Even in the Philippines we are following the bizarre story of that fighting lady who died in police custody.

If the news is to be believed, her family are VIP’s, so expect a major lawsuit.

But this story has a hint that there might have been major health problems or major psychiatric problems, making one wonder why the family thought she was stable enough to travel alone:

“Carol, who was only 5-foot-7 and 105 pounds, appears to have been manhandled by the Phoenix Police Department,” Betsy Gotbaum said…

At the same time the family revealed Gotbaum was headed to an alcohol rehabilitation center when the incident began Friday night.

A person who is 5 foot 7 and 105 pounds is grossly underweight, to the point of malnutrition. Here are the acceptable weights for small, medium, and large frame women.

5’7″
123-136
133-147
143-163

So Mrs. Gotbaum was 20 to 40 pounds underweight. The photo that the family released to the papers did not suggest such a thin person, so we have to assume that the weight loss was since the photo was taken. 
A list of diseases that cause weight loss is HERE,

Was the weight loss recent? And if so, did she have a medical checkup before going into alcohol rehabilitation?

As a family doctor, we had to medically clear patients to be accepted into Rehab: They had to be drug free and not in danger of drug or alcohol withdrawal, they had to be checked for hepatitis and other problems.

Yet although alcoholics are often malnourished, most alcoholics are not so severely underweight (most social alcoholics drink their calories, and unless they are on skid row, eat meals). So why the underweight to the point of cachexia? And what disease causes severe weight loss and an aggressive outburst?

The first thing that comes to mind is that it was connected with her substance abuse problem. If she was that thin, she may have suffered from a nutrition related cardiomyopathy that made her heart vulnerable to sudden death.

But I’ve seen diabetics become violent when their blood sugars went too low, and people without glycogen in their liver e.g. underweight people, are also prone to hypoglycemia when they haven’t eaten for a few hours.

Since she was arrested, and not taken to the hospital, we can assume she was not psychotic or acting weird. This suggests mania or more likely a panic attack  or a medical/psychiatric problem rather than a major psychotic break.

So we go down the list. Was she suffering from panic attacks, or a bipolar illness (manic depression) and self treating her symptoms with alcohol (a common problem)? Or did she merely have a major panic attack? Was she bipolar and placed on an anti depressant that put her into a manic state? Or was she overusing stimulants to diet, and took a few before she got on the airplane?

Was her thyroid level too high? Was she diabetic, and having a low blood sugar attack?  Did she have a cancer, with a metastasis to her frontal lobe that made her judgement clouded? Was she anorexic/bullemic and had an electrolyte imbalance?
But the note about strangulation makes one wonder if the restraints were indeed the cause.

Hospital deaths from restraints in the olden days were rarely reported, but not unusual; indeed, even siderails and restrain jackets have been associated in deaths of confused or patients going through withdrawal, which is why the rule  in hospitals now  is not to use restraints at all, or if they are absolutely needed, that the patient has to be checked every five minutes, and the doc has to rewrite a restaint order every so many hours.

We don’t expect policemen to be doctors, but if there had been a “headsup” to the airline, or if a family member had been with her to let them know she had health problems, this lady would still be alive today.

The good news about all this is that the big BIG BIG lawsuit that will result from the case will lead to better regulations on restraint use in police custory, with new regulations on how often to observe aggressive people in custody, and training of law enforcement agents to be aware of medical problems that can cause aggression and violence.

The dangers of death and injury when handling violent patients who might have medical problems is real, as is the danger of injury or suicide in those arrested. Police get some training about these dangers, but I wonder how many hours training are given to airport security guards?

And, like the LIbby Zion case, that blew open the farce that doctors in training could efficiently work 120 hour weeks and led to mandating shorter hours for doctors on call, one hopes that some good will come from Mrs. Gotbaum’s death.
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Nancy Reyes is a retired physician living in the rural Philippines. her webpage is Finest kind Clinic and Fishmarket and she posts medical essays at HeyDoc Xanga Blog

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