Ian Tomlinson inquest – Tuesday 12 April 2011

• Former Home Office pathologist Freddy Patel giving evidence
• Police asked whether Patel could 'rule out' assault injuries
• Ian Tomlinson died at the G20 protests in London in 2009
• Read the lunchtime summary

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Pathologist Dr Freddy Patel arrives to give evidence to the Ian Tomlinson inquest on 12 April 2011. Photograph: Stefan Rousseau/PA

5.03pm: Here's a summary of today's proceedings:

Dr Freddy Patel, the pathologist who conducted the first postmortem on the body of Ian Tomlinson, and concluded he died of a heart attack, has finished his first day of evidence. He revealed that four police officers were present at the mortuary, the most senior of whom asked him whether Tomlinson's leg injuries were consistent with a baton strike and dog bite. The postmortem was conducted on 3 April 2009, four days before video footage emerged showing Tomlinson's confrontation with police.
Patel said he was asked by the officers to rule out injuries consistent with an assault. He said the officers gave him "additional information" about the circumstances of the death moments before he began examining the body. This included the suggestion that, when Tomlinson had collapsed, there was "a lot of broken glass bottles and a lot of protesters were using sticks and there were a lot of sticks around the body where it was found".
The jury heard from Patel that, in his opinion, Tomlinson died of a heart attack and not internal bleeding. The inquest has already been told that two other pathologists, who are expected to give evidence in the coming days, concluded Tomlinson died of internal bleeding in the abdomen. Patel said he found evidence of coronary artery disease. He said he found some bleeding in the abdominal area, but not enough to have caused Tomlinson's death. He said a sample of the three litres of fluid found in Tomlinson's abdomen was inadvertently discarded.
That's all for today. Back tomorrow.

4.32pm: Today's proceedings have finished. Summary soon.

4.30pm: Patel has further explained his conclusion that Tomlinson died of a heart attack. He said it was partly a "process of elimination", because there was nothing else to explain the death. As I explained earlier (12.56pm), two other pathologists found that Tomlinson died of internal bleeding.

Hewitt: "To be clear about this, then, it is clear from what you described that you saw some internal bleeding?"
Patel: "Yes."
Hewitt: "At postmortem, does it follow that as far as you were concerned that was not the cause of death?"
Patel: "That's correct, yes."
Hewitt: "And why did you reach that conclusion?"
Patel: "Because there was no major injury sufficient to cause bleeding to cause death."

Hewitt also asked whether the amount of blood he had seen was enough to cause death. He replied: "No, not in my opinion."

4.18pm: Patel has said some heart attacks can happen "spontaneously".

I have had many examples of where a death has occurred as a result of coronary artery disease where somebody is in a car talking to somebody at one minute and in the middle of a sentence and just collapsed and died. I have had a case where a mother was reading a story to a child and in the middle of it just collapsed and died.

Other heart attacks, the pathologist said, can be "precipitated by a stressful situation".

4.16pm: This next bit is somewhat complicated. Hewitt is asking Patel about his report into the death, which differed slightly from his original notes. The contemporaneous notes stated, in abbreviated form, that there was three litres of fluid, then a small blood clot with blood. His later report stated: "There was intra-abdominal fluid blood – about 3L [litres] with small blood clot."

Patel said he made a mistake when describing the fluid the second time. Elsewhere in his report, the pathologist described a "large volume of intra-abdominal bleed". However, Patel said this phrase was not intended as a reference (as it might seem) to bleeding in the abdominal area.
The judge has repeatedly asked Patel to clarify this crucial point. So has Hewitt. Here is an example:

Hewitt: "You understand Dr Patel that as this reads it would appear to suggest you found a large volume of blood. Is that what you intended by these words, or not?"
Patel: "What I [was] intending to say is that the amount of blood I found, for example the blood clot, is large comparatively, because of the liver disease."

3.53pm: We're back now, and Patel is explaining how he took various samples for laboratory tests. Part of the fluid that was found in Tomlinson's abdomen was initially kept, but later lost. Patel said he later returned to examine the sample but found it had been discarded. (See 12.20pm and 2.17pm on the possible significance of the fluid.)

Judge Thornton: "You say 'I think'; do you know it was discarded, or not?"
Patel: "I didn't see it being discarded, but when the issue arose about the cause of death I went back to the mortuary to ask where is that sample and it wasn't in the mortuary. So it can only mean it was discarded."

Talking through his final notes, Patel said he had found Tomlinson died of natural causes, specifically coronary artery disease.

3.29pm: We've been taking a 10-minute break. Here's a quick roundup of web coverage of today's inquest:

My colleague Karen McVeigh writes that a senior officer asked Patel whether Tomlinson's injuries were consistent with a baton strike or a dog bite – four days before video footage emerged showing his encounter with police
The Press Association takes a similar line, stating that the detective asked whether the "tramline" bruise on Tomlinson's leg was caused by a baton.
The BBC takes a different angle, leading on the fact Patel's postmortem on Tomlinson was "upgraded" from a routine examination to a "more thorough, forensic" analysis of the body.

3.11pm: Patel said he also recorded fractures to Tomlinson's sternum and ribs. Hewitt is now questioning the pathologist on his examination of Tomlinson's heart, blood vessels and coronary arteries.

Quick context here: the jury was told on day one that Patel concluded Tomlinson died from coronary artery disease and could have died at any time. Two other pathologists, who are set to give evidence in the coming days, found that the father-of-nine died of internal bleeding.
Again, much of this is very technical and graphic. The jury is being shown photographs which, for obvious reasons, we cannot reproduce here. But to sum up: Patel said he found symptoms consistent with a heart attack – including blocked arteries. His notes stated one artery was "80-90%" blocked.

2.48pm: To summarise, Patel has said he found evidence of bleeding in the omentum (fatty tissue near the intestines) and liver. He added he could not find a source of bleeding "large enough" to cause somebody to bleed to death.

2.39pm: The jury is back, and Hewitt is asking Patel about what he found on Tomlinson's liver, which was much larger than normal. The barrister has essentially been asking the pathologist to elaborate on his contemporaneous notes (see post: 11.40am). Much of this is quite technical; questioning is focusing on whether any damage to the liver or the capsule that surrounds it could have permitted "free bleed" into the abdominal area. Patel has said that while he could not see any significant tears, this was possible.

2.17pm: Some jurors have asked to view photographs taken during the examination. Judge Thornton said they could view the images in the jury room. This will take a few minutes, so there will be a short delay until the hearing resumes. Thornton has reiterated that the issue surrounding blood and fluid in Tomlinson's abdominal area is likely to be important. (See earlier post: 12.20pm.)

Judge Thornton: "I am sure we are going to come back to this, because the amount of bleeding, the source of any blood, will be important in the inquest."

2.08pm: The jury has returned from lunch. To recap, Alison Hewitt, counsel for the inquest, is questioning pathologist Dr Freddy Patel.

1.35pm: Here's a summary while the jury is out for lunch:

A senior police officer asked a pathologist whether Ian Tomlinson's injuries were consistent with a baton strike and dog bite – four days before video footage emerged showing his encounter with police. Dr Freddy Patel, the first pathologist to examine the newspaper seller's body, told the inquest that Detective Superintendent Tony Crampton, of City of London police, asked the question during a postmortem examination on 3 April 2009. Video footage showing Tomlinson's confrontation with police did not emerge until four days later.
Patel said DS Crampton and three other police officers were present during the postmortem, and he was asked to "rule out" injuries consistent with an assault at the G20 protests. He said the officers gave him "additional information" about the circumstances of the death. They told him there was "a lot of broken glass bottles and a lot of protesters were using sticks and there were a lot of sticks around the body where it was found".
The jury has already been told that Patel concluded the newspaper seller died of a heart attack. Two other pathologists said the cause of death was internal bleeding; they are yet to give evidence. Patel has given an explanation of his findings about levels of blood contained in fluid in Tomlinson's abdomen. He said there was about three litres of fluid, which he described as "heavily blood-stained".

1.04pm: Patel said it was "very obvious" that Tomlinson had a sclerotic liver. We have heard previously that Tomlinson was an alcoholic.

12.56pm: To recap: Patel was the pathologist who concluded Tomlinson died of a heart attack as a result of natural causes. However, two other pathologists concluded he died of internal bleeding in the abdomen.

Continuing to give evidence about his internal examination of the body, Patel said he looked for "damage or tear or laceration" in the intestine area and surrounding structures that could explain "the large quantity of blood".

I couldn't find any. I think we went over it very carefully, even when demonstrating with the mortuary assistant, and the superintendent and the coroner's officer.

He said there was also no damage on the spleen or the stomach that would account for the blood.

12.44pm: Correction – the jury has not been shown most of the photographs, which have been described as "distressing". They are being referred to in detail by counsel, and Patel has copies in front of him. The judge has told the jurors they are entitled to see the images later if they wish.

The family of Ian Tomlinson, with his widow Julia in the centre. Photograph: Stefan Rousseau/PA

12.39pm: The jury is being shown some very graphic photographs. Some members of Tomlinson's family have had to leave the hearing.

12.36pm: Patel said there was some bleeding on the front of the abdomen. He described them as "tiny haemorrhages" near the intestines.

12.20pm: Patel has finished his preliminary explanation of findings on the outside of Tomlinson's body. Hewitt has now moved on to his internal examination.

The pathologist said he found large amounts of fluid in Tomlinson's abdominal cavity, which began escaping. I'm reluctant to go into too much detail of this medical evidence, which is at times quite graphic, but this needs to be relayed because it is potentially crucial.
The judge said on the opening day of the inquest that two other pathologists found Tomlinson had died of internal bleeding in the abdomen (rather than a heart attack from coronary heart disease). Judge Peter Thornton QC said specifically the presence of fluid in the abdomen and the extent to which it contained blood would be a point of "controversy".

Peter Thornton QC: "There is likely to be controversy, too, about the finding by Dr Patel in the first postmortem of the presence of fluid in the abdomen and to what extent it contained blood." (29 March)

Patel has just said of the fluid:

It was heavily blood-stained. The colour was sort of darkish red. But the feel of it was not that of blood. It was more sort of watery and oily … Because I said it didn't quite feel like blood, the only explanation for that is fluid accumulating in the body as a result of his liver disease, medically known as ascites.

Under questioning, he said the fluid was a combination of blood and "ascitic fluid". The pathologist could not tell what proportion there was of each. There was about three litres of fluid, he said.

12.02pm: Jury back in – hearing has resumed. More on the conversation between police and the pathologist. First, there was a discussion about the large elongated bruise on Tomlinson's left-leg.

Hewitt: "Did you recall Detective Superintendent Crampton asking you whether that injury was the result of a baton strike?"
Patel: "That is correct, yes."
Hewitt: "Did you say to him at the time you could not rule that out, but you thought it was more likely to have been as a result of falling against something?"
Patel: "If I remember correctly, what I said was that as you say, I can't rule it out, but it is in keeping with contact from falling against a linear object, yes."

He added that the bruise was consistent with "either falling against a linear edged object or a linear implement striking the body".
Second, police asked Patel about the puncture marks on the newspaper seller's lower right leg. Hewitt asked Patel if the senior officer asked him if the wound "could be the result of a dog bite". He replied he believed the puncture marks were inconsistent with those that would have been caused by a dog bite. He advised that a swab and a forensic examination of Tomlinson's torn trousers could help answer that question. He added:

Patel: "And because I had been told there were a lot of broken bottles thrown there, I said it could also have been caused by a rugged, sharp object."

11.40am: Revisiting my notes from that first session, Alison Hewitt specifically asked Patel if he "was requested by police to rule out any assault or crush injuries" associated with public order. The pathologist replied: "That's right, yes." He was asked if he "had that in mind" when he conducted the examination. Patel confirmed it was.

11.33am: Quick adjournment.

11.22am: Patel is giving jurors an account of what he found when examining the outside of Tomlinson's body.

I won't recount every single finding, but the pathologist said he initially found a 3mm "graze" above Tomlinson's left eyebrow. Three days later he was asked to recheck the body, and amended his notes:

After I completed my postmortem, after a few days, I had a call from the coroner's officer to say: "Were there any bruises on the forehead, on the right side?" The first postmortem, [bruises] were not visible. So on April 6, we had a second look at the body, and I noticed that 3mm abrasion had now developed into a half centimetre bruise and in the temple there was further bruising which was 2.5cm long.

Dissection revealed fractures on the sternum and the ribs, but there were no injuries on the surface of the abdomen, Patel said. The pathologist said there were minor cuts and bruises on Tomlinson's right arm and grazing and lacerations on his right leg. There was an "elongated bruise" – 14cm long and 6cm wide – on his left thigh. Jurors have access to some photographs, which it would be inappropriate for us to publish here.

10.58am:

Hewitt: "Did you have any evidence before you to suggest that Ian Tomlinson had suffered an injury as a result of an assault or crush injuries or anything of that sort?"
Patel: "No, I didn't have any direct evidence. But because it was a Section 19 [routine postmortem], it was upgraded to a Section 20 [suspicious death case] – now you can have a Section 20 without involvement of the police and so I feel that I may have queried why are the police attending and [I] would have been informed by the coroner's officers that they would like to rule out whether [Tomlinson] had suffered any injuries as a result of an assault and there was a big crowd there, whether he suggested any crush injuries related to the protesters in the public disorder."

Screen grab of footage from the events preceding Ian Tomlinson's death. Photograph: Guardian

10.55am: Freddy Patel has just revealed police gave him additional information moments before he conducted the postmortem.

Patel took contemporaneous notes in a 21-page booklet. The jury now has this, and Hewitt is talking through what he wrote while conducting the examination.
The postmortem took place at 5pm. Detective Superintendant Tony Crampton, the City of London police officer leading the inquiry, was present along with three other police officers. The police gave him additional information (to that included in the fax) before he began examining the body.

The additional information was that [Tomlinson] was found collapsed outdoors on the pavement but there were no police officers nearby – when I say nearby I mean in the immediate vicinity of the body.
There was a lot of broken glass bottles and a lot of protesters were using sticks and there were a lot of sticks around the body where it was found. That was the information I was given before we went into the mortuary.

Important: I should note that none of the footage or photographs shown to the jury so far have shown protesters "using sticks" or sticks in the immediate vicinity of the body after collapse. The jury saw one photograph showing an unbroken bottle although bystanders heard other bottles breaking nearby.

10.34am: To assist his examination, Patel received information from the coroner's office via fax. It included basic biographical details, and stated Tomlinson had collapsed two days earlier on Cornhill. The pathologist was told bystanders saw Tomlinson "went blue" and police, "who were nearby, due to the demonstration", administered first aid. The fax gave details of Tomlinson's medical problems and stated he was an alcoholic who had been a "rough sleeper in the city of the last 20 years" who had recently secured accommodation at a hostel.

10.28am: Alison Hewitt, counsel for the inquest, is questioning Patel. He said that the postmortem examination on Tomlinson's body took place on Friday 3 April – two days after his death. He explained it would have occurred the previous day, but there was a delay.

If I remember correctly the postmortem was done on the Friday. On the Thursday morning I received a call from the mortuary – there was a body and the coroner would like a postmortem … As far as I remember it was going to be a routine postmortem examination, or Section 19.
I got to the mortuary on the Thursday, and one of the police officers who had come to do identification was also present. Then I was informed by the coroner's officer that due to some legal arguments or whatever, the postmortem couldn't go ahead that day.

Patel said that by the time he did get round to doing the postmortem, he was told it had been "upgraded" to a "Section 20" (forensic examination in a suspicious death case).

10.17am: Dr Freddy Patel has taken the stand. He is wearing a stripey red tie and is resting his hands on a file of papers he has taken with him. He listed his qualifications, and said that in April 2009, at the time of his examination of Tomlinson's body, he was on the Home Office list of accredited forensic pathologists.

Patel has explained the different between a "Section 19" (routine) postmortem, and a "Section 20" (forensic) case, which takes place in suspicious death cases.

10.12am: The jury has entered – we're about to start.

10.09am: Quick reminder: it has been widely reported that Dr Freddy Patel has twice been suspended by the General Medical Council (GMC) in recent months. A fortnight ago, he was suspended for four months over his botched postmortem which led to a delayed murder investigation into a serial killer. The case concerned his 2002 examination of the body of Sally White – the first victim of "Camden Ripper" Anthony Hardy. He found she had died of natural causes (a heart attack) despite blood staining her clothing, bedding and a wall at Hardy's flat. The GMC also found Dr Patel had falsified his CV. The earlier suspension, in September last year, concerned professional failings in three other postmortem examinations.

9.58am: We are entering the third week of the inquest into the death of Ian Tomlinson. Today, Dr Freddy Patel, the pathologist who controversially concluded the newspaper seller died of a heart attack caused by coronary heart disease, takes the stand.

The inquest is entering a new phase: medical evidence. So far the jury of 11 has mainly heard evidence about the circumstances surrounding Tomlinson's death at the G20 protests. The focus has been his encounter with Metropolitan police officer Simon Harwood, who has accepted the father of nine posed no threat to him when he struck with a baton and pushed him to the ground.
Here is a quick recap of the nine days we've had so far:
Day 1: The Tomlinson inquest opened with detailed footage showing the newspaper seller's last moments alive. The judge told jurors to anticipate "controversy" over divergent medical opinions and stressed that Harwood was not "on trial".
Day 2: The jury heard how Harwood was a van driver in the Met's territorial support group (TSG) who strayed from his post without the knowledge of his supervisor. He had several confrontations with protesters and bystanders in the minutes leading up to his encounter with Tomlinson.
Day 3: A New York investment fund manager said he believed Harwood was trying to make an example of Tomlinson when he pushed him to the ground. Chris La Jaunie, who shot crucial video footage of the incident, told jurors the newspaper seller was not being confrontational.
Day 4: A police officer who witnessed Harwood pushing Tomlinson said she had been "shocked by the forcefulness" of the shove. She said she did not believe the newspaper seller posed a threat.
Day 5: In the opening day of his evidence, Harwood said he "feared for his life" in the minutes leading up to his encounter with Tomlinson. The newspaper vendor's relatives left the courtroom in tears when Harwood announced he wanted to "help the family at this difficult time".
Day 6: Harwood told the jury he was "amazed" when Tomlinson fell to the ground and was accused of lying under oath. He conceded the father of nine posed no threat to him and offered a partial apology "if it is the case" his actions led to Tomlinson's death.
Day 7: In his final day of evidence, the police officer said he believed Tomlinson had been "almost inviting a physical confrontation". He also said he believed his training allowed him to baton a person who posed no threat. Harwood eventually appeared to retract much of his earlier testimony.
Day 8: A City worker who saw Tomlinson collapse less than three minutes after his encounter with Harwood said he heard him tell a bystander: "The fuckers got me." A medical student who went to Tomlinson's aid told how she was pushed out of the way by police.
Day 9: Paramedics and doctors gave evidence about the failed attempts to resuscitate Tomlinson in the hour following his collapse. Amid divergent accounts, one ambulance worker said his initial assessment was that the father of nine could have been dying of internal bleeding.