KUALA LUMPUR, Nov 30 — There was no reason to disagree with Nora Anne Quoirin's initial autopsy examination findings in Malaysia as it was reasonable and well-argued, which concluded she had possibly died of internal bleeding brought on by starvation, an external consultant forensic pathologist told the Coroner Court today.
Dr Nathaniel Cary, who is based in the United Kingdom, cited his autopsy report in which he had concluded that there has been a thorough assessment for significant injuries regarding the extent of the subcutaneous dissection and description outlined in the Malaysian post-mortem report which subsequently provided no evidence for any injuries of assault or restraint.
In the Malaysian post-mortem report filed by Dr Siew Sheue Feng and Dr Hanif Mahmud of Hospital Kuala Lumpur, Quoirin’s cause of death was listed as upper gastrointestinal bleeding due to duodenal ulcer complications with perforation.
“Whilst it's not possible at my examination to confirm the cause of death recorded in Malaysia because the duodenum has either become autolysed or retained in Malaysia for microscoping analysis, I'm satisfied that there was evidence of duodenal ulceration, perforation and hemorrhage on the basis of a detailed description provided.
“My opinion is duodenal ulceration, perforation and hemorrhage which was the principle underlying cause of death has developed as a result of starvation and physiological stress,” Cary, the inquest’s 43rd witness, said during the hearing that was conducted via video-conferencing.
Cary also said the autopsy on Quoirin was conducted at Westminster Public Mortuary in London after her body was repatriated from Malaysia following her discovery several days after she had gone missing at a jungle resort in Negri Sembilan.
At the material time, Cary said Quoirin’s body had severely decomposed when he performed the autopsy on August 28, 2019.
As for possible signs of potential sexual assaults by a third-party, Cary testified that he agreed there was no positive evidence of such circumstances, only if one chooses to adopt the Malaysian pathologists’ report which substantiated his own dissection of the labia majora.
“The genitalia have decomposed at my examination thus making the exclusion of sexual assault not possible.
“However my further dissection of the labia majora did not show evidence of bruising at all.
“I am unable to exclude (sexual assault) from my examination alone, but If one adopts the Malaysian pathlogists report, then in my opinion the examination has been very thorough, then I agree that there is no positive evidence,” he said, adding that Quoirin’s genitalia also did not show any abnormalities.
When asked if one could assume rape did not occur, Cary replied in the affirmative but pointed out that sexual assault can take many forms including limited digital penetration without causing injuries.
“Based on the analysis carried out in Malaysia and my own examination, I think we could exclude serious trauma to the genitalia.
“I wouldn't be able to exclude minimal trauma because of the decomposition obscuring things. So that’s how it stands in my mind,” he said.
Earlier in his external observation of recent injuries, Cary had noted that there were superficial scratches on both of Quoirin’s legs and not obvious major areas of wounding on both front and back torso.
He also said there was no convincing evidence of subcutaneous contusion (bruise just beneath the skin) on Quoirin’s limbs with the superficial injuries on her lower limbs consistent with moving through the undergrowth.
“On the basis of the findings in relation to internal organs there is no evidence of underlying natural disease that caused or contributed to death.
“The lack of bony injuries suggests that she's had not any major force applied by whatever means to her body,” he said on the lack of skeletal injuries sustained during her time in the jungle in regards to Quoirin’s physical limitation due to her disability.
Cary also said he was unable to comment on the period of time Quoirin had been alive before being found dead but sees no reason to dispute the suggestion in the Malaysian post-mortem report that death occurred four days before she was found on August 13, 2019.
Examination’s comprehensiveness hampered by decomposition
Cary told Coroner Maimoonah Aid that his expert opinion was somewhat hampered by decomposition, a circumstance that was shared by his Malaysian counterparts as well.
“The case is disadvantaged from the outset of decomposition because of the length of time both from disappearance to discovery and then clearly from death to discovery.
“That is very difficult and I've been involved in a number of cases that involved deaths of children where it’s clear there are suspicions of third-party involvement and you are really disadvantaged by decomposition, it is very much easier to apply forensic scientific test to a body that is fresh.
“The cause of death here to me is quite straightforward, I don’t think it's controversial and I agree with meticulous examinations clearly being carried out.
“The difficulty here is in what circumstances those deaths occurred, and probably not the cause but the circumstances,” he said.
He affirmed when asked whether an independent assessment of possible third-party involvement was difficult to ascertain as Quoirin’s body had decomposed.
Nora Anne, a 15-year-old with learning difficulties, disappeared from the resort last year where she was staying with her London-based family, triggering a 10-day hunt involving helicopters, sniffer dogs and hundreds of searchers.
Her body was discovered close to the jungle retreat and an autopsy found that she likely died of internal bleeding linked to starvation after spending about a week in the dense rainforest.
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