Monday, 2 May 2016

A tale of medical murder and extortion

It sounds like the plot of a TV detective thriller but this is real life. A 41-year old man is brought by a friend into a Chengdu hospital suffering from diarrhoea. They both appear to be respectable middle class citizens. The illness is not serious, and the man is treated in the usual way for acute gastroenteritis. He is given intravenous antibiotics including clindamycin, and usually his symptoms would be expected to resolve within 24 hours. 

However, an hour after the antibiotics have been given, the man loses consciousness, turns blue and dies. All attempts to resuscitate him by hospital staff fail. He appears to have died from cardiac arrest. The victim's companion becomes indignant, agitated and blames the hospital staff for negligence. He says the clindamycin may have triggered the cardiac arrest and should not have been used. He demands compensation otherwise he will commence an expensive lawsuit against the hospital for damages.

At this point some of the medical staff find something suspicious about the behaviour of the 'respectable' man, his certain knowledge knowledge of clindamycin's rare side effects, and advise that the body undergo an autopsy. The victim's friend becomes more agitated at this suggestion, but the body is taken away for examination.

A detailed physical examination reveals a small puncture in the back of the victim's left hand. This was the intravenous line where a catheter had been inserted to give the antibiotics. To rule out the possibility that a nurse had given the wrong drug, the pathologist orders tests run on the victim's blood sample, and these come back with surprising results. The victim appears to have been sedated and anaesthetised, because the blood contains high levels of propofol - the anesthetic that killed Michael Jackson. It also contains the sedative midazolam and the muscle relaxant vercuronium. Combined, these three drugs would be sufficient to cause rapid respiratory failure and cardiac arrest. That's why they are used to execute prisoners in the US.

The victim's friend was apprehended and questioned by police and the true story emerged.
He confessed to secretly added mannitol - a liquid laxative - to the victim's drink, which caused diarrhea. Next, the man brought his apparently sick friend to the hospital for treatment. When the victim fell asleep and no other people were present, the man injected 10 mg of midazolam into the victim's vein through the path established for fluid infusion. Next, the companion twice injected 200 mg of propofol and 4 mg of vecuronium into the victim's vein. A few minutes later, the victim's breath and heartbeat stopped.

The perpetrator was revealed a surgeon with four years' experience who had gained access to the drugs from a former colleague at the hospital. He would have got away with the crime - and perhaps received a large sum in compensation if his behaviour had not raised suspicions of the vigilant medical staff.

This case is reported in the Journal of Forensic Sciences by Dr Ye Yi and colleagues of the Department of Forensic Analytical Toxicology, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu. The fate of the perpetrator is not given, but it can be presumed he was tried for homicide - and if found guilty, received the death penalty.

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