Skin mottling — the non-specific sign that drove the diagnosis
Prosecution claim
The prosecution's expert told the jury that a particular pattern of skin discolouration — pink patches on a pale or blue-tinged background — was 'characteristic' of air embolism. Multiple counts of murder and attempted murder rest substantially on post-mortem or contemporaneous photographic descriptions of this skin pattern.
Counter-evidence
Skin mottling in a neonatal collapse is not specific to any single cause. It is seen in sepsis, shock, severe hypoxia, cardiac decompensation, disseminated intravascular coagulation, late-stage necrotising enterocolitis, and intracranial haemorrhage — all of which are common causes of neonatal collapse independent of any wrongdoing. The 1989 Lee & Tanswell paper that was cited as authority for the diagnosis described a different pattern: migrating bright-pink vessels against pallor, in large-vessel air obstruction. The Shoo Lee Panel concludes the skin descriptions given at trial did not match the Lee & Tanswell criteria.
Skin mottling is a non-specific sign of any severe circulatory compromise in a preterm infant. It is not diagnostic of air embolism, or of any other specific mechanism of harm.
What the jury heard
The jury was shown contemporaneous and post-mortem photographs and told that the mottling pattern was 'characteristic' of the Crown's proposed mechanism. The alternative-cause differential was not given comparable prominence.
What the Panel says
The Panel is direct: the skin findings described at trial are compatible with natural causes in critically ill preterm infants. They are not diagnostic of deliberate harm, and in particular do not match the pattern described in Dr Lee's 1989 paper.
What independent experts add
- UK neonatal teaching explicitly describes skin mottling as a non-specific indicator in preterm infants.
- Radiological re-reading of contemporaneous images has not identified intravascular gas of the kind air embolism would produce.
- The rush to a single diagnostic attribution for the skin pattern — rather than a structured differential — is itself a methodological problem with the Crown's expert evidence.