Wednesday, April 29, 2009

Conflicts of Interest

The ongoing inquiry into the events leading to Robert Dziekanski's death following tasering by the RCMP has provided a classic conflict of interest scenario:
A cardiology expert paid by the company that makes Tasers told a public inquiry Tuesday he doesn't think Robert Dziekanski's death was at all related to the controversial stun guns.

Dziekanski died on the floor of Vancouver's airport in the early morning of Oct. 14, 2007, minutes after four RCMP officers confronted him and stunned him several times with a Taser.

Dr. Charles Swerdlow, a cardiac electrophysiologist who receives compensation for sitting on Taser International's medical advisory board, appeared at the inquiry by video conference from California.

Swerdlow said if the Taser negatively affected Dziekanski's heart, it would happen almost immediately after he was stunned.

But he noted that an airport security guard has testified that he checked Dziekanski's pulse three times before firefighters arrived more than 10 minutes after his collapse. Trevor Enchelmaier told the inquiry that each time he checked, Dziekanski had a heartbeat.

"In Mr. Dziekanski's death, we know his [heart stopping] was not immediate, we know he had an adequate cardiac rhythm for a number of minutes following exposure to Taser," said Swerdlow, who works at Cedars-Sinai Medical Centre in Los Angeles and also teaches at the University of California.

"So nothing here fits with direct cardiac electrical stimulation."

Swerdlow also said that if the heart is affected by electrical current, the resulting heartbeat would be either too fast or irregular. The first time anyone noticed anything wrong with Dziekanski's heart was when firefighters arrived and found he had no pulse at all.
I gather that cross-examination of Dr Swerdlow has yet to occur, but I might ask him the following questions:
  • An airport security guard has testified that he was able to find Mr Dziekanski's pulse "three times" in the approximately ten minutes following his collapse prior to the arrival of the firefighters. Does evidence of a pulse in and of itself rule out arrhythmia or any other adverse effect potentially caused by multiple Taser "stuns"?
  • Did the security guard have adequate training or equipment (e.g. stethoscope, ECG leads) to ascertain Mr Dziekanski's condition?
  • What is the appropriate means of diagnosing an arrhythmia?
  • What level of electrical current would be sufficient adverse cardiac events or death? What are the causes of such results?
  • How do you know that Mr Dziekanski's cardiac rhythm was "adequate" in the period prior to his death and following the tasering? Were you present at the scene? If not, on what basis can you testify that his rhythm was "adequate"?
  • How much compensation do you receive from Taser International annually? Have you ever noted any examples of adverse cardiac events resulting from Taser use? Do you feel there is any conflict of interest in testifying in favour of the safety of a product whose manfacturer compensates you? Did you receive any additional compensation to appear at this inquiry? How often do you testify in Taser-related cases? Have you ever testified that the use of a Taser contributed to death or other adverse cardiac events?
I think that about covers it. I'd be very interested in the responses.

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