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What happened to Max O'Mara? Foreword We decided to present this case as a study of the manner in which the General Medical Council deals with Expert Witnesses no matter what is said in the public domain. Recently, Mr Finlay Scott Chief Executive of the General Medical Council UK fought to argue that experts should not have complete immunity. This case is a illustration as to whether Mr Scott and his colleagues practice what they preach. The complaint was screened out very early on without due attention to finer detail. Due attention should be paid to the criticisms of the General Medical Council made by Dame Janet Smith and the Public Policy Institute’s finding’s regarding the council’s ability to deal with complaints. These findings should be considered in tandem with the tale we are about to present. Mr Gary O Mara discusses his experience with the General Medical Council UK. He examines the transparent anomalies in General Medical Council Fitness to Practise Directorate report (FPD/2002/1582), concerning Professor David I Graham (GMC Number) of Southern General Hospital, Glasgow . It is clear that the General Medical Council UK has failed a very young child named Max O’ Mara, a wonderful little boy. This case is similar to Toth v General Medical Council. In this case internal documents found Finlay Scott admitting that the General Medical Council had in fact mishandled Mr Toth’s complaint. As a insult to the memory of Wilfred Toth, the General Medical Council ensured that Dr Jarman was able to “jump ship” as opposed to face a trial for professional misconduct. Similarly, in the case of Max O Mara, the General Medical Council can be seen to be nothing less than slipshod and careless. We therefore request that the General Medical Council reconsider their decision again with a view to ensuring justice is done once and for all. R Pal ( Editor) editor@nhs-exposed.com List of key personnel in the case: Max O’Mara, aged 5, (deceased) Helsinki Introduction The recent judgment in the Court of Appeal concerning Professor Sir Roy Meadow places added emphasis on the objectivity and reliability of medical witnesses. Rather than relying on the cult of the expert, transparent anomalies in medical statements should be scrutinized by competent authorities while not being blinded by reputation, brotherhood or knighthood. What is also important is that British doctors, who are often asked to provide expert opinions in matters abroad, should also be subject to serious scrutiny.
In 2002, the consultancy of David I. Graham became the focus of my complaint to the GMC, which subsequently published a series of statements. I request that, in the light of what has come out of the Meadow’s matter, the GMC re-visit my complaint and look at the correspondence and opinions again, thoroughly and objectively, with a view to safeguarding the honour and the memory of Max O’Mara; and that transparent anomalies in medico-legal consultations, when they occur, are fully investigated, with due regard to the facts in the case, by professional screeners, both Lay and Medical at the GMC. The details of medical events in Finland; Professor Graham’s unhelpful contributions to forensic medicine and his relationship with white coated rogues in Helsinki - who were straight out of central casting in a 60’s James Bond movie, as well as the GMC’s curious response to my complaints, form the basis of this paper. In 2002 I began to experience the parallel universe of the GMC. While I initially had no reason to doubt the integrity of the GMC - and they did share my pain – it did seem, however, that they just did not understand anything, or indeed want to understand anything about head trauma and aspects of pathology in the case. Their reporting was weak and ineffectual; while I wanted a proper hearing about the facts in the case, which I was not getting in Helsinki, notions of medical objectivity, intelligence and common sense were not, it seemed, part of the GMC’s practice. Max’s 3 death certificates and 1 addendum The result of the consultation case between David I. Graham (SGH), Dr. Anders Paetau (HYKS), Professor Matti Haltia (HYKS) and ex-Soviet-trained police surgeon, Dr. Erkki Tiainen was the publication of three (3) death certificates and one (1) addendum. The multiple death certificates related to various typologies of congenital brain disease; in one case a spontaneous bleed of a congenital, cryptic “varicose vein” in the child’s brain, unknown in pediatric forensic science and epidemiological circles, such was the brotherhood's determination to continue covering up a child’s death and clumsily try to close down the case. A brief summary of what happened to Max at a daycare center in Helsinki When Max was found by his teachers in the snow, in a government-run day care center in Helsinki, he was giving out a shrill cry and vomiting. Max was able to tell his teachers that he had been “bullied” and “hit” pointing to the forehead. The teachers did not call an ambulance or, apparently, find out what had happened to Max. Instead, they called Max’s mother, Eeva, to come and get the wounded child. When Eeva arrived, not long after, the teachers were either unable or unwilling to give any details of Max’s injury. By then, Max’s face had begun to turn blue and Eeva, grief stricken, rushed Max straight to hospital. On the way Max hemorrhaged in the brain – and suffered. There is ample evidence to suggest that Max was the victim of external violence to the head, supported by the clinicians and expert witness statements1. A Finnish lawyer’s view of Max’s cause of death investigation I asked my lawyer Mr. Heikki Salo, in Helsinki, to respond to fake police investigations, not conducted under mandated preliminary law (inquest) in Finland. This is an extract from the document: The deficiencies in the investigation may partly be explained by the fact that a preliminary investigation (inquest) was never even begun, which means that at no stage did the policemen even suspect (presume) that Max O’Mara’s injury and delay in his medical treatment might have had something to do with the way the day care staff had behaved. The investigative measures were not in accordance with normal preliminary investigation. Firstly, the daycare staff was heard more than a month after the injury and after the crime had been reported. Considering the serious nature of the matter this is unusual. There are three maps and six photographs of the site and a weather report. This can be considered unusually little when investigating events leading to the death of a child. The police left the hearing of the other children in the yard to phone calls made eight (8) weeks later to their parents. obvious that this information been obtained when it was still fresh, more and better information could have been obtained…. To show the reader how parallel universes exist in the matter in Finland, here is an extract from what the Finnish Police Commander Mr. Reijo Naulapaa had to say about Max’s case, to a self-serving, credulous Australian Federal government: I personally regret the grief and uncertainty about the cause of Max’s death has caused to his parents during his investigation, which lasted for several months. To establish a cause of death thoroughly, however, can sometimes take such a long time in Finland, this is due to a comprehensive forensic investigation, which always takes a long time in my country. In my opinion, however, the most important thing at the moment is that the cause of Max’s death has been established and that the parents can grieve properly for Max. A personal comment Let me say this: for anyone to insinuate that a thriving, intelligent, bi-lingual young boy of 5 was genetically asocial and brain diseased is a crime against all children; but to confect evidence, and discard legitimate forensic data, is even worse - and, as it appears, not easy to successfully accomplish, as the medics in Helsinki, and their expert witness in Glasgow, were soon to find out. Since Max’s death, three more children have died in government-run daycares in Helsinki. Since Max's death, three more children have died violent deaths in government-run daycares in Helsinki and environs. It is unknown who the children were (it's a state secret) but two were drowned and another child, who was mortally injured not more than a few kilometers from where Max was injured, was fatally crushed by steel poles left idle in the daycare yard. What we do know about the tragedies is that there were no apparent witnesses - like in Max’s case, to any of the tragedies; there was no media coverage2 and no public inquiry as to the state of Finnish childcare institutions. I am reminded of what the writer Czeslaw Milosz wrote about generalizations, ones that had justified destroying a race, a creed, an enemy class or, let’s say, the memory of a small child: The truth was in the detail, and the detail of the detail: the words, the deeds the date. Expert witness David I. Graham, a pathologist at Southern General Hospital, Glasgow – an unsolicited email Professor David I. Graham's initial involvement took place outside the consultative process. Soon after the first death certificate was published, and my subsequent investigations into transparent anomalies in the two autopsies, general and neuropathology, Professor Graham wrote an unsolicited email to my wife, Eeva, offering various advice about Max’s cause of death. Evidently, Professor Graham had obtained our name and email address via the bush telegraph and from colleagues in the USA. I immediately became suspicious when Professor Graham suggested we contact a colleague of his, a Professor Hannu Kalimo in Turku, Finland. Kalimo not only wrote for Graham’s Greenfield’s Neuropathology but he was also a close colleague of the two Finnish pathologists, Dr. Anders Paetau and Professor Matti Haltia, who were involved in the fake autopsies in Helsinki. I thanked Graham for his interest in the matter and did not hear from him again, that is, until he turned up as an expert witness for the State of Southern Finland. Max’s first death certificate - published in Helsinki During my investigations it came as no surprise to find out that the Finns had lost Max’s brain specimen for some 2 months; the sad spectacle was put down to an ‘administrative’ error. But soon after the brain was found again, Erkki Tiainen, Anders Paetau and Matti Haltia claimed they had found a (putative) congenital arterio-venous malformation (AVM) in the child’s brain specimen. They also claimed they could not find a contusion in the specimen. However, when I challenged the State of Southern Finland over the result, considerable backsliding began to occur. Firstly, the pathologists Haltia and Paetau destroyed Max’s brain specimen while they we discussing ‘problems’ associated with Max’s autopsy with their superior, Eero Saksela. This illegal and highly suspicious practice, it seems, passes muster in Helsinki. I also noted also that the congenital nature of Max’s (putative) brain disease, underpinning the AVM, was in a report by, yet another expert witness, a geneticist at HYKS hospital, in Helsinki, a Dr. Ilkka Kaitila. Kaitila was not Max’s doctor, however we now also know that Dr Kaitila was investigated for fiscal fraud at HYKS, but the police later dropped the charges. (Dr. Kaitila is still an expert witness for the TEO, the health watchdog in Finland.) According to hospital records, two police officers (Peltoniemi and Halinen) from Espoo police at Kilo had clandestinely visited Kaitila and requested a statement, which might confirm that Max had genetic abnormalities, causing a spontaneous bleed in the brain. Kaitila followed the police’s wishes and wrote a lengthy tome about Max’s genetics – which he was not in a position to discuss - he was not Max’s doctor. As readers can see from Max’s picture, he did have myopia, which the police surgeon Erkki Tiainen mendaciously used in an attempt to arrive at an already pre-determined cause of death, which was brain disease. As my lawyer Heikki Salo writes I have been informed that afterwards it has transpired that serious factual errors regarding, for example, a disease seen as a contributing cause of death (Stickler syndrome). If this is the case, this should lead by itself lead to a preliminary investigation and, in addition, to an investigation as to whether there have been wrongful actions in the cause of death determination and the related documentation. Writing incorrect documents is, as a rule, prohibited and a punishable offence. After I had obtained a copy of Dr. Kaitila’s report, I showed it to experts at Cambridge University who, in turn, wrote a short statement - enough for me to give some details to Kaitila’s superiors at HYKS. The upshot of events can be seen in the geneticist’s two statements here: Two genetic statements in relation to the death of Max O’Mara by Dr.Ilkka Kaitila, a geneticist at HYKS Helsinki:
When HYKS hospital executives found out about the ‘Kaitila’ syndrome,’ and the fact that Commissar of Violent Crime Jukka Kaski had made a clandestine visit to Kaitila’s rooms at the hospital and requested the fake report, HYKS executives requested Kaitila to invoice the police for his ‘services’ to children and retract his statement, while including in the hospital records details of the police’s illegal visit. (HYKS Ref –10-1050 370990). It should be noted also that, in my investigations, I have discovered that Chief of Violent Crime, Jukka Kaski, has been the investigative officer in other daycare cause of death investigations. At autopsy - The matter of Max’s massive thiopental infusions. The following extract written by Erkki Tiainen shows that he had sent
Max’s autopsy samples for forensic toxicology testing, but they
were never commented upon or included in State’s autopsy papers.
It constitutes a cover-up of forensic data and further evidence that the
Finns were engaged in criminal activities to cover-up Max’s death.
In response to Max’s missing forensic toxicology statements, the Finnish Parliamentary Ombudsman - the child advocate, Ms Riita-Leena Paunio intones In Finland forensic toxicology statements are not important; we know how Max died. What makes the cover-up worse: Erkki Tiainen merely moved on to genetics and microscopy - exclusively, to solve Max's cause(s) of death while leaving out toxicology data from the forensic investigation. In the circumstances, the childish attempt to cover-up spilt milk was not hard to expose, even for an ordinary layman like myself, with limited resources and a bunged-up word processor. The Finns, who have falsely dined out for years on their so-called human rights record, were caught in a forensic web of their own making and, in Max’s case multiple death certificates followed, and more children were to die violently as a result of unknown circumstances in daycare. As we shall see, this form of medical mendacity and overarching power of a heartless bureaucratic state - that will brook no dissent of any kind, meant nothing to the office workers at the GMC. It seemed that the GMC, desperate to avoid any conflict with Professor Graham and, no doubt, the Medical Defence Union, discarded any sense of ethical intuition whatsoever. As Cicero tells Salus populi suprema est lax – The good of the people is the chief law. Children were dying in daycare in Finland while the GMC were fiddling at their desks hoping the whole matter would go away. It simply did not occur to the Gt. Ormond St citadel that the State of Southern Finland, well known for their forensic expertise at home and, in such places as Bosnia and Rwanda, was relying totally on Professor Graham’s obvious medical fiction to get them off thin ice in Helsinki. The contrivance of a highly evolved forensic service in Finland, relying exclusively on a pathologist in a bat cave in Glasgow, who had no forensic qualifications whatever, did not seem to occur to anyone at the GMC, or for that matter in Finland. Pediatric euthanasia in Finland – including Max’s missing body parts Whether Finland routinely practices pediatric euthanasia and harvests body parts I cannot say. But it is obvious that, when one finds evidence that salient toxicology documents and hospital papers are omitted at autopsy, as well as in State’s papers, it suggests transparent anomalies in the matter. The history of Max’s intensive care treatment and secreting away of salient forensic data is instructive, because its absence undermines the foundations of the second autopsy namely the neuropathology statement, and, of course Professor Graham’s advocacy in the matter. The first autopsy – thiopental infusions Erkki Tiainen had the benefit of soviet-era medical training and spent his formative years, after graduating from the I.V Pavlov Institute in the former Leningrad, doing autopsies. As we have already seen, Erkki Tiainen has unusual forensic habits, which may not cut the mustard in best practice forensic circles. Humiliated in court over his views that smoking does not cause lung cancer, Tiainen’s claim to fame are his quick wit viz a viz Max’s missing forensic toxicology statements, hospital records. At autopsy, along with Erkki Tiainen, there was a Dr. Juha Ohman. Ohman was, in fact, chief of intensive at Toolo hospital - where Max received massive thiopental doses. Following successful surgery to remove a separate contusion hematoma and a subdural hematoma in the brain, Max was put into an induced coma, using Thiopental. Under Dr.Ohman’s curious management neither EEG nor blood serum monitoring were used during the infusions. The result was a catastrophe for Max, as well as for those who had to witness, over 15 days, the total physical destruction of the child, in situ. Thiopental is routinely used as a preferred sedative to execute prisoners in the USA and there is debate today about how much of the barbiturate should be used in the process. Thiopental, however, is seldom used there days as a sedative after surgery, simply because of its high toxicity; but after a bolus is administered, infusion rates of around 4 mg/kg/hr are thought reasonable and until such time as electrical silence/ burst suppression is achieved. However, Max did not receive EEG/blood serum monitoring and, when his infusions reached, after 3 days, 39/mg/kg/hr he suffered, not surprisingly, massive cardiac arrest and shortly after end-stage renal failure. The child, according to hospital papers, was originally prescribed by a Dr.Tarja Randell at Toolo hospital with up to 55mg/kg/hr of Thiopental. Herein lays the evidence from the hospital records, which proves the mendacity, at best, of the State of Southern Finland, Professor Graham, and even the GMC. The Finns try to mitigate the massive doses of thiopental given to the child by insinuating that Max was supposed to be in such critical condition only huge doses of thiopental would, somehow, save him. How they came to these conclusions, without having looked at the child’s hospital records, is hard to say, but the child’s ICP was mostly below 10. Extract from Max’s hospital records Toolo hospital, Helsinki: Thiopental infusions at continuous hourly rates ICP:6,5,3,2,1,10,9,11,11,11,12,14,14,16,13,15,10,13,14,13,14,12,7, Extract from Max’s hospital notes Toolo Hospital, Helsinki
Max’s heart stopped and was resuscitated the morning of 4.2 4.2 Anesthesiologist Lounamaa A single distinct reason for the collapse of hemodynamism and consequent resuscitation but in the morning the patient is clearly asilotic hypovolemic, badly ventilating and bad oxygen saturation. There are probably sufficient reasons for the worsening in the patient’s condition apart from the actual brain injury. 7.2 Anesthesiologist Lounamaa: The clinical aulogy department contacted the emergency about high Thiopental levels; have been remarkably high 560-460 micromoles/l. I have consulted a neurologist and anesthesiologist/intensivist at the Children’s hospital who say thiopental levels should normally be around 20 micromoles, in any case under 100. The high levels probably explain why the patient is unconscious. 9.2 Neurosurgeon Ohman: noticeable pneumothroax and subcutaneous emphyseema. Air in mediastiniuim and hear sack. The lung parenchyma is totally infiltrated. The patient is still deeply unconscious. Yesterday the thiopental was 274 which is almost triple the normal. Noticeable sepsis and multiple organ damage. 14.2 Clinical situation unchanged. No new treatment will be started. Thiopental is still 97mmol.litre, which is very high. The care has been complicated by cardiac arrest on the 4th day and bad sepsis on the 7th. Gradual multiple organ damage had developed. 15.2 Oxygen saturation collapsed in the morning and worsens during the day. Hand ventilation becomes more difficult. Nothing more can be done. The heart stops at 22.15. In respect of Max’s head injury, his secondary cause of death was put down by Erkki Tiainen as pneumonia; the forensic toxicology statements (Vuorio and Seppell) were secreted away and never commented upon. In response to an attempt to cover-up Max’s intensive care and thiopental treatment, and in the absence of anyone in Finland prepared to come forward and discuss the case, I obtained, in 2002, a report about the use and effects of thiopental from a professor at Columbia University in New York, I believe it is an authentic expert witness statement together with footnotes and logical conclusions about using, in clinical practice, a highly dangerous drug: Professor Peter Rothstein, Columbia University, New York – Extract of his report on Max’s Thiopental infusions (copy given to the GMC and Professor Graham) Although the bolus doses of thiopental that were administered (50+50mg) were appropriate, subsequent infusion rates were far in excess of any published or reasonable doses (Day 2 dose range: 14-28 mg/kg/hr; Day 3 39mg/kg/hr. Recall that the literature usually gives an infusion rate of 4-8mg/kg/hr. The departure from accepted doses of thiopental was magnified by the absence of EEG recording to monitor for burst suppression/or electrical silence. Given the known cardiac depressant effects of Thiopental at doses required for EEG silence, it can be postulated that there was significant myocardial depression caused by the very large and excessive doses that Max was given. It should be noted that cardiac arrest in a head-injured patient, in the absence of previous heart disease, an acute hypoxic event, or acute brain stem herniaition is very, very rare. Given the very large doses of Thiopental given to Max, and its associated cardiac depression, it is possible that in this case, thiopental contributed to the cardiac event on Day 3. Diabetes insipidus is a very, very rare occurrence in head trauma children, or in adults. It is usually associated with a pituitary injury. There is no evidence for such an injury in Max. It is likely that the occurrence of diabetes insipidus in this case is associated with thiopental use and concomitant hypothermia is a very, very rare occurrence in head trauma children, or in adults. It is usually associated with a pituitary injury. There is no evidence for such an injury in Max. It is likely that the occurrence of diabetes insipidus in this case is associated with thiopental use and concomitant hypothermia. Neuropathology in Max’s cause of death investigation Following the way the child’s first autopsy was conducted and, after Max’s brain was found again, some 10 weeks after the first autopsy, a neuropathology survey was conducted. A salient extract from the report, written by Anders Paetau and Matti Haltia (consultant) appears later. But both of these pathologists were fully aware of the thiopental infusions and the associated genetics report. But no one would put their hand up and acknowledge what had happened to the child. In one case, an executive at the TEO (the Finnish health watchdog) a Dr. Aulikki Wallin wrote the neurosurgeon only thought he had seen a contusion in the child’s brain due to the emotional experience of seeing a child in such a condition. This medico-legal claptrap apparently passes for best watchdog practice in Finland! To be sure, everyone sat back and trivialized the child’s cause of death until it became a routine mantra. In Finland, it is called the culture of forgetting, as in the Roman dictum damnatio memoriae. The terrible decree that meant traces of a public figure’s memory and legacy were to be erased. For the sake of the Finnish State, Max’s death had (my italics) to be natural and obedient folk apparently believe in the honesty of their leaders and officials. This deafening silence is the price of social democracy Finnish-style and the unnecessary deaths of at least four children in government-run daycares. However, in spite of the lack of legal transparency in the case, II continued on searching for evidence and support, deeply disturbed that there was not a scintilla of ethical intuition anywhere in Finland, that something might have been wrong and needed fixing up in the case. I took heart from Milan Kundura, the struggle of men against power is the struggle of memory against forgetting. The GMC - response to my complaint concerning David I. Graham - Ms Lisa Edge, Lay screener GMC - Report (FPD/2002/1582) One question that pervades the consultation case between Professor David I Graham and his Finnish colleagues was who, in fact, Graham writing for, in his series of mutually contradictory medical statements. We know Professor Haltia quietly left the scene after it was discovered his opinion about the AVM was seriously flawed. It was not Anders Paetau, who was merely a pointman for Erkki Tiainen. In effect, it was the State of Southern Finland which benefited mostly from Graham’s consultation with the pathologists. While Prrofessor Graham and, indeed, the GMC, which tries to make out that it was simple laboratorial consultation, the fact of the matter was that Graham was a willing medical advocate of the Finnish state. It is certain that Ms Edge, at the GMC, downplays the consultation between Graham and his colleagues as a simple discussion point about a routine death, instead of the seriously compromised position the authorities who were skating on thin ice in Helsinki. Ms Edge writes: Dr. Paetau on behalf of the Clinical Pathology Laboratory of HYKS wrote to Dr. Graham at this point requesting his opinion as to whether Max’s death was attributable to traumatic or spontaneous ICH. This is a misleading annotation by Ms. Edge: The quote from Paetau’s consultation letter to Professor Graham is far more revealing: I have investigated, consulting professor Matti Haltia, a neuropathological specimen from a forensic autopsy of a child dying of intercrannial bleeding (left occipital ICH +acute haemispheric SDH) ………Paetau also tells Our experiences of evaluating trauma-suspect cases is quite limited. Oh really! (My italics) In view of the pathologists playing innocent, just take a look at assault and homicide statistics in Helsinki; the drunken brawls in bars and domestic violence, they are second to none. There was never any shortage of brain tissue and CT scans to mull over in Paetau’s long medical experience. And, looking at post-insult brain tissue, which was a nice little earner for the Hartmann Institute in Helsinki, it seems inconceivable that, after countless autopsies, Paetau could utter such mendacious nonsense about his lack of experience. Ms Lisa Edge, Lay screener GMC - Report (FPD/2002/1582) An extract form the Lay screener Ms Edge: Doctors are entitled to give their medical opinion and in order for them to be given in such a transient profession it is surely vital that they are subject to change (MsL.Edge FPD/2002//1582) Here is, then, an example of Ms Edge’s thinking when it is applied to Anders Paetau. Paetau, having first told that Max had suffered a bleed of a congenital AV Malformation in “A,” when questioned about this outcome, writes a retraction see “B” (A) A congenital, small arteriovenous malformation that was situated in the left occipital lobe and started bleeding. Such bleeding is in most cases spontaneous, not caused by injury. The case is exceptional in that the bleeding was directed upwards, including the subdural space. (Anders Paetau and Matti Haltia HYKS Ref V 3143). (B) Anders Paetau’s retraction I sincerely apologize for the trouble my interpretation difficulties in the neuropathological examination seem to have induced. I can only add, that the classification and terminology of small vascular malformations can be difficult and controversial. I have tried to do my best all the time, and I, once more, sincerely apologise for the unintentional inaccuracy in my original statement. Max’s case must be considered most unusual, and I am not aware of identical cases from the literature. (Anders Paetau MD PhD, neuropathologist, Haartman Institute, HYKS hospital, Helsinki). Following my serious reservations about the way Ms Lisa Edge handled my complaint about the conundra in the case, Mr. Neil Marshall took up the matter. He intones, As to whether the screeners properly understood your complaint; they were required at this early stage only to understand it in as much depth as was necessary to apply our screening test. In some cases, screeners may ask for a specialist opinion in order to enable them to understand a complaint in sufficient detail. In this case, however, our screeners did not feel this was necessary. How Mr. Marshall is able to make light work of Max death I cannot say; he fails to offer any substantive defence as to why he thought the case was insignificant and not worth delaying his important work. When I complained to the GMC about the meaning of pencil notations written by a Medical screener, Mr. Paul Philip responds, She is an experienced acute physician, who has had the care of many patients with and without preceding head trauma. The subject matter of this complaint is well within her previous professional experience. However, we are not certain how to classify an acute physician. Do we include neuropathologists, neuroradiologists or neurologists; or does the GMC have other less professional options to support their opinions? Unimpressed by the GMC’s nostrums and lack of will to provide adequate responses to reasonable questions, I asked the following, for which I received no reply 1. What precise forensic evidence, including CT scans and histological slides, does the Medical screener use to form her professional opinion? 2. On what forensic basis does the Medical screener support per se a spontaneous bleed of a ‘varicose vein’ in a child’s brain and bleeding upwards (my italics) into the subdural space? 3. What impact does Max’s toxic levels of Thiopental viz a viz his intensive care treatment and autopsy have on the case generally and on neuropathology statements in particular? 4. In view of the terms of reference in the case, to what extent is Professor Graham responsible for not including discussion of toxicology levels as part of his statement? 5. What impact does the fake congenital nature of Max’s death and associated bleeds in the brain relate to this inquiry? 6. Why were documents, which were essential to any understanding of the case, missing from my statutory declaration? Perhaps this explains why the GMC failed to understand the case. The documents missing from the file were:
Ms Edge was also fully aware that expert witnesses should not endorse nor offer medical opinions on matters of which they have little or no experience. In the text of Professor Graham's unsolicited email to my wife (referred to earlier) he tells, amongst other things,
In the secret consultation case, Professor Graham was asked specifically by Anders Paetau to state whether there was an AVM or not? Anders Paetau writes, I have carefully prepared a quite compact set with pre-and postoperative CT’s neuropath macro-and micro-dias and a small set of relevant HE-slides, which I think include the key changes in this case. The relevant anamnestic, hospital and forensic data are of course also included in this set. Paetau also asks :Are the pathological left occipital vessels really a small/cryptic AVM? It is not clear whether Ms Edge understood what the significant changes were in terms of doctors’ pathology opinions. The most obvious point of difference is in the letter of instruction, as Anders Paetau clumsily attempts to change the original cause of the child’s death, without submitting corresponding new evidence. It is now apparent that Andes Paetau, with a shuffle of the cards, introduced a joker, a “cryptic” malformation into the pack of lies. The reality is that the fiction about the AVM has suddenly morphed, while in transit to Professor Graham, into a pre-existing “cryptic” vascular malformation, and that the once thrombosed vessel is now called a “cryptic” malformation. In the original cause of death, the salient pathology was a small arterio-venous malformation (AVM), in the left occipital lobe; now Paetau is introducing the notion of a cryptic malformation, which is altogether a separate typology of vascular malformation. Whether Paetau and Haltia found the thrombosed vessel is open to intense speculation. And when you weigh up the fact that their magisterial tome is near textbook perfect and, as we have just read, they cannot even properly identify the salient pathology. Then, as Paetau tells he has no experience of trauma, the whole matter appears to be very suspicious indeed. Professor Graham, it appears, failed to answer the direct question about the existence of the AVM. It was only after I wrote to Graham months later and asked him straight, about the putative AVM, he responded back Your son did not have an AVM. It is well known that working around, hiding or even insinuating AVM’s can be interpreted as medical fraud (Hyman et al). Given, then, the intention of the pathologists to subtly change the primary pathology in the case, Graham’s actions look suspicious. Since the word “cryptic,” in this case, is left open to the wildest interpretation and speculation, such as fairies dancing on the point of needles; whereas the AVM is a part of rational medical science and not open to guesswork and preposterous theorizing. It is especially apparent, when one considers that Max had no prior history whatever of headaches or neurological damage of any kind, that no one bothered to check up on the child’s medical history per se. Later, in Anders Paetau’s mendacious mea culpa he tells Max’s case must be considered most unusual, and I am not aware of identical cases form the literature Professor Graham’s expert opinion in the consultation case with the State of Southern Finland I have now had the opportunity of reviewing the materials provided and of discussing them with colleagues. Our view is that histological changes, in the left occipital lobe, are strongly suggestive of a pre-existing vascular malformation that has given rise to a spontaneous intercranial bleed from which the patient ultimately died. The view is that the vessels are abnormal (thrombosed) and are indicative of a vascular abnormality We have considered that the changes might be secondary to a traumatic hematoma, but we believe this to be unlikely, and in our considerable experience of material from head injured patients, we have never seen vascular changes of this nature that could be ascribed per se to trauma. Rather, we think that the vascular changes were pre-existing and were likely to be the cause of the bleed… All in all, therefore, we believe the hematoma to have been spontaneous from a pre-existing vascular malformation. However, we would point out the temporal relationship between the head injury and the subsequent intercranial bleed, an interpretation, therefore, might be that although the bleeding occurred from a pre-existing malformation it was, in fact, precipitated by trauma. As the Appeals Court decision stated in the Meadows matter, an expert witness should state the facts or assumptions upon which his opinion is based. He should not omit to consider material facts, which could detract from his concluded opinion. Professor Graham did not show any of the forensic materials to his colleagues, and, as far as I am aware from discussions at SGH Glasgow, they were totally ignorant of the professor’s consultation with the Finns. When I questioned Professor Graham later about this slip-up, and what materials he used in the case, he replied in writing It is true that I did not show any materials to my colleagues in Glasgow and it was and remains true that I have examined, histologically, the section from the occipital lobe in the belief that I was being asked specifically about it rather then to provide an overall interpretation of the case material – including the CT scans. Max’s thiopental infusions – Professor Graham fails to response to the anomalies in the matter. Given Professor Graham’s receipt of Max’s hospital papers, it is unacceptable and suspicious that he turns around and tells, after having stated that he did review all the papers and materials in the case that he, in fact, did not look at them. Even a glance at the infusion numbers in Max’s hospital papers - would have been enough for Professor Graham to smell a rat. The amounts of thiopental administered to Max were so astronomical as to affect the child’s brain and major organs, as such, a major cause of his death. How could Professor Graham miss this vital forensic factor? So what was Professor Graham doing talking about fairies dancing on the heads of pins, when the salient toxicology results were missing! Thus without taking into account the salient evidence that the child had received excessive doses of a dangerous drug, had diabetes insipidus, emphysema, end-stage renal failure and finally multiple organ failure, and his infant body was misshapen at 28 kilos at the time of death, Professor Graham is pretending not to know the situation. A Comment: A particularly unattractive feature of this expert witness was his general unwillingness to accept any personal responsibility for matters in which he was personally engaged. Professor Graham, whose endeavors, after his original statement, to explain away what he had told, appears totally contrived. Furthermore Professor Graham offers, in the same statement, a half-baked contrary opinion, without having looked at the evidence he was given. Graham writes However, we would point out the temporal relationship between the alleged head injury and the subsequent intercranial bleed, an interpretation, therefore, might be that although the bleeding occurred from a pre-existing vascular malformation it was, in fact, precipitated by trauma. (Ref. A990470) It is clearly not the work of a forensic pathologist. Graham has no reason to suggest external trauma, if he has not looked at the CT scans and the clinicians in detail, as, say, Professor de Silva did, (see page 2) So on what basis is Graham saying that the child had a pre-existing vascular disposition, (which condition did not manifest in terms of headaches, for instance) which, when subjected to external force, say, resulting in the contre coup fashion, caused the vessel to bleed. It is clear that Graham is an advocate for the State of Southern Finland and applying the illogicality of insisting the child was ‘sick’ without any evidence whatsoever to support his spurious conclusions. Further advocacy on the part of Professor Graham It is advocacy of the first order when Professor Graham, having committed himself to a generic, highly questionable first statement, returns to the textbook and theory and argues about Max’s supposed vascular pre-condition, while second guessing the clinicians and the existence of the contusion (in the absence of the child’s illegally destroyed brain specimen); talking about gliding contusions and the possibility that the vascular malformation/thrombosed vessel was, somehow, superficially placed. A Comment: A particularly unattractive feature of this expert witness was his general unwillingness to accept any personal responsibility for matters in which he was personally engaged. Professor Graham, whose endeavors, after his original statement, to explain away what he had told, appears totally contrived. Professor Graham, quite apart from falsely using his colleagues at SGH as backup and misrepresenting the materials he used in the case – also uses Max’s mother to misrepresent the case – again. He writes to Paetau, Matters have become slightly complicated since I agreed to look at the materials for you (presumably all the materials) for you, in that Mrs. O’Mara contacted me by email and asked for advice about the case of her son. This is untrue: My wife was the one person who had to endure Professor Graham’s unsolicited email and unwanted comments. Meantime, Mr. Paul Philip, at the GMC, goes one step further, into classic bureaucratic circumlocution, as he plays the devil’s advocate. Mr. Philip misunderstands entirely the correspondence and case materials in the matter. Mr. Philip’s statement about AVM’s We also took the view that, whilst Dr.Graham expressed his opinion several times in different ways in an attempt to clarify his meaning, his view as to the likely cause of death was consistent throughout… Dr Graham never supports the proposition that the pre-existing problem was arterio-venous malformation (AVM). When this was later raised he explicitly discounts it, but whilst his opinion does not specifically state the AVM was not the cause, neither could it be read to support a diagnosis of AVM. There is a difference between a diagnosis of AVM (a specific condition) and the finding which Dr. Graham sets out in his first opinion – that is, that there was likely to have been a ‘pre-existing vascular abnormality or malformation. Ms Edge had no justification either in saying that Mr O’Mara claims (her words) that the neurosurgical unit at HYKS was apparently unanimous that the injuries were caused by external trauma. The evidence I gave Ms Edge was clear; there was never any dispute about the external nature of Max’s head injury and a copy of the operating notes and the neurosurgeon’s report was included in my statutory declaration. This was supported by expert witnesses who independently supported the clinicians’ statements about the external nature of Max’s head injury. Ms Edge continues on, Professor Haltia (Dr. Paetau’s superior) is apparently an expert in AVM and he has an article on the subject in a book that is edited by Dr. Graham. Mr. O’Mara concludes from this that Dr. Paetau and Professor Haltia used their relationship with Dr. Graham to support what he calls their flawed autopsy. The complainant does not conclude anything: Here it is unclear whether Ms Edge is admitting Haltia’s involvement in the autopsy; yet the reality was Max did not have an AV malformation and Professor Haltia must take some responsibility for making such a colossal blunder at autopsy, and worse, his disappearance from the so-called extra-legal cause of death investigation after the fact of the wrongful autopsy. The matter is suspicious and places considerable doubt on the integrity of Haltia and those, including Professor Graham, who was primarily associated with him. In point of fact, Professor Haltia also writes magisterial tomes about AV malformations in Professor Graham’s prestigious Greenfield’s Neuropathology (Arnold 1996); ethically, when Professor Graham discovered that, not only had the original cause of death been changed but there was no AV malformation present in pathology, he should have at once declared the mistake to Haltia, and to Arnold publishing, and had nothing more to do with the case. The matter lacks all manner of legal transparency, ethics and personal responsibility. Recall that I was denied my legal rights to have a preliminary investigation in Finland - five (5) times; and Haltia’s reputation in vascular diseases and AV malformations was used foremost by the Finnish police and Erkki Tiainen to underline their view that Max’s death had to be natural. Now suddenly there were discrepancies in the autopsy! The Kaitila syndrome – Ms Edge’s comments about Max’s putative genetics Recall Ilkka Kaitila’s ill-fated involvement in the case. It is hard to fathom why Ms Edge includes the genetics information and not concludes something from it. One conclusion might be that the genetics study of Max, in connection with the brain autopsy, was a fraud; and, as genetics was the fake underlying cause of Max’s death, it places some serious doubt on the autopsy itself and the genuineness of the consultation in particular. Haltia and Paetau were involved with Erkki Tiainen in seeking a congenital basis for their (fake) AV malformation finding. AV malformations are as a rule accompanied by congenital issues. As Ms Edge knows, the brain autopsy was done before (my italics) the genetics finding, so the Finns had to ‘find’ later an appropriate congenital cause of the (putative) brain disease. What happened after Erkki Tiainen received Professor Graham’s original statement (see on page 13) about Max’s cause of death? The Addendum to Max’s first death certificate, published by Erkki Tiainen Erkki Tiainen, as we have seen already seen here, falsified the description of (putative) brain disease in the first death certificate; this time in the Addendum he merely writes that Professor Graham agrees with the original autopsy report; and all because Professor Graham anomalously fails to answer the salient question about the AV malformation. Erkki Tiainen seizes on Graham’s generic description of the pathology and writes the Addendum. Erkki Tiainen’s plan was to maintain a status quo ante and the case was to be closed without ever acknowledging the falsehoods in the first death certificate. The death certificate of Max O’Mara security code 010793-229N, records that the basic cause of death was a left occipital lobe subcortical vessel malformation which was associated with an intercrannial bleed which had penetrated the subdural space which had been removed during operation. The vessel malformation was discovered in a neuropathological examination at HYKS Diagnostic clinical pathology in conjunction with the medico-legal autopsy. Because of the problematical nature of the case the HYKSDiagnostic laboratory had consulted with Dr. David I Graham. According to the view of Professor David I Graham the vessel malformation located on the left occipital lobe of Max Oscar O’Mara’s brain has caused a spontaneous bleed inside the skull, which resulted in the death of Max O’Mara Professor Graham’s consultation reply, according to the findings, conforms to HYKS exam V3143-99 and does not give cause to change the cause of death statement or the death certificate issued the same day. The above I swear on my honour and conscience Erkki Tiainen Provincial medico-legal officer Erkki Tiainen - False application of WHO codes To the police surgeon Erkki Tiainen, scientific fraud over genetics meant nothing, as did the anomalies in the publication of the first death certificate. In terms of the primary cause of death, (putative) brain disease, being a bleed of a congenital arterio venous malformation (AVM), Erkki Tiainen used the correct WHO cause of death code, Q282; but, the I.V. Pavlov graduate, backing each-way on the tote, was still expecting winner’s odds, and he only recorded a generic description on the death certificate Malformatio vascularis subcorticalis lobi occipitalis sinistri cerebri cum heamorrhgium. Which, of course, did not correspond to the highly dangerous typology of, WHO code AVM Q282. The wrongful application of the WHO code was an intentional mechanism,
used to validate a fall back position, when needed. When the pathology
of the AVM was indeed exposed as a fraud, a generic description of a ‘varicose
vein’ bleed in the brain was then used instead. So, in the second
death certificate, also published by Erkki Tiainen, the existing WHO code
Q282 was simply changed to Q283, the description of the offending (putative)
bleed - not surprisingly - remained the same, that is status quo ante. Ms Edge fails to discuss the fact that after Erkki Tiainen had written the fraudulent Addendum; Professor Graham continued to write opinions, which Erkki Tiainen used to write two (2) more death certificates. From what appears in Erkki Tiainen’s Addendum (written on A4 paper and not gazetted in Helsinki) either Professor Graham did not read Erkki Tiainen’s fake Addendum or he chose to ignore it. Seizing on the inconsistencies about Max’s pathology and the Addendum, I demanded an explanation as to the basis of the addendum. So, acting as pointman still, Anders Paetau writes again to Graham requesting yet another opinion, using the same histological slides as before. Professor Graham this time, under the aegis of the University of Glasgow, gives a completely inadequate statement suggesting that Max had a (congenital) ‘varicose vein’, which also had spilled upwards into the subdural space. What makes the statement suspicious is that Graham offers no supporting citations; and he still fails to review the CT scans. From Graham’s additional statements, the police surgeon Erkki Tiainen writes another two death certificates In a final transparent novelty Graham writes it is with deep regret that I appear to have fuelled the uncertainties over the circumstances relating to the death of Max O’Mara. Basically the opinion expressed in my letter of 21 October remains unchanged, but in the process of trying to be helpful to the parents (untrue), I have made matters worse (really) both for you [Haltia and Paetau] and them. The second death and third death certificates Erkki Tiainen used Graham’s final statement and wrote up yet another death certificate. This death certificate was false too. There was no evidence of ‘congenital’ in the ‘varicose vein,’ so Erkki Tiainen had to write up yet another death certificate, without a genetics underpinning the child’s death. It was the third death certificate, which I received suddenly and without notice, in the post in Sydney some 3 years after Max’s death. What is to be done? In view of what has been discussed here, I think it is appropriate that the GMC undertake at once a review of the case in full, taking into account an objective and detailed account of the evidence and statements made by all parties, which includes the GMC’s contribution to the matter. My concerns in the matter are that, following the Finnish judge’s decision about external trauma to Max’s head, there was fear a proper investigation of what, in fact, happened to Max at the daycare, and at the intensive acre unit of Toolo hospital, might bring down the house of cards. In effect, no one in Helsinki or, indeed, Canberra, has moved to investigate the judge’s claim The most obvious reason Max O’Mara was found crying was that he had hurt his head…the first statement witness Valimaki gave to the police over the phone was that Max had knocked his head against something, even though the witness later on changed her account. The judge in his verdict also told that those responsible for Max’s duty of care were not guilty of any crime and that they had performed their duties according to the law. According to my lawyer, it was a rather incoherent judgment, but one that has created a dangerous precedent in respect of children’s human rights and the subsequent deaths of three (3) more children in government-run institutions. Latest developments in Helsinki In 2003, I managed to get an inquest on foot in Helsinki, that is, after I was able to prove that a TEO expert witness, a Dr. Mikko Remes, lied in his statement about Thiopental – claiming it had nothing to do with Max’s terminal condition. Subsequently, the Interior Minister ordered the police to re-investigate Max’s death at the hospital. The upshot was that the TEO were used again to investigate while the police sat back and watched ice hockey. One expert witness, a Dr. Juha Perttila of Turku failed to include Max’s Thiopental infusions in his report and the matter was simply covered up and the case was closed. However, in 2004 the Deputy State Prosecutor intervened and ordered the police to re-investigate the matter: The Deputy State Prosecutor’s decision to re-investigate Max’s death Date: February 2nd 2004, Dnro 153/27/04 Addressed to District Prosecutor Otto Jamsen, Helsinki area prosecutor’s office By this decision made today I believe there is reason to consider carrying out a preliminary investigation in this matter (notice number 6070/S/310352/02) in which the Helsinki police investigator Karalahti has on November 11th, 2003 decided not to carry out a preliminary investigation. I order the matter to be resolved by you based on the law 10 2nd article regarding public prosecutors. The state prosecutor’s office is to immediately inform of the outcome of the matter. Signed by Jorma Karlske, Vice State Prosecutor and Johanna Hervonen, inspector. A Kafkaesque investigation - the police failed to investigate anything; there was no record of interviews or any documentation whatever. In February 2006, presumably while the inquest about Max’s thiopental infusions was still on foot, the State Prosecutor of Finland, Mr. Matti Kuusimaki, issued a decree, that Max’s case was closed, invoking the statute of limitations. I state that after the death of Max O’Mara on 15 February 1999, Gary O’Mara had contacted the police with a request of investigating the medical treatment of Max O’Mara. The request of Gary O’Mara led to the gathering of large scaled expert evidence from various officials. No inappropriate procedures have been established. All possible measures have been taken in trying to save Max O’Mara’s life. There has been no cause to suspect that, in this matter, any physician had made oneself guilty of a crime. The Deputy Prosecutor General Jorma Karlske has stated in his decision of 1st February 2006 that he will not order any further investigations to be carried out in this matter. The right to institute criminal proceedings for negligent manslaughter and offence in office has fallen under statute of limitations on 15 February 2004. In recent months I have been in contact with Ms.Nina Suomilainen, a human rights activist in Helsinki and Mr. Aaron Rhodes of International Helsinki Watch in Vienna, who is very mindful of the mendacity about Max’s case that is going on in Helsinki. Together we will insist that the Finnish authorities review Max’s case and discuss what the judge told about the external nature of Max’s head injury, and that they provide all documentation related to the recent inquest into Max’s intensive care treatment and Thiopental doses at Toolo hospital in Helsinki. My final wish is to know how Max came into harm’s way at the daycare and why he was given such colossal infusions of a highly toxic drug, Thiopental, when, in fact, he was on the road to recovery. Yours sincerely Gary O’Mara 1What the clinicians at Toolo hospital in Helsinki said about Max’s head injury Clinicians in Helsinki confirmed that Max had suffered a blow to the head, involving a contusion hematoma and a separate hyper-acute subdural hematoma, in the contrecoup fashion. Independent forensic reports concerning Max’s head injury The clinical symptoms and signs at the time and subsequently up to an including neurosurgery are consistent with intracranial bleeding resulting from a blow to the head. The left occipital lobe (at the back of the brain) was injured as the brain moved against the inside of the skull as an immediate consequence of sudden deceleration. Professor De Silva makes the important point that the absence of sub-arachnoid bleeding supports the thesis (Forensic pathologist Professor Peter Herdson) 2In fact, the editor of the broadsheet in Helsinki, Helsingin Sanomat, Mr. Mika Pettersson, was openly hostile to my suggestions that the paper should do some investigative journalism in Max’s case. He called my approaches for legal transparency “grievances.” This disgraceful journalist, an oligarch in Helsinki, who, in the light of three more children’s deaths in government run daycares, remains today mute and moribund behind his typewriter, a mere Pravda-like functionary of the state, to be sure. Related Links Sad mystery of the boy who died at play
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In
my case, after the suspicious death of my 5 year old son Max, an Australian
citizen, living in Finland, I experienced a Kafkaesque nightmare, in a
series of cause of death investigations in Helsinki. After serious anomalies
in the original cause of death investigation, including two false and
misleading autopsies, fake genetics statements, missing forensic toxicology
reports and illegal police interference in expert witness statements two
Finnish pathologists, who were central to Max’s investigation, Professor
Matti Haltia and Dr. Anders Paetau, destroyed vital forensic evidence,
Max’s brain specimen, and mendaciously sought an expert witness
statement concerning the etiology of Max’s death from a Professor
David I. Graham of SGH Glasgow.