Published March 13, 2006
THE HAGUE, Netherlands – A Dutch toxicologist said Monday that Slobodan Milosevic was taking antibiotics that diluted prescriptions for heart ailments and high blood pressure while he was pleading with a U.N. tribunal for permission to get treatment in Russia.
Donald Uges said he found traces of rifampicin, an antituberculosis drug, in Milosevic's system earlier this year after the former Yugoslav leader did not respond to blood pressure medication given at the U.N. detention center.
Rifampicin "makes the liver extremely active," possibly hindering the effectiveness of other medications.
"If you're taking something, it breaks down very quickly," Uges said.
Milosevic, 64, was found dead in his jail cell Saturday morning of an apparent heart attack. Hours earlier, he wrote an accusatory letter alleging that a "heavy drug" had been found in his bloodstream during a medical exam.
His ailments caused numerous delays in his four-year trial for orchestrating a decade of conflict that killed 250,000 people and tore the Yugoslav federation asunder. No verdict will be issued.
Uges suggested Milosevic may have taken the unprescribed medicine in a bid to be released from jail and get medical attention in Russia -- by portraying his Dutch doctors as unable to treat his condition.
"First he wasn't taking his medicine. Then he was forced to take it under supervision and his blood pressure still didn't come down. So his camp said: 'You see, these Dutch doctors don't know how to treat him and he should go to Russia,"' Uges said.
Milosevic's widow, Mirjana Markovic, and their son, Marko, live in Russia.
Rifampicin is used with other drugs to treat tuberculosis. It also can be used alone to treat certain bacterial infections or asymptomatic carriers of a type of meningitis.
According to the U.S. prescribing label, the drug affects enzymes in the body to speed metabolism of a host of other drugs, meaning higher doses of those other medications may be needed to compensate. It also can cause liver damage.
Doctors who examined Milosevic at the detention center diagnosed him as having hypertension, or high blood pressure, and hypertrophic heart disease, a thickening of the heart muscle.
U.N.-appointed doctors examined Milosevic in November and initially concluded he had been refusing to take his prescribed medicine, since the blood pressure was not responding.
Under orders of the judges, Milosevic was then required to take his medicine under supervision, but the "pressure still didn't come down," said Uges, a toxicologist from University Hospital of Groningen.
He said Dutch doctors concluded after a Jan. 12 examination that the most likely explanation was that Milosevic was taking another drug that counteracted his blood pressure medication.
Milosevic, who asked the court in December to be released to travel to Russia for treatment, contested the doctors' opinion, so the court asked Uges to conduct a more sophisticated test.
Uges said he conducted the tests two weeks ago on a sample taken earlier this year.
But he said his investigation -- performed initially without knowledge of who the patient was -- confirmed the earlier doctors' findings.
He said toxicological tests conducted during Sunday's autopsy would show whether the traces were still in Milosevic's blood when he died.
In Belgrade Monday, Serbian President Boris Tadic said the U.N. war crimes tribunal is responsible for Slobodan Milosevic's death, but he added that it would not hamper Serbia's future cooperation with the court.
"Undoubtedly, Milosevic had demanded a higher level of health care," Tadic said in an interview with The Associated Press. "That right should have been granted to all war crimes defendants."
A legal aide to Milosevic said the late Serb leader would be buried in Belgrade, Serbia-Montenegro -- a funeral that could provoke tumultuous scenes in the capital he ruled for 13 years before being extradited to the war crimes tribunal for trial.
Zdenko Tomanovic said Milosevic's family wanted a state funeral in Belgrade, apparently resolving an internal dispute over whether he should be buried in Serbia, Russia or Montenegro.
It was unclear if Serb authorities would approve.
Milosevic's widow and son are wanted on international arrest warrants for abuse of power and could be taken into custody if they return to Serbia for a funeral.
The allegations in what amounted to Milosevic's deathbed letter put the tribunal and U.N. prosecutors on the defensive about whether they gave Milosevic the medical treatment he needed and whether they conducted the trial properly and effectively.
The tribunal said Sunday a heart attack killed Milosevic, according to preliminary findings from Dutch pathologists, who conducted a nearly eight-hour autopsy on the former Yugoslav leader.
However, Russian Foreign Minister Sergey Lavrov said Moscow does not fully trust Milosevic's autopsy and wants to send doctors to examine the body.
Before the autopsy results were available, chief U.N. war crimes prosecutor Carla Del Ponte said suicide could not be ruled out. Milosevic's parents committed suicide.
Tomanovic said the ex-president feared he was being poisoned. He showed reporters a six-page letter Milosevic wrote to Russian officials Friday -- the day before his death -- claiming that traces of a medication used to treat leprosy or tuberculosis were found in his blood during a January exam.
"They would like to poison me," Tomanovic quoted Milosevic as telling him.
Uges, asked by the tribunal to confirm the findings, said he found the same antibiotic in Milosevic's blood weeks later.
Milosevic asked the tribunal in December for permission to seek heart treatment in Moscow. That request was denied after tribunal officials expressed concern Milosevic might not return. He repeated the request last month.
Lavrov said Russia was disturbed by the tribunal's refusal.
"Now they are conducting the autopsy," he said Monday. "In the situation when we weren't believed, we also have the right not to believe and not to trust those who are conducting these autopsy."
Tribunal President Fausto Pocar said he ordered the autopsy and a toxicological examination after a Dutch coroner was unable Saturday to establish the cause of death. Serbia sent a pathologist to observe the autopsy at the Netherlands Forensic Institute.
Milosevic was arrested in 2001 and put on trial in February 2002 on 66 counts for war crimes and genocide in Croatia, Bosnia and Kosovo during Yugoslavia's violent breakup in the 1990s. He was the first sitting head of state indicted for war crimes.
But his health problems repeatedly delayed the proceedings, which cost an estimated $200 million and were due to wrap up this summer.
Milosevic was the sixth war crimes suspect from the Balkans to die at The Hague. A week earlier, convicted former Croatian Serb leader Milan Babic, a star prosecution witness against Milosevic, killed himself in the same prison.