The case of Kathleen Folbigg: medical expert testimony, a system failure

Perhaps we need to consider whether overwhelming bacterial infection caused the deaths of some of the Folbigg children.  It has been known that bacterial infection can contribute to the sudden and unexpected deaths of infants since the original Folbigg trial in 2003 and the appeal in 2004.

Cot death expert Professor Paul Goldwater writes that studies show that bacteriological findings at autopsy have been found in cases of ‘sudden infant death syndrome’.   Professor Goldwater states serious consideration should be given to recognised pathogens, especially Staphylococcus aureus, found in normally sterile sites, which may have a contributory role to an infant’s death.  Professor Goldwater says there is now a strong view that if an infant dies unexpectedly, it is more likely to be carrying pathogenic bacteria than a healthy baby.

Bacterial infection was accepted by superior courts to quash murder convictions around the time of the Folbigg hearings from April to August 2003 and the judgment in October 2003.  The role of infection was accepted in Sally Clark’s second appeal in 2003 where the court heard from Professor James Morris, an expert in the role of bacteria and bacterial toxins in SIDS.  Professor Morris stated that one of the Clark children, Harry, died from natural causes, and it was difficult to avoid the conclusion that the bacteria had contributed to the death.  The court noted Professor Morris’ conclusion that ‘overwhelming staphylococcal infection was the most likely cause of death’; and therefore, the conviction relating to Harry’s death was ‘unsafe’ and needed to be ‘quashed.’

I asked microbiology expert Professor Caroline Blackwell and Professor Goldwater to review the autopsy reports on Folbigg’s children and other material from the case that I obtained from the NSW Supreme Court.

Professor Blackwell noted that there was evidence of infections in two of the Folbigg children: Sarah and Laura.  The autopsy report concerning Sarah Folbigg showed petechial haemorrhage in lungs, pericardium and thymus.  Professor Blackwell said these findings in Sarah were consistent with sudden unexplained death in infancy (SUDI).  Sarah also had copious numbers of coliforms in the lungs, along with alpha haemolytic streptococci and some Staphylococcus aureus.

This view that Sarah’s death is consistent with a SUDI rather than suffocation is supported by the peer reviewed publications of Professors Goldwater et al and Weber et alon the role of infection in SUDI.

Professor Blackwell stated that Laura had increased lymphocytes in the lungs and plentiful numbers of coliforms in the lungs and the spleen, profuse numbers of alpha haemolytic streptococci and moderate numbers of Staphylococcus aureus. The increased numbers of lymphocytes in the lungs and spleen indicate that Laura had mounted an inflammatory response.

Professor Blackwell considers that infectious illness cannot be ignored as a potential cause of death of either Sarah or Laura.

Further, the post mortem report for Patrick Folbigg did not provide any evidence to support a finding of an unnatural death according to Professor Goldwater.  He said the autopsy findings for Patrick, who died aged eight months, were compatible with SUDI.

It was curious, as Professor Goldwater points out, that there was no attempt made to interpret the brain findings in Patrick’s post mortem.  He refers to the key findings that Patrick had a larger than normal brain for his age, including abnormal brain grooves along with cystic degeneration. Professor Goldwater says this is compatible with pathology often found in cerebral palsy: therefore a diagnosis of cerebral palsy could have been put forward.  Such a diagnosis for Patrick was not mentioned in any of the Folbigg judgments.

These expert opinions have never been presented to a court.  Perhaps they should be, and an injustice corrected.