What you need to know:
In a medical postmortem examination determination of the time of death by the pathologist is often unnecessary as this will have been established by the medical personnel who attended to the deceased
The word postmortem comes from two words; post meaning after and mortem meaning life. The postmortem examination is an examination of a dead body for medical, legal or scientific purposes (such as research) and is regarded as the gold standard in establishing the cause of death. There is no better way to establish the cause of death than a postmortem examination.
There are essentially two types of postmortem examinations, the medical and the forensic postmortem examinations. The medical postmortem examination is usually carried out at the request of medical personal or relatives of a deceased person to establish the medical illness responsible for the death, usually from natural causes and where no foul play is suspected. The medical-legal or forensic postmortem is usually requested for by a body such as the police or courts of law investigating a death.
The postmortem report will accordingly depend on the purpose of the postmortem examination. In a medical postmortem examination report the identity of the deceased is not rigorously interrogated and documented as in a forensic postmortem.
In a medical postmortem examination determination of the time of death by the pathologist is often unnecessary as this will have been established by the medical personnel who attended to the deceased.
Circumstances of death
In a forensic postmortem the circumstances of death play a vital role. However, investigating a death suspected to have occurred due to medical negligence often falls in between the two.
On January 16, 2015 the body of Robert Byaruhanga, who had died two days earlier following a botched surgical operation in Kabarole hospital, was transported to Kampala for a postmortem examination. One of Uganda’s first forensic pathologists carried out the postmortem examination. The pathologist was told that the patient died shortly after the operation. The pathologist was not given the operation notes, as should have been the case and the relatives were not told what transpired during the surgery.
The pathologist dissected the body and from the preliminary findings an obvious cause of death could not be established.
All the organs except the lungs looked normal when inspected and weighed; the lungs were one and half times their normal weight.
The pathologist thought of two possible mishaps that could have occurred during the surgery; the deceased could inadvertently have been given the local anesthetic agent into a blood vessel which caused the heart to fail and therefore congesting the lungs in the process or the patient had been given a general anesthetic agent.
There are a number of ways general anesthesia can lead to death. The pathologist took two sets of samples for analysis. One set of samples was sent to the Government Analyst to establish if indeed there was any anesthetic drug in the body of the deceased.
The other set was taken to the pathology laboratory for analysis and later the tissues were examined under the microscope. This is referred to as histology. The Government Analyst did not find any drugs or toxic organic compounds in the samples submitted for analysis. However the other samples, when examined under the microscope, indicated very sever lung damage.
The pathologist was eventually availed the patient’s file in which it was noted that the patient was admitted in Kabarole Hospital on January 14, 2015 in a good general condition.
It was not mentioned in the file that the patient had an obstructed hernia. The patient was examined that day and he did not have any abnormalities or illness except for the hernia.
In the file it was noted that the operation started at 5 pm under local anesthesia but later general anesthesia was given as the patient is reported to have complained of severe pain. The patient is then stated to have developed cardio-respiratory arrest and resuscitation was done for about 10 minutes until the patient picked up.
The patient’s blood pressure started dropping at 7:30pm until he passed on at 8:30pm that evening. There was no mention in the file that the patient vomited after the administration of the general anesthesia. However the theatre staff who attended to the patient told court that the patient vomited shortly after the administration of the anaesthesia.
The pathologist testified in the case and told court that the young man died when his lungs collapsed after he aspirated the content of the stomach following the general anaesthesia. The pathologist further told court that the patient was made to sleep in the course of the operation for which he should never have been made to sleep.
To the pathologist the patient was not given proper instructions for general anesthesia the drug for sleeping, which essentially was for him to fast before such an operation. The patient vomited and chocked on what he vomited as it went into his lungs, compromising his breathing and resulting to failure of all the organs of the body. The pathologist classified this as an anesthetic death. The pathologist blamed the surgeon and the anesthetist for this mishap.
The defense called another pathologist to rebut the evidence of the pathologist who performed the postmortem examination. The pathologist who performed the postmortem examination super specialised in forensic pathology in 2005. The defense pathologist did his examinations in forensic pathologist in 2012.
The defense pathologist noted that the postmortem report was incomplete as it did not talk about postmortem changes on the body when a person dies, which affects the findings and conclusions. He also told court that the postmortem report should have confirmed the time of death which it did not. However these were clearly documented in the patient’s file and were not in question.
To be continued