REVEALED: Mum's death not black and white, Coroners Court hears
"WE CAN'T give you a black or white answer."
That was the confession Doctor Nigel Buxton made in the Coroners Court in Gladstone today, to the disappointment of several lawyers seeking a straight answer.
The second day of inquiry proceedings into the death of Tracy Ann Beale, 45, saw five different witnesses take the stand.
Mrs Beale, 45, died the morning of January 21, 2013, after she was put in a chokehold by husband James Andrew Beale.
The court heard that on the night of the altercation Mrs Beale, who had been drinking considerably, repeatedly struck her husband during an argument about finances.
While the official cause of Mrs Beale's death is neck compression, family members, an entire bench of lawyers, expert witnesses and Coroner David O'Connell gathered this week to determine what scientific and medical factors (following the chokehold) were involved in her death.
Senior Forensic Pathologist and witness Doctor Alex Olumbe performed the autopsy on Mrs Beale in 2013.
He said scattered bruising on the victim's neck and left jaw and the lack of markings on her right side were consistent with neck compression in a chokehold, which was maintained until she went limp due to asphyxia (unconciousness or death caused by lack of oxygen).
Dr Olumbe told the court Mrs Beale's autopsy indicated the jugular vein and carotid artery had been compressed at the same time, causing air and blood flow to stop.
Mrs Beale's neck was winched tightly in the crook of her husband's arm moments before she died.
The carotid artery supplies essential oxygenated blood to the large front part of the brain and monitors heart rate.
Prompted by Coroner O'Connell, the inquiry was established to determine whether Mrs Beale died due to asphyxia, a vasovagal attack (reflex cardiac arrest), a combination of the two or neither.
It is hoped the inquiry will also uncover whether Mrs Beale's pre-existing medical condition (dilated cardiomyopathy) or the consumption of alcohol played a part in her death, and by how much.
Dilated cardiomyopathy is a defect caused by a genetic predisposition or other factors including infection or excessive alcohol consumption.
People may not always know if they have the defect, which can, in cases, lead to sudden death.
Speaking to the court over the phone, Dr Olumbe told the Coroners Court vasovagal activity (a form of cardiac standstill) played the biggest role in Mrs Beale's death, in his opinion.
He noted, however, this form of activity could not be measured in an autopsy.
Another question raised in court was whether a heart arrhythmia may have led to the victim's death.
Counsel assisting the Coroner John Aberdeen said in fight or flight conditions, where a person is fearful, adrenaline is released, desensitising the heart muscle, which can lead to a heart arrhythmia.
But these two events (the release of adrenaline or a heart arrhythmia) can also not be measured post-mortem.
Dr Olumbe told the court that mild to medium force was required to cause a vasovagal attack. He gave the example of a carotid massage, which is a dangerous practice rarely used by even the most skilled doctors to lower a person's heart rate.
According to the National Coronial Information System, there have been 42 deaths caused solely by vasovagal events and no other factors between 2000-2013.
The court heard most of these were hangings.
Doctor Buxton added to his colleague's assessment of the severity of vasovagal attacks and the high risk associated with the carotid artery.
Anything involving compression of the neck is dangerous ... Even if you know what you are doing, the risk of killing someone is there," he said.
He told Barrister for Mrs Beale's family, Michael Anderson, that if it was his case, he would conclude a vasovagal attack with the contributing factors of alcohol and cardiomyopathy in the patient's death.
But he said he could not confidently say what the final trigger was.
"I don't think you can say any one particular thing worked on its own ... that's why these deaths are so complicated," he said.
Dr Baxton also said it was likely his opinion could be disagreed with by other pathologists.