What should an inquest into Nebanda’s death look at?

Sunday January 13 2013

By Tabu Butagira

The death of Butaleja Woman MP Cerinah Nebanda may have sparked indignation and polarised the Executive and Legislature, but the crisis has not all gone to waste. From the ruins of the quarrels and invective emerged an important lesson: The statutory requirement to conduct official inquests into suspicious deaths in the country.

The inquests Act, Chapter 11 of the Laws of Uganda, provides for an inquest when there is reasonable cause to suspect that a person died a violent/unnatural death caused or accelerated by the violence or any culpable or negligent conduct of any person other than the deceased.

“Notwithstanding subsection (1), in the following cases the coroner shall always hold an inquest: If the deceased died as a result of a road traffic accident; an accident in a factory as defined in the Factories Act, or in a mine as defined in the Mining Act,” the Act reads in part.

A coroner is defined as a person duly authorised or appointed under the legislation to hold an inquest. And inquest under the law is more than just a postmortem exercise; it follows an elaborate process involving a coroner and exercise of power to view or exhume to establish cause of death. The findings, the law says, must be entered in an Inquest Book that every court established under the Magistrates Court Act must have.

So, why has government largely ignored or been reluctant to undertake the statutory inquests until Nebanda dropped dead, triggering an avalanche of accusations and counter-accusations?

Opening to public scrutiny
In accepting to conduct an inquest into the politically-divisive death, government opened itself up to public scrutiny, including demands by relatives for special investigations into suspect passing on – whether past or in the future - of their kins. Monies for conducting inquests are drawn from public coffers, so private persons would not have to worry about costs.

Chief Justice Benjamin Odoki named Anti-Corruption Court judge Paul Mugambwa to inquire into the cause of the death of Nebanda, an exercise expected to peel the layers off what investigators may have failed to unravel.

The government, relying on parts of reports of an inconclusive toxicological analysis it commissioned to be done in the United Kingdom, has told the nation that the MP succumbed to an overdose of narcotic drugs. The police have already taken the view that Nebanda died from an overdose, in effect endorse the UK report.

So, what will an inquest exhume that ongoing investigators cannot find? Or will Mugambwa help produce results the public will not doubt by tying the loose ends and explaining the contradictions in the account offered by officials so far. There are plenty of areas for the inquest to start from.

First, toxicological experts in London noted that the traces of narcotic drugs they found in Nebanda’s body were in such “low concentrations” as to kill anyone. Quiet inquiries by this newspaper in Kampala suggest that separate findings of the final postmortem done at National Referral Hospital, Mulago, under the stewardship of Prof. Henry Wabinga, does not mention drugs as the probable cause of the Butaleja Woman MP’s sudden demise.

The government has kept quiet about those Mulago findings released on December 30, 2012, nine days after the UK report, whose results confirming observed traces of heroin and cocaine, were promptly made public by President Museveni.

Both reports, read side-by-side, offer contrasting findings; deepening the mystery regarding circumstances of Nebanda’s demise mid-last month. Whereas the final Mulago report attributes the cause of the MP’s death to unexplained “multiple organ failure”, experts in UK note that “in the absence of any other pathological explanation for the cause of Ms Nebanda’s death, combined drug and alcohol toxicity offers a possible cause”.

“Although the concentration of cocaine measured in the blood is far lower than typically observed in fatalities attributed to acute cocaine toxicity, the possibility that such concentration could have resulted in some cardio-toxic effects cannot be excluded,” the eight-page report signed by consultant forensic toxicologist Simon Elliot reads in part.

Dr Elliot is the managing director of ROAR Forensics, the private laboratory in the UK where government took samples that the Ugandan team, which made unrelated findings, extracted from Nebanda’s body.

The two examinations used different methods and technologies. The Mulago team observed body tissues recovered from Nemanda’s body under a microscope to determine cause of death (pathological histology), while the UK group examined the presence and concentration of toxic substances to determine the effects (forensic toxicology).

The overseas experts only tested samples of Nebanda’s postmortem blood and urine to make their assessments, although it remained unclear who had removed the urine sample. Police Medical Services head, Dr Moses Byaruhanga, and Andrew Kizimula Mubiru delivered the samples to ROAR’s Malvern laboratory at 12:25pm on December 20, 2012 and picked the results at 8pm the next day. While at Mulago, it took 15 days from postmortem day - on December 15 - to conclude examination on specimens drawn from the deceased’s liver, lung, pancreas and kidney.

Relatives and some Members of Parliament, in days after the death, alleged that Nebanda could have been poisoned. President Museveni branded as “idiots and fools” anyone suggesting his government could have eliminated the lawmaker, and warned that individuals spreading such rumours would be arrested. And a number of lawmakers have indeed been picked up and detained subsequently.

The 24-year-old Butaleja legislator subscribed to the ruling NRM party, and those speaking of foul play have provided no iota of evidence why she would have been snuffed out by the regime, her acerbic attacks and lively tendency to criticise senior establishment figures notwithstanding.

Ugandan investigators led by Prof. Wabinga said they could not ascertain the precise cause of the acute pancreatitis, resulting in multiple failure of Nebanda’s internal organs, but suspect probable heavy alcohol intake, the commonest trigger. Former Minister of Defence Permanent Secretary Noble Mayombo, five years ago, succumbed to multiple organ failure, but the actual cause of his death remains a mystery amid allegations of probable foul play.

The UK findings noted something different, even intriguing, about Nebanda. It found 90 milligrams of alcohol in a decilitre of Nebanda’s urine, removed before her death, and 10 milligrams of alcohol in a decilitre of the postmortem blood. Both figures are significantly lower than the 350 milligrams of alcohol in a decilitre of blood observed in fatal cases, according to Dr Elliot’s team.

Under the UK laws, which Ugandan Traffic Commissioner Dr Steven Kasiima said they have replicated, a driver, for instance, is considered to have surpassed the permissible drinking threshold if tests detect 80 or more milligrams of alcohol in a decilitre of their blood. This would imply the amount of alcohol in Nebanda’s body could not on its own have been lethal.

So what killed her? Ugandan investigators reported that Nebanda’s pancreas was severely damaged due to pancreatitis; the kidneys collapsed prior to her demise; the lungs were consolidated and their alveolar spaces saturated with bluish fluid while her liver had mild patchy periportal fatty change.

They also pointed out the likelihood that the lawmaker could have suffered a respiratory tract infection prior to her passing on. The government is yet to officially make these findings public – if it ever will. Or maybe the inquest will unlock them to connect the dots in the sharply contrasting inconclusive outcomes of inquiries by medical teams in Uganda and the UK.

The Mulago team comprised Police’s Moses Byaruhanga, Dr Sam Kalungi of Ministry of Health and now interdicted Mulago Hospital pathologist Sylvester Onzivua (as an observer). It is believed the UK team was similarly experienced.

A likely question for Justice Mugambwa to resolve would be why the cause of Nebanda’s death has mystified the experts. This newspaper contacted independent scientists overseas to make sense of the variations in the separate findings, and two of them advised that a team comprising other should collate and analyse the disparate pathological and toxicological findings simultaneously alongside any information detectives have gathered from witnesses or the scene of crime.

These sources, who asked not to be named in order not to jeopardise possible future businesses with the government of Uganda, said it seemed suspicious that a woman who was not known to be unwell had such a cocktail of drugs in her body on her final day.

Other than ‘recreational’ cocaine and heroin, British experts found traces of dextromethorphan used as a cough suppressant/pain relief and chloroquine, a drug the Uganda government had long phased out as a treatment for malaria.

The UK medical investigation only detected traces, and never uncovered any high concentration, to lend credence to assertions by Ugandan police on day one – prior to any examination - that narcotic drugs led to the lawmaker’s death.

Sunday Monitor was unable to establish whether results of an alternative investigation done in Israel are out, and what the findings could be about Nebanda’s sudden demise. Attention has now turned to Adam Suleiman Kalungi, the alleged close friend of Nebanda, whom the State considers a prime suspect, having been in the company of the late in her last hours.

Kalungi first confessed he was indirectly responsible for Nebanda’s death, having supplied the killer narcotics, but made a U-turn the next day in court to plead innocent. He even denied dealing in drugs. Even if the suspect trafficked narcotics as alleged, legal experts say holding him responsible for Nebanda’s death would be a tall order. Kalungi’s accounts to local media upon his arrest was that the deceased, that fateful Friday ,mistakenly snorted heroin instead of having it injected directly into her bloodstream. Information gleaned on the Internet shows heroin can be injected, sniffed or smoked, therefore showing nothing unusual about the manner in which Nebanda is alleged to have consumed the killer portion.

Kalungi’s claim also flies in the face of findings during toxicological analysis at Malvern laboratory that detected traces of cocaine and possibly heroin in the white, and not the red wine in Nebanda’s body. Why would have the traces only settled in the specimen of white wine if she ‘irregularly’ sniffed it as alleged? Perhaps the legislator a rookie and her body reacted badly to the narcotics? If the pair shared the drugs as narrated, what alien substance killed the MP and spared Kalungi?

The UK team noted that overall, their findings demonstrated that Nebanda had “consumed or been administered” heroin, cocaine, chloroquine and dextromethorphan at some time prior to her death.
The unresolved questions remain: Was Nebanda poisoned? Was she a habitual consumer of recreational drugs and unknowingly reached a tragic limit? Could she have possibly died of drugs or causes not detected by methods applied in both the pathological and toxicological examinations. Or did she simply die of natural causes?

The inquest could not have more than enough questions to begin with, but only after ongoing criminal proceedings conclude as required by law.