Expert: Dr.Paul Skett - 11/6/2006

Question
Tks for your information.  I am wondering, would it be within the scope of the biomedical expertise to comment on whether or not BAC should be considered the predominant factor for the fall, especially since the "accident victim" used the same stairs several times every day, prior to the accident with the same recipe of mind-altering chemicals in his system?   A separate question would be can the biomedical expert comment on the presence of other factors that may have contributed to the fall, specifically, let us say the victim had a very full bladder and was anxious to get home before he wet his pants.  Wouldn't the anxiety caused by a need to urinate create its own synergistic effect regardless of toxic chemistry?

Thanks again very much,
Theresa
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The text above is a follow-up to ...

-----Question-----
I want to dispute a coroner's finding that "acute alcohol intoxication" caused the deceased to fall which caused the BTI which caused the death.  This conclusion was based on the results of the toxicology report that was done when the victim arrived at the trauma center.  He also had morphine (I know he was underdosed because we had gotten his new prescription too late on Friday to make it to the pharmacy and were rationing his pills to bridge the dates, so if anything, he was in early light withdrawal, certainly not high!) and benzo (he had taken one 2mg ativan earlier that day, although he was prescribed 2mg3x day with 2 30mg dalmanes at night) but he these were part of his total med recipe he had been taking as prescribed for a very long time.

There were absolutely no witnesses (except me and the victim was not slurring, nor wobbling, nor stumbling drunkenly along!)  Can you help me find the wording?  Clearly the weight of the person drinking affects their BAC (the smaller person gets higher numbers faster) but BAC does not necessarily mean "more intoxicated".  A person with a tolerance for drinking may be quite functional at 3-4x the BAC as a person who does not normally drink.

I realized you are not the legal man but I am bothered by the assumption that this man was "acutely intoxicated" when
he was not!  I have no problem with stating his BAC on the death certificate if that turns the coroner on, but cause of death being "acute alcohol intoxication" seems rather ugly and personal to me somehow.

PS  He was walking home from store when he evidentally had
   a fall which I still do not understand.  He was badly
   injured at the bottom of stairs near our home.
-----Answer-----
Hi, Theresa,

I am sorry to hear of your troubles - such decisions can be difficult to take.

This is a legal matter that is best taken up with a lawyer who will then employ an expert witness such as myself.

However, without prejudicing the case, you should be aware that people become tolerant to alcohol mainly by getting rid of it faster from the body - a BAC level indicates the level of intoxication fairly well - individuals can be quite good at hiding intoxication (it is called functional adaption or tolerance) but are still intoxicated and this comes out when something untoward happens e.g. a driver may think they can drive after a few drinks but will not react well in an emergency situation (a child running into the road).

The other drugs that may have been in his system (morphine and benzos) will not have helped either as they both enhance the effect of alcohol (but not its level).

Please take these facts into consideration before deciding what to do.

Happy to answer any follow-up questions.

Best wishes,


Paul  

Answer
Hi, again, Theresa,

Thanks for the nice comments!

An expert witness would take everything within their area of expertise into account - I specifically have expertise in how alcohol and drugs affect someones performance (both mental and physical) but could not comment on other matters.

The expert would be able to say if the events were consistent with alcohol intoxication (or a combination of drugs and alcohol). It is more difficult to say if the fall would have occurred in the absence of alcohol and/or drugs.

Hope this helps.

Best wishes,


Paul