Kota Kinabalu: The Coroner’s Court on Wednesday heard that Form One student Zara Qairina Mahathir’s injuries were consistent with a fall from height and showed no evidence of physical abuse.
Forensic pathologist Dr Jessie Hiu, the first deponent in the inquest, told Coroner Amir Shah Amir Hassan that based on her expertise, the distribution and nature of the injuries were not consistent with physical abuse.
“The injuries in this case are consistent with a fall from height. The injuries are caused by two mechanisms which are direct impact trauma and deceleration height injury.
“In this case, the direct impact trauma was to both knees. These are common findings in those who fall and land on their feet. The secondary impact trauma was to the left upper limb, sustained when she fell backwards, resulting in injuries to the left hand and forearm.
“The direct impact on the lower limbs caused force to be transmitted vertically upward, resulting in fractures of the lumbar vertebrae and injuries to muscle tissue,” she told the Coroner.
Dr Hiu was answering questions from Prosecution Deputy Chief II Datuk Badiuszaman Ahmad, who led the team of conducting officers in the inquest into Zara’s death.
She further testified that the deceleration injuries were due to the movement of the body and internal organs when the body landed on the ground.
“In this case, the bleeding in the brain was due to stretching and tearing of the blood vessels,” she said.
Dr Hiu further testified that there were six external and two internal injuries that can be seen which were stated in the post-mortem report.
Earlier, Dr Hiu, in reading out her witness statement in the open court, said: “Based on the scene examination at the deceased’s hostel, the measurement from the floor to the topmost horizontal metal rail attached to the concrete railing at the third floor, is 118cm.
“I was informed that the deceased’s antemortem height was 154cm. The difference between the deceased’s height and the topmost horizontal metal rail is 36cm. The height of the metal rail is more than three-quarters of the deceased’s height and is likely above her centre of gravity. (In females, the centre of gravity is generally located in the pelvic region, often just below the belly button in a standing position).
“Based on the measurements, in my opinion, it is unlikely that the deceased accidentally fell or was pushed from a standing position next to the concrete railing along the corridor.
“Based on the height and width of the concrete railing, the height of the horizontal metal rails, and the deceased’s antemortem height, it is possible for her to climb onto the concrete railing, cross over the metal rails and stand on top of the concrete railing.
Dr Hiu said on Aug 2, this year, she was requested to provide a professional opinion regarding the deceased’s antemortem injuries.
“I reviewed her medical records, including radiographs, CT and CTA scan reports and conducted scene examination,” she said, adding the scene examination was conducted on Aug 2, commencing at 12.30pm in the hostel block of the school in Papar.
Dr Hiu further said in her statement that Zara was admitted to Queen Elizabeth Hospital on July 16, this year, at 4.38am.
“Her condition was critical, with a Glasgow Coma Score of 3/15, indicating severe brain injury. She was unconscious upon admission. At 4.45am, a trauma alert was activated. Further clinical examination and imaging studies were conducted, which showed multiple injuries,” she said.
She also revealed that among the injuries were a scalp haematoma at the vertex, intracranial bleeding with brain swelling, hypoxic ischaemic encephalopathy, fracture of the distal part of the left radius, dislocation of the left wrist joint, bilateral comminuted fractures of the distal tibia, an open wound and fracture of the left ankle, comminuted fracture of the left calcaneum and fractures of the second to fourth lumbar vertebrae with left psoas muscle haematoma and pelvic tissue haematoma. Zara died at 1.07pm on July 17.
The cause of death was severe traumatic brain injury with hypoxic ischaemic encephalopathy.
On Aug 10, the post mortem examination was performed 11.25am in the Forensic Medicine Department at Queen Elizabeth Hospital (QEH), here.
The examination was conducted by Dr Hiu and another forensic pathologist, Dr Muhammad Uzair Ahmad Suriani, also from QEH, and Hospital Sultan Idris Shah’s pathologist Dr Khairul Anuar Zainup, and assisted by QEH medical officer Dr Lau Cheng.
On post-mortem examination, the body was in moderate to advanced state of decomposition.
Dr Hiu said exhumation of her remains were conducted on Aug 9 at Tanjung Ubi Mesakol cemetery, Sipitang.
The deceased was identified by her mother at the cemetery after the exhumation and before the post-mortem examination in Queen Elizabeth Hospital.
Dr Hiu said the state of decomposition of the body was consistent with the duration of burial in soil.
“Although the body was decomposed, the tissues except for the brain, remained fairly intact, allowing for both external and internal post mortem examination and documentation of injuries.
“The external and internal post mortem examination on the deceased showed a sutured laceration at the back of the head with no skull and facial bones fractures. Brain showed liquefactive changes due to decomposition and could not be assessed.
“The lower part of her left forearm, left wrist, left hand and left fifth finger were bruised with deformity of the left forearm and wrist due to underlying fracture of the left distal radius bone and dislocation of the wrist joint.
“There were bruises of the right ankle with comminuted fracture of the distal part of the right tibia (bone of right leg) involving the right ankle joint, laceration at the left foot, bruises of the left ankle and left foot with comminuted and oblique fractures of the distal part of left tibia and comminuted fracture of the calcaneum (bone of left leg and heel), dislocation of left ankle joint, fracture of the second to fourth lumbar vertebrae (lower back bones), “Psoas muscles hematoma and localised retroperinoneal pelvic tissue hematoma. These injuries are consistent with the injuries documented in the deceased’s medical records, CT scan, CTA scan and radiographs.
“Additional external injuries identified were a small abrasion on the back of the left forearm and another on the back of the left elbow. These injuries were superficial and did not show underlying subcutaneous tissue, muscles and skeletal injury.
“The distribution and nature of the injuries sustained by the deceased are consistent with fall from height.
“Reconstruction based on the injuries indicates that the deceased Ianded on her left foot, followed closely by the right, resulting in more severe injuries to the left heel and leg bones (comminuted fracture of the left calcaneum, comminuted fracture and oblique fracture of the distal left tibia).
“Following the impact, she fell backward, predominantly onto her left side, sustaining injuries to her left wrist, left forearm, left elbow and the back of her head.
“The force generated upon landing on her lower limbs was transmitted upward, leading to fractures of the fourth to the second lumbar vertebrae associated with Psoas muscles hematoma and localised retroperitoneal pelvic tissue hematoma.
“The impact on the back of her head, resulted in bleeding on the surface of her brain (subdural and subarachnoid hemorrhages). The bleed led to brain swelling and subsequent hypoxic ischemic encephalopathy (insufficient cerebral perfusion and oxygen supply as result of brain swelling) and death. These findings are based on antemortem CT scan report and her medical records.
“During the post-mortem examination, the brain exhibited liquefactive changes due to decomposition and could not be evaluated. The brain showed more advanced decomposition than the other internal organs, due to antemortem swelling secondary to intracranial bleeding, which caused parenchymal softening and hastened the liquefactive changes associated with decomposition.
“Additional internal injury observed during the post mortem examination was fracture of the sternum bone and adjacent costosternal joints. The fracture was not associated with overlying soft tissue hematoma, underlying mediastinal tissue hematoma and other injury. These features are consistent with a post mortem fracture.
“The external and internal examination of the neck, back of the chest and right upper limb showed no traumatic injury of the soft tissues, ribs, vertebrae, cervical spinal cord, right upper limb bones and laryngeal structures.
“The chest, abdominal and pelvic organs did not show any traumatic injury or significant disease process that could have caused or contributed to her death.
“There was an area of dark reddish skin discoloration at the lower posterior aspect of the abdomen. However, internal examination revealed no hematoma of the subcutaneous tissue and muscles to indicate trauma. The observed skin discoloration is more consistent with hypostasis - the settling of blood in the dependent parts of the body under the influence of gravity after death.
The conducting officers team had also tendered about 172 photographs pertaining to the case.
Forensic pathologist Dr Jessie Hiu, the first deponent in the inquest, told Coroner Amir Shah Amir Hassan that based on her expertise, the distribution and nature of the injuries were not consistent with physical abuse.
“The injuries in this case are consistent with a fall from height. The injuries are caused by two mechanisms which are direct impact trauma and deceleration height injury.
“In this case, the direct impact trauma was to both knees. These are common findings in those who fall and land on their feet. The secondary impact trauma was to the left upper limb, sustained when she fell backwards, resulting in injuries to the left hand and forearm.
“The direct impact on the lower limbs caused force to be transmitted vertically upward, resulting in fractures of the lumbar vertebrae and injuries to muscle tissue,” she told the Coroner.
Dr Hiu was answering questions from Prosecution Deputy Chief II Datuk Badiuszaman Ahmad, who led the team of conducting officers in the inquest into Zara’s death.
She further testified that the deceleration injuries were due to the movement of the body and internal organs when the body landed on the ground.
“In this case, the bleeding in the brain was due to stretching and tearing of the blood vessels,” she said.
Dr Hiu further testified that there were six external and two internal injuries that can be seen which were stated in the post-mortem report.
Earlier, Dr Hiu, in reading out her witness statement in the open court, said: “Based on the scene examination at the deceased’s hostel, the measurement from the floor to the topmost horizontal metal rail attached to the concrete railing at the third floor, is 118cm.
“I was informed that the deceased’s antemortem height was 154cm. The difference between the deceased’s height and the topmost horizontal metal rail is 36cm. The height of the metal rail is more than three-quarters of the deceased’s height and is likely above her centre of gravity. (In females, the centre of gravity is generally located in the pelvic region, often just below the belly button in a standing position).
“Based on the measurements, in my opinion, it is unlikely that the deceased accidentally fell or was pushed from a standing position next to the concrete railing along the corridor.
“Based on the height and width of the concrete railing, the height of the horizontal metal rails, and the deceased’s antemortem height, it is possible for her to climb onto the concrete railing, cross over the metal rails and stand on top of the concrete railing.
Dr Hiu said on Aug 2, this year, she was requested to provide a professional opinion regarding the deceased’s antemortem injuries.
“I reviewed her medical records, including radiographs, CT and CTA scan reports and conducted scene examination,” she said, adding the scene examination was conducted on Aug 2, commencing at 12.30pm in the hostel block of the school in Papar.
Dr Hiu further said in her statement that Zara was admitted to Queen Elizabeth Hospital on July 16, this year, at 4.38am.
“Her condition was critical, with a Glasgow Coma Score of 3/15, indicating severe brain injury. She was unconscious upon admission. At 4.45am, a trauma alert was activated. Further clinical examination and imaging studies were conducted, which showed multiple injuries,” she said.
She also revealed that among the injuries were a scalp haematoma at the vertex, intracranial bleeding with brain swelling, hypoxic ischaemic encephalopathy, fracture of the distal part of the left radius, dislocation of the left wrist joint, bilateral comminuted fractures of the distal tibia, an open wound and fracture of the left ankle, comminuted fracture of the left calcaneum and fractures of the second to fourth lumbar vertebrae with left psoas muscle haematoma and pelvic tissue haematoma. Zara died at 1.07pm on July 17.
The cause of death was severe traumatic brain injury with hypoxic ischaemic encephalopathy.
On Aug 10, the post mortem examination was performed 11.25am in the Forensic Medicine Department at Queen Elizabeth Hospital (QEH), here.
The examination was conducted by Dr Hiu and another forensic pathologist, Dr Muhammad Uzair Ahmad Suriani, also from QEH, and Hospital Sultan Idris Shah’s pathologist Dr Khairul Anuar Zainup, and assisted by QEH medical officer Dr Lau Cheng.
On post-mortem examination, the body was in moderate to advanced state of decomposition.
Dr Hiu said exhumation of her remains were conducted on Aug 9 at Tanjung Ubi Mesakol cemetery, Sipitang.
The deceased was identified by her mother at the cemetery after the exhumation and before the post-mortem examination in Queen Elizabeth Hospital.
Dr Hiu said the state of decomposition of the body was consistent with the duration of burial in soil.
“Although the body was decomposed, the tissues except for the brain, remained fairly intact, allowing for both external and internal post mortem examination and documentation of injuries.
“The external and internal post mortem examination on the deceased showed a sutured laceration at the back of the head with no skull and facial bones fractures. Brain showed liquefactive changes due to decomposition and could not be assessed.
“The lower part of her left forearm, left wrist, left hand and left fifth finger were bruised with deformity of the left forearm and wrist due to underlying fracture of the left distal radius bone and dislocation of the wrist joint.
“There were bruises of the right ankle with comminuted fracture of the distal part of the right tibia (bone of right leg) involving the right ankle joint, laceration at the left foot, bruises of the left ankle and left foot with comminuted and oblique fractures of the distal part of left tibia and comminuted fracture of the calcaneum (bone of left leg and heel), dislocation of left ankle joint, fracture of the second to fourth lumbar vertebrae (lower back bones), “Psoas muscles hematoma and localised retroperinoneal pelvic tissue hematoma. These injuries are consistent with the injuries documented in the deceased’s medical records, CT scan, CTA scan and radiographs.
“Additional external injuries identified were a small abrasion on the back of the left forearm and another on the back of the left elbow. These injuries were superficial and did not show underlying subcutaneous tissue, muscles and skeletal injury.
“The distribution and nature of the injuries sustained by the deceased are consistent with fall from height.
“Reconstruction based on the injuries indicates that the deceased Ianded on her left foot, followed closely by the right, resulting in more severe injuries to the left heel and leg bones (comminuted fracture of the left calcaneum, comminuted fracture and oblique fracture of the distal left tibia).
“Following the impact, she fell backward, predominantly onto her left side, sustaining injuries to her left wrist, left forearm, left elbow and the back of her head.
“The force generated upon landing on her lower limbs was transmitted upward, leading to fractures of the fourth to the second lumbar vertebrae associated with Psoas muscles hematoma and localised retroperitoneal pelvic tissue hematoma.
“The impact on the back of her head, resulted in bleeding on the surface of her brain (subdural and subarachnoid hemorrhages). The bleed led to brain swelling and subsequent hypoxic ischemic encephalopathy (insufficient cerebral perfusion and oxygen supply as result of brain swelling) and death. These findings are based on antemortem CT scan report and her medical records.
“During the post-mortem examination, the brain exhibited liquefactive changes due to decomposition and could not be evaluated. The brain showed more advanced decomposition than the other internal organs, due to antemortem swelling secondary to intracranial bleeding, which caused parenchymal softening and hastened the liquefactive changes associated with decomposition.
“Additional internal injury observed during the post mortem examination was fracture of the sternum bone and adjacent costosternal joints. The fracture was not associated with overlying soft tissue hematoma, underlying mediastinal tissue hematoma and other injury. These features are consistent with a post mortem fracture.
“The external and internal examination of the neck, back of the chest and right upper limb showed no traumatic injury of the soft tissues, ribs, vertebrae, cervical spinal cord, right upper limb bones and laryngeal structures.
“The chest, abdominal and pelvic organs did not show any traumatic injury or significant disease process that could have caused or contributed to her death.
“There was an area of dark reddish skin discoloration at the lower posterior aspect of the abdomen. However, internal examination revealed no hematoma of the subcutaneous tissue and muscles to indicate trauma. The observed skin discoloration is more consistent with hypostasis - the settling of blood in the dependent parts of the body under the influence of gravity after death.
The conducting officers team had also tendered about 172 photographs pertaining to the case.
