Jayalalithaa had gag reflex before she died, says Apollo doctor

A cardiothoracic surgeon at Apollo Hospitals on Monday told the Commission of Inquiry looking into Jayalalithaa's death that doctors had noted that the former Chief Minister had a gag reflex seven hours before she was declared dead.

Dr. T. Sunder said the reflex, observed at 4.30 p.m. on December 5, 2016, was considered a “sign of life” that made the hospital keep the then-CM connected to the ECMO device longer.

Multiple sources said Dr. T. Sunder had told the Justice (Retd.) A. Arumughaswamy Commission that he was in the room around 5.05 pm on December 4, 2016. Jayalalithaa had had a cardiac arrest at 4.20 pm.

The doctor said he had informed the extracorporeal membrane oxygenation (ECMO) device team about the development en route; they were waiting for him when he entered the room. Doctors were performing cardiopulmonary resuscitation on Jayalalithaa. Dr. Sunder was a member of the team that connected the then-CM to the ECMO device. He left the room after the CM was connected to the device, never to return. She was monitored by other doctors.

While being examined by the Commission, Dr. Sunder referred to the Critical Care Unit’s master chart to talk about the gag reflex. He said that it was observed at 4.30 pm on December 5, 2016. Jayalalithaa would be declared dead at 11.30 pm.

Dr. Sunder said that the gag reflex was one of the two reasons that the hospital decided to keep the CM connected to the ECMO device. The other, he told the Commission, was because Apollo's “standard of care” stipulated a 24-hour observation when connected to the device.

The treatment summary of Jayalalithaa, released by Apollo Hospitals, also talks about the CM responding to other stimuli while connected to the ECMO device. “Neurological examination revealed spontaneous intermittent horizontal eye movements and slow blinking. Right pupil was 5mm, irregular and not reacting, but left side pupil was 5mm irregular and sluggishly responding to light,” it said.

Dr. Sunder testified before the Commission that eventually, Jayalalithaa had to be disconnected from the ECMO device as she never recovered a sustained intrinsic heart rhythm.

He also testified that before Jayalalithaa, he had been part of the team that connected nine other patients to the ECMO device. Dr. Sunder said that four of the nine had recovered.

The Commission was informed that cardiothoracic surgeon Thangaraj Paul Ramesh had examined Jayalalithaa on September 29, 2016. He had concluded that the CM’s Murray Score for acute lung injury did not warrant placing her on an ECMO device.