This morning the jury at Gaia’s inquest heard from the pathologist, Dr Russell Delaney, who conducted her post mortem and ascertained her cause of death. Dr Delaney has been a Home Office Registered Pathologist since March 2009, and he undertook Gaia’s post mortem on 19 November 2017 at Holly Tree Lodge mortuary in Boscombe, Bournemouth.
Senior Coroner Rachael Griffin first explored what information Dr Delaney had been provided prior to conducting the post mortem and he confirmed he’d access to a two page GP summary detailing Gaia’s pre-existing medical conditions and prescribed drugs. Dr Delaney also confirmed he’d spoken with Gaia’s GP Dr Gwinnett at some stage who confirmed that an MRI conducted on Gaia in 2015 did not identify any significant structural abnormalities. The Coroner asked Dr Delaney how the decision was made that he would not attend the scene where Gaia was found, and he explained that it was felt it was most appropriate for him not to attend the scene but make an assessment based on photographs and sampling in the mortuary:
RD: Each case has to be considered individually, some cases where it is beneficial for the body to remain in situ for longer period of time for examination at scene, there are other cases where it is considered more appropriate not to remain there. Factors in this case, weather conditions at the scene, where the body was, if you’re to take samples from the body at the scene the best time do that is before it has been moved, wherever it is.
Gaia’s body was deep in undergrowth. I’d not have been able to get there to do sampling in situ, or make any more of an observation than that which I was subsequently able to make on photographs. So to remove the body from where it was lying to somewhere where sampling could be done, would mean body would be in open air, it didn’t seem appropriate cause of action, because then you’re compromising any sampling you’re taking. Because body would be exposed to elements. If taking swabs to look for foreign DNA that would be compromised by being exposed to elements, for example.
Dr Delaney was provided with a briefing by Dorset Police prior to conducting his post mortem, he saw photographs of Gaia’s body in situ when it was discovered on the night of 18 November, and also of its recovery from the scene. Asked to summarise what he knew before conducting his post-mortem, Dr Delaney recounted:
RD: I was told that Gaia had a history of mental health problems, and recently her mental health had deteriorated. She had an appointment to see her GP on 7 Nov 2017
Coroner: at 17:00 hours is that right?
RD: yes ma’am. She’d suffered with epilepsy since the age of 14, and had experienced daily seizures. I was told at that stage she was treated with diazepam, lamotrigine, clobozam and tegretol [which he explained was a brand name for carbamazepine].
And she also suffered with post traumatic stress disorder. There was an incident a few weeks ago which provoked some anxiety, leading to a deterioration in her mental health. Her aunt, who she was staying with, who was trying to keep her calm…. had called police at 18:18 hours on 7 November, Gaia left around 16:30 in distress. Gaia attended a nearby address, she was described as behaving irrationally, and began undressing.
Coroner: can I just stop you there, want to cover one point prior to that, appreciate this is what you were told, matters clarified as matters go through, this isn’t direct evidence you can verify is that right?
RD: no this is information given to me as background at that time
Coroner: we understand her aunt had been trying to control her and calm her prior to the GP appointment, Gaia was becoming increasing distressed that she was pregnant, despite a negative test and the fact she was menstruating… had split from her boyfriend… [missed chunk] … that was when she ran out of the property
RD: Yes ma’am
Coroner: Then she ran to another address where she appeared to be behaving irrationally; she was acting in a highly sexualised manner is that right?
RD: that’s what I was told ma’am. Another person persuaded her to put her clothes back on, except her jacket. She left at 16:30… to visit another person… there’s CCTV on Morrison Road showing her going there at 16:39 hours, she’d not been seen since
Coroner: in respect of that, there was also some information provided that she was known to use cannabis and MDNA is that right?
RD: yes, MDNA is an abbreviation of the full chemical name for ecstasy
Coroner: do you know where that information came from?
C: and there was none of that found in her system?
RD: No MDNA, no, was cannabis.
Coroner: On 16th November a member of the public found an item of clothing in a field, near to where Gaia was found
RD: I was told it was approximately 1 mile away from the last sighting, and nearby to where her body found
Coroner: in relation to clothing and the history you were provided with, what were you told?
RD: that her clothing was spread as if she was undressing and walking towards the cliff top… skirt, vest top, leggings, knickers and bra and sock… a subsequent sock was found in an adjacent field. Shoes in field, clothing was undamaged and no blood staining.
Coroner: anything else you were told in respect of history before your examination?
RD: I was told the body was found in overgrown ground towards the cliff top, in steep downwards slope in gorse and bramble… weather at time of disappearance described as rotten.
Later in questioning, Caoilfhionn Gallagher, for Gaia’s maternal family confirmed again the details in the summary Dr Delaney had been provided, and what he had not been told. Dr Delaney confirmed that the GP summary he’d been provided included a table detailing major and minor conditions. Under major there was an entry on 14 December 2013 stating change in behaviour which was described as ongoing. A further entry, dated 22 October 2017 stated manic episode, unspecified also described as ongoing. Dr Delaney confirmed he had no further information about these episodes when he was preparing his reports.
Ms Gallagher then checked the information that had been provided to him in the november briefing by DI Dixey of Dorset Police, as recorded in Dr Delaney’s report of February 2018.
CG: first, you read out some parts of that report including reference to going to a GP appointment, her aunt trying to keep her calm, and reference to her childhood acquaintance. There are two other matters the family want to highlight. You mentioned PTSD?
CG: It’s written in the summary given by DI Dixey following “she suffered with PTSD linked to a previous sexual assault which was investigated but not actioned”?
RD: That’s what I was told yes
CG: were you also told in relation to the incident few weeks previously that provoked anxiety earlier… few weeks earlier she’d been engaging with a male on social media who sent images which led to flashbacks and deterioration of her mental health… that’s what you were told by DI Dixey?
CG: from report here, your second papagraph you refer to being told Gaia left the address in distress at around 16:30?
CG: we’ll hear later whether that is accurate or not, but that’s what you were told. You were also told her aunt called at 18:18, that’s what you were told?
CG: you were told nothing by DI Dixey about a call her aunt made 2hrs 36 mins earlier at 15:42? Or any other calls from family members between then and 18:18 were you?
CG: summary by DI Dixey, it appears you were told about the GP appointment on the day of disappearance?
CG: and her being preoccupied with that?
RD: I was told there was an appointment
CG: and her aunt was trying to keep her calm… you were told her aunt had been trying to control her and keep her calm?
CG: summary doesn’t make any reference to Gaia being due to see the police on that day, on 7 November, is that something you were told?
CG: doesn’t make any reference to family members raising concerns she’d gone missing without her medication, you weren’t told those things?
CG: if you had been told you’d have written it down in your report?
RD: yes its not my job to leave it out
It would appear that only partial information was provided to Dr Delaney, what is not known at this stage, is whether that was a known and deliberate omission, or the result of confusion and poor information sharing at the time. The Coroner pointed out that a number of these issues will be explored further as the inquest proceeds.
Dr Delaney explained to the jury the steps of a post mortem examination, starting with an external examination to “document general features, look for any signs of natural disease externally, any signs of injury, to look for any signs of surface contamination of body, and to look for evidence of post mortem change, decomposition or deterioration”.
I’ll not detail all of the findings. Dr Delaney found no evidence of a penetrating injury, a stab or gunshot wound for example, no evidence of a head injury, no injury to Gaia’s neck and no injuries he’d consider to be defence type injuries, no bruising or marks on the backs of her hands or forearms. He didn’t identify any evidence of mechanical injury to suggest an injury had contributed to her death.
One finding of note was that Gaia’s body was found naked, and that there was “evidence of the contamination of the surface of the body with vegetation and mud”. Dr Delaney noted there was mud on the soles of Gaia’s feet, and a small amount of blood on her right shin, inner part of her right foot and on top of her right big toe.
RD: To summarise her injuries, rather than give individual detail, were multiple fine scratches over the trunk and limbs. Some of those over lower legs and feet showed signs of bleeding, on surface, which gives indication they were sustained while she was alive.
Coroner: in relation to those scratches, what do you believe was the cause of those?
RD: their nature and distribution, given the lack of clothing, given what I could see in scene photographs and what was told about scene, are typical from fine scratches can see when body comes into contact with undergrowth and brambles and the like.
Some of the injuries also had, rather than bleeding in their depths, had a very dry and brown surface. They’re the, that’s type of appearance, that suggests hasn’t been long period of survival after they’ve been sustained.
Dr Delaney outlined the findings from the internal examination. Again I won’t detail the findings, bar the ones that he deemed most relevant and possibly, or probably, indicative of the cause of Gaia’s death.
RD: The heart was structurally normal; the lungs appeared normal; within the abdomen the stomach contained a small amount of bile, and on the lining of the stomach there were scattered small black spots. Which are called Wischnewsky spots, and they are a finding in which is not specific of, but strongly associated with deaths due to hypothermia
Coroner: they aren’t specific for hypothermia, can they indicate anything else then?
RD: they can be seen in acute stress reactions, which is most probably why they develop in hypothermia, although the exact reason they develop in hypothermia more than other stressful deaths is not clear
When they are seen, whilst not specific to hypothermia, is a marker to then consider whether or not their appearances fit with death that might be due to hypothermia, in conjunction with other signs that may also be seen. So for example, a negative finding I didn’t mention externally, is absence of frost erythema, which is reddening of parts of skin, often over joints of hips and knees which again is not specific for, but may be seen in, hypothermia
Coroner: apart from acute stress reaction that can cause these spots, any other thing that can cause?
RD: deaths due to alcohol and drugs, although described in literature, is not something I’ve encountered. By far and away the most common situation I’ve occurred are deaths due to hypothermia, or where hypothermia may have played a role
C: on the balance of probabilities then you consider those spots due to hypothermia?
RD: when consider the case as a whole, yes ma’am.
There were a number of other soft or weak signs that could also indicate hypothermia, including mild accumulation of fat in liver cells, and the absence of bleeding or inflammation in the pancreas, which Dr Delaney explained was unusual because the pancreas usually deteriorates quite rapidly after death, the fact that Gaia’s was well preserved might be an indication her body was cold, not just from hypothermia, but from being outside for a period of time.
Dr Delaney briefly recapped the toxicology results, as the court were told about yesterday, and he also discussed the findings from the consultant neuropathologist’s examination, nothing of which he felt was relevant to causation of death. Similarly he discussed epilepsy and its potential role or otherwise in Gaia’s death:
RD: the other neuropathological finding was in parts of brain were sunken neurons; neurons being word for nerve cells. That again is a non-specific finding, and could occur as consequence of what’s called an agonal change, or terminal change, changes in nerve cells because deprived of oxygen at end of life but [neurppathologist] felt she couldn’t exclude seizure activity prior to death with those changes.
On questioning from the coroner, Dr Delaney confirmed in the absence of a witnessed seizure, it is not possible to determine whether epilepsy contributes to someone’s death.
RD: strictly speaking, no ma’am. The epileptic seizure is in layman’s terms a disruption of electronic activity of the brain, you can’t assess after death, in same way that you can’t assess heart activity after death.
Can look for structural abnormalities that may have caused epilepsy, more often than not is no structural abnormality identified, is a functional problem rather than a structural problem. You may seen signs that you can attribute to seizure activity in other parts of the body, injury, for example, biting of the tongue, but that’s not specific, can see other forms of death in which someone may have bitten their tongue. Can also see someone who has had seizure in which no tongue biting has occurred.
In absence of witnessed seizure, there isn’t a way of determining with satisfactory degree of certainty whether someone has had a seizure immediately prior to death.
Asked about Gaia’s likely time of death Dr Delaney urged caution in interpreting what was known:
RD: I do have some wider knowledge of the estimation of time of death in general terms, and I would always urge caution in trying to be too specific in narrowing time frame down too much.
The Coroner asked Dr Delaney if he concurred with Dr Hall’s assessment given to the court yesterday, that it was likely Gaia’s death took place “somewhere between the 7th when she was last seen and 12 noon on 10th” and he responded:
RD: my view from my findings was death had occurred a number of days prior to discovery… not specific…. to empathise I don’t think I can put a number on it. It’s not inconsistent with her dying on the day she disappeared, and I don’t feel there’s anything more I can do to be more specific based on my findings.
Dr Delaney concluded that Gaia’s cause of death was 1a Hypothermia. He provided more information in his conclusion including:
RD: Overall I’m of the opinion died as result of hypothermia, note her body was naked and clothing recovered from nearby field. Paradoxical undressing is a feature of some hypothermic death, paradoxical feeling of warmth as result of confusion and changes as result of hypothermia. Is feature of some deaths due to hypothermia, but not all, in which before an individual dies they exhibit behaviour where gradually take their clothes off. This is a phenomena I’ve encountered before, well described in medical literature. It’s called paradoxical undressing. Seem unusual behaviour to do when cold, to take your clothes off, precise cause of it is not known, one of postulated causes is get paradoxical feeling of warmth as your brain function becomes altered when your brain gets very cold.
Another type of behaviour shown in hypothermia, called hide and die behaviour… individual suffering from hypothermia is noted to burrow into an enclosed space, sometimes outdoors, or indoors, goes under table or pulls furniture down on top of self, thought to be a primitive reflex. Precise cause not known, behaviour observed in some, but not all hypothermic deaths.
In this case it’s not clear whether removal of clothing was direct consequence of hypothermia, or consequence of deterioration in her mental health, with effects of undressing causing the hypothermia.
Location of her body may be as consequence of hide and die behaviour, or simply as result of disorientation and confusion in dark as result of hypothermia.
Coroner: or presumably as a result of mental health illness?
RD: yes ma’am or combination.
Brain identified shrunken neurons of blood cells, may have occurred as consequence of hypothermia, not possible to determine whether she suffered a seizure prior to her death.
The Coroner explored what hypothermia is and the cause in Gaia’s case, exposure to cold temperatures or weather exposure.
Coroner: for whatever reason. Am I right in saying her undressing led to her exposure to weather which led on to her hypothermia?
RD: that’s one possibility, it’s possible she has undressed because of her deterioration in her mental health and that that, has made her vulnerable to hypothermia. It’s also possible deterioration in her mental health has led to her being outside, exposed and cold and wet, regardless whether got clothes on or not, has become hypothermic, confused and as consequence has then taken her clothes off in hypothermic state. Gradual stripping off is typical of paradoxical undressing described in hypothermia.
C: both of those scenarios you’ve just mentioned stem from a deterioration in her mental health?
RD: yes ma’am
Coroner: third possibility, as I said, is that she chose to take her clothes off?
RD: that is possible, but its not something I can assist with its likelihood based on my findings
When the coroner explored the role of epilepsy further, Dr Delaney again exercised caution:
RD: I’m not sure I’m able to say what is likely, but what’s possible
Say for example, an individual with epilepsy is outside, with less than adequate clothing on, have a seizure, they’re alone, don’t get anyone to help them, because of the time it takes to recover from seizure they’ve got cold and wet, that might make them more vulnerable to hypothermia.
It is also possible, as a result of getting cold, that provokes an epileptic seizure that makes you less likely to survive hypothermia.
Either of those may have occurred, they may not, from my findings I cant assist with their likelihood.
Coroner: insufficient evidence on the balance of probabilities to say epilepsy was contributory factor to her death?
RD: yes it is a possibility… but cant say
Coroner asks about hypothermia
RD: I’m certain hypothermia has made a significant contribution to her death, it is sufficient to explain her death on its own. It could have acted in concert with epilepsy, but it need not have done.
Coroner: it’s enough in itself?
RD: yes ma’am.
On questioning by Ms Gallagher, Dr Delaney confirmed that Gaia’s injuries, scratches, may have been caused by her burrowing into the undergrowth, or could have been caused by her body falling into the undergrowth, and he couldn’t say which was more likely.
RD: Injuries reflect contact with undergrowth, I cant say by what means that contact occurred
CG: I understand. In respect of time of death, thank you for very clear evidence in respect of that, if another witness would state, medical evidence is likely she died on day of her disappearance, that would be an inaccurate summary of your evidence wouldn’t it?
RD: that would be someone else’s evidence and not mine
CG: thank you. You make reference in your February 18 report in bundle 1, p 5 of 12, under heading tattoos, could you describe the tattoo you refer to there on that page please.
RD: I’ve written in quotes “please meet me at the gate” and two red birds, was below her right breast
CG: that was the tattoo used to identify Gaia’s body
RD: that was the evidence I heard yesterday, yes
CG: please meet me at the gate is a quote on her body
CG: Thank you very much, those are all my questions Dr Delaney.
There were a number of questions from the jury for Dr Delaney, one of which he took the opportunity to again exercise caution about too heavily relying on some of the estimates of time of Gaia’s death that we heard yesterday, in relation to the toxicology reports he stated:
RD: drugs present are generally stable after death, heard yesterday from the toxicologist about reasons why blood levels may on some occasions not reflect blood levels in life; without knowing exactly when and in what dose those medications were last taken, I don’t believe we can use the blood levels to a satisfactory degree of confidence to determine at what point she died.
Coroner: so other than what we’ve heard you cant assist?
RD: well I can assist, in saying I don’t think it can be used to determine the date of death. Toxicology blood levels are not generally accepted way of determining time and date of someone’s death. There’s huge variability in how individuals will metabolise certain drugs and not knowing when last taken, can’t do a backwards calculation.
There were a couple more jury questions, including one about epilepsy but it was deemed more appropriate to put that to the epilepsy specialist the court were hearing from this afternoon. The final question was:
Coroner: Jury final question, in recorded examples of hide and die and effect of hypothermia, is it generally confused movement or deliberate movement. The way I interpret thequestion is if someone hides and dies is that usually deliberate or confused?
RD: precise cause is not known, it’s considered some kind of primitive protection mechanism, whether deliberate or part of hypothermic confusion state I don’t know and don’t think answer is generally known. Behaviour seen in some hypothermic deaths, some theories, no more than theories about why it occurs.
I can’t imagine how difficult it is for Gaia’s family to hear this evidence, especially knowing that her body was found, 11 days after she disappeared, only a mile away from where she was last seen. The inquest continues.