The M-27 inquiry expanded across fourteen health facilities.
Review teams traced delivery records, complaints, certificates, and patient outcomes.
Not every incident belonged to the same cause.
One hospital had a leaking pipeline.
Another clinic used a damaged regulator.
Six facilities, however, showed repeated serials, false certificates, or gas that failed the medical standard.
Families were contacted privately before names appeared in public.
Teresia Naliaka was on the list.
So were Moses Kamau, Baby Amina Yusuf, Samuel Kariuki, Jane Atieno, and Patrick Muli.
The review did not claim one cylinder caused every death.
In some cases, destroyed or incomplete records made certainty impossible.
Baby Amina’s mother asked the county team:
“You are giving me a report that says you do not know?”
“We know the cylinder failed the standard and the supply was interrupted,” the officer said.
“We do not have enough preserved clinical data to measure exactly how much it contributed.”
“You lost the data.”
“Yes.”
The answer was painful and inadequate.
It was still more honest than inventing certainty.
The families formed their own group, with their own lawyer, spokesperson, and privacy rules. Wanjiku did not lead it.
They refused to let Rift Gas control the compensation process.
“The company that closed complaints cannot decide who deserves payment,” Baby Amina’s mother said.
An independent trust was created with family representatives, an auditor, and external medical review.
Some families accepted settlements.
Some continued to court.
Some wanted corrected death records more than money.
Each chose separately.
Rift Gas entered temporary administration. Verified operations continued so safe supply and workers’ livelihoods did not collapse. Northline and Kibo contracts were suspended.
Naserian refused the acting-chief-executive role until the audit and family ownership disputes were resolved.
“If I take the chair now,” she said, “every safety action can be dismissed as my route to power.”
Kelvin and Gichuru faced trial.
Peter entered a plea on some charges and provided evidence, but his direct role still carried punishment.
Miriam Chebet faced corruption and misconduct proceedings.
Pauline received disciplinary sanctions for unauthorised changes and initial concealment, while her later preservation of evidence was also recorded.
Brian was suspended for a period, completed ethics training, and returned under supervision.
Faith was reinstated through labour proceedings but chose not to remain at Mwangaza.
Malik rejected a settlement that required silence about system failures.
The medical board finally lifted Wanjiku’s suspension.
The letter said:
**No adverse finding remains against Dr Wanjiku Naliaka regarding the death of Jonah Kibet.**
She read it three times.
Achieng negotiated a public correction from the hospital.
It was dry and carefully worded.
Mwangaza withdrew its earlier implication concerning Wanjiku’s clinical conduct.
No emotional apology followed.
“Do you want to sue?” Achieng asked.
“Yes. Not today.”
She preserved the claim without allowing litigation to become her only future.
Mwangaza’s external review adopted many of the reforms Wanjiku, Malik, and Faith had proposed:
independent clock synchronisation;
immutable audit trails;
alerts for administrative overrides;
separation of executive and clinical authority;
outside whistle-blower channels;
verified backup retention;
proper pass expiry;
legal counsel for staff whose interests conflicted with the hospital.
The hospital tried to publish the reforms without naming the staff who exposed the failures.
Malik noticed.
“They used our language.”
Faith asked the more important question.
“Are they implementing it?”
Wanjiku insisted the implementation report acknowledge the staff, nurses, engineers, and patient families whose evidence created the changes.
The board agreed.
County clinics introduced scannable cylinder serials, but Wanjiku warned that technology alone would not protect anyone. Staff also needed replacement supply, complaint numbers, and protection from retaliation.
Susan from Gatundu became one of the trainers.
At the families’ memorial, the wall did not display compensation amounts or levels of legal certainty.
It displayed names.
Above them were the words:
**They were people before they became files.**
Under Teresia’s name, Wanjiku wrote:
**She loved strong tea and very long voice notes.**
Under Moses Kamau:
**He repaired radios and carried one everywhere.**
Under Baby Amina:
**She lived eleven days and was known for her wide eyes.**
Naserian read a statement about Jonah.
“He was our father and the chairman who helped build the company. He also signed reports that concealed complaints. At the end, he tried to release evidence. His last actions do not erase the first. His earlier wrongdoing does not make his murder lawful.”
After the memorial, Wanjiku gave Naserian one of Teresia’s voice notes.
Naserian listened to the laughter.
“She had a beautiful voice.”
“She talked too much.”
They smiled.
The names on the cylinders were not only serial numbers.
They belonged to the people who manufactured, inspected, received, reported, suffered, and survived.
Any system claiming reform had to see all of them.