Deciphering Kugan’s post-mortem reports
Helen Ang’s compelling column article
‘Placating Kugan’s ghost’ raised a valid question about the bewildering amount of medical jargon used by Health Ministry director-general Dr Mohd Ismail Merican when the ministry presented the findings of its official inquiry into the cause of Kugan Ananthan’s death.
It is a matter of national importance, as well as personal importance for Kugan’s bereaved family, to try to shed some light into the dense fog generated by all the medical jargons.
The Bernama report of the Health Ministry’s announcement quoted the director-general (DG) as saying that Kugan, 22, died of fluid in the lungs (pulmonary oedema), caused by inflammation of the heart muscle (myocarditis).
The inquiry asserted that there had been blunt force injuries to Kugan’s body but these “were insufficient to cause death directly” as there were no broken bones or ruptured internal organs.
The DG also mentioned that myocarditis (inflammation of the heart muscle) is a well-recognised cause of sudden death in young people. These findings were based on the first post-mortem report by senior forensic pathologist Dr Abdul Karim Tajuddin from Serdang Hospital in Selangor.
The ministry’s panel also looked into the post-mortem report by Universiti Malaya Medical Centre (UMMC) pathologist Dr Prashant N Samberker, who examined Kugan’s body at the request of Kugan’s family. He concluded that death had resulted from kidney (acute renal) failure.
The kidney failure was caused by rhabdomyolysis, Prashant reported, due to blunt trauma to the muscles. Rhabdomyolysis, or muscle breakdown, is a well-recognised result of trauma to the muscles, especially with prolonged or repeated injuries.
Rhabdomyolysis releases poisons from injured or dead muscles into the blood, and the poisons cause kidney failure. Kidney failure, in turn, can cause inflammation of the heart lining, and can cause pulmonary oedema (fluid in the lungs).
If the kidneys shut down, fluid cannot be removed from the body in the urine, and fluid can then accumulate in the lungs. Kugan was detained and interrogated for five days before he died – more than enough time for severe kidney failure and fluid retention to develop.
The Health Ministry did not contradict Prashant’s findings of acute renal (kidney) failure. The DG was quoted by Bernama as admitting that blunt force trauma could have led to acute renal failure, “aggravating” the acute myocarditis (inflammation of the heart muscle), and resulting in acute pulmonary oedema (fluid in the lungs).
