"A RECENT INVESTIGATIVE GUIDELINE SENT TO CANADIAN PATHOLOGISTS URGED THEM TO "THINK DIRTY" WHEN CONFRONTED WITH A POSSIBLE SIDS CASE, JUST TO BE SURE TO EXCLUDE ALL POSSIBILITY OF FOUL PLAY."
BRITISH BROADCASTING CORPORATION REPORT PUBLISHED FOLLOWING CONVICTION OF SALLY CLARK;
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Ontario's unique "think dirty" policy - circulated to coroner's and pathologists by former Chief Coroner Dr. James Young in 1995 - was noticed far beyond Canada's borders.
This is evident from a BBC report published after the conviction of Sally Clark in 1999 for the the murder of her two babies Christopher and Harry - within two months of each other.
By way of brief background, Wikipedia informs us that:
"Sally Clark (15 August 1964 – 15 March 2007) was a British lawyer," the Wikipedia account begins.
"She was the victim of a miscarriage of justice; her convictions in 1999 for the murder of two of her sons were quashed in 2003," it continues;
"Clark's first son died suddenly within a few weeks of his birth in 1996.
After her second son died in a similar manner, she was arrested in 1998 and tried for the murder of both sons.
Her prosecution was controversial due to statistical evidence presented by paediatrician Professor Sir Roy Meadow, who testified that the chance of two children from an affluent family suffering Sudden Infant Death Syndrome (also known as cot death in Europe or crib death in North America) was 1 in 73 million, when in fact it was closer to 1 in 200.
In an unusual intervention, the Royal Statistical Society wrote to the Lord Chancellor saying there was "no statistical basis" for Meadow's figure.
Clark was convicted in November 1999.
The convictions were upheld at appeal in October 2000, but after she had served more than three years of her sentence, they were quashed in a second appeal in January 2003, and she was released from jail.
Journalist Geoffrey Wansell called Clark's experience "one of the great miscarriages of justice in modern British legal history."
She was found dead in her home on 16 March 2007."
The BBC on-line story ran under the heading "Verdict reawakens cot death debate;"
"The Sally Clark case highlights the difficulties faced by doctors trying to judge between genuine cot death cases, and those in which a parent played a part," it began.
"Solicitor Mrs Clark was convicted of murdering her two babies Christopher and Harry - within 14 months of each other," the story continued.
"She said that sudden infant death syndrome (SIDS) was to blame for both.
Much of the available evidence on cot death is contradictory.
The court was told by one expert witness that the chances of the both children suffering cot deaths were one in 73 million.
However, cot death support and research groups point to strong evidence that families which suffer the trauma of a genuine cot death are at higher risk of suffering a second such tragedy.
The verdict will reawaken the controversy over whether doctors, and the statistical analysis they produce, are able to distinguish between genuine tragedy and foul play.
And parents who have suffered the trauma of cot death will be distressed that suspicions could be aroused, regardless of the presence or absence of clear physical evidence.
Medical catch-all;
The term "sudden infant death syndrome", as with many other medical syndromes, is a catch-all term, used in this case to describe any death of an baby which remains unexplained - even after a full post mortem has been carried out.
However, research suggests that some form of maltreatment, either deliberate harm, or simply cases of poor care or neglect is probably to blame in a small percentage of cot death cases.
A government study, known as the confidential enquiry into sudden deaths of infants, looked at deaths in the UK between 1993 and 1996, and put the figure at six percent.
Another University of Sheffield-based study suggested that only a total of 2.5 per cent of deaths were either infanticide, or suspicious.
The fall in cot death rates over recent years means that cases are subject to more scrutiny than before.
There are few telltale signs for the pathologist to spot.
The presence of bleeding in the lungs has been taken by some as a clear result of smothering of the child, but many commentators say that this is an unreliable method of diagnosis.
So, are some parents still getting away with murder?
Sir Roy Meadow, head of the Department of Paediatric and Child Health at St James' Hospital, Leeds, looked at 81 cases of children in which the courts had found the parents guilty of killing them.
He found 49 of these had originally been certified as cot deaths following post mortem.
He wrote in the journal Archives of Childhood: "SIDS has been used, at times, as a pathological diagnosis to evade awkward truths."
'Think dirty';
A recent investigative guideline sent to Canadian pathologists urged them to "think dirty" when confronted with a possible SIDS case, just to be sure to exclude all possibility of foul play.
The Foundation for the Study of Infant Deaths is at pains to stress that the vast majority of cot deaths are natural - in fact, it says it has evidence that one family every year in the UK loses a second child to the syndrome.
A spokesman said: "If a couple have a child who dies suddenly and unexpectedly the risk of it happening again does increase.
"The reasons for this are varied and range from metabolic disorders, to maltreatment and environmental and social factors.
"Certainly second cot deaths can be true cot deaths, where all other causes have been excluded."
The problem facing doctors confronted with an apparent case of cot death is that medical science simply does not conclusively know what causes it.
It is virtually impossible for them, in the absence of unequivocal signs of physical abuse, to rule it out entirely."
Harold Levy...hlevy15@gmail.com;
