Nebanda’s death reports

By Haggai Matsiko

New evidence shows how suspects in the case could walk free

•   She needed to have consumed 200 times more Cocaine to die

•   She needed to have consumed 35 times more alcohol to die

•   Urine sample sent to UK and Israel possibly was not hers

New analysis emerging eight months after then-Butaleja District Woman MP Cerina Nebanda died on December 14, 2012, could mean that all suspects in the case either walk away free or are convicted on cases other than her death.

Adam Kalungi, who is the prime suspect and is said to be a former boyfriend the deceased, is charged with five others on cases ranging from manslaughter, and unlawful possession and peddling of narcotic drugs.

His defense team, led by top city lawyer McDusman Kabega, will be attempting to poke holes in the prosecution’s claim that the MP died of a lethal combination of drugs and alcohol and that Kalungi had a role in her death.

Nebanda, aged 24 when she died, had spent barely one year in Parliament but she had made a mark as an outspoken critic of the government and President Yoweri Museveni.

Her death sparked a furor among MPs. Many believed the youthful MP who had appeared healthy at Parliament the previous morning, was poisoned. Several of them who made vitriolic attacks on the government soon after her death were arrested. Among them were MPs Theodore Ssekikubo, Chris Baryomunsi, Mohammad Nsereko, Betty Nambooze, and Sam Lyomoki.

Doubts over the investigations into Nebanda’s death started as soon as news trickled out that she had died of alcohol and drug abuse at Mukwaya General Hospital in Kampala on December 14, 2012.

The police agreed with Nebanda’s family members and Parliament to carry out an independent investigation into the cause of death.

Police sparked suspicions of foul play when it turned around and arrested Dr Sylvester Onzivua, a government pathologist, who was taking her body samples to South Africa. Those samples were confiscated and have never seen light of day.

That was the last hope for another post mortem inquiry since preservatives had already been introduced in Nebanda’s body, making it impossible to get any other samples.

This confusion compounded an already combustible issue dotted with allegations that the state was trying to fail investigations into what killed Nebanda.

So far, during the trial, which has been going on before the Makindye Chief Magistrate’s court in Kampala, the prosecution has based on pathology and toxicology findings contained in the four reports commissioned by the government and conducted by experts in the UK, Israel, and the Department of Pathology at Makerere University College of Health Sciences.

The findings of Ugandan experts who observed the deceased’s body, opened it up, and observed her different organs – a method known as pathology – have raised little contestation.

In the report released on Feb.01, about two months after the MPs death, the Makerere pathologists said they did not find any natural cause of death.

They concluded: “The cause of death was multiple organ failure (kidney, pancreas, lungs, and stomach) following combined effects of alcohol and drug toxicity.”

Titled, ‘Final postmortem examination findings for the late Hon. CerinaNebanda, Butalejja Woman MP,’ the report was arrived at by Prof. Henry Wabinga of Makerere University, College of Health Sciences, Department of Pathology, who led the team that also included; Dr Moses Byaruhanga; the Uganda Police Head of Medical Services, and Dr Sylvester Onzivua of Mulago Hospital.

The same report indicates that Nebanda’s several body organs were “grossly normal” to a naked eye.

But based on the high profile nature of the case and the suspicious circumstances around the MP’s death, more extensive analysis was done by the Uganda Government Analytical Laboratory, the UK’s Roar Forensics Limited, and Israel’s Clinical Toxicological and Pharmacological Institute.

The process in the UK and Israel was to establish whether Nebanda died of poisoning or toxicity from toxic substances.

The outcome of these tests did centre on the samples of blood, urine, stomach contents, liver, kidney, bile and others that were either used or were rejected.

attempt to prove that the results of the tests were inconclusive.

In reports seen by The Independent, Roar Forensics, which gave the most comprehensive analysis, listed morphine, codeine, chroloquine, cocaine, alcohol and dextromethorphan as the drugs in the samples.

It concluded: “In the absence of any other pathological explanation for the cause of Ms NEBANDA’s death, combined drug and alcohol toxicity, offers a possible cause.”

The case is also built around two reports from Israel; one from its Health Ministry’s Chaim Sheba Medical Centre, which is affiliated to Tel Aviv University, and the other from the Israel Police Division of Identification and Forensic Science.

Kalungi’s defense is expected to claim that both reports from Israel are equally inconclusive.

The Israel police describe how representatives from Uganda were present in the laboratory during the analyses and made specific requests on the manner in which the procedures should be conducted.

Dana Sonenfeld, a forensic expert at the Israel Police Division of Identification and Forensic Science concludes: “The terms ‘most probably’ and `probably’ were used because the chromatographic peaks of the identified drugs were of low abundance, which lead to poor mass spectra. These circumstances required us to lower the certainty of the results according to our standards of identification”.

The Chaim Sheba Medical Centre focused on tests for opiates, cocaine, marijuana and others in samples of blood and urine.

It concluded there was no alcohol in the blood but it was present in urine and that both blood and urine had traces of cocaine and benzoylecgonine; a substance formed when the body breaks down cocaine.

Kalungi’s defence lawyers are expected to exploit the lack of conclusive evidence that Nebanda, in fact, died of narcotic drug abuse.

They are expected to say that in cases where narcotic drugs are the suspected cause of death, the suspected drugs must be shown to be in the tissues and organs of the victim and in sufficient concentration to explain the death with a reasonable degree of scientific certainty.

They are also expected to question the selection of specimens to be tested because different body fluids and body organs are necessary when testing for specific substances.

In case of tests for cocaine, for example, the required body parts are usually the kidney, spleen, bile and to a lesser extent muscle tissue.

It is, therefore, not clear why in Nebanda’s case the UK lab, Roar, opted to use only urine and blood samples.

“The kidney, liver, and bile samples were not required to be used,” the report says.

The urine sample results are expected to attract special attention during the witness testimonies and cross-examination.

The urine became an issue in a parallel case in which Dr Chris Baryomunsi, the Kinkizi County East MP and Dr Onzivua were being tried for their role in carrying out a separate investigation into Nebanda’s death.

The lawyers defending Baryomunsi and Onzivua quizzed police over the urine.

The police have already told the court that unlike all the other samples, which were postmortem samples – meaning the pathologists collected them after Nebanda was dead – the urine was ante-mortem; meaning it was collected before the MP died.

“How did you know that the legislator was going to die, for you to collect her urine for toxicology?” the lawyer asked.

This forced the police witness to admit in court that the urine that was sent to Israel and UK was found in a basin in the house where Nebanda is alleged to have been before she died.

Police said they assumed it was urine from Nebanda. Doubts are being cast on that claim. But Kalungi’s lawyers could argue that urine analysis is usually not useful for testing for toxic agents because various factors affect urine in the body and its concentration.

Baryomunsi, who is a medical doctor, told The Independent that the difference between the reported concentration of alcohol in Nebanda’s blood and that in her urine, also known as the urine-blood alcohol concentration ratio, was too much compared to what has been recorded in world history.

Citing medical literature, Baryomunsi said that difference was “simply too abnormal.”

He quoted a book;  ‘Garriott’s Medicolegal Aspects of Alcohol’ by James C.Garriot, and said after 1-2 hours of taking alcohol, this ratio is usually 1 and 1:2 – 1:5 depending on the period after taking alcohol, with the highest ever ratio was recorded at 2:26. Yet, in Nebanda’s case, the ratio was a historic 9:1.

Significantly, family members, friends, and fellow MPs have all sworn that they had never seen the deceased consume alcohol.

Garriott’s Medicolegal Aspects of Alcohol is described by lawyers as an indispensable book for forensic toxicology and for anyone involved with the medicolegal aspects of alcohol.

“A ratio of 9:1 is extremely bizarre,” Baryomunsi told The Independent, “that is why to me, this finding alone discredits the credibility of all the findings.”

Despite that, the UK report indicates that for alcohol, 10 milligram per deciliter (mg/dL) was found in Nebanda’s blood. To show how harmless this was, the experts noted that in the UK the legal driving alcohol content limit is 80mg/dL.

They added that for cases of death, the concentrations of alcohol are usually greater than 350 mg/dL.

This means that if Nebanda was living in UK, she needed to have drunk eight times what she had in her blood to be arrested for drunk driving and more than 35 times to die of alcohol.

In her urine, however, 90mg/dL was found. Experts say that when one drinks alcohol, the body through metabolism tries to get rid of it – the reason its concentrations are always higher in urine—because the body is trying to get rid of it.

This might have explained why Nebanda had low concentrations of alcohol in her blood and more in her urine. However, as Baryomunsi says, the difference between the concentration in blood and that in urine is abnormal.

The cocaine in the samples was also equally low.   In Nebanda’s samples, the UK toxicologists only found 0.01 ml/L of cocaine, which they note, was consistent with recreational use and did not indicate an overdose.

Nebanda needed to have consumed 200 times what she had in her blood, to have died of cocaine. According to the report, fatalities or death caused by cocaine are usually associated with concentrations of greater than 2 milligram per liter (mg/L).

But Kalungi’s team could have difficulty explaining why he said publicly that the cause of death was inhaling heroin, and yet the toxicological reports indicate that the drug had been allegedly ingested or swallowed as a pill not inhaled.

Such contradictions, observers say, cast a lot of doubt on the findings.

Kalungi’s lawyer’s will most likely follow Baryomunsi’s line that either more alcohol was poured in the urine or the urine was not Nebanda’s.

“It is because of things like these,” Baryomunsi said, “that we had decided to carry out an independent investigation because now, in my view, these other results cease to be credible.”

Baryomunsi concludes:  “When you look at all the reports, the major finding is that although there were drugs in the samples, their levels of concentration were too low to cause toxicity let alone death.”

As it stands, it is looking increasingly unlikely that the accused will get guilty verdict given the glaring inconsistencies in the experts’ evidence. If not to walk free from the court, the most they can expect is to get convictions on charges other than causing her death.