Radiographs — X-rays reinterpreted by the Panel
The prosecution’s claim: Plain chest and abdominal X-rays taken around the time of several collapses were described at trial as showing gas in unusual places — consistent, the Crown said, with deliberate injection of air into lines or deliberate over-inflation of the stomach via an NG tube.
Prosecution claim
Plain chest and abdominal X-rays taken around the time of several collapses were described at trial as showing gas in unusual places — consistent, the Crown said, with deliberate injection of air into lines or deliberate over-inflation of the stomach via an NG tube.
Counter-evidence
The Panel and paediatric radiologists reviewing the same films describe the appearances as non-specific — and, in the cases where they were relied on, as explicable by the treatment that preceded them. For Child G, every X-ray showing gaseous distension was taken after bag-and-mask ventilation had been given. For Child Q, the '++ air' aspirated from the nasogastric tube was most likely introduced by the bagging that came immediately before the aspiration; the Panel's finding in that case is early NEC or sepsis. Intraluminal gas in the gastrointestinal tract is in any event typical of critically ill preterm infants, particularly those developing necrotising enterocolitis, and gas in the hepatic vasculature is a late-stage finding in NEC that does not imply injection. The radiological inference the Crown drew from these films is, at best, ambiguous — and at worst a picture of the resuscitation rather than of the alleged crime.
Key point: The radiographs show findings that are routine in sick preterm infants — and, where air was found, findings that a bag-and-mask resuscitation minutes earlier is enough to explain. They do not, on their own, establish any deliberate act.
What the jury heard
Expert witnesses described specific X-ray findings as consistent with air injection. The jury was shown annotated images.
What the Panel says
The Panel found no evidence of air injection on the films. The gaseous distension relied on at trial follows bag-and-mask ventilation — every Child G film showing it was taken after bagging — and the air aspirated from Child Q's nasogastric tube was most likely put there by the bagging that preceded it.
What independent experts add
- Portal venous gas in NEC is a well-described phenomenon.
- Intraluminal bowel gas is routine in critically ill neonates regardless of cause.
- Pneumatosis intestinalis (intramural bowel gas) is the diagnostic radiological feature of necrotising enterocolitis; the Panel's NEC finding among the indicted babies is Child Q, whose picture it reads as early NEC or sepsis.
- The annotation methodology used at trial — pointing to specific findings without a structured differential-diagnosis frame — is itself a documented methodological problem identified by independent paediatric radiologists in the post-conviction re-readings.