Black eye for the medical profession (V)
posted in - Ethics, - Nation, - Palmdoc |According to the Star, the Independent committee has found that Kugan died of inflamed heart
An Independent committee that investigated the two post mortem reports of suspected car thief A.Kugan, who died in police custody, found that the cause of death was due to acute pulmonary oedema due to acute myocarditis, compounded by blunt force trauma said Health Director-General Tan Sri Dr Ismail Merican on Monday.
In releasing the findings, the 10-men committee unanimously agreed there was no evidence of thermal injuries in the skin on the back of the deceased as reported in the second post mortem and was of the opinion the injuries on Kugan’s back were the result of repeated trauma by a blunt but flexible object, like folded rubber hose.
Health director-general Tan Sri Dr. Ismail Merican said the deceased was found to have an underlying acute myocarditis and the blunt force trauma could have led to acute renal failure.
“This (renal failure) had aggravated the acute myocarditis, resulting in acute pulmonary oedema or lung congestion,” he said.
As for injuries on Kugan’s back, they were in fact patterned imprint injuries which had been caused by a blunt and flexible object.
“There was no evidence that the deceased had been `branded’ or be given repeated application of heat with an instrument or object.
“All body injuries noted on the deceased were insufficient, either individually or collectively to cause death directly,” he told a press conference Monday.
So it seems, according to this news, the cause of the Pulmonary oedema found in both post-mortems was “Acute myocarditis”.
The first report had apparently stated “Pulmonary oedema” but the cause could not be determined. The second report had allegedly stated the cause of death was “acute renal failure due to rhabdomyolysis” which in turn presumably lead to the pulmonary oedema.
But no, it seems the pulmonary oedema was of cardiac origin after all - Myocarditis or inflammation of the heart muscle. The renal failure only “aggravated” the situation.
This means Kugan “died of natural causes” and the injuries documented have been dismissed as “insufficient, either individually or collectively to cause death directly”.
So it seems we were misled by the alleged post-mortem reports put up by Malaysiakini.
The 1st alleged report (page 3) had mentioned “jantung normal”. Surely a pathologist with “26 years experience” won’t miss myocarditis. So I guess this alleged report can’t be the correct one.
The second alleged post mortem had recorded more details as far as the heart is concerned.
Gross examination:
- while there was external haemorrhage, the heart muscle (pericardium, myocardium and endocardium) did not show any abnormality on gross examination
Histological findings:
- “few scattered foci of lymphocytes” would not be what one expects to find in Myocarditis where there is typically “…abundant edema and inflammatory infiltrate, rich in lymphocytes and macrophages. Focal destruction of myocytes”
I don’t read much cardiac inflammation in those alleged findings of the second report to suggest “Acute myocarditis”.
Based on this, one can only conclude the “Independent committee” must have access to the real post-mortem reports and that we observers have been misled all along by the information put up in that online news portal.
I am sure we can all rest easy now. The Independent committee members too can sleep well for doing such a good job getting to the bottom of things and revealing the truth. There were injuries no doubt but it was “natural causes” that killed Kugan. Police exonerated. Cased closed. Can tutup fail now.
Related MMR posts:
Another custodial death. No foul play?
2nd post-mortem: Kugan was beaten to death
Black eye for the medical profession
Black eye for the medical profession (II)
Black eye for the medical profession (III)
Black eye for the medical profession (IV)
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April 10th, 2009 at 11:58 am
Its not a question of agenda but a medical question on how the committee concluded there was myocarditis. This is a question I think physicians would be curious since the details were not divulged. In the light of the second post mortem “report” available online I think in the interest of transparency, perhaps the committee could share how they concluded it was myocarditis. True they might be privy to some information we don’t have or are not aware of but I see nothing wrong in being transparent.
April 10th, 2009 at 11:03 am
I think we should just stop speculating or justify why the conclusions of the committee didn’t suit our agenda. The committe may well have the access to all the HPE samples, photos, slides for the consultant histopatholigist to review and make a stand. All we have are just the 2 written reports by the 2 pathologists available online.
The setting up of independent committee is to find out the truth and not to sing along with particular agenda. If we cannot accept the conclusions other than the conclusion that we want, no measure can solve this problem because we refuse to believe any conclusions that not conform with our prejudgement. Even if this were brought to the court, any decision against the our intend outcome will be viewed as another conspiracy.
Looking at the root of this fiasco, it’s not difficult to understand the reason of us not to trust the committee stand. It is our political inclination and our hatred against a particular body that cloud our judgement rather than making the decision based on facts and truth.
Unless we are thinking that the 10 power packed committee members will agree to conspire in order to help the police to be directly linked to murder allegation. But to risk their hard earned credential and credibility for this (including those 2 experts from overseas) is beyond my wildest imagination.
April 10th, 2009 at 7:38 am
Interestingly the recent issue of NEJM has a review on Myocarditis. Worth a read for CME
On the definition
Presumably the learned panel had all the information at hand to make a definitive diagnosis of myocarditis. I concur too that it appears the second (alleged) post-mortem report is more comprehensive and while no one disputes the learned committee’s findings, it is strange that “a few scattered foci of lymphocytes” makes it myocarditis. Clearly there must be more to it than that and we trust the committee had in-depth knowledge on the real situation.
Another point dranony in the MMR forums brought up is that “scattered lymphocytic infiltrate in the myocardium can be explained by contusion, and are certainly not pathognomic of myocarditis from a particular cause” (ref)
April 9th, 2009 at 10:13 pm
Looked like the 10-member committee is made up by all the experts and consultants with credibility, and no one should challenge their findings. According to the Star reporting, the cause of death was “due to acute pulmonary oedema due to acute myocarditis”. I am not sure whether the layman is been deliberately misled or was it a false reporting by STAR? Everyone in the medical community would agree that whether it is pulmonary oedema or myocarditis (both are syndromes and not a diagnosis), the cause of death was still unanswered. Myocarditis could be result from many causes, e.g. infective, poisoning, autoimmune etc. Similarly, Altantuya may be killed by Azilah and Sirul, but we still do not know who instructed them to do so. But then, what was most striking in the 2nd post-mortem report was that the victim had rhabdomyolysis due to massive muscle breakdown (whether due to seizure or trauma)causing renal failure as evidenced by the histopathologic findings. Many people would be more incline to believe the 2nd post-mortem was more comprehensive and thorough.
April 9th, 2009 at 4:47 pm
Let’s wait for more drama. If the Aussie will let go someone lightly just because he didn’t know English, personally I don’t think the CSI Melbourne will risk an international conflict or challenge the power packed independent committee. It just not worth the price for the Aussie. A telephone call will just kill this idea.
April 9th, 2009 at 4:21 pm
Well, it’s not CSI Miami, but CSI Melbourne roped in now
Kugan’s death: MIC to ask advice from Aussie specialists
April 8th, 2009 at 8:13 pm
“Puchong MP Gobind Singh appealed to the Attorney-General to initiate a court inquiry so that the court could decide which post-mortem reports was valid.
“Arrests should not be delayed. If the Attorney General cannot decide which report to accept then let the court decide. Let the family have their day in court,” he said.”
If the independent committee conclusions cannot be trusted, how the AG or jufge will decide which report to accept? Who will be the expert witness for this case as all the top pathologist and forensic specialists had been included in the independent committee.
April 8th, 2009 at 5:45 pm
http://m.themalaysianinsider.com/articles.php?id=22711-kugans-father-offers-to-exhume-his-body
The fiasco goes on. Maybe this time, they should sent to CSI MIami to get the justice. They can’t beat the police without getting higher ‘authority’ than the independent committee.
April 8th, 2009 at 3:30 pm
Oh…
Actually I was just exercising my neck… heh heh. *wink*
April 8th, 2009 at 12:33 pm
Jimbo, you’re not supposed to shake your head. You’re expected to exercise unilateral contraction of the obicularis oculi such that the aperture between the superior and inferior palpebrae is reduced to a minimum.