Natural or unnatural death?
Published Oct 25, 2022 12:05 am
UNDER THE MICROSCOPE
Dr. Raymund W. Lo
The recent ambush killing of Percy Lapid (real name: Percival Mabasa) by gunmen riding in tandem shone a most unflattering spotlight on our criminal justice system. The ensuing widespread outrage, publicity, and investigation led to a self-confessed killer surrendering for fear of his life. He incriminated several people, including accomplices and middlemen. And now, one of the middlemen is dead, supposedly of natural causes. An autopsy has been conducted, but was it done the right way?
Death investigations have to resolve one question: Did the person die of natural or unnatural causes? The unnatural causes are either homicide, suicide, or accidents. Forensic autopsy is one method at arriving at an answer. Once a natural cause of death is ruled out, then foul play is suspected.
However, an autopsy must be done scientifically, which requires that the autopsy prosecutor be a trained, experienced, and board-certified pathologist.
The initial investigation is the gross examination, wherein the body is inspected for signs of violence or accidents: gunshot wounds, stab wounds, ligature marks, burns, and other such wounds. The trained eye can tell if the changes are ante- or post-mortem, and so conclude if there was deception being foisted to give the impression that, say, a burned body meant the person died in a fire.
If there are no signs of violence, the next step is a full autopsy — the examination of the internal organs for signs of a pre-existing disease, which may point to a natural cause of death.
After an initial inspection and photo documentation, the stomach contents and body fluids (vitreous humor of the eye, blood from the heart, bile, urine, and cerebrospinal fluid) must be collected to check for the presence of poisons or toxins, called a toxicologic examination.
Then, the internal organs are individually examined grossly for signs of congenital or chronic diseases.
In a 42-year-old man (the age at which the alleged middleman was said to be), it would be unusual to find chronic disease of such severity as to cause sudden death. Assuming there was no immediate cause of death on gross examination of the internal organs, the next step will be the microscopic examination of tissue sections from the organs.
If the microscopic examination fails to reveal the cause of death, then the case is signed out as a death of undetermined origin. However, the toxicologic examination may show the presence of a poison or toxin that can cause death but not have any gross or microscopic autopsy findings.
Failing to find a morphologic or toxicologic diagnosis, a physiologic cause of death may be invoked, such as Brugada Syndrome, a cause of sudden death in young, healthy men, especially of Asian origin. It is a genetic disorder that increases the risk of abnormal heart rhythms and sudden cardiac death. In fact, many cases ascribed to “bangungut” are due to Brugada syndrome, also called sudden unexplained nocturnal-death syndrome. The other proposed cause of “bangungut” is acute hemorrhagic pancreatitis (now debunked) which can easily be diagnosed during an autopsy.
But unless all these steps are done sequentially, we can’t be certain that this person actually died of natural causes. Considering the suspicious circumstances — that he was a person deprived of liberty —foul play should be first and foremost suspected until proven otherwise. We are certain he did not die a violent death, there being no evidence of external wounds, but poison could have been slipped into his food or drink which could not be diagnosed without a toxicologic examination.
Unfortunately, the quality of forensic autopsies in the Philippines is in question, unless performed by the only two forensic pathologists in the country. In this particular instance, the one we saw on TV going into the funeral parlor to conduct the autopsy on the alleged middleman was neither of the two. If none of these investigators is a pathologist, who will examine the microscopic sections to give a histologic diagnosis? If they did not obtain body fluids or gastric contents, then all the examinations will be inconclusive.
Will we ever find out the truth about this sudden death of the alleged middleman of a murder case? The case gets murkier and murkier. And so is the resolution of the Percy Lapid case, a real case of injustice of a murder most foul, as it seems like events are being manipulated by its mastermind. We pray it will not be so, for the sake of the Mabasa family and for those media people who are being terrorized by the threat of a premature death.
Dr. Raymund W. Lo
The recent ambush killing of Percy Lapid (real name: Percival Mabasa) by gunmen riding in tandem shone a most unflattering spotlight on our criminal justice system. The ensuing widespread outrage, publicity, and investigation led to a self-confessed killer surrendering for fear of his life. He incriminated several people, including accomplices and middlemen. And now, one of the middlemen is dead, supposedly of natural causes. An autopsy has been conducted, but was it done the right way?
Death investigations have to resolve one question: Did the person die of natural or unnatural causes? The unnatural causes are either homicide, suicide, or accidents. Forensic autopsy is one method at arriving at an answer. Once a natural cause of death is ruled out, then foul play is suspected.
However, an autopsy must be done scientifically, which requires that the autopsy prosecutor be a trained, experienced, and board-certified pathologist.
The initial investigation is the gross examination, wherein the body is inspected for signs of violence or accidents: gunshot wounds, stab wounds, ligature marks, burns, and other such wounds. The trained eye can tell if the changes are ante- or post-mortem, and so conclude if there was deception being foisted to give the impression that, say, a burned body meant the person died in a fire.
If there are no signs of violence, the next step is a full autopsy — the examination of the internal organs for signs of a pre-existing disease, which may point to a natural cause of death.
After an initial inspection and photo documentation, the stomach contents and body fluids (vitreous humor of the eye, blood from the heart, bile, urine, and cerebrospinal fluid) must be collected to check for the presence of poisons or toxins, called a toxicologic examination.
Then, the internal organs are individually examined grossly for signs of congenital or chronic diseases.
In a 42-year-old man (the age at which the alleged middleman was said to be), it would be unusual to find chronic disease of such severity as to cause sudden death. Assuming there was no immediate cause of death on gross examination of the internal organs, the next step will be the microscopic examination of tissue sections from the organs.
If the microscopic examination fails to reveal the cause of death, then the case is signed out as a death of undetermined origin. However, the toxicologic examination may show the presence of a poison or toxin that can cause death but not have any gross or microscopic autopsy findings.
Failing to find a morphologic or toxicologic diagnosis, a physiologic cause of death may be invoked, such as Brugada Syndrome, a cause of sudden death in young, healthy men, especially of Asian origin. It is a genetic disorder that increases the risk of abnormal heart rhythms and sudden cardiac death. In fact, many cases ascribed to “bangungut” are due to Brugada syndrome, also called sudden unexplained nocturnal-death syndrome. The other proposed cause of “bangungut” is acute hemorrhagic pancreatitis (now debunked) which can easily be diagnosed during an autopsy.
But unless all these steps are done sequentially, we can’t be certain that this person actually died of natural causes. Considering the suspicious circumstances — that he was a person deprived of liberty —foul play should be first and foremost suspected until proven otherwise. We are certain he did not die a violent death, there being no evidence of external wounds, but poison could have been slipped into his food or drink which could not be diagnosed without a toxicologic examination.
Unfortunately, the quality of forensic autopsies in the Philippines is in question, unless performed by the only two forensic pathologists in the country. In this particular instance, the one we saw on TV going into the funeral parlor to conduct the autopsy on the alleged middleman was neither of the two. If none of these investigators is a pathologist, who will examine the microscopic sections to give a histologic diagnosis? If they did not obtain body fluids or gastric contents, then all the examinations will be inconclusive.
Will we ever find out the truth about this sudden death of the alleged middleman of a murder case? The case gets murkier and murkier. And so is the resolution of the Percy Lapid case, a real case of injustice of a murder most foul, as it seems like events are being manipulated by its mastermind. We pray it will not be so, for the sake of the Mabasa family and for those media people who are being terrorized by the threat of a premature death.