Thread by @dhadjowa

Day 17 of the coronial inquest into the death in custody of Veronica Nelson. Today, Medical examiner Dr Yeliena Baber will give evidence. Court will resume at 11am. You can listen in online via the link, or follow here for updates #JusticeForVeronicaNelson csvic.webex.com/mw3300/mywebex…

Content warning: Today's evidence and the related tweets in this thread include details from the autopsy findings after Veronica's passing, and many of these are distressing.
#JusticeforVeronicNelson

Counsel Assisting commences questions, and Dr Baber, who did the autopsy report, goes through her descriptions of Veronica being "very malnourished”& explains that her findings in the report referred to loss of muscle and fat, says this would have been "progressive, not sudden."

Dr Baber gives evidence that Veronica's body was weighed immediately on arrival at the mortuary on 2 Jan 2020 and her weight recorded as 33kgs. This is 7.7kg lighter than the weight recorded by Dr Runacres at Veronica's prison reception medical intake #JusticeForVeronicaNelson

The Court has previously heard evidence from Registered Nurse, Stephanie Hills, that Dr Runacres did not actually weigh Veronica, and that she was so unwell that she remained in the chair during that prison medical assessment #JusticeForVeronicaNelson

CA: Can there be a loss of body weight after death and before that time [arrival at mortuary]? She [Veronica] was believed to have passed between 4am and 8am...
Dr Baber: No significant loss... Nothing that would really register in terms of kgs
#JusticeForVeronicaNelson

CA: Could she [Veronica] have lost any significant weight between [when weight recorded in prison] and when she passed away [33-38 hours later]?
Dr Baber: No
CA: Would it have been possible for her to have lost 7.7kg in that timeframe?
Dr Baber: No

Asked about Veronica's BMI of 12.9 in autopsy findings, Dr Baber says, “Tells you she is grossly underweight, normal BMI is around 20. If you saw someone with a BMI of that, you would be immediately thinking, what is their nutritional status? How have they come to be that light?”

Dr Baber continues, “Just from looking at her [Veronica], you can see she is very thin and underweight. [BMI] is another pointer that she is probably undernourished” #JusticeForVeronicaNelson

Asked about the possibility that Veronica had fallen while in prison, Dr Baber gives evidence that she was not able to determine this post-mortem, and that the absence of bruising does not mean no fall occurred #JusticeForVeronicaNelson

CA: Are you able to conclude from the fact you found no injury that [Veronica] didn't have a fall or unable to say?
Baber: No, it's possible she may have had a fall & not sustained any significantt injury. Or that she died within a rapid timeframe of fall so no bruising developed

CA: If she passed relatively soon after a fall occurred you wouldn’t necessarily see any bruising?
Baber: Correct
CA: Why is that the case?
Baber: It can take some time to develop, post-mortem… plus Veronica had dark skin which would hide any signs of early bruising

CA: You stated in your first report that the cause of [Veronica's] death is complications of Wilkie syndrome?
Baber: Yes
CA: It is an uncommon disorder
Baber: Yes, I’m not sure of exact figures, but it is quite rare

CA: Wilkie syndrome can result in malnutrition, dehydration with electrolyte disturbances?
Dr Baber: Yes

Info on Wilkie syndrome, a rare cause of intestinal obstruction can be found here: ncbi.nlm.nih.gov/pmc/articles/P…
Dr Baber says this is "more common in very thin people"

CA: How can [electrolyte readings] help you in drawing conclusions about the cause of death?
Baber: They can [be a] guide as to whether someone was dehydrated or whether they were in renal failure, or whether the changes are just due to decomposition.
#JusticeForVeronicaNelson

CA: Do some of these results indicate to you that Veronica was suffering from dehydration?
Baber: Yes…

Dr Barber goes on to explain results and states, “[Results] would indicate that there was some dehydration at the time of death.”
#JusticeForVeronicaNelson

Asked if there was anything else that would lead Dr Baber to find that Veronica was dehydrated at the time of her death, Dr Baber gives evidence that possibly her sodium levels being high in the normal range might also indicate this

CA: Are you saying that results are supportive of a finding of dehydration, but you can’t put it any higher than that?
Dr Baber: Yes, I would agree with that
#JusticeForVeronicaNelson

Counsel Assisting (CA): You accept that Veronica was suffering from malnutrition
Dr Baber: Yes
#JusticeForVeronicaNelson

Dr Baber is asked about reports [other medical opinion] & whether on reflection, it may have been more prudent to give cause of death as complications of Wilkie syndrome in the setting of withdrawal from chronic opioid use. Dr Baber says, "Yes" & confirms this is now her opinion.

Counsel: And do you say that's a change in opinion [re cause of Veronica's death] or simply a clarification, in your opinion?
Dr Baber: I’d say a clarification
#JusticeForVeronicaNelson

Dr Baber expands:"Because both Wilkie Syndrome & chronic opiate use & withdrawal, both these conditions involve vomiting & fluid loss & electrolyte loss to varying degrees. So it's not possible to actually determine which of those contributed more to her state of malnourishment."

Dr Baber states: "I felt it was more urgent to actually have two of those conditions [Wilkie Syndrome and opiate withdrawal] together as the cause of death."
#JusticeForVeronicaNelson

Counsel: Are you effectively saying she [Veronica] died of malnutrition?
Dr Baber: Yes, I would say that's the end point from both of these conditions [Wilkie's Syndrome & opiate withdrawal] together
#JusticeForVeronicaNelson

Counsel: And so would it equally be said by you that she died of withdrawal from chronic opioid use in the presence of Wilkie Syndrome? Could you turn it around?
Dr Baber: Yes
#JusticeForVeronicaNelson

CA: Is it your position.. that malnutrition was the most significant causative factor in Veronica’s passing?
Baber: Yes, I think the long-term malnutrition then with acute period of being in a state of opiate withdrawal in the last day or two. So malnutrition would be main cause

CA: From looking at her body after passing.. [can you] determine whether malnutrition would have been apparent before [Veronica] passed?
Baber: Yes because she was incredibly thin..certainly my first impression of her was that’s a very, very thin lady, so yes it would be apparent

CA: Would it also have been possible to remedy to some extent any electrolyte imbalance?

Dr Baber: I really can’t answer that. I think it would be misleading the court if I gave an opinion on that

#JusticeForVeronicaNelson

CA refers to an expert report authored by Dr Sally Bell for the Coroner, which states "given the lack of post mortem evidence of aspiration pneumonia, it is more likely [Veronica] died from electrolyte disturbance caused by recurrent vomiting resulting in a cardiac arrhythmia."

CA: Is this consistent with what you just told his Honour to be [Veronica's] cause of death?

Dr Baber: Yes, it’s entirely consistent.

#JusticeForVeronicaNelson

CA refers back to the earlier qs she asked Dr Baber about Veronica's recorded weight in the autopsy report.

CA: Would it have been possible for Veronica to have lost 5kgs in the 36 hours prior to that weighing?

B: No, not in terms of her body weight. No, not at all...

CA asks Dr Baber if an accurate proposition of Veronica's cause of death is "complications of withdrawal from chronic opiate use and Wilkie Syndrome in the setting of malnutrition."

Dr Baber: Yes, I would be in agreement with that.

#JusticeForVeronicaNelson

Mr Woods, Counsel for Percy Lovett, Veronica's Partner, is now asking questions. He informs Dr Baber that Percy will likely make a submission that Veronica's death was preventable and caused by grossly inadequate care.

#JusticeForVeronicaNelson

Mr Woods asks Dr Baber a series of questions about the use of the phrase 'natural causes' in her report, with the intention of clarifying what the phrase does and does not mean.

#JusticeForVeronicaNelson

Q: By using [the] phrase [natural causes], you're saying that the death didn't occur from, for example, ingesting significant drugs, a stabbing, a fire, or some sudden active physical trauma, but that it was something occurring internally in Veronica's body?

B: That's right

Q: By [the phrase] 'natural causes', you're not providing an opinion obviously as to whether or not Veronica's death was preventable. Is that right as well?

Dr: Thats absolutely right.

#JusticeForVeronicaNelson

Court is adjourned until 10am tomorrow, when we will hear evidence from the medical panel of experts.

#JusticeForVeronicaNelson

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