The Nancy Kissel Case - Part 44

Doctor tells murder trial Nancy Kissel's bruises not necessary visible after brawl with husband Dr Annabelle Dytham told the High Court Monday that Nancy Kissel could have been suffering from intense pain from a weapon-swinging brawl with her murdered husband without showing any visible marks.

Kissel visited Dytham 36 hours after her husband is thought to have been killed, saying she was in serious pain. Dytham testified last week that she thought Kissel's reaction to the physical examination on November 4, 2003, was ''disproportionate to the actual injury'' since she did not see any visible bruising in some of the areas that evinced a pained response.

When informed by defense counsel Alexander King SC that blood tests later showed the possibility of ''skeletal muscle injury,'' Dytham said that would definitely have been a matter for consideration and would have suggested that her ''expressions of pain were not exaggerated.''

Dytham added that ''deep tissue injuries do not necessarily show up as bruises'' or red marks.

Dytham, who was part of the medical team during the Hong Kong Rugby Sevens tournament, agreed with King that rugby players often come off the pitch not realizing until the next day the extent of their injuries.

Kissel, 41, is accused of serving her husband a pink milkshake laced with sedatives which left him unconscious at the foot of the bed as she bludgeoned him to death with a heavy metal ornament on November 2, 2003 in their luxury Parkview apartment.

Kissel has testified there was a furious fight that night and that she feared for her life when her husband bore down on her swinging a baseball bat.

She has accepted that she killed her husband, but she says cannot recall how she came to inflict five fatal wounds to the side of his head. She denies the charge of murder and is out on bail.

The decomposing body of Robert Kissel, a high-flying Merrill Lynch banker, was found wrapped in a rug and locked in a storeroom in the Parkview residential complex in the early hours of November 7.

The prosecution alleges Kissel went shopping for drugs in the week leading up to that fatal Halloween weekend, and secured a prescription of Rohypnol, the infamous date rape drug which was found in the stomach of the deceased, from Dytham on October 23, 2003.

The prosecution has charged that Kissel misled Dytham into composing a report of injuries supposedly inflicted on her during an assault by her husband.

The fact that Kissel managed to recount a version of events to Dytham on November 4, albeit without mention of the baseball bat or the life-or-death struggle, suggests that the defendant's claim of memory loss since November 4 is a lie, the prosecution alleged last week.

Senior Assistant Director of Public Prosecutions, Peter Chapman, completed his cross-examination of the doctor Monday, noting her report made no mention of memory disorder, baseball bat, nor nine or 10 areas of injuries which the defense had previously said were ''classic areas of defensive injuries.''

Dytham said she had not been aware of Kissel's visits to a Dr Desmond Fung, who prescribed Lorivan, Stilnox and Amitriptyline, the other hypnotics and sedatives found in the stomach of the corpse along with Rohyphnol.

Dytham said she saw no signs of confusion or problems with recollection when she examined Kissel on November 4, but she emphasized she is no expert in psychiatry.

There seems to have been no mention of rape since ''rape is very serious and if it had been mentioned, I feel I would have explored that at greater depth,'' she said.

In relation to the nine or 10 areas of injuries, she said: ''I may have seen them, but did not record them.''

''The other possibility is they just weren't there at the time,'' Chapman said.

Dytham agreed with Chapman that the carpet burns found on Kissel's knees could have been caused by her efforts to push a dead body into a sleeping bag while kneeling on a carpet, but said that they could equally have been caused by being dragged around the room.

''If an adult male was swinging that [baseball bat], accompanied with threats that he was about to kill, and manage to land blows, what type of injury would you expect to see?'' asked the prosecutor.

Dytham replied: ''Bruises, collection of blood over areas of bone, possible fracture - and if on the head, loss of consciousness.''

She added that such injuries should have been readily identifiable.

In re-examination by King, Dytham said she would have examined Kissel in a different light had she known of possible ''skeletal muscle injuries'' which are often deep in the body hidden from sight.

The trial continues today before justice Michael Lunn.

(SCMP; no link)  No sign of heavy blow to Kissel: doctor.  By Polly Hui.  August 16, 2005.

Nowhere on Nancy Kissel's body did doctor Annabelle Dytham, who examined Kissel two days after she killed her husband, see anything to suggest she had received "serious forceful blows" from an object such as a baseball bat, the Court of First Instance heard yesterday.

But Dr Dytham said Kissel may not have been exaggerating the pain she was suffering from an alleged assault by her husband - contradicting her testimony on Friday that she may have overstated it. The doctor made the statement yesterday after defence counsel told her of tests that suggested Kissel had musculo-skeletal injuries.

During cross-examination by prosecutor Peter Chapman, Dr Dytham was asked to view and touch the baseball bat that Kissel, 41, claims Robert Peter Kissel used to beat her in their bedroom on November 2, 2003, the day she is accused of murdering her husband.

Mr Chapman asked Dr Dytham what injuries she would expect to see if a man had used the bat to land forceful blows on a woman. She said bruises, possible bone fractures and - if hit on the head - possible loss of consciousness.

"In relations to injuries you had noted in your medical notes, were they consistent with an assault by Robert Kissel, threatening to kill Nancy Kissel by the use of a baseball bat?" Mr Chapman asked. The list of Kissel's injuries recorded by Dr Dytham on November 4 included swollen fingers, puncture wounds to the right hand, pain in the ribs, chest and shoulders, and leg bruises and markings. X-rays showed no fractures.

"The injuries suggested there was an assault. Whether the bat was used forcibly or whether the bat was used, I am unable to comment," Dr Dytham said. "As far as I can see, there's no area that implies serious forceful blows."

Kissel is accused of bludgeoning her husband, a top Merrill Lynch banker, to death with a metal ornament in their Parkview, Tai Tam flat, rolling his body in a carpet and having it taken to a storeroom. She has pleaded not guilty to murder.

Kissel went to see Dr Dytham "in total body pain" on the morning of November 4, alleging her husband had used his feet and fists to attack her, but she did not mention a baseball bat during the visit.

Dr Dytham was asked to study photos of the deceased wrapped in the carpet and weigh the new rug the accused carried home on November 3. She was asked if she was surprised by Kissel's ability to roll up her husband and carry the new carpet with her injuries.

"Nancy was very distressed when I saw her. If it now seems that she's admitted she had killed her husband, then I could imagine how frantic she must have been and desperate to destroy or remove any evidence under those circumstances," Dr Dytham said.

"Given how she presented herself to me, I am surprised. Given how she was exaggerating her injuries, then I am not surprised."

In re-examination, defence counsel Alexander King SC told Dr Dytham two blood tests, which detect injuries to skeletal muscles, conducted after Kissel's arrest on November 7 recorded CK levels of 358 and 450 per litre. The normal CK level was 24 to 180, he said.

Referring to the findings, Mr King asked: "Would that suggest to you that the pain may not have been exaggerated?" The witness said: "Yes. I cannot comment on the subjective level of pain with the level of CK. But yes, you are right."

Mr King asked: "If someone was holding the ornament to protect herself from the blows from a bat and the bat came into contact with the ornament, would the shock transfer itself to the joints of the elbows and shoulders?" Dr Dytham said this was possible and that there could be injuries to the ribs even without a fracture.

"You were aware when Nancy Kissel came to see you, she had been in the room with Robert Kissel's body for one or two nights?" Mr King asked. Dr Dytham said she had not been aware that was so.

The case continues today.