Dr R Chapman - PM Report (10) (4)

Dr. R.C. Chapman MB ChB FRCPath DMJ(Path) FFFLM
Statement of
STATEMENT OF WITNESS
(Section 9 Criminal Justice Act 1967 and Rule 16.2 Criminal Procedure Rules)
Age of Witness Over 18
Occupation of Witness
Address
Robert Charles Chapman
MB ChB ,FRCPath, DMJPath, FFFLM
Consultant Forensic Pathologist
Forensic Pathology Services
Aspect House, Grove Business Park,
Wantage, Oxfordshire OX12 9FA
FPS
Forensic Pathology Services
Aspect House
Grove Business Park
Wantage
Oxfordshire
OX12 9FA
Tel: 01235 773332
Fax: 01235 773330
O Biedrzycki
N R B Cary
R C Chapman
A W Fegan-Earl
A J Kolar
S M Poole
B Swift
Consultant: M P Cieka
Consultant: V Fitzpatrick-Swallow
Consultant: B Lockyer
Consultant: M S Lyall
Consultant: C Randall
This statement, consisting of 7 pages signed by me, is true to the best of my knowledge
and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to
prosecution if I have wilfully stated in it anything which I know to be false or do not believe
to be true.
Qualifications and Experience
Dated: 4 th June 2020
Signed …………………………..
Signature witnessed by ………………………………
I hold the degrees of Bachelor of Medicine and Bachelor of Surgery. I am a Fellow of the
Royal College of Pathologists and I hold the qualification of Diploma in Medical
Jurisprudence in Pathology. I am a Fellow of the Faculty of Legal and Forensic Medicine.
I have been a Forensic Pathologist since 1988, previously holding Senior Lecturer and
Consultant posts in teaching hospitals within London. I currently practise as a full-time
Consultant Forensic Pathologist within a practice of 7 partners. My ongoing experience
includes the full range of general forensic pathology and the investigation of sudden and
suspicious deaths on behalf of the Coroners and Police Services of the London and Home
Counties regions. I teach both senior and junior police officers and forensic scientists
regarding scene examination and about forensic pathology in broad terms. I participate
in seminars associated with my specialty. I maintain membership of various learned
societies including the British Association in Forensic Medicine, the Forensic Science
Society and the Royal Society of Medicine.

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
Page 2 of 7
Declaration
I understand that I owe an overriding duty to the Court to provide independent assistance,
to the Court, by way of unbiased opinion in relation to the matters within my expertise and
that such advice must be uninfluenced by the exigencies of the case. I have complied
with, and will continue to comply with, my duty to the Court.
I confirm that I have read guidance contained in a booklet known as Disclosure: Expert's
evidence and unused material which details my role and documents my responsibilities,
in relation to revelation as an expert witness. I have followed the guidance and recognise
the continuing nature of my responsibilities of revelation. In accordance with my duties of
revelation, as documented in the guidance booklet, I:-
a. confirm that I have complied with my duties to record, retain and reveal material
in accordance with the Criminal Procedure and Investigations Act 1996, as
amended;
b. have compiled an Index of all material. I will ensure that the Index is updated
in the event I am provided with or generate additional material;
c. that in the event my opinion changes on any material issue, I will inform the
investigating officer, as soon as reasonably practicable and give reasons.
POST MORTEM REPORT
20-S-0082/RC.jf 4 th June 2020
On 11 th February 2020 I attended the Mortuary of the Royal Surrey County Hospital,
Guildford, where I was briefed concerning the death of:
Saul Alexander ALTAL (Prev. TURNER Saul) – Age 36 years
Date of Birth: 08/12/1983
CIRCUMSTANCES
Prior to my examination I received a Coroner’s Officer’s history and a briefing from
Officers present. This was preliminary information and may therefore be incomplete or
contain errors.
It is understood this man died on 6 th February 2020 at 09.35 hours. He was a prisoner at
High Down Prison. It is understood that he had been found in the top bunk of a shared
cell. The covers were up around his body and head and his head had been turned to the
Signature………………………………………Signature of Witness………………………….

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
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right. He had been in the cell for approximately 16 hours with a new cell mate. According
to the cell mate he had been retching. There was no disturbance of the cell to suggest a
fight. A PC observed apparent discoloration around the neck a burst blood vessel in the
eye. SOCO attended and his neck, face and finger nails were swabbed at the scene and
his clothing obtained.
It is believed he had been at the prison since 8 th January. He had been in healthcare for
the previous two weeks for assessment and poor mood. He had been transferred out of
healthcare on 5 th February 2020 and moved to the current cell house block. He had been
in the cell overnight until being found unresponsive by prisoners and staff. He had been
discharged from the healthcare with no issues raised.
POST MORTEM EXAMINATION
Those present at the examination included:
Darren Kirby
DS Holly Say
Rachel Graham
Gemma Rance
Keeley Harvey
Coroner’s Officer
Senior SOCO
SOCO
SOCO
My examination commenced at 11.20 hours.
Receipt of body:
EXTERNAL EXAMINATION
The body was received within a body bag, sealed with a tag RA/13 and label reading,
‘BELIEVED SAUL TURNER 8/12/83’.
There were the following further external observations:
The body was that of an adult male, 170cm (approximately 5ft 7in) in height and 71kg
(approximately 11st 3lb) in weight. He was clad only in boxer shorts. The body surface
appeared clean with no signs of contamination.
There were defibrillator pads on the trunk, in the right upper chest and left lateral chest
positions. There were ECG pads on his shins x 2.
The head hair was brown with areas of greying, approximately 4cm in length. The eyes
were unremarkable and no petechiae or other haemorrhages were seen within the
conjunctivae of the eye lids or sclerae. There were no petechiae in the face or neck.
Signature………………………………………Signature of Witness………………………….

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
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There was a tattoo reading ‘MOTHER’ on the left upper chest and of ‘ELLA’ on the right
forearm.
The finger nails had been recently trimmed and were approximately 1mm in length at their
free margins. They appeared clean.
The anus appeared slightly dilated but there was no evidence of injury and no drugs or
packages were concealed.
There were the following post mortem changes:
There was hypostasis on the back of the body. The body was in full rigor mortis. There
was early decomposition with greening discoloration of the abdominal wall.
There were the following marks of injury:
There were no external marks of injury.
There were the following older features:
There was an old linear scar to the back of the left calf.
Head & Neck
INTERNAL EXAMINATION
Reflection of the scalp revealed no evidence of bruising or other injury. The skull was
intact. The brain coverings were healthy. The brain was of normal external appearances.
No evidence of intracranial bleeding was seen. Serial coronal sections of the brain
showed no evidence of focal natural disease or injury. Cerebral blood vessels were of
normal distribution and appeared healthy.
The facial soft tissues were dissected. There was no deep bruising or bony injury.
The lips were healthy. The dentition was natural and undamaged. There was no bruising
to the tongue.
The neck structures were dissected in layers following removal of cranial and thoracic
contents. The soft tissues showed no evidence of bruising or other injury. The hyoid
bone and laryngeal cartilages were intact. The vessels of the neck were healthy.
Trunk
There was no bruising to the anterior or lateral chest walls. The ribs and sternum were
intact. The pleural linings of the chest were unremarkable. The lungs appeared
Signature………………………………………Signature of Witness………………………….

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
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congested and oedematous. Some froth material was present in the trachea and bronchi.
The coronary vessels were clear.
The pericardium was healthy. The heart was of normal overall size and weight. Left
ventricular wall thickness measured 1.1cm; the right ventricular wall thickness 0.4cm.
The atria and ventricles were of normal configuration. The heart valves were of normal
size and appearance. The coronary arteries were of normal anatomical course. The
proximal part of the left anterior descending branch of the left coronary artery showed pinpoint
occlusion by firm atheroma. There was a possible thrombus (histology) within the
remaining lumen of this vessel. The circumflex branch of the left coronary artery and the
right coronary artery were fully patent throughout. The myocardium of the left and right
ventricles appeared healthy. The aorta was healthy and free of atheroma.
Abdomen
The oesophageal lining was normal. The stomach contained a quantity of rice and fluid
material. The small and large bowels were unremarkable. The peritoneal cavity was
moist.
The liver was of normal size and appearance. The gall bladder was healthy. The
pancreas was unremarkable.
The spleen was large and firm. There was no lymphadenopathy.
The kidneys were of normal size. Capsules stripped readily. Good cortical width present.
Ureters healthy. The bladder contained approximately 30ml of clear urine.
The prostate gland appeared normal. The testes showed no evidence of injury or natural
disease.
The adrenal glands appeared healthy.
The following organ weights were obtained:
Brain: 1325g Liver: 1831g
Heart : 323g Spleen: 329g
Right Lung: 897g Right Kidney: 185g
Left Lung: 789g Left Kidney: 162g
Exhibits:
My examination was completed at 12.20 hours when the following exhibits were handed
to the exhibits officer:
Signature………………………………………Signature of Witness………………………….

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
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RCC/1
RCC/2
RCC/3
RCC/4
RCC/5
RCC/6
RCC/7
RCC/8
RCC/9
Blue boxer shorts
Head hair toxicology
Vitreous humour
Blood for toxicology
Blood for toxicology
Urine
Stomach contents
Histology
Deep muscle tissue
Further investigations:
Toxicology:
I have seen a streamlined forensic toxicology report by Andrew Christopher Love. Post
mortem blood was analysed, and the substances 5F-MDMB-PICA and 5F-MDMB-PICArelated
substance were detected. Mirtazapine was also detected. There were no other
significant findings. In the urine, alcohol was detected at a concentration of 13mg per
100ml.
The toxicologist indicated that:
“The results showed that Mr ALTAL had used the synthetic cannabinoid 5F-MDMB-PICA
which belongs to a group of substances more commonly referred to as ‘Spice’ or ‘Mamba’.
It was not possible to say how much of the drug had been used or precisely when, but
the results could reflect relatively recent use and he may have been experiencing the
effects associated with this drug at the time of his death.” There is limited published
scientific information on the effects of this drug. Synthetic cannabinoids may be more
potent than herbal cannabis and effects include increased heart rate, vomiting,
breathlessness, agitation, convulsions, hallucinations and, in some instances, death. The
substance has become one of the more frequently reported synthetic cannabinoids and
has featured in clinical hospital admissions and in fatalities. The substance related to it
was probably a metabolite also detected in the blood. The drug Mirtazapine is an antidepressant
drug. Its concentration was not accurately measured but it appeared broadly
consistent with therapeutic use. Mr ALTAL was not under the influence of alcohol at the
time of his death. The alcohol in the urine may be residue of alcohol consumed at an
earlier time or it may have been produced post mortem.
Histology:
Eleven blocks of the major organs were retained for histological study. A section from
the proximal segment of the left anterior descending branch of the left coronary artery
shows an eccentric atheromatous plaque with virtual complete obliteration of the
remaining lumen by a recent thrombus. Sections of the myocardium showed no evidence
of established myocardial infarction or other pathology. Sections of lung showed marked
pigmented macrophages and patchy oedema. Sections of kidney and liver appeared
normal.
Signature………………………………………Signature of Witness………………………….

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)
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CONCLUSIONS
1. Saul ALTAL was a 36-year-old man who was suffering with significant natural
disease. He had suffered a recent coronary artery thrombosis in one of the three
major epicardial vessels of his heart and this appeared to be the probable
mechanism of his death.
2. Toxicology analysis revealed the presence of the drug 5F-MDMB-PICA (“Spice”),
a synthetic cannabinoid, which has been associated with hospital admissions and
fatalities. Whilst there is limited information on the toxic effects of this drug, related
synthetic cannabinoids are associated with cardiac toxicity, hypertension,
arrhythmias and myocardial infarction. It appears likely that in this case, the
presence of the Spice had played a part in death by increasing heart rate and
myocardial ischaemia in a man with underlying coronary heart disease, and
increasing the risk of the development of a fatal arrhythmia in the presence of a
coronary artery thrombus.
3. I give as the cause of death:
1a
1b
Coronary Artery Thrombosis
Coronary Atheroma
2 5F-MDMB-PICA (Spice) Toxicity
Dr R C Chapman MB ChB, FRCPath, DMJ(Path), FFFLM
Home Office Registered Consultant Forensic Pathologist
Signature………………………………………Signature of Witness………………………….