IQALUIT - By the time Elisapee Michael arrived in Ottawa via medevac from Iqaluit, there was nothing that could be done for her, the forensic pathologist who conducted her autopsy told an inquest into her death Tuesday.

The cause of her death was head injury, and the pattern of bruising on the brain and skull fracture were characteristic of someone who had fallen on the back of the head, he added. She had a blood clot under the thick membrane surrounding the brain and bleeding in the frontal lobe.

Dr. Christopher Milroy added the surgery in Ottawa her family decided not to authorize – which the surgeon told them had a 50/50 chance of being successful and a less than 50 per cent survival rate -- would not have saved her life at that point.

The inquest has previously heard that on Aug. 8 Michael, 52, had gone to the bar at the Nova Inn where she consumed a number of alcoholic drinks. She was asked to leave the bar and was seen falling down the stairs of the hotel. A security guard found her unresponsive so an ambulance was called and Michael was sent to the hospital.

The doctor on duty at Qikiqtani General Hospital that night testified last week he examined Michael's head and found swelling, but could not rule out a skull fracture without a CT scan, which Iqaluit does not have. Though the symptoms of head injury and intoxication are similar, he said he felt she was intoxicated.

Michael was deemed disruptive by hospital staff and they called RCMP. She was taken into custody and put in a cell.

When Michael was found unresponsive later the next day, she was taken back to Qikiqtani General Hospital, diagnosed with a head injury and medevaced to Ottawa.

Milroy, a staff forensic pathologist at the Ottawa Hospital, testified on the second week of the inquest presided by coroner Garth Eggenberger.

The United Kingdom-trained forensic pathologist has practised full time from 1990 to 2008 in the U.K. before starting employment at the Ottawa Hospital in 2008. Michael died in Ottawa on Aug. 13, 2009 and Dr. Milroy performed the autopsy on Aug. 17.

Milroy said a CT scan performed in Ottawa showed Michael had bleeding in the front of the brain, a collection of blood on the overall brain and bruising at the back of the brain.

During his external examination of the body, Milroy said he noted 13 injuries, including healing abrasions or scrape marks on the forehead, forearm, shoulder, back of the knuckles, right hand and back of right knee. No lacerations or abrasions were noted on the back of the head, said the forensic pathologist. He also noted bruising on the centre and right of the chest as well as the hip area, he added. Dr. Milroy said he would expect to see those injuries if someone had suffered one or more falls.

He said if the abrasions occurred in the fall, he would have expected them to have been seen, but he was told, he added, the abrasions were not seen by nurses on the first hospital visit but during the second.

He did admit the abrasions could have resulted from someone dragging themselves in a cell in a T-shirt, something he has seen in the past in the U.K.

The internal examination of the body revealed bruising at the back and front of the brain, with the injury on the back of the brain related to a skull fracture, said the forensic pathologist.

When someone fall backwards and hits their head, the brain ricochets and also hits the skull at the opposite side from the impact, explained Dr. Milroy.

The forensic pathologist said he confirmed a blood clot under the thick membrane surrounding the brain and bleeding in the frontal lobe.

The inquest continues.

We welcome your opinions. Click here to e-mail a letter to the editor.