Coroner's Finding: ARBUCKLE Claudia Anna Maria

CORONERS ACT, 2003 SOUTH AUSTRALIA FINDING OF INQUEST An Inquest taken on behalf of our Sovereign Lady the Queen at Adelaide in the State of South Australia, on the 17th day of September 2008, the 23rd day of April 2009 and the 4th day of June 2010, by the Coroner’s Court of the said State, constituted of Mark Frederick Johns, State Coroner, into the death of Claudia Anna Maria Arbuckle.

The said Court finds that Claudia Anna Maria Arbuckle aged 44 years, late of 492a Main Road, Coromandel Valley, South Australia died at Coromandel Valley, South Australia on the 23rd day of August 2008 as a result of mixed drug toxicity with aspiration of gastric contents. The said Court finds that the circumstances of her death were as follows:

1. Introduction and Inquest findings 1.1. Claudia Anna Maria Arbuckle, aged 44 years, was found deceased at her home address on 23 August 2008. A post-mortem examination was carried out by Professor Byard on 26 August 2008 and he has given the cause of death as mixed drug toxicity with aspiration of gastric contents and I so find.

1.2. Professor Byard provided a post-mortem report1 and said that the drugs which contributed Ms Arbuckle’s death included potentially lethal and toxic levels of a number of drugs including amitriptyline, diazepam, codeine and lorazepam.

1.3. Ms Arbuckle had suffered a back injury some considerable time prior to her death.

As a result of this she suffered from ongoing pain which was difficult to manage. As a result of this she also suffered from depression.

1 Exhibit C5

1.4. Ms Arbuckle had a previous history of admissions to hospital for over medicating.

She had, shortly before her death, been accepted into the Flinders Medical Centre Pain Clinic but, unfortunately, she died before she had an opportunity to take advantage of the services offered by that clinic.

1.5. I heard evidence from her treating general practitioner, Dr Bunton. He indicated that he had a consultation with her very shortly prior to her death at which he found her to be happier in her demeanour than usual. He said that there was really nothing out of the ordinary in her presentation and she certainly gave no indication of suicidal intent.

Her purpose for attending on that day was to renew a prescription for the pain medication, Endep.

1.6. Dr Bunton said that for some time he had had questioned in his own mind whether Ms Arbuckle was taking more medication than she should have. There had been occasions when she had presented requesting further prescriptions claiming that she had lost medication or left medication at her sister’s house in Sydney. Dr Bunton was keenly aware of the possibility that Ms Arbuckle may be consuming some of the medication she claimed had been lost. However, Dr Bunton was keenly aware of the importance of maintaining a therapeutic relationship in order to keep Ms Arbuckle on track as best he could. He did not want to threaten the therapeutic relationship by refusing to offer prescriptions on a reasonable basis. He felt that it was important for Ms Arbuckle to have a consistent general practitioner rather than to move from one practitioner to another, as would inevitably have occurred if their relationship ceased.

1.7. In my opinion this was an entirely reasonable attitude on the part of Dr Bunton.

1.8. Toxicological results of a blood sample taken at autopsy showed that amitriptyline was present at a potentially lethal level; diazepam was present at potentially toxic level; codeine was present at a therapeutic level; lorazepam was present at potentially toxic level; olanzapine was present in the blood at a concentration that was of uncertain significance; paracetamol was present at a greater than therapeutic concentration and morphine was present at a non-toxic, therapeutic concentration.

2. Conclusions 2.1. It is really not possible to say, having regard to Ms Arbuckle’s medical history, whether she intentionally consumed an overdose of medication or whether her death

was the result of an unfortunate combination of circumstances. Certainly there was no suicide note found amongst her effects.

2.2. A thorough investigation and search of her household effects was carried out by Constable Pagac2. Senior Constable Pagac gave evidence and I commend him on his diligent work in this case.

2.3. It is clear that Dr Bunton did all that he could for Ms Arbuckle and could not have predicted that this event might have occurred. If anything, on his most recent consultation with Ms Arbuckle, she appeared to be improving.

2.4. In conclusion I find that Ms Arbuckle’s cause of death was mixed drug toxicity with aspiration of gastric contents.

3. Recommendations 3.1. I have no recommendations to make in this matter.

2 Now holding the rank of Senior Constable

Key Words: Drug Overdose In witness whereof the said Coroner has hereunto set and subscribed his hand and Seal the 4th day of June, 2010.

State Coroner Inquest Number 34/2008 (1194/2008)