Death at the Mental Hospital

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Was it a case of an erroneous medico-legal report or a homicide?

The conflicting reports about the cause of death of Randy Carreon, 41, an in-patient of the National Center for Mental Health (NCMH) in Mandaluyong City, stirred up a controversy and attracted media attention a few months ago.

Carreon’s death at the mental health facility’s infirmary on the afternoon of October 9 puzzled his relatives and the National Bureau of Investigation (NBI) which eventually took up the case.

Separated from his wife and two children, Carreon had been confined at the facility since 1998 after he was diagnosed with paranoid schizophrenia, a mental disorder that gave him delusions and paranoia. A court order citing his drug abuse problem had kept him inside the NCMH.

His would have been an ordinary death had his relatives believed what they had been told by the hospital staff. According to Rizaldy Rivera, the NBI investigator on case, doctors claimed that Carreon had died of natural causes, “possibly acute myocardial infarction” or heart attack.

But Carreon’s brother-in-law, Erwin Pineda, began to have doubts when he was told the death certificate would only be released if he would sign an autopsy waiver.

“I was confused,” Pineda said in an interview. “Our relatives abroad wanted to make sure that no foul play was involved.” The family sought the help of the Philippine National Police’s (PNP) crime laboratory in Camp Crame and requested for an autopsy.

The report of Dr. Joseph Palmero, PNP medico-legal officer, deepened the family’s confusion. Palmero’s autopsy report indicated that Carreon had died of “asphyxia by ligature.” The PNP officer also concluded that the death was a homicide.

The news story about Carreon’s mysterious death first came out on television, but without a response from NCMH officials, the controversy only stirred up more questions.  Said Rivera: ’Who between the doctors of the NMHC and the doctor of Camp Crame was telling the truth?’ That was the first question. If it was homicide, why would the hospital hide it? And who did it or would have ordered it?”

Rivera said he started his own investigation within the hospital.  “I talked to at least nine staffers of the mental hospital and five patients who last saw Carreon before he died,” he said. “Normally, we look into the time and motion before, during, and after the incident. If there was a huge gap, we would entertain suspicion that the subject was killed,” he added.

But so far, Rivera said, the statements of the hospital employees were consistent with each other.

This was what happened according to his interviews at the NCMH:

At around 4:05 p.m. of October 9 last year, a patient called the attention of nursing attendant Francisco Bacus, and said that Carreon was suffering from a “drug reaction.”

The attendant went inside Pavilion 5 where Carreon and other patients were confined. He saw Carreon standing and then suddenly slumping to the floor, drooling. He wiped Carreon’s mouth and with help from other patients, brought him to a room outside the Pavilion where another nurse checked his vital signs.

The staff called for an ambulance to transfer Carreon to the infirmary in hopes that he could still be revived.  Carreon was still alive then but gasping for breath.  The attending physicians said they “did everything they could” but the patient later flatlined and was pronounced dead at 4:35 p.m.

Doctors Donnabelle Quindipan, Carl Chester Go, and Vincent Estrella who attended to the patient claimed they had found no ligature marks on the victim’s neck, chest, abdomen and extremities before his death.

Post-mortem marks

Rivera was puzzled. “But where did these ligature marks come from? We asked the nurse who did the post-mortem care on the patient.” He was told it has been the practice at the NCMH for quite some time to wrap the corpse with a white cloth tied from the nape to the feet.

According to his sources, Rivera said, “this was done to keep the cadaver in an anatomical position.”  This meant, he was told, that the body is erect with the arms at the sides and the palms forward.

He was also told that the marks seen by Dr. Palmero on different parts of Carreon’s body could have been due to the staff’s post-mortem care. In the presence of Dr. Romil Aguirre, NCMH pathologist and the NBI, the nursing attendants of the hospital demonstrated on a real cadaver what they did to Carreon.

In his statement to the NBI, Aguirre said the marks on Carreon’s body as shown in the TV news were “post-mortem in nature rather than ante-mortem,” meaning they happened after the patient had died and not before.

No possible motive

But what made the PNP medico-legal officer conclude that the death was caused by asphyxia by ligature?  Rivera said. “I have not yet spoken to Dr. Palmero about the matter because of the long holiday break,” he added. A case conference scheduled on a Monday mid-January failed to push through because the PNP official was absent, he said.

“We can solve this in a matter of weeks. But one crucial piece in the puzzle would be Palmero’s statement,” Rivera said.

In a phone interview, Dr. Bernardino Vicente, NCMH director, said the media reports about Carreon was “very damaging” to the mental facility.

“The news was obviously written by a reporter who was not given [an interview] and like a child, resorted to throwing a tantrum,” Vicente said. “And then you have an irresponsible pathologist who came out with a hasty statement without even asking about a patient’s medical history,” he added.

Vicente said he was not sure how Palmero had carried out the autopsy. “But all of us could not reconcile the report that Carreon was killed because many saw him dying and slumping to the floor.” He added: “We have no motive whatsoever.”  They were also waiting for the final outcome of the NBI probe, the NCMH official said. “If they find out that Carreon’s case was really a homicide, then who killed him?” •

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  • http://twitter.com/ThelmaMarisol Thelma Marisol

    Carreon was suffering from a “drug reaction.”

    Poor human. A guinea pig under the hands of so-called health experts.

  • http://jaoromero.wordpress.com Jao Romero

    “The news was obviously written by a reporter who was not given [an interview] and like a child, resorted to throwing a tantrum,” Vicente said. “And then you have an irresponsible pathologist who came out with a hasty statement without even asking about a patient’s medical history,” he added.

    eh kung binigyan nyo ba ng interview eh di sana na-ere ang side nyo, mga bobo pala kayo eh.

  • http://www.facebook.com/profile.php?id=100000064752857 Joseph Palmero

    the doctors in the hospital will definitely protect its own people. they should first read the autopsy report and pictures taken during autopsy before defending the hospital employees. remember a heart attack will not show a antemortem ligatute mark on the neck nor drooling of saliva prior to death.

  • http://www.facebook.com/chase.go Chase Go

    The 3 of us MDs tried to revive a patient who is already dead when he was brought to the infirmary as opposed to this article that the patient was still alive when being brought. We have not found any ligature marks on the neck.

  • http://www.facebook.com/chase.go Chase Go

    @ Joseph Palmero. In a patient suffering in a myocardial infarction, one of the possible symptoms and manifestations are drooling of the saliva as well as diaphoreses. 

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