Director-General of Health Tan Sri Dr Mohd Ismail Merican said Monday Kugan was found to have a underlying acute myocarditis, while the blunt force trauma could have led to acute renal failure aggravating the acute myocarditis, resulting in acute pulmonary oedema.
"Acute myocarditis is an acute inflammation of the heart muscle which may be caused by infections or toxins. It is a known cause of sudden death in young adults and gross examination of the heart appears unremarkable in up to 30 per cent of the cases," he said to reporters here.
Dr Ismail said all body injuries noted on Kugan were insufficient, either individually or collectively, to cause death directly.
"There was no evidence of injuries to the internal organs and no skeletal fractures were detected," he said.
Kugan, who was detained by the police on Jan 15 for investigation for alleged car theft, died on Jan 20 while in police custody.
The post-mortem done by the Head of the Forensic Unit of Serdang Hospital, Dr Abdul Karim Tajuddin, concluded the cause of death as Acute Pulmonary Oedema.
Kugan's family requested a second post-mortem, which was done by the University Malaya Medical Centre's (UMMC) pathologist, Dr Prashant N Samberkar, who gave the provisional cause of death (pending toxicology) as Acute Renal Failure due to Rhbdomyolysis due to blunt trauma to skeletal muscles.
The dicrepancies between the two reports had raised some questions and this led the Health Ministry to set up a committee to investigate.
Dr Ismail said the committee, which was chaired by Kuala Lumpur Hospital senior consultant forensic pathologist Dr Mohd Shah Mahmood and comprised by nine other local and foreign doctors including those from Singapore and Saudi Arabia, also found that both pathologists who did the post-mortems had no intention of misleading or hiding any information on the findings.
However, he said, the second pathologist had misidentified and misinterpreted some of the post-mortem changes as being part of the initial injuries sustained by Kugan.
He said the pathologist also misinterpreted the patterned imprint injuries on the body as 'burn wounds', as there was no evidence of inflammatory infiltrates or thermal injuries in the skin from the back of the deceased, which would be present in thermal injury.
"It has to be emphasised that the autopsy report by Dr Prashant is a provisional report because he has not completed the autopsy as the toxicology is still pending, as stated in his report," he said.
Dr Ismail said the committee also was not able to establish how and where Kugan's body was kept after being released to his family until it was brought to UMMC for the second post-mortem, as it would significantly affect the physical state of the body.
The report would be handed over to the Attorney-General tomorrow and it is up to him to take any actions needed, he said.
-- BERNAMA
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Kugan’s post mortem files seized from UMMC
By Neville Spykerman, themalaysianinsider.comPETALING JAYA, April 6 — All files, pictures and samples in relation to A. Kugan, who died in custody, were seized by police from a hospital which had carried out a second post mortem on Jan 25.
A search warrant was issued to the University Malaya Medical Centre here before policemen took away the items.
Kugan was arrested on suspicion of car theft on Jan 15 but died at the police lockup five days later.
Federal Criminal Investigation Director Datuk Seri Bakri Zinin told The Malaysian Insider police were instructed to make the seizures by the Attorney-General and the move was part of ongoing investigations into the case.
Lawyer N Surendren, who is representing Kugan’s family, said he was shocked with the latest development adding police had been at UMMC the whole morning.
“I have been informed in writing by the hospital because Kugan’s family had sought the second post mortem which was carried out there.”
Meanwhile Surendren also slammed the findings of an independent committee formed by the Health Ministry today which concluded he died due to water in the lungs or acute pulmonary edema, inflammation of heart muscles or acute myocarditis which was compounded by blunt force.
Surendren said the committee has effectively found a third cause of death which is inflammation of the heart, which was never found by either pathologist who carried out the first and second post mortem.
The first post mortem carried out at the Serdang Hospital by Dr Karim Tajuddin on Jan 21 stated Kugan’s casue of death as “acute pulmonary edema” or fluid in the lungs.
A second post mortem was carried out by Dr Prashant N. Samberkar and he found Kugan died from a condition known as rhabdomyolysis, which is the rapid break-down of skeletal muscle tissue which will lead to kidney failure.
Other discrepancies, peviously reported were V-shaped marks which were described as abrasions in the Serdang Hospital report but burn wounds with a heated object in the second report.
The first report only found 22 external injuries on his body while the second found 40 such injuries.
The second post-mortem revealed congested blood vessels in Kugan’s brain haemorrhage in his neck muscles, heart and spleen, and contradicts the Serdang Hospital report which found these organs were normal.
The Serdang Hospital report says other organs in Kugan’s body were examined and were normal but the second findings showed that the organs were intact and not even removed for dissection, before the second post-mortem was conducted.
Surendren said the committee had “second guessed” the findings of the two doctors without the benefit of carrying out a post mortem and labelled the committee a whitewash.
He said unlike an on going inquiry by the Malaysian Medical Council into the case, the government independent inquiry had not called in family members or himself to give evidence or observe proceedings.
Earlier at a press conference in Putrajaya, Health Director-General Tan Sri Dr Ismail Merican disclosed the findings of the committee which was formed to investigate the discrepancies in the two post mortems. An eight page report was released to the press.
The 10-men committee unanimously agreed there was no evidence to show that the deceased had been ‘branded’ or been given repeated application of heat with an instrument or object as reported in the second post mortem.
In their opinion the injuries were the result of repeated trauma by a blunt and flexible object, like a rubber hose.
The committee found that all injuries on Kugan were insufficient to directly cause death and the discrepancies in the two reports were due to the absence of communication between the two pathologists, the misinterpretation of post mortem changes and some of the injuries by the second pathologist.
They concluded the discrepancy was not because of any foul reporting, misleading of information and there was no intention to hide information.
Dr Ismail said the differences in the number of external injuries found on Kugan, was because of different methodology used by the doctors. Dr Karim had tabulated 22 external injuries because he had grouped them by regions while Dr Prashant had listed some individually and some in groups, on the body.
He said the findings will be handed to the Attorney-General’s Chambers tomorrow.
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