‘Nalunod or nilunod?’: Forensic science in drowning investigations

Friday the 13th, this month of June, the accidental drowning of Aizza Mae Balbin, the 26-year-old nurse from Bohol, while white water rafting in Cagayan de Oro City was a tragic loss for her family and friends. The inflatable boat that Aizza was riding capsized and the strong undercurrent must have taken her body to the boulders along the river, where she was found two days later. This incident was a wake-up call for the white water rafting industry in CDO to review its safety measures in order to prevent such accidents in the future. Without need for further investigation, the death of Aizza was clearly accidental.

Drowning by definition is the inability of a person to breathe because of “being in or under the water.” Liquid enters the person’s lungs preventing the absorption of oxygen and subsequently resulting in cerebral hypoxia and cardiac arrest. The manner by which a person finds himself in this state is crucial to determining whether the drowning is an accident by natural or other causes, an intentional act of a person to commit suicide, or resulting from an action of another individual aimed at ending the victim’s life. According to the Philippine Drowning Prevention Plan 2010-2015, drowning is the leading cause of death for Filipinos of all ages. An estimated 40,000 fatal and non-fatal incidents occur each year, with roughly eight persons drowning daily in the Philippines. Determination of the real cause of death by drowning or otherwise, in most of these cases, is not routinely performed.

Besides natural causes such as in the case of Aizza Balbin, accidental drowning may also occur as a result of a variety of unrelated and predisposing events such as seizures, injury, alcohol use, drug use or disease which led to the victim’s submersion in water and consequent drowning. Both drug and alcohol use can cause impairment of judgment, level of consciousness, and motor function. For example, Whitney Houston’s body was found under water in her Bellevue suite on Feb. 11, 2012. Initial questions were — did Whitney commit suicide or did she die of another cause? According to the coroner who performed the autopsy, Houston’s history of cocaine use and heart condition was responsible for her death. The presence of water in her lungs indicated that Houston was still breathing but was unable to get herself out of her bathtub. In the end, Houston died of drowning but there was no evidence to support her intention to commit suicide. In the coroner’s report, the cause of death indicated was accidental drowning.

However, in some cases, the cause of death by drowning may not be as clear as the Balbin and Houston cases. In intentional drowning, there are traumatic injuries present in the victim’s body. These injuries may make the person incapable of taking himself/herself out of the water. Take the case of Anna Karissa Grandine, a Filipina living in Toronto, Canada who was found dead in her home on Oct. 17, 2011. She was six months pregnant at that time. The cause of death listed was drowning. Seven months later in May 2012, her husband, Philip Grandine, was charged with first-degree murder. According to police investigators, they had a very strong case against the husband, albeit the pieces of evidence they had were not shared with the public.

At times, a victim’s body is thrown into the water to simply conceal the crime but the person may have died of causes other than drowning. In the Ruby Rose Barrameda Jimenez case, for example, the body was found stuffed inside a cemented steel drum in the waters of Navotas City on June 10, 2009. A plastic bag covered her head and a belt was placed around her neck. She had been missing since 2007 and the perpetrators had used the Navotas River to hide the body. Ruby Rose did not die of drowning but her body in the cemented drum was submerged in water to cover up the crime. 

To determine the cause of death and associated factors that could have contributed to it, a comprehensive autopsy is needed in most drowning cases, particularly when death by a natural cause is not clearly evident. For intentional drowning, forensic diagnoses of injury may aid in reconstructing the sequence of events and the level of violence involved prior to the victim’s death. For unintentional drowning, investigation is mainly focused on excluding foul play and reviewing the circumstances and contributing factors which led to the incident. The use of proper forensic procedures is essential to determine the cause and manner of death, to reconstruct the sequence of events that led the victim into the water and to search for evidence that would unmistakably identify and indict the perpetrator of the crime. In addition, a forensic pathologist must be able to identify the victim, to evaluate the postmortem submersion time, to determine the cause and manner of death and to ascertain whether the victim was still alive before the body was found in the water.

Notably, the significant issues raised in forensic diagnosis of drowning are: first, bodies recovered from water are often unidentified during the first phase of investigation. By determining the victim’s personal history, important clues can be obtained to link circumstantial data and postmortem findings to the actual death. Second, witnesses’ accounts are sought after but the consistency with the estimated postmortem interval should be well thought out. Third, in determining the cause and manner of death, the circumstances surrounding death, environmental factors, pre-existing diseases of the victim and autopsy findings must be appropriately considered. Lastly, both the antemortem and postmortem pathological processes, toxicological findings, traumatic lesions sustained, and other factors that may have led to the fatal outcome must be thoroughly considered to reconstruct the sequence of events.

The Philippines being an archipelagic country will always be subjected to events wherein drowning of a person or persons will take place, by natural or unnatural causes. In fact, the number of drowning incidences in the country has prompted the creation of the first Philippine Drowning Prevention Council in July 2010 for the enhancement of Drowning Prevention Initiatives in the Philippines. This included the formulation of the Philippine Drowning Prevention Plan (PDPP) 2010-2015 (http://www.philippinelifesaving.org/filecabinet/ PDPPlan2010-15Primer.pdf). The PDPP, that includes 34 recommendations, was developed to save lives and targets to reduce drowning incidences in 2015 by 50 percent or less. However, work to improve the diagnosis of the causes of drowning in the Philippines was not included. In a report released by the World Health Organization in 2001  (http://c.ymcdn.com/sites/www.usla.org/resource/resmgr/lifeguard_library/drowningfactsheetwhosep03.pdf), WHO recognized that the magnitude of drowning deaths is far greater than the estimates included in their report since it excluded drowning due to floods, death while being transported in water, assaults and suicide. We believe that the reported number of 40,000 deaths by drowning in the Philippines annually is a gross underestimate. Although majority of these deaths are likely due to accidental drowning, one must recognize the potential role of forensic science toward answering the question — “nalunod” or “nilunod” — and is a step forward in making this prevention plan more comprehensive.

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Leonora P. Nudo is currently finishing her doctorate degree in Biology at the Institute of Biology, University of the Philippines, Diliman. She was in the pioneering batch of graduate students that enrolled in BIOL 397 (Forensic Biology Seminar Series) that was first offered in November 2012 and handled jointly by Dr. Maria Corazon A. de Ungria and Dr. Ian Kendrich Fontanilla. As part of the course, Nudo reviewed scientific literature on the physio-pathological mechanisms of drowning and the significance of forensic investigation procedures for the accurate diagnosis of drowning. She is convinced of the need to use more sciences, particularly biology, in investigations of drowning to identify cases that involved foul play so as to catch the perpetrator of the crime, and help find justice for victims and their families.

Dr. Maria Corazon A. de Ungria is a University Researcher III of the University of the Philippines and Scientist II of the Scientific Career System of the Department of Science and Technology/Civil Service Commission. She engages in research and extension work full-time, being appointed as a Research, Extension and Professional Staff (REPS) in UP. Although not required to teach, De Ungria agreed to teach the BIOL 397 graduate course at the Institute of Biology in order to encourage more researchers and graduate students to use their degrees in the basic sciences as the foundation to do forensic science. The BIOL 397 course is enriched by actual material/casework examples derived from the work of the DNA Analysis Laboratory, Natural Sciences Research Institute (www.dnaforensic.org; https://www.facebook.com/ DNAForensicAndEthnicity/info), which she heads, albeit all examples are anonymized to protect the genetic privacy of individuals. In running the course, De Ungria hopes to inspire the youth in finding their work, particularly their scientific research, as a vital tool to serve society and as an integral part of nation building. E-mail at [email protected].