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Unexpected infant death: lessons from the Sally Clark case

In November 1999, in the United Kingdom, a woman was convicted of the murder of her two infant sons. An appeal against the conviction was dismissed in October 2000, but the conviction was quashed by a second court of appeal in January 2003. Review of the autopsy findings showed that standard procedures had not always been followed, thus limiting verification of the alleged findings. Some potentially important diagnoses and conclusions were also altered over time. This case and its sequelae demonstrate the difficulties that may arise if cases are not fully investigated by pathologists with specific training or experience in paediatric forensic pathology, with all of the results being clearly summarised and discussed in autopsy reports. Trying to clarify findings, diagnoses and circumstances of death at a later stage may simply not be feasible, owing to a wide variety of possibilities other than inflicted injury. This type of case has unfortunately led to mistrust of the medical and legal systems and has made the investigation of such emotive and tragic cases all the harder.