contact: Dr. Stuart Hamilton
East Midlands Forensic Pathology Unit
Level 3, Robert Kilpatrick Building, Leicester
Royal Infirmary, Leicestershire, LE2 7LX
Tel: 0116 252 3220
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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