A forensic doctor who treated a severely disabled teenager has claimed that injuries which led to her death were not the result of a botched medical examination.
Rebecca McKeown died five days after sustaining an injury alleged to have been the result of a sexual assault.
Last month her elderly grandparents, David and Sarah Johnston, walked free after being acquitted of manslaughter.
Now a medic who examined Rebecca said her injuries were the result of "considerable force". The claim will raise further questions about the teenager's death.
It is unclear if Rebecca's death was still the subject of a police investigation.
It was the Crown case that one or other grandparent had caused the injury while they were looking after Rebecca in March 2001 - an accusation both denied.
But, last month, the prosecuting QC said no further evidence was being offered against the Johnstons.
It followed testimony from Dr Mary Donnelly, who was working as an out-of-hours locum GP.
She admitted for the first time during the trial that two of her fingers "unintentionally" slipped into Rebecca's body - a fact she failed to report for 11 years.
Now the case has taken a further twist after a second medic - the forensic doctor who examined the teenager's injuries - said this could not have been the cause.
Dr Lea Cramsie said the injuries she saw that night were the result of "considerable force", adding the "damage was already done" by the time Dr Donnelly examined Rebecca.
The trial collapsed before Dr Cramsie was able to give evidence. It is understood she was due to be called at a later point in the case.
Her comments are made in a letter to the Belfast Telegraph. In it she writes: "I am dismayed at the collapse of the McKeown case, with its implication that the injuries that Rebecca received were the result of the out-of-hours GP visit and subsequent examination by Dr Mary Donnelly on the night of March 19, 2001.
"What seems to have been forgotten is that Dr Donnelly was called out because Rebecca was bleeding profusely - not the other way around. The damage was already done.
"Doctors are, by training, investigative and Dr Donnelly could not have realised that this was to become a police investigation.
"She did what we all would have done; she examined and removed a clot to try to see where the bleeding originated.
"The injury I saw that night, as the forensic medical examiner on call, was not caused by a 'finger or two' slipping into Rebecca's body, but by considerable force."
The collapse of the Johnstons' trial means that no-one has been convicted of involvement in Rebecca's death.
The couple's solicitor, Seamus Leonard, claimed no crime had been committed.
Dr Cramsie said the circumstances of what happened will now never be known.
She added: "We can only hope that the McKeown and Johnston family will find some peace.
"The McKeown case marks the end of a 20-year forensic career for me. The work of a (forensic medical examiner) is often gruelling and the hours anti-social.
"But these obstacles are small compared to the examination of one's evidence and the questioning in court under cross-examination months to years later, as Dr Donnelly has experienced."