Experts: Was Kugan drowned?

Senior medical practitioners and a senior lawyer agree that the police version that suspected luxury car thief Kugan Ananthan collapsed and died upon drinking a glass of water, doesn’t quite tally with reports on the first post-mortem which attributes the cause of death to the presence of fluid in the lungs.

Based on the reported police version, a senior medical practitioner pinpoints three possibilities:

1. the deceased suffering a sudden act of violence while he was drinking, resulting in the water entering the lungs;
2. the deceased being forced to drink large quantities of water in a short space of time with no time given to breathe; and
3. forcible submersion of the deceased by the head in a pail of water, something similar to the water-boarding torture as practiced at the Guantanamo Bay Detention Centre in Cuba.

Drowning or disambiguation is defined as death from suffocation (asphyxia) caused by a liquid entering the lungs and preventing the absorption of oxygen, leading to cerebral hypoxia (deprivation of oxygen) and cardiac arrest.

A continued lack of oxygen in the brain, say doctors, will quickly render a victim unconscious usually around a blood partial pressure of oxygen of 25-30mmHg.

Near drowning is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious complications after the event and resulting in death.

Secondary drowning is death due to chemical or biological changes in the lungs after a near drowning accident.

Doesn't make medical sense

Finally, there’s submersion by another person.

“One could of course drop dead suddenly while doing anything, for any number of reasons, not necessarily drinking a glass of water,” added another doctor in private practice for many years.

“However, to say that someone suddenly collapsed and died while drinking a glass of water that he had requested for in the first place and later to state the cause of death as a result of the presence of fluid in the lungs, doesn’t quite make medical sense.”

In forensic pathology, water in the lungs indicates that the victim was still alive at the point of submersion, according to the doctor.

Forensic is a branch of pathology concerned with determining the cause of death by examination of a cadaver (corpse or dead body).

The autopsy is performed by the pathologist at the request of a coroner usually during the investigation of criminal law cases and civil cases in some jurisdictions. Forensic pathologists are also frequently asked to confirm the identity of a cadaver.

Medical literature cited by doctors show that if water enters the airways of a conscious victim, the victim will try to cough up the water or swallow it thus inhaling more water involuntarily.

Upon water entering the airways, both conscious and unconscious victims experience laryngospasm - the larynx or the vocal cords in the throat constrict and seal the air tube.

This prevents water from entering the lungs. Because of this laryngospasm, water enters the stomach in the initial phase of drowning (liquid in the lungs) and very little enters the lungs.

Unfortunately, this can interfere with air entering the lungs too. In most victims, the laryngospasm relaxes some time after unconsciousness and water can enter the lungs, causing a “wet drowning”.

However, about 10 to 15 percent of victims maintain this seal until cardiac arrest and this is called “dry drowning” as no water enters the lungs.

'Novous Actus Interveniens'

In the absence of the truth, rumours spread like wildfire.

The story making the rounds in the medical community is that the deceased - Kugan - had his head forcibly ducked in a pail of water.

It is not known what efforts, if any, the police made to revive Kugan after he reportedly dropped dead.

Doctors say that the rule “no patient should be pronounced dead until warm and dead applies” and “drowning victims should be treated even if they have been submerged for a long time”.

In extreme cases known to medical science, a child survived after being submerged in cold water for 70 minutes while a young man survived 38 minutes under water.

Widely circulated video footage of Kugan’s body show that he apparently suffered numerous lacerations with open wounds and cuts consistent with being beaten or whipped, being tied or even hanged, swellings, burn marks and water scalding in patches of discolouration.

Without a close examination of the body, doctors say it would not be possible to determine whether these had any bearing on the cause of death.

“Internally, there could have been hemorrhaging,” say doctors.

“Videos clips shown of the deceased’s body could be a critical area of inquiry,” writes senior Malaysian-Aussie lawyer, Quintin Rozario, in an email this morning from Brisbane, Australia where he’s in private practice.

“Did Kugan go into custody with bruises or was it a result of something that happened in custody. The police commissioners or minister’s statements in this regard are important in that they corroborate what illegal practices they acknowledge occur including assault during interrogation.

“They may now rely on a lesser charge of saying that another intervening act to theirs caused his death. The Latin term is 'Novous Actus Interveniens'. Hence, the water excuse.

"While he may have been assaulted, the argument would be that it was not assault occasioning grievous bodily harm resulting in his death. Instead, they will, say that he gulped the water down so fast it killed him.”

Medical opinions sought by Rozario do not rule out death as a result of severe trauma to the brain caused by blunt instruments including a clenched fist over a sustained period of time, trauma and shock to the bodily wounds inflicted by a sharp instrument or something that would caused the skin and flesh to be ripped open as the video clippings show.