Over three months after Jayalalithaa’s death, over five months after she was first hospitalised, the Tamil Nadu govt has released the health records of the late Tamil Nadu Chief Minister.
The govt has combined reports from two hospitals - Apollo and AIIMS - and released it on Monday.
Talking about how she was hospitalised, the report says, "Apollo Hospital received a call at around 10pm on 22 nd September, 2016 from the residence of the late Honourable Chief Minister of Tamil Nadu and when the ambulance reported there and they found that the late Hon’ble Chief Minister was breathless with low oxygen saturation resulting in drowsiness."
The report denies that there was any trauma - busting the theory that Jayalalithaa was pushed prior to her hospitalisation. "There were pre-existing co-morbidities like diabetes, hypertension, asthmatic bronchitis and hypothyroidism, but clearly the treatment report of Apollo Hospital, as well as that of AIIMS do not mention any evidence of trauma or any other event as alleged by certain political leaders," the release says.
"Certain insinuations have been made that administration of wrong drugs over a period of time prior to hospitalization had led to health complications for the late Honorable Chief Minister. In this context, the medical reports indicate that except for corticosteroids administered for atopic dermatitis, the late Hon’ble Chief Minister was only taking oral hypoglycemic and anti-hypertensive drugs to control pre-existing diabetes mellitus and hyper tension," the release says.
According to the reports, Jayalalithaa had atopic dermatitis - which is a chronic eczematous skin disease that usually begins in childhood. Acute atopic dermatitis produces weeping, oozing plaques of very itchy skin. Often an inherited condition, patients with atopic dermatitis seem to have a misguided immune response.
A team of 18 doctors from Apollo hospitals treated Jayalalithaa. Seven doctors from AIIMS, 12 other specialists from various hospitals including Dr KM Cherian and Dr Richard Beale were also part of her medical team. There were doctors from TATA Memorial Hospital Bombay, CMC Vellore, Hinduja Hospital Mumbai, Johns Hopkins Hospital USA and Apollo Hospitals in Hyderabad and Bengaluru.
The chronology, according to the Apollo report:
On September 22, 2016, Apollo Ambulance service was urgently called to Jayalalithaa's residence in Poes Garden. She was not consistently responding to calls and was breathless with low oxygen saturation, approximately at 48%.
Apollo says, her pulse rate was 88 per minute and BP was at 140/70.
She was admitted to the emergency room of the hospital by around 10.25pm. She had sinus tachycardia (high heart rate) with a BP of 140/100 mmhg. She also had bilateral basal crackles - or crackles at the bases of her lungs.
She had pulmonary oedema - which means that there was a fluid accumalation in the lungs, which is often caused by the heart not pumping enough.
Apollo hospital says she was admitted in a very critical condition after initial treatment in the ER.
Apollo hospital says that her ECG was abnormal and she was treated for a peri-cardiac arrest situation. Basically, it is the period just before or after a full cardiac arrest, in which the condition of the patient is very unstable.
Apollo then describes in detail the various treatments given to Jayalalithaa, including that a temporary pacemaker was inserted in her heart.
Since she had bradycardia (low heart rate), she was put on medication for that.
Apollo says they also started medicine infusion for her due to her worseing hypotension (abnormally low blood pressure).
Jayalalithaa also had urinary tract infection and Leukocytosis (high white blood cells) with a wbc count of 17690.
Apollo says that they kept into account her past medical history, including problems like obesity, hypertension, poorly controlled diabetes, hypothyroidism, irritable bowel syndrome with chronic diarrhea, and chronic seasonal bronchitis.
According to the report, Jayalalithaa had fever for five to seven days before she was hospitalised.
Initial set of blood cultures was suggestive of growth of Enterococcus, a bacteria that causes urinary tract infections.
Apollo says that she slowly started recovering and her requirements for a non invasive ventilator had reduced by Day 3.
But from Day 4, her health deteriorated when she developed a significant wheeze - tachypnoea, or rapid breathing.
Her breathing deteriorated further on September 28, and after obtaining permission from family and government officials, she was placed on ventilator.
A panel of cardiologists including Dr MR Girinath, Dr KM Cherian, and Dr LH Sridhar recommended continuation of her medical therapy as there was no indication for any emergency surgery.
Inspite of the various treatments oprovided, Jayalalithaa's condition worsened on September 30, requiring escalation of sedation and oxygen supplementation.
Then, Dr Richard Beale was brought in.
An intensivist from UK, Dr Beale was invited by Apollo hospital to provide expert opinion. After studying Jayalalithaa's medical history, Dr Beale opined that she carried a mortality of 40%.
In the reports made public, Apollo hospital says that over the next few days, Jayalalithaa's condition kept fluctuating, but many parameters started improving.
Though there were attempots made to wean her away from the ventilator, there was acute increase in her blood pressure, followed by pulmonary oedema, and hypoxia (deficiency in the amount of oxygen reaching the tissues.)
By this time, the team of doctors from AIIMS and Dr Richard Beale were visiting Jayalalithaa multiple times a day.
With a likely need for long time ventilator support arising, a tracheostomy was performed - an incision was made in her windpipe to insert the ventilator - after getting permission from family and senior government officials.
By October 9, her kidneys started failing and her urine output came down.
After October 10, she once again started showing signs of improvement and was awake, alert, comfortable and interacting.
With many complications including oedema still persisting, the patient's family asked Apollo to obtain external opinion from an expert cardiologist.
Dr Stewart Russel from Johns Hopkins Hospital and Dr Jayan Parameshwar from Papworth UK were consulted and according to their diagnosis, her breathlessness was because of a diastolic heart failure - a condition due to which there isn't enough blood in the lower left chamber of her heart. She also had capiallry leak syndrome - a rare disorder.
By the first week of November, Jayalalithaa removed the tube through which she was being fed, and started taking food orally. However, since this was inadequate, she was given IV infusion.
She was also encouraged to enagage in physical therapy, and she was made to sit on the edge of the bed and on a wheelchair.
By November 19, her health had improved considerably, says Apollo. She was moved out of the ICU to a specially designed high dependency bed.
Meanwhile, a hypertension expert from the Apollo Institute of Blood Pressure Management, Hyderabad, was consulted to suggest treatment to manage her episodic hypertension.
Jayalalithaa's last 48 hours
On December 3, a team of AIIMS doctors headed by Dr Khilnani reviewed Jayalalithaa and had talks with her family. On the same day, her health started worsening with increased coughing and increased oxygen requirement.
With the diagnosis showing an onset of pneumonia, she was placed on ventilator overnight.
On December 4, Jayalalithaa was placed back on the tracheostomy mask and required oxygen. Jayalalithaa had an episode of vomitting after her breakfast.
At about 4.20pm, while watching television, she complained of worsening breathlessness with her nurses, duty doctors and family members present in the room.
She was placed on ventilator immediately with high heart rate and breathlessness.
CPR was performed on her, and defibrillation done.
Apollo then describes in detail how she was put on ECMO, but Jayalalithaa's health kept deteriorating.
A team of AIIMS doctors reached Chennai on December 5, and after multiple interventions, her body temperature was brought down to normal.
Jayalalithaa then had brainstem dysfunction (brain death) and no heart rhythm. After consultation with all doctors, it was decided that there no point continuing the ECMO.
The decision was conveyed to the Chief Secretary, Health Secretary, O Panneerselvam, Sasikala, Thambidurai and the Health Minister.
After ECMO withdrawal, Jayalalithaa was declared dead at 11.30pm.
The cause of death, as per Apollo's discharge report is:
1. Ventricular Fibrillation
2. Infective Endocardytis
3. Acute Respiratory Distress Syndrome