Medical records from Thammasat University Hospital state that pro-democracy activist Netiporn “Bung” Sanesangkhom had no vital signs upon arrival and that an endotracheal tube was found in her esophagus instead of her windpipe, says Krisadang Nutcharus, Netiporn’s lawyer.

Krisadang Nutcharus (center, white shirt) speaking to reporters at Netiporn's funeral on 18 May. (Photo by ไข่แมวชีส)

Krisadang said during a press conference on Saturday (18 May) that, according to a death certificate issued by Thammasat University Hospital, Netiporn died from heart failure and asphyxiation. She had no vital signs upon arriving at Thammasat University Hospital at 9.30 am on 14 May. According to medical records that Thammasat University provided the family, doctors found that an endotracheal tube had been placed in her esophagus instead of her windpipe. As a result, oxygen was pumped into her stomach and intestines instead of her lungs. Krisadang said that, when he observed Netiporn’s autopsy, her stomach was swollen and full of air.

Krisadang said he consulted with doctors, who told him that this was a major cause of Netiporn’s death, although there could be other reasons. Other substances were also found in Netiporn’s blood and some lab results were abnormal.

Krisadang also said that the question remains of why Netiporn went into cardiac arrest to begin with. He insisted that Netiporn was starting to eat again and had been receiving medicine and potassium supplements. Lawyers from Thai Lawyers for Human Rights (TLHR) visited her every day while she was at the Corrections Hospital and had never been told that she refused to take medications.

“I’m not letting this go, because this time, [Netiporn] died under the care of the Corrections Hospital and because of the Corrections Hospital. Who is going to be held responsible, I don’t know,” said Krisadang.

He stressed that the placement of the tube was noted when Netiporn arrived at the emergency room at Thammasat University Hospital, and that doctors asked the family to find out when the tube was placed. A doctor at Thammasat University Hospital recommended that the family request Netiporn’s medical records from the Corrections Hospital, along with CCTV footage from her room.

“Just like us, the doctor also wants to know how they could have done this, because even medical students don’t do this,” said Krisadang.

Krisadang also questioned how it was so easy for Netiporn to be transferred to Thammasat University Hospital when it has always been difficult to have detained activists transferred. He has also not seen records of the transfer request, which raises many questions. Nevertheless, he said that it is not only the Department of Corrections or its personnel that are at fault. The police who arrest activists and oppose the granting of bail and the public prosecutors who indict them are also at fault, he said, asking why Netiporn was not granted bail.

“If the court had granted her bail, Bung would not be dead. A lot of people have to be held responsible,” he said.

Krisadang is also concerned about activist Tantawan Tuatulanon, who has also been on a hunger strike and is now detained at Thammasat University Hospital. Tantawan was previously held at the Corrections Hospital with Netiporn and was reportedly a witness when Netiporn suffered cardiac arrest. Krisadang said he has told Tantawan’s family and friends to keep her safe and to visit her even during the weekend. He has also asked Corrections officials not to make her sign any document as an eyewitness. She is also in a state of shock, and although she has told Krisadang what she saw, he asked that she not be questioned.

The Department of Corrections issued a statement on Sunday (19 May) responding to Krisadang’s press conference. It claimed that the Corrections Hospital followed normal procedure when attempting to resuscitate Netiporn and that doctors were with her while she was being transferred. It also claimed that the Corrections Hospital meets the standard of care set by the Ministry of Public Health, that it has the necessary equipment and personnel, and follows professional standards.

Krisadang held another press conference on Sunday evening (19 May), during which he read a statement saying that Netiporn’s autopsy concluded that her cause of death was acute heart failure, electrolyte imbalance, and cardiomegaly (enlarged heart).

He said that according to the medical records obtained from Thammasat University Hospital, Netiporn had no vital signs when she arrived. An electrocardiogram found that she was in asystolic cardiac arrest, while doctors could not hear any air in her lungs. An examination with a video laryngoscope found an endotracheal tube in her esophagus and her end-tidal carbon dioxide (ETCO2) level was zero. Emergency room doctors re-intubated Netiporn, after which her ETCO2 level rose to 10 mmHg and air could be heard in her lungs.

He noted that although esophageal intubation can happen, there is a standard procedure to ensure that the tube is placed correctly. While placing the tube in the wrong position and allowing it to go undetected might not cause death, it is a serious mistake that reduced her chances of survival to zero.

“I have asked permission from the family, because this is private information about the deceased. I only report it after getting permission. These are the facts we obtained from Thammasat [University Hospital]. We are not accusing anyone, but we have to say it because a phone call was made to Thammasat University Hospital asking for an explanation,” Krisadang said. “There is a very thin line between an inquiry and a threat.”

Krisadang noted that he was told by Justice Minister Tawee Sodsong that doctors were with Netiporn in the ambulance, as well as the Director of the Corrections Hospital. He said that questions have been raised about the Corrections Hospital’s standard of care so that such an incident will not happen to other patients.

The Department of Corrections has been refusing to hand over Netiporn’s medical records and the CCTV footage. The Department claimed that Netiporn’s sister could not grant the power of attorney to her lawyer to obtain the record and that only her parents can do so.

Lawyers and other activists were made to wait for several hours on Monday (20 May) in front of the Corrections Hospital. TLHR said that the Corrections Hospital closed its gate. Officials refused to inform TLHR’s lawyers whether they could hand over the records and asked for Netiporn’s family members, although the lawyers told them that the family have granted power of attorney to the lawyers to obtain the records since they are still busy with Netiporn's funeral.

At around 13.00, TLHR said that the Corrections Hospital had handed over Netiporn’s medical records to her lawyers. However, the hospital has not given them the CCTV footage during her resuscitation as it wants to blur the faces of people not involved in the incident. TLHR said that the process is likely to take at least 4 days.

Netiporn was pronounced dead at 11.22 on 14 May after suffering a cardiac arrest while she was on a hunger strike to call for judicial system reform and the release of political dissidents.

The 28-year-old activist had been held in pre-trial detention on a royal defamation charge since her bail was revoked on 26 January and had been on a hunger strike since 27 January.

TLHR said that an autopsy was performed on Netiporn’s body on the morning of 15 May. It will likely take at least a month for an autopsy report to be completed, after which a court inquest will be conducted.