INVESTIGATING THE PRESIDENT’S DEATH University of Cape Coast—Cape Coast 1st August, 2012 Let me begin this solemn piece with my deepest condolences to the family of President Mills and to all Ghanaians on the President’s death. Since the President’s death, there has been a concerted effort to move on and not to assign blame by many. Indeed, the few who have tried to assign blame have been criticized vigorously. That desire not to ask hard questions is consistent with our culture as Africans and Ghanaians. As a Doctor, I deal with death more than most people. And I am very familiar with the argument to “Let things go, after all he/she is already dead and nothing we do will bring him/her back.” President Mills was a teacher both in the classroom and in life. It is my carefully considered and deeply held view that we must learn important lessons from the President’s death. There will be time for tributes but today, I urge that we ask some hard questions. At this point, I wish to apologize sincerely to all those who may be offended by my concerns and to beg their forgiveness. Since the President’s death over a week ago, I have had sleepless nights. My concerns have only increased as I have read accounts of his last hours and days. Joy FM reports the account of Reverend Amoo Darko, a member of the Council of State and the President’s friend. Joy reports that “According to Reverend Amoo Darko, the late President complained of neck pains on Sunday and so was unable to participate in church-related activities that day. He added that on Tuesday around noon, he received a call that the President had been rushed to 37 Military hospital on an emergency.” The BBC reported that “according to a Presidential aide, the leader had complained of pains on Monday evening and his condition had deteriorated.” The President’s brother and wife have also weight in. It is reported that Mrs. Mills tried to get the President to resign. If that is true, it is the most reassuring thing I have learnt in this unfortunate event. It is heart-warming that she put her husband’s health ahead of politics. Reacting to charges and/or rumours of negligence, the President’s brother, Dr. Cadman Atta Mills said, “Negligence is a very strong word to use in this context. I can guarantee you that everybody around the President did the very best that they could do and I start especially with those Doctors who have been with him ever since he became President.” From his words and his passion, Doctor Mills love for his brother is obvious and his gratitude for those who cared for him is natural and understandable. However, while we must trust that those involved in the President’s care did their best, we must verify that what was done accords with the best standards all over the world. Indeed, one can do harm while acting with the best of motives. For instance, if a Diabetic were to become unconscious, either from a very, very elevated sugar or a very very low sugar level, the administration of insulin, done with the best of motives might kill the patient in one instance and be life-saving in the other instance. In either instance, the one giving the insulin would have the same motive—to save the patient’s life. To set the standard for what we should be striving for, let me recount an incident. A few weeks before the President’s death, I was contacted by the US Embassy in Accra. They had paid a visit to Cape Coast to plan for a visit by a high ranking US government official to the city. To plan for the health of the official and his delegation, they had asked about Doctors in the city and had selected me, probably because of my US training. Before the visit, we discussed possible contingencies and I contacted officials at the Central Regional Hospital as well as the National Ambulance Service and went through a check-list of what might be needed. In the end, everything went well and no medical services were needed. But what I have just recounted is prudent planning at its best. We are told that the President was rushed to 37 Military hospital around noon and died at about 2:15 that same day. In law, since he died within a day of his arrival at the hospital, which makes the President’s death a CORONER’S CASE that must be investigated. To add to the confusion, a number of foreign media have reported that the President died of cancer. While this has not been confirmed by the government, the deceased President’s spiritual advisor, Prophet T.B. Joshua is reported to have confirmed that the President had cancer. This inquiry must be broad and forward-looking. It must respect the President’s privacy and sensibilities of his family while being thorough. And it must guide our conduct in the future if we should have a President who has health problems. It needs to address a number of important questions. The first is what the President’s state of health was. Did the President have cancer? If yes, when did he know it? Second, when the President was in the US for his last visit with his Doctors, what did they tell him and his handlers? Was he accompanied to that appointment by any of his Ghanaian Doctors? Third, when the President returned from the US, was there any contingency plan for emergencies relating to his health? What was the plan and was it followed? Fourth, the President started complaining of feeling unwell on Sunday, according to Rev. Amoo Darko. When was he examined and what did the examiner find? When he took sick on Tuesday and he was being rushed to 37 Military hospital, who was in the ambulance with him? What equipment was in the ambulance? Was any treatment administered en-route to the hospital? Fifth, was the hospital called before the President’s arrival? If yes, what preparation did the hospital make to receive the ailing President? Sixth, when did the President leave the Castle and when did he get to the hospital? Seventh, when he got to 37 Military hospital, was the President alive? Eighth, if he was alive, what treatment did he get at the hospital? Did he go into cardiac arrest as has been reported? How was that treated? Ninth, looking at how his health was managed throughout his Presidency, are there generalized shortcomings in how he was managed? Tenth, what does this show of our healthcare system and what are the lessons? Do we need legislation and or guidelines on how we should care for our Presidents? Should a President be obligated to disclose the state of his health to the public or to some public official? It is important that we ask these questions not because we suspect anybody of foul-play but because we need to learn the necessary lessons from this unfortunate tragedy. Already, politics appears to be emerging in the handling of the President’s death. That is unfortunate. There have been charges that the President died from vilification as well as charges that his health was sacrificed to politics by his handlers. Both charges are unwarranted, unwise and unhelpful. This is a time when we must come together—to comfort the President’s family and to dedicate ourselves to our nation and its best values. Let us, even in the midst of our sorrow, move forward—together. Arthur Kobina Kennedy, MD