Thursday, August 19, 2010

Reflections on Truth : The strange case of Messrs Teoh Beng Hock and Mrs Porn

A close analysis of yesterday’s testimony juxtaposed against the available data reveals a novice trying to demystify the inscrutable through home-cooked clairvoyance and hocus pocus..Despite her strident condescending assertions, the evidence suggests that she is generalizing and making ill-informed assertion to push a specific agenda. Without compromising the integrity of my research, I will juxtapose several of her purportedly ‘scientific’ claims with the available data and let you, the reader, be the judge as to whether, her assumptions stand up to scrutiny.

Claim 1 : Dr Pornthip said she disagreed with MACC expert witness Prof Dr Peter Vanezis’ earlier opinion that Teoh had landed on his feet and was conscious when he fell. She said Teoh was probably unconscious when falling as the first post-mortem report stated he suffered a cerebral edema.

Research evidence indicates cerebral trauma including oedema is a common phenomenon associated with falls:

Source : Chapter 2 : Fatal Falls From Heights : E.Turk in Forensic Pathology Review : Volume 5 (Michael Tsokos. ed): pages 26 - 38.

b.Gupta et al. (1982) found a 79.3% incidence of head injury in their autopsy study. Agalar et al. (1999) reported cranial trauma to be the major determinant of mortality in their series comparing injury patterns in survivors and non-survivors presenting to hospital. Isbister and Roberts (1992) concurred that head/face injury represented the single most fatal injury, and in his series, 76% of falls deaths were attributable primarily to such injuries.In falls, brain injuries are a result of distortion of the skull and/or movement of the brain in relation to the skull (Gupta et al., 1982). Scalea et al. (1986) found contusion and oedema the most common finding in fallers with head injury....
Source : Free Fall Trauma by S.Tan and K.Porter in Trauma 2006 8: 157

c. Out of 27 patients with head injuries there were six with intracranial hemorrhage and eight patients with skull fractures. A significant difference (P10.05) between intentional and accidental falls was not seen. (This data was collated on survivors of suicidal and accidental falls)

2. Claim: Base Skull ring fractures are pathoneumonic indicators of suicide falls from heights. Absence of ring fractures indicates a causative agent other than suicide.

Evidence indicates otherwise:

a.At autopsy, severe injuries of the head like multiple skull fractures, ruptures of brain structures, and severe intracranial bleeding were seen in 34 cases (50%). A ring fracture of the skull basis (Fig. 2) was seen in one case. (This from a study on 68 medicolegal autopsy case of which 34 were suicides. Ring fracture incidence = 3% or 1 case out of 34)
source :Elisabeth E. Tu¨rk, MD, and Michael Tsokos, MD in The American Journal of Forensic Medicine and Pathology • Volume 25, Number 3, September 2004

b.There does not appear to be any specific injury that is pathoneumonic of either intentional or accidental fall. Roy-Camille et al. (1985) coined the phrase ‘suicidal jumper’s fracture’ to describe transverse fractures of the sacrum, and suggested that these injuries are usually associated with intentional falls. Several authors have observed the occurrence of this injury in jumpers but significant incidence in accidental falls has also been recorded (Ganssien et al., 2000; Richter et al., 1996; Isbister and Roberts, 1992). Insufficient evidence exists to support the premise of it being peculiar to a particular subset.

b.There is no fracture that is typical of a suicidal jump. Fractures of the sacrum, that might be typical according to Roy-Camille et al, were only found in five of our patients, three of them after suicidal jumps.

Corollary Question to Mrs Porn : What if he accidentally fell through an open window in a sleep deprived state and NOT jumped?

Data supporting this postulation:

Accidental falls from buildings tend to be rare events; when they do occur they usually involve children or youths, occur in the summer and result in severe injuries and sometimes death. The extent of these injuries depend in part on impact velocity, the surface landed upon, the orientation of the body on impact and the age of the person who fell. Head (depressed skull fracture, cerebral contusion, intracranial hemorrhage), thoracic (pulmonary contusion, ruptured bronchus or aorta, sternal fracture resulting from hyperflexion of the chin), spinal (burst vertebral bodies) and abdominal (shearing of the bowel at the junction of fixed and mobile portions) injuries are common, although skeletal injuries predominate.

3.Claim : On the marks on Teoh’s neck, Dr Pornthip said the size of the haemorrhage was not due to manual strangulation and that injuries of that size required MORE FORCE THAN A MAN COULD EXERT. She said the injury COULD NOT have happened during the fall, adding that it could have been a result of someone placing something against the neck or pushing the head down against something.

Response from the data:

a. As to the question if someone fell or jumped over by himself or has been pushed over by another person, in falls from heights some findings usually proposing infliction by another person can be quite misleading. For example, in falls from above 10 m, neck injuries like hematoma of the ventral neck muscles and fractures of the hyoid bone and the upper horn of the thyroid cartilage were seen in 33% of the cases.This finding is usually strongly indicative of strangulation and should direct the forensic pathologist’s thoughts into the homicide direction,but our results suggest that in cases of falls from great heights, this interpretation should be taken with considerable caution. (see also 1a above)
source :
Pathologic Features of Fatal Falls From Height
Elisabeth E. Tu¨rk, MD, and Michael Tsokos, MD in The American Journal of Forensic Medicine and Pathology • Volume 25, Number 3, September 2004

b. Human bodies are composites of many tissues and organs with different elasticities, viscosities and resistances to deceleration forces. In addition, these tissues and organs do not impact in their entirety all at once: each organ and structure has a different deceleration distance depending on its position and moment relative to the body parts making initial and subsequent contacts. Furthermore the transmission of forces at contact may be in the form of compression, distraction, rotation, shearing or a combination thereof (Maull et al., 1981; Buckman and Buckman, 1991). The energy imparted to different tissues and organs of the body at impact is therefore different for each tissue and organ. It depends not only upon the kinetics of the free fall but also on the biomechanical situation of the different body parts and the intermolecular resistance of the tissues to these applied forces.

c. Source : same as 1 (a)

Watch out for my next instalment as my unveil more discrepancies in that testimony before I stitch the available evidence to show what it is actually pointing at.
Revert : I guess this titbit below got thrown out of the window:

She added that marks on Teoh’s neck region looked like he had been strangled manually.“The contusion of the skin on the right side of the neck looks round, indicating it might have been caused by fingers,” she added.:
cos it would left her looking like the street punk of her desires as any self respecting patho with a basic 101 knowledge would know that the hyoid bone would have fractured in a strangulation so what to do but tukar theorylah......hahahaha (ROFL)
Buffalo: mooooooo.......master. Not bad so far for a brown skinned native Malay farmer who was a former physician....mooooo....Mahidol is number 30 in Asia according to QS and no 18 in Life Sciences (also by QS). I see... 1+8+3 = 12 =1+2 = 3 i.e top 3 in Asia moooooooooooooooooohuhuhuhuhuhuhuhuhuhuhu
Note : All references will be cited in my final instalment.

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