Liberia: 2nd Autopsy for Princess Cooper

Ms. Cooper's body was found in a fence behind the FAWAZ Building Construction Company at the ELWA Junction, Paynesville City, in a pool of blood that had oozed from her mouth and nose.

... As the family rejects the autopsy report… saying their daughter never had tuberculosis

The family of Princess Cooper, the 25 years old lady whose lifeless body was found face-down in a pool of blood, has vehemently rejected an autopsy report by two Liberian pathologists that the deceased died mainly of progressive secondary pulmonary tuberculosis.

The autopsy report by Drs. Benedict Kolee and his colleague, Zoebon B. Kpadeh said the evidence pointed out that Ms. Cooper had underlying health conditions that caused her death. They argued that from professional and expert opinion, the deceased died naturally as a result of hemorrhagic shock, that massive hemorrhage from a ruptured Rasmussen aneurysm and erosion of bronchial vessels, as well as progressive secondary pulmonary tuberculosis.

"In our professional and expert opinion, the manner of death is NATURAL," Dr. Kolee, who read the report yesterday at the Ministry of Information, Cultural Affairs, and Tourism, on behalf of he and his colleague.  “Findings from the autopsy suggested that Princess Cooper died of internal bleeding caused by tuberculosis.”

However, the family of the deceased has not just rejected the autopsy report but denied the pathologists’ claim that Ms. Cooper died of tuberculosis. They too argued that there is no medical history of their deceased daughter having tuberculosis and the contents of the report aren't just consistent with the medical history of the deceased, and it also falls short of making sense of the pattern of death.

Ms. Cooper's body was found in a fence behind the FAWAZ Building Construction Company at the ELWA Junction, Paynesville City, in a pool of blood that had oozed from her mouth and nose, according to the Liberia National Police. She was a resident of the Tweh Farm, Bushrod Island Community.

Second autopsy

The deceased's death led to widespread outrage and protests with many people demanding justice – and with the rejection of the autopsy report, the government has succumbed to the family and the public demand for the conduct of an independent autopsy. 

Conceding, President George Weah in a late-night post yesterday said he had directed the Minister of Justice Musah Dean to avail the remains of Ms. Cooper for the conduct of a second autopsy. The decision, the president said, is to lend support to the bereaved family, in their quest to bring closure to the circumstances surrounding the death of their loved one along with concerns raised by some citizens with the initial autopsy.

“The government will fund the conduct of the second autopsy and call on the family to designate a pathologist of their choice, possessing the requisite credentials and qualifications,” a release from the Executive Mansion notes. 

In the directive, President Weah urged Minister Dean to ensure that all civil society, political and other interest groups and individuals “who have been involved with advocacy in the case cooperate with the family and send the name of a designated qualified pathologist to the government in the soonest possible time for the conduct of the second autopsy.”

The Liberian Chief Executive reiterated his condolences to the bereaved family, saying the death of any Liberian, whether by natural or unnatural causes, is concerning to the government.

Family not accepting

The spokesperson of the family, Dr. Abel Momoh, said Ms. Cooper's medical report, presented to the pathologists before the autopsy, was hematemesis — a serious condition in which blood is expelled from the mouth.

“I will tell you that tuberculosis — which is the cause of death according to the pathologists — is Hemoptysis.  Hemoptysis is coughing of blood, but what Princess had was hematemesis, so hematemesis is not consistent with tuberculosis,” he said. "So the collective view of the family is that they are not accepting the report because we strongly believe that Princess did not die from hemorrhagic shock.  We feel that the report is not consistent with the normal happenings of our sister's death; as such, the family cannot take such a report from the Liberian government.  What came out is not consistent with the pattern of death.”

Hematemesis as mentioned by Dr. Momoh is the vomiting of blood, usually indicating bleeding in the digestive system and it is sometimes confused with the term hemoptysis, which is coughing blood from the lower regions of the respiratory system, usually indicating a problem related to the respiratory or cardiovascular system.

Medically, the most common causes of vomiting blood are problems in the gastrointestinal system — peptic ulcer, gastritis, and malignant stomach tumors all are causes of hematemesis.

Gastric varices or esophageal varices are when blood vessels swell up and burst in the stomach and esophagus; this happens in liver failure and a Mallory–Weiss tear is when part of the esophagus tears due to the force of vomiting or even coughing, resulting in bleeding. Bleeding in some cases can be dangerous, leading to anemia but, most importantly, shock due to blood loss can lead to death.

While Hemoptysis is a respiratory condition caused by pneumonia, tuberculosis, bronchiectasis, and cystic fibrosis.  Simply coughing too hard and too much can lead to some bleeding due to microscopic vessel breaking; this can occur when a person has a respiratory illness. A pulmonary embolism, lung cancer, and even cardiovascular disease can also lead to hemoptysis. Bleeding may be mild or in extreme cases, severe. It is when hemorrhage is uncontrolled that the risk of death is increased and treatment to stop the bleeding becomes urgent and necessary.

Massive depletion of the intestine

The autopsy report by Drs. Kolee and Kpadeh disclosed that sections of the lungs of the deceased show massive depletion in the intestine and dental spaces and that no ammonal was found in her blood and stomach and there was no trace of alcohol in the systems during the conduct of the autopsy.

Dr. Kolee further told the news conference that Ms. Cooper, three days before her death, had visited the New Community Clinic in the St. Paul Bridge area for a medical examination. There, health practitioners confirmed that she was “suffering from fever, non -productive cough, and severe pain in the chest.”

The pathologist noted that during the conduct of the autopsy, they discovered and removed two liters of clotted blood inside the stomach of the late Cooper.

The hemorrhagic shock spoke of in the autopsy report by Drs. Kolee and Kpadeh is a type of hypovolemic shock, where intravascular blood loss and consequent alterations in the cell due to the hypoxia, resulting in tissue and organ dysfunction, leading to death, once a certain threshold level is exceeded.

Also, massive hemoptysis arising from a Rasmussen aneurysm is a potentially life-threatening condition involving bleeding from the pulmonary or bronchial vasculature, which is usually due to higher pressure on the bronchial system.  And in cases where bronchial artery embolization has not yet been performed, mortality approaches 70 percent.

Disagreeing with MOJ

The family of the late Princess Cooper, before the conduct of the autopsy by the government, had previously clashed with the Ministry of Justice regarding the matter. Ms. Cooper's family, as a result of their demand for a forensic autopsy, did not attend the March 27 clinical autopsy that was conducted by the government.  

The family of the deceased demanded a forensic autopsy on grounds that the cause of death may be criminal, while the government pushed ahead with the conduct of its clinical autopsy to find the medical cause of death of the deceased.

The government autopsy report comes just weeks after Police spokesman Moses Carter disclosed that the Liberia National Police preliminary report revealed no foul play. Carter noted that a physical forensic examination conducted revealed that there was no foul play in the death of the young lady.

“Our forensic team conducted a physical examination on the body of the late Princess Cooper from the physical examination, observed that there was no laceration, and there were also no bruises. Our coroner conducted a coroner inquest on the body at the John F. Kennedy medical center and that coroner inquest that was conducted… for now there has been no foul observed. Our investigation is continuing,” said the police spokesman.

The late Ms. Cooper on March 24, the day of her death, reportedly left her residence early that day to do some catering work at Capitol By-pass, but subsequently received a call to which she was lured to the Paynesville area. She reportedly told friends that she was going somewhere and would be back.

Ms. Cooper is reported to have placed a Facebook messenger video call after an hour of her departure to a lady named Welleh, who is believed to be a close friend, telling her, “They are killing me ooo…” and the deceased immediately then dropped the call.

She did not pick up again when Welleh reportedly tried to return the call.

There have, however, been a series of protests since Ms. Cooper demise with Liberians from all walks of life calling on the government to ensure that justice is served and that her killer is found and prosecuted in accordance with the law.

Protesters stormed Capitol Hill, visiting both the Capitol Building, the seat of the Legislature and the Executive Mansion, which serves as the offices of the presidency to voice out their frustration over how the government was handling the situation.

Meanwhile, Dr. Momo has disclosed that his family was not officially invited by the government, nor was their lawyer, Cllr. Tiawan Gongloe, invited to the press conference nor were they informed ahead of time about the autopsy report.