Kota Kinabalu: The Coroner’s Court on Tuesday was told that Zara Qairina Mahathir was not prescribed with Phenytoin when she was admitted to the neurosurgery ward of Queen Elizabeth Hospital (QEH) on July 16, this year as her condition to survive was very poor.
Neurosurgery Medical Officer Dr Pavankumar Balachandran said this was because the seizures prophylactic medication would not change the chance of Zara’s survival.
Dr Pavankumar, 32, was answering questions from Datuk Ram Singh on whether Zara was prescribed with such medication.
Ram Singh: From your initial assessment on Zara, did you prescribe the medicine? Dr Pavankumar: No Ram Singh: Why not? Bearing in mind Zara in such a critical situation which may lead to her death.
Dr Pavankumar: As I said before, following the initial assessment, clinically and radiologically, she sustained irreversible injuries. In this case, seizure prophylactic medication would not change the outcome.
Ram: Do you by any chance know that when Phenytoin was prescribed to Zara? Dr Pavankumar: No.
He informed the coroner that he was not at the hospital when Zara was admitted to the neurosurgical ward after 6pm on July 16 as he was off shift.
During the proceedings, Dr Pavankumar, the fourth deponent in the inquest, said Zara sustained severe traumatic brain injury with hypoxic changes, leaving her with no brainstem reflexes and unable to breathe on her own.
When asked by Prosecution Deputy Chief II Datuk Badiuszaman Ahmad, who led the team of conducting officers in the inquest, on the chances of Zara surviving based on his medical assessment, Dr Pavankumar said rather than using the term survival, he would say that the condition prognosis of Zara was severely guarded.
He explained that the term “prognosis severely guarded” describes an individual with severe traumatic brain injury has very poor survival chance.
Dr Pavankumar, who read out his witness statement, said Zara died from severe traumatic brain injury after being found unconscious on the ground near a drain in a hostel on July 16.
“Zara was brought in by the Pre-Hospital Care team from the Kinarut Health Clinic at 4.38am on July 16, after she was discovered lying near a drain at the ground floor of the hostel. Trauma alert was activated at 4.42am.
“Upon assessment by the neurosurgery team, the patient was intubated and ventilated. Initial neurological assessment, namely the Glasgow Coma Scale (GSC) was E1VTM1 with fixed and dilated pupils with absent brainstem reflexes. External examination revealed a posterior scalp haematoma and laceration wound with hemostatic suture applied to it,” he said.
Dr Pavankumar said following assessment by his team, a family conference was conducted to explain the patient’s critical condition.
“The family was informed in detail of her critical state and poor prognosis. She was admitted to the ward on the same day but showed no signs of improvement.
“She gradually deteriorated and eventually died at 1.07pm on July 17.
“The cause of death was recorded as severe traumatic brain injury with hypoxic-ischemic encephalopathy.
“The investigating officer and Zara’s mother were later briefed about the cause of death before the body was referred to the Forensic Medicine Department,” said Dr Pavankumar, who graduated with a medical degree from Universitas Padjadjaran, Indonesia in 2017, and has served in neurosurgery since 2021.
To a question from counsel Rizwandean M Borhan, Dr Pavankumar said during the initial assessment, Zara’s level of consciousness was very low as she had lost the ability to breath on her own, hence she had to be intubated and put on mechanical ventilator. Dr Pavankumar further said the mother was informed immediately after the death of Zara and also the Investigating Officer (IO).
“I also explained to the mother the cause of her death. I saw the IO discussing with the mother,” he said.
To another question, Dr Pavankumar said he was told by staff nurse that it was police case because it was a fall from school and that was all they knew at that time.
The third deponent, Dr Janefer Voo, who testified in the morning session, said the trauma team placed priority on saving Zara’s life.
She said when Zara arrived at the emergency and trauma ward of QEH, her condition was critical.
According to Dr Voo, they did not call the police as Zara was in critical condition, and based on the additional information from the medical staff that they also could not ascertain the mechanism of the incident that caused injuries to her.
“In this case, we prioritise on stabilising the patient,” Dr Voo said.
She also told the coroner that when Zara arrived at the hospital, neither a police officer nor Zara’s mother, Noraidah Lamat, was present.
On a question by Ram whether she was aware that Zara’s clothing should be surrendered to police or could be used for forensic analysis, Dr Voo said it did not at that time as she was resuscitating the patient, and after the clothing was removed, it was kept in a bag by their staff.
Dr Voo, who has five years of experience as medical officer at the emergency and trauma unit, also said she did not refer Zara to One Stop Crisis Centre (OSCC) for the same reason of life-saving.
The OSCC is meant to refer for cases involving child abuse, bullying and rape, among others.
When questioned by Ram, Dr Voo testified that she did not see any “barcode injuries”, parallel stripe-like marks, on Zara’s body when she attended her.
Ram asked whether she had come across any such injuries on Zara’s body.
Dr Voo replied: “No, I did not notice any such injuries.”Pressed further on whether she had failed to notice them or had not examined the body properly, Dr Voo explained: “When the patient arrived, we conducted an immediate examination of her hands and arms. We found an abnormality on the left hand, which was later fitted with a splint.
“At that time, the preliminary diagnosis was a closed fracture. Nothing was recorded regarding stripe-like injuries resembling a barcode,” she said.
The fifth deponent, Inspector Maidon Bernadus, said a police simulation showed that a vertical fall from the third-floor corridor of a school hostel was the closest match to where Zara was found dead.
Maidon, who led the reconstruction with his Crime Scene Investigation (CSI) team from the Sabah Police Headquarters, said two simulations were conducted at the school on Aug 3, where a mannequin dropped straight down and another with a slight forward push.
He told the coroner that the first test landed 2.14m from the base of the building, while the second landed 3.45m away.
“The first simulation was nearer to the victim’s position as recorded in the initial investigation,” said Maidon.
The simulation was carried out at 3am, the estimated time of the incident, using both hostel lighting and additional forensic tower lamps.
“A mannequin originally weighing 10kg was reinforced with bricks to bring its total weight to 53kg, close to Zara’s body weight. However, its height was 180cm, some 27cm taller than the victim, who was 153cm.
“The reconstruction was carried out at the request of the IO, following the death of Zara,” he said in his witness statement.
He further said the reconstruction ended around 6.30am after photographs and videos of both simulations were recorded for reference.
Meanwhile, Ram asked: Upon impact using your simulation, what was the damage to the mannequin? Maidon: Severe damages on the feet and the head.
He also said the weather during the simulation was not windy or raining.
Ram: What was the sound like when your mannequin dropped upon impact on the ground floor at 3am in the morning? Maidon: A loud "boom!!" sound. Ram: Was it loud because it is a mannequin? Maidon: YesRam: Will the sound be loud if it were human? Is that what you meant? Maidon: Yes. Probably the same.
He also told the coroner that at the time of simulation during weekend, there were no students as they went back home.
The court had asked Maidon to bring the damaged mannequins to the court Wednesday if both are still available.
The conducting officers consist of State Prosecution Director Nahra Dollah, Deputy Public Prosecutors (DPP) Mohd Fairus Johari, Dana Arabi Wazani, Dacia Jane Romanus and Sofia Sawayan.
Zara’s family legal team were counsels Rizwandean, Shahlan Jufri, Mohd Luqman Syazwan Zabidi, Mohd Syarulnizam Mohd Salleh and Farrah Nasser.
For Zara’s father, Mahathir Hashim Marikin, was represented by counsel Sherzali Asli, Nurul Rafeeqa Afdul Mutolip and Clarice Vyonne Conrad.
Four of the teenagers were represented by counsel Azhier Farhan Arisin and Abdul Fikry Jaafar Abdullah while counsels Ram, Joan Goh, and Prem Elmer Ganasan representing one of them.
Sabah Law Society (SLS) and Ministry of Education’s representatives acted as a watching brief to observe the proceedings.
The inquest continues.
