202401229 B2 - [2025] EWCA Crim 945

Dr David Ramsay, a Neuropathologist and Emeritus Professor in the Departments of Pathology at the London, Ontario Health Sciences Centre and Western University, London, Ontario, was also instructed to review the evidence on behalf of the Applicant. He concluded that the cause of Molly’s acute illness was undetermined. It might have been the result of an inflicted injury or, as suggested by some atypical features, an unidentified non-traumatic cause, such as the progressive expansion of a post-natal subdural haematoma and/or subdural bleeding associated with benign enlargement of the subdural spaces. Dr Ramsay accepted Dr du Plessis’ contention that the non-triad features of Molly’s case may provide independent support for the traumatic head injury hypothesis, but he posited other non-traumatic explanations. The lapse of time between injury and death rendered the interpretation of these features more difficult.

Dr Joseph Scheller’s evidence was that Molly did have a pre-existing condition that was apparent on her CT head scan carried out on 19 October 2005. In his view, the scan demonstrated the presence of excess fluid between her brain and inner skull. In his oral evidence, Dr Scheller clarified that this fluid was subdural rather than subarachnoid. It was likely responsible for her head circumference being greater than the 90^th percentile at the time. Although Molly could have suffered mild head trauma at any stage during the first three months of life, Dr Scheller’s opinion was that it was chronic and that “the only head trauma we can be sure she suffered was that of birth via a vacuum delivery.” Dr Scheller considered that the most significant injury that Molly suffered on 19 October was a subarachnoid haemorrhage, and that her severe retinal haemorrhage in the left eye could have been a complication of that, brought about by the excess pressure in the subarachnoid space – Terson’s syndrome. Dr Scheller also considered it to be significant that there was no evidence of external marks on Molly’s body when she was brought to hospital.

In cross-examination, Dr Scheller agreed that the presence of all three elements of the “triad” was suspicious, “but you must look for other evidence”. He disagreed with Dr du Plessis’ analysis of the spinal findings. As he put it:

“If someone throws a grenade into a house, 15 years later you can’t say what happened because too much time has elapsed between the grenade going into the house and all the damage being caused and your investigation 15 years later. … To bring a pathologist into the case simply makes no sense when the damage was all caused 15 years earlier.”