A forensic pathologist who reviewed the death of Dalian Atkinson has told a court the continued use of handcuffs in spite of unconsciousness probably contributed to the ex-Ipswich Town footballer’s death.

Dr Nathaniel Cary told Birmingham Crown Court that the “poor management” of the former Aston Villa and Sheffield Wednesday star after he lost consciousness, was “more likely than not” to have been a factor in the death.

In the fourth week of the trial of PC Benjamin Monk, Dr Cary also identified a “third Taser deployment and/or kicks to the head” as playing a role in the fatal outcome.

West Mercia PC Monk, who denies murder and manslaughter, is standing trial alongside fellow PC Mary Ellen Bettley-Smith, who has pleaded not guilty to assault, after striking Mr Atkinson with a baton.

The Court heard Monk, 43, claims the former Ipswich Town player, who had been tasered to the ground, was “very, very obviously attempting to get up” before he kicked him twice in Meadow Close, Telford, on August 15 2016.

Dr Cary told the jury he had provided a report into the “complex” death to the Independent Office for Police Conduct in 2019.

After stressing he was keen not to trespass on the burdens of proof before the jury, Dr Cary said: “In my opinion, it’s beyond any reasonable doubt that (pre-existing) enlargement of the heart contributed to the fatal outcome in this case.

“My second conclusion is that in my opinion it is beyond any reasonable doubt that the deceased’s mind-altered state contributed to the fatal outcome.

“In the simplest of terms, none of this would have happened if he hadn’t had a mind-altered state.”

The expert witness went on to state that, again in his opinion, a third Taser deployment, which is accepted to have lasted for 33 seconds, and/or kicks to the head contributed to the death.

Addressing the Taser use and kicks specifically, Dr Cary added: “Because of the close proximity of one to the other I am not able to identify whether one or both was the main factor.”

Dr Cary then commented on what he described as poor management of Atkinson, including poor posture, the “continued use” of handcuffs after unconsciousness, and an inability to adequately assess him.

“In my opinion, on the balance of probabilities, poor management of the deceased following the unconsciousness contributed to the death.”

The Home Office-approved pathologist added: “I cannot state that this contributed to death beyond any reasonable doubt because the deceased’s fate might already have been sealed.”

During his evidence, Dr Cary also said that he believed baton strikes had not contributed to the death.

The trial continues.