Kota Kinabalu: The Coroner’s Court on Tuesday heard that no medication, including phenytoin, was administered to Zara Qairina Mahathir during her initial emergency treatment by an assistant medical officer.
Klinik Kesihatan Kinarut Assistant Medical Officer Mohd Faiszal Md Saimi said that from the initial emergency treatment until the handover to healthcare personnel at Queen Elizabeth Hospital (QEH), he did not administer any medication to Zara.
He was responding to questions from Conducting Officer Deputy Public Prosecutor Sofia S. Sawayan on whether he had given Zara any medication, including phenytoin.
Sofia: You said no medication was given to Zara in this case. What about phenytoin?
Mohd Faiszal: I did not administer phenytoin.
Sofia: To your knowledge, was the drug administered to the victim after she was sent to QEH?
Mohd Faiszal: I am not sure, as it is a medication for seizures.
Sofia: In this case, during your initial treatment of the victim, did you observe any signs of seizures?
Mohd Faiszal: There were no signs of seizures, as the patient was fully unconscious and had a low Glasgow Coma Scale (GCS) score of 3/15.
He further testified that the priority in early emergency management for an unconscious trauma patient with a suspected head injury was airway management, assessment of breathing, and control of bleeding and circulation, rather than administering medication.
Mohd Faiszal told the court that administering drugs would not have had any positive effect on the victim and could potentially worsen her condition, such as lowering blood pressure and aggravating bleeding.
“Assistant Medical Officers are also not allowed to administer medication without a doctor’s approval, except for Class C drugs such as aspirin, glyceryl trinitrate (GTN), paracetamol, oral rehydration salts (ORS) and infusion fluids like 0.9 per cent normal saline,” he said.
In response to a question from counsel Shahlan Jufri, Mohd Faiszal said phenytoin may fall under Category B, similar to diazepam, which is a controlled medication that can only be administered by a medical officer.
“However, in seizure cases, the first-line treatment is diazepam. Phenytoin is a last-line drug for uncontrolled seizures, such as when a patient continues to have seizures for more than five minutes or experiences recurrent seizures despite being given diazepam,” he said.
He added that members of the public could obtain phenytoin in tablet or capsule form at pharmacies with a prescription from a medical officer or specialist.
In September last year, Queen Elizabeth Hospital pathologist Dr Jessie Hiu testified that a post-mortem on Zara did not detect any common drugs in her body, although phenytoin was found in her kidney tissue.
The media had also reported that a neurosurgeon and a medical officer from the QEH Emergency and Trauma Department testified that no phenytoin was administered to Zara during their shifts.
The inquest continues this Thursday.
