Deaths in the family

A mother is accused of murdering her four children. But Karen Kissane discovers the case has the experts divided.
IT WAS supposed to be a routine operation, but little Joshua Matthey, only six weeks old, had a reaction that was not routine. A nurse noticed he was in trouble: he was grimacing and extremely pale, his back was arched, and his hands and feet were clenched. His body was so rigid that she could not turn his neck from side to side. And his breathing was “minimal”.
Joshua was resuscitated and put on ventilation for the next 60 hours. The neonatal physician in charge of his care, Dr Peter McDougall, this week told the Melbourne Magistrates Court that he thought Joshua’s behaviour suggested he had been in severe pain, and that his breathing difficulties had been the result of morphine that had been given to relieve that pain.
There was no basis, he said firmly, for another doctor’s later theory: that Joshua might have been poisoned with strychnine while he was in hospital. Strychnine poisoning would have produced more symptoms, and would have been impossible to administer at that time as Joshua had a naso-gastric tube and was not able to suck or take in anything orally.
McDougall is the director of neonatology at the Royal Children’s Hospital. The strychnine theory he was rejecting had been put forward by a senior surgeon at the same hospital. The surgeon, who is yet to give evidence, had supervised the operation to correct a digestive problem in Joshua in May 2002.
This division in medical opinion over Joshua is only one of many hotly argued scientific issues in a complex criminal case involving his young mother. Carol Louise Matthey, 26, of Geelong, sat in court this week facing charges that she killed not only Joshua but three more of her small children. She is on bail and has pleaded not guilty to all charges.
There was a history of medical mysteries in the Matthey family. Matthey had collapses for which no cause could be found, and two of her children had crises involving breathing difficulties and unconsciousness. Does the answer to the deaths of the Matthey children lie in the frontiers of knowledge about genetic science, as her defence lawyers insist, or in a mother’s mind?
Matthey lost four children in five years. Seven-month-old Jacob died in 1998 and was found by a coroner to have been a cot death. Chloe, aged nine weeks, died in November 2000 and was also found to be a cot death. Joshua survived his respiratory arrest at the Royal Children’s but died six weeks later after he stopped breathing while in a supermarket car park. He had an ear infection at the time, and a coroner later ruled that he had died of a rare infection, klebsiella septicaemia.
The last death was that of 31/2-year-old Shania. Her mother had previously told a doctor that Shania had episodes in which her breathing stopped until she turned blue. The night before she died, according to her mother, Shania fell off a coffee table in the lounge room while pretending to ride her Barbie’s horse. She died in the early hours of the next day, April 9, 2003. An autopsy found no cause of death.
Matthey is a solidly built woman with storybook rosy cheeks. In court this week she dressed plainly – workboots, pants, shirt and jumper – and wore her straight dark hair pulled back. Most days she was accompanied by a male relative, and they murmured occasionally to each other as the evidence moved back and forth in a committal hearing that was strongly contested.
This week’s evidence painted only a sketchy picture of Matthey. The court was told that her sister had told police that “even as a child, (Matthey) never really showed her emotions, so she wasn’t outwardly very emotional as an adult”.
Geelong GP Cindy-Lou Nelson, who accepted the Matthey family into her clinic after their first two children died, said that she could not remember Matthey showing emotion. She had recorded in her notes that Matthey was “quite reserved, and presented as a sad and lonely woman who was probably quite shy . . . Isolated, no supports, not interested in doing anything to help herself”.
Another doctor at the clinic recorded that Matthey had been tearful and had trouble sleeping. She was on anti-depressants and was being counselled in a program for bereaved parents.
When pregnant with Joshua, Matthey came to the clinic worried when she could not feel him moving. Nelson agreed with defence counsel Gerard Mullaly that Matthey was appropriately concerned for the safety of her pregnancy, and that she had always had a valid reason for attending the clinic.
Doctors were not always able to help her. In July 1998, Dr Jaycen Cruikshank told the court, Matthey had had several spells of fainting from which it was difficult to rouse her. The first doctor to see her in Geelong Hospital’s accident and emergency department had wondered whether a heart problem, or a “conversion disorder” – a psychiatric condition in which a patient develops physical symptoms that have no physical cause – might be among the potential diagnoses. Cruikshank concluded it was most likely that Matthey had had brain seizures.
In a statement to police, he said it was worth asking whether, given that the cause of her collapses was uncertain, there could be a genetic disorder in the family that linked her faintings and her children’s deaths.
Dr Andrew Davis, a pediatric cardiologist, told the court how such disorders can work. He said a genetic abnormality can cause conditions such as Brugada syndrome, which was discovered only in 1992. “If you have it, you are prone to abnormal dangerous heart rhythms that cause sudden death, especially in your sleep.”
The Matthey parents had tested negative, but only 25 per cent of people with the syndrome have a genetic abnormality, making it difficult to detect, he said. And there were doubtless other such disorders that had yet to be discovered, he agreed under cross-examination.
Asked Mullaly: “We now can explain some sudden deaths in infants that we couldn’t before? . . . We are learning more about sudden death, but there is much more we can’t explain?”
“Yes,” said Davis.
Dr Susan Beal, an Adelaide pediatrician and expert on sudden infant death syndrome, allowed for fewer uncertainties in her assessment of the Matthey children’s deaths.
She told senior defence counsel Ian Hill, QC, that a study by other researchers claiming that even three infant deaths in the same family might be from natural causes “was extremely flawed and was refuted in The Lancet by very good people”.
She said it would be “very, very unlikely” for three children in one family to die of SIDS. “I did see it once, and I missed it; I was young and innocent, and I didn’t believe mothers killed their children.”
BEAL said the main cause of SIDS was babies being put to sleep on their stomachs. If a child was found dead on his or her back, it was questionable that it was SIDS.
“The incidence is one in 10,000, in my experience, and I would always be suspicious that something else had gone on in that family.”
Beal reviewed the Matthey children’s files in a report to police. She concluded that Jacob and Chloe’s deaths could be either SIDS or “filicide” (killing by a parent); that Joshua’s death was most likely filicide; and that Shania died of “some totally unknown disorder” or filicide.
“In more than 30 years of experience, I know of three other families who have had four or more children die suddenly and unexpectedly,” she wrote.
“In all three families, some of the deaths were stated to be due to SIDS, and others have been attributed to infections. In all these families it was later proved that the children were all murdered . . . In the Matthey family . . . I believe all the evidence points to all children having been killed by non-accidental suffocation.” Hill challenged her vigorously on this. What evidence was there that any of the children had suffered physical injury, he demanded to know?
Beal said that in cases of suffocation, she would not necessarily expect to find signs of physical injury. “The autopsy is absolutely unable to distinguish between induced suffocation and SIDS,” she said.
Her conclusion that the deaths were suspicious was based on several “pointers”, including that:
· Jacob was outside the normal age for SIDS;
· Chloe had been found on her back, and Beal believes babies on their backs, whose faces are not covered by bedclothes, do not die of SIDS;
· The family had a history of children experiencing “ALTEs” – apparent life-threatening incidents where they stopped breathing or were found unconscious. “ALTES are not a predictor for SIDS; they’re a predictor for filicide,” Beal said.
Hill asked: “You take an event and put the worst possible spin on it?”
Beal: “I put the most likely spin on it.”
Hill then referred to British cases in which the evidence of a prominent pediatrician, Sir Roy Meadows, was later found to have helped wrongfully convict of murder mothers who had lost two or more children to cot death.
Hill asked Beal: “At the end, you are left with an approach similar to that of Sir Roy Meadows, looking at the statistical improbability of events happening in one particular family, because you have no medical evidence?”
Beal said tartly: “What do you mean? I have just outlined it to you!”
Most of the hearing this week was taken up with doctors and ambulance officers who had dealt with the Matthey family.
The court heard a recording of a call Matthey made asking for an ambulance. She reported that Shania had fallen off a coffee table, begun to scream, suddenly held her breath and passed out. The child was purple and not breathing, she told the operator.
In the call, Matthey sounded tearful and distressed. At one point she told the operator that she knew CPR. She dropped the phone, and a few moments later, a small child coughed and wailed.
When ambulance officers arrived, they found Shania upset and clinging to her mother but showing no signs of ill health.
Shania, who had a history of asthma, died early the next morning. Her mother said she found her not breathing in bed.
As she listened to the emergency-call recording in court, Matthey cried, quietly.
The hearing continues with prosecutor Susan Pullen, SC, before magistrate Duncan Reynolds.

First published in The Age.