Injury Causation

Experts in this field have significant experience interpreting how injuries may have occurred largely in the deceased as Forensic Pathologists. Pathologists can examine and assess all materials in a case involving such injuries and provide not only the opinion of how the injuries came to be but also whether scenarios put forward by the accused are viable.

Whether you require an expert witness to attend court or opinion in report form, our experts are all on the Home office register of Forensic Pathologists and undergo rigorous annual auditing as a result. They can review photographic evidence and are experienced in producing reports on all types of criminal or civil cases where the mechanism of injury is in question.

Free initial consultation with an estimate and overview of the work required, which may include:

  • Check the conclusions obtained from Prosecution
  • Consider the evidence in the context of the defendant’s explanation and statement
  • Examine the primary evidence and consider any additional evidence
  • Prepare reports or Section 9 Statements for court use
  • Attend court as an expert witness
  • Produce a short report or detailed witness statement
  • Preparation of material for court demonstrations

In cases where injury causation is in question, it's imperative that you instruct the right type of expert who has experience and knowledge in how injuries are created.

In addition, our injury causation experts have experience in working for both prosecution and defence, which provides them unparalleled knowledge of the criminal justice system and where it might be relevant to your case.

What is an injury causation report?

An injury causation report or a mechanism of injury report gives an indication as to the ways in which an injury could have occurred in the case of a violent crime. In someone who is deceased this work is included in the post-mortem report provided by the Home office registered pathologist who undertook the post-mortem. An injury causation report provides commentary on those injuries sustained by a living individual. These may have occurred during a fight or section 18 assault or perhaps it is alleged that the injuries to the individual were caused as the result of an accident.

An injury causation report can address whether your client’s defence statement or a version of events is feasible, well in advance of trial.

As a legal professional, you would want an injury causation report to:

  • Provide concise and easy to understand answers to the questions posed by counsel
  • Outline the supporting evidence for the expert’s opinion which must hold up in court
  • Include a clear explanation based on the balance of probabilities, in instances where it is not possible to give a definitive answer.
  • Contain clear and appropriate language to prevent any misunderstanding by the jury.

Injury causation experts

Registrars, consultants and A&E doctors are occasionally used to provide witness testimony on injury causation for the criminal justice system, even by other forensic services providers. At Forensic Access, only Forensic Pathologists provide opinion on injury causation. This is for several reasons. Perhaps the most important reason is that they are experts in assessing how injuries occur. That is to say, this is what they do every day on those that are deceased.

Whilst a registrar or a doctor in A&E is the person you would want to care for you if you sustained an injury, they are not the appropriate person to be providing a report on how the injury may have been caused. There is a phrase very often seen in crown medical expert reports provided by a doctor who has treated the patient “This injury is consistent with the mechanism described”. This phrase actually means very little and gives you no indication as to the likelihood of the injury having been caused by the mechanism in question. The forensic pathologists at Forensic Access can tell you whether it is more or less likely. Which in cases with no witnesses such as domestic abuse, can be very useful.

When we consider all the points that an injury causation report should address a one-line report by a registrar falls short on all of these and therefore on the expectations of the court.

Forensic pathologists are licenced medical and forensic professionals. Their expert opinion is provided in an appropriate format. Their peer-reviewed report includes a self-certification section as well as the necessary declaration required in order to comply with the criminal procedure rules.

They have a clear understanding of the role of the expert and that their duty is to the court, not the instructing party. This line can sometimes be blurred when instructing a consultant or doctor who is not used to working in the criminal justice system.

Types of cases where a mechanism of injury report may be useful

Given that injury causation reports deal with injuries to individuals they can be pertinent in a wide variety of cases. These may include:

  • Section 18 and section 20 assaults, where we often see bruises, lacerations, abrasions and in the case of stabbings, incised wounds.
  • Sexual offences in which the victim may have sustained bruising and injuries to the genital area.
  • Child cruelty cases often include burns and abdominal injuries.
  • Domestic abuse cases where the victim may have suffered fracturing of bones, contusions, burns and many more injuries.
  • Non-fatal shooting cases where the victim is left with a gunshot wound but may not be willing to confirm that they were shot with a gun.
  • Non-fatal road traffic accidents on behalf of insurance companies.

Nature of injuries

There are a number of different injuries that occur during these types of cases.

They are largely separated into closed wounds, where the surface of the skin has not been broken. And open wounds where the surface of the skin has been penetrated or disrupted in some way.

Some typical examples of closed wounds are:

Bruises or contusions.

These are patches of discolouration that appear on the skin when significant pressure is applied. This causes the blood vessels and capillaries to burst and the blood leaks out into the tissues surrounding them, causing the familiar purple colour.

Internal bruising can also occur causing pain and tenderness without the discolouration of the skin.

Since different people bruise and heal from bruises at different rates injury causation experts are unable to age bruises and say when the injury causing them may have occurred.

Closed fracture

These are defined as a break in continuity of bone that doesn’t penetrate the skin. In layman’s terms, broken bones. They may be caused by trauma either during an intentional attack or by falling accidentally.

Those with weaker bones will suffer closed fractures with less force.

Some examples of open wounds are:

Laceration

Lacerations are produced by the body tissue tearing and as such, they often have a torn or jagged appearance. They can be small or large and may be caused by a blunt instrument striking the skin, a fall against a hard surface or a number of other mechanisms.

They appear similar to incised wounds to the untrained eye and are often wrongly interpreted as such by those not specialists in injury causation work.

Lacerations are very common in cases of blunt force trauma to the head. The skin over the skull tears due to the impact inflicted on it during the assault.

Incised wound

An incised wound occurs when the tissues are sliced apart by a sharp object. They tend to have neater edges depending on the object used to inflict the injury.

Incised wounds are typically seen in stabbing incidents. A common incised wound that can be very useful in injury causation cases is when they appear on the fingers of a victim giving an indication that the victim may have been trying to defend themselves from the attacker.

Abrasion

These can be characterised as scraping injuries, in that the skin has come into contact with a surface that has removed at least the top layer of skin, if not more. Some examples in casework might be abrasions seen on the knuckles of those involved in a fight or injuries seen around the wrists of those that have had their wrists tied, often known as ligature marks.

Gunshot wound

These are a form of abrasion. This is due to the bullet scraping or scuffing the skin surrounding the bullet hole as it enters. If the bullet enters the skin nose on it leaves a uniform abrasion around the hole. If however, the bullet penetrates the skin at an angle it will leave an abrasion that is thicker in one area and thinner in others.

There are times when the bullet may have penetrated through something before contacting the skin. A ricocheted bullet for example. These tend to leave a more irregular shape wound on the skin.

Exit wounds, i.e. where the bullet has exited the body can be many different shapes but are characterised by the absence of a ring of abrasion around the bullet hole.

This information can be used by the forensic pathologist to determine how many bullets have penetrated the body and at what angle they contacted the skin.

It may be necessary to undertake this work alongside a Forensic Firearms examiner.

Punctured wound

These are usually caused by a sharp pointy object, such as a nail or an animal tooth. They don’t tend to bleed and can sometimes appear to close up immediately after they have been made. Their size and shape may give an indication as to the weapon that has been used to inflict them.

Bite wound

These are common in abuse cases and the expert is able to say whether the injury is a bite mark or not.

If further work is required to compare the injury to a particular person’s teeth then we would enlist one of our Forensic Odontologists to take the moulds and undertake the comparison work.

Burn wound

A burn to the skin can either be inflicted in a physical manner or via chemical means.

Some examples of physical burns are thermal burns from dry heat such as a flame or from wet heat such as steam from a kettle that causes scalds. A common type of burn seen in child abuse cases when a child is helped up against a hot radiator is a contact burn. Similarly, small round burns on the skin may indicate intentional burning using a lit cigarette.

Provided the forensic pathologist has good photographs of the burn they should be able to tell you the type of burn that has occurred and how it might have occurred.

Chemical burns have become more common in recent years and can leave victims with life-changing injuries. The role of the injury causation expert in these cases is to give an opinion on how liquid burns injuries have been caused. For example, a victim has had acid thrown in their face. Was this done accidentally or as the result of an intentional act?

Mechanisms of injury

The expert will review the case papers including your client’s defence statement, any witness statements, the injured party’s version of events and any CCTV footage that is available. This will allow them to determine the potential actions by all parties involved during the incident and to consider the injuries within the context of these actions.

Interpretation of mechanism of injury

The expert will assess the colour photographs of the injuries provided and comment on a number of aspects to assist them in their interpretation.

Nature

They will comment on the nature of the injury. For example, whether it is a bruise, a laceration or a burn etc.

Location

The report will also detail the location of the injury in relation to known body parts. An example you might come across could be ‘the bruise was on the inner surface of the right upper arm, 5cm from the crease of the elbow.’ This can assist the expert in determining causation.

Size and Shape

Provided the photographs available for the expert to review have a scale in them, the forensic pathologist will give an indication of the size of each injury in their report. This may help them in their determination of potential weapons used and also in their interpretation of how the injury came to be.

The shape of each injury will be described in terms that are easy to picture for the jury should the statement be read out in court. The injuries shape can often give a very good indication of the type of weapon used to inflict it. For example, some bruises appear as tramline bruises. These are two long thin line-shaped bruises parallel to each other and can indicate that the victim was struck with a cylindrical object, such as a baseball bat or metal bar.

Number and Distribution

If there are many injuries, they are often given individual numbers by the forensic pathologist to make the report easy to follow. The distribution across the body will also be noted as this can give a significant indicator as to how the injuries came to be. For example, 3 or more small round bruises on the upper arm may indicate that the injured party was gripped tightly in this area.

Causation

All of the information described above will be combined with the expert’s considerable knowledge and experience in the field of determining how injuries are caused to provide a statement detailing the likely mechanisms of injury.

What can an injury causation report not tell you?

Accurately age injuries.

As previously discussed, people and their skin and tissues heal at different rates, this makes it very challenging to accurately state when an injury may have occurred. In addition to this very often the photographs of the injuries provided do not include enough fine details to draw any meaningful conclusion.

Tell you exactly which knife caused an injury

A forensic pathologist may be able to tell you the likely dimensions of a knife which caused the injury, but given that most households in the UK have a set of knives made up of standard sizes this doesn’t narrow it down. If the blade used has some defining characteristics that are represented in the wound, such as a serrated edge or perhaps both edges are serrated, this detail will be included in the final report and may exclude potential weapons from being included as evidence against your client.

Tell you who committed the crime

An injury causation report alone will not tell you the identity of the perpetrator. It may give you information that when used in conjunction with other evidence will include or exclude your client. But the report will only comment on the medical findings of the case.

Tell you why

The report may tell you the most likely mechanism that caused the injury, but it cannot tell you why the perpetrator decided to inflict it.

Comment on clinical treatment.

Home office registered forensic pathologists are specialists in the field of injuries and how they are caused. They are not experts in the medical treatment given to the patient after the injury has occurred although in some cases that are able to comment on aspects of this. If you require a review of the treatment given to a patient, then please look at our Specialist Medical expert page, or please contact us to find a more suitable expert.

 

What information or materials are required for an expert injury causation report?

To provide a meaningful opinion on the injuries in your client’s case the minimum required by an expert at instruction is:

  • Digital colour photographs of the injuries with a scale in the photograph. (higher quality and resolution the better)
  • A case summary.

The following documents will help the expert to build a picture of the incident in question and also to evaluate the medical findings in line with your client’s version of events and that of the victim and any witnesses.

  • A copy of the crown experts report.
  • Your client’s version of events or defence statement.
  • Witness statements
  • The injured party’s statement.
  • Any available CCTV footage.

Are you looking to ensure your deadlines are met?

We offer free initial consultation with advice and support at all stages.

Find out more about Injury Causation services

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Expert Witnesses

Dr Alexander Kolar

Dr Alexander Kolar

Forensic Pathologist

Dr Brett Lockyer

Dr Brett Lockyer

Forensic Pathologist

Dr Charlotte Randall

Dr Charlotte Randall

Forensic Pathologist

Dr Stuart Hamilton

Dr Stuart Hamilton

Forensic Pathologist

Dr Virginia Fitzpatrick-Swallow

Dr Virginia Fitzpatrick-Swallow

Forensic Pathologist

Case Studies

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