Coroner's Finding: KNOWLES Edward James

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 10th day of October 2019 and the 10th day of January 2020, by the Coroner’s Court of the said State, constituted of David Richard Latimer Whittle, State Coroner, into the death of Edward James Knowles.

The said Court finds that Edward James Knowles aged 80 years, late of 43 James Well Road, Ardrossan, South Australia died at the Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia on the 12th day of May 2016 as a result of inanition complicating end stage dementia. The said Court finds that the circumstances of his death were as follows:

1. Introduction 1.1. Edward James Knowles was born on 29 March 1936, and died at the Lyell McEwin Hospital on 12 May 2016. He was 80 years-old.

2. Cause of death 2.1. A pathology review was undertaken by Dr Jane Alderman, in consultation with forensic pathologists Drs Karen Heath and Stephen Wills of Forensic Science South Australia.

It was not necessary to conduct an autopsy to determine the cause of death. I find, in accordance with the opinion expressed by Dr Alderman, that the cause of Mr Knowles’ death was inanition complicating end stage dementia.

3. Mandatory Inquest 3.1. This is a mandatory inquest, as the cause of death arose whilst an Inpatient Treatment Order was in place. Mr Knowles was subject to a series of three Inpatient Treatment

Orders, made pursuant to section 21 and section 25 of the Mental Health Act 2009, during the time leading to his death.

3.2. A Level 1 Inpatient Treatment Order was made on 17 March 2016 by his general practitioner Dr Babu, when Mr Knowles did not agree to stay at the Ardrossan Hospital, where he had been admitted on account of his dementia.

3.3. On the following day, he was transferred to the Lyell McEwin Hospital, where the Inpatient Treatment Order was confirmed by Dr Draper on 19 March 2016. That was due to expire on 24 March 2016.

3.4. A Level 2 Inpatient Treatment Order was made on 23 March 2016 by Dr Rischbieth, and was due to expire on 4 May 2016.

3.5. On 4 May 2016 Dr Robertson made a Level 1 Inpatient Treatment Order, with the intention of later making a Level 3 Inpatient Treatment Order. The order expired on 11 May 2016, and no further order was made.

3.6. A ‘death in custody’, as defined in the Coroners Act 2003, includes the death of a person where there is reason to believe that the death occurred, or the cause of death, or a possible cause of death, arose, or may have arisen, while the person was being detained in any place within the State under any Act or law. The cause of Mr Knowles’ death arose, or may have arisen, whilst he was subject to an Inpatient Treatment Order, and section 21 of the Coroners Act 2003 provides that an inquest must be held in such circumstances.

4. Background 4.1. Mr Knowles was married to Maureen May Knowles on 18 April 1960. They had known each other since they were children, and remained married until his death. Together they raised four sons. After 41 years working at General Motors Holden at Elizabeth, Mr Knowles retired at the age of 55. In 1994, he and his wife moved to their shack in Ardrossan. They suffered the tragedy of losing their son Grant, who died in 1996 and later his twin brother Robert, who died in 2006. Mr Knowles was an elite-level rifle shooter, representing Australia on a number of occasions.

5. Decline in health 5.1. Mr Knowles had no major health concerns until he was diagnosed with dementia in

6. He remained in the community and was cared for by his wife at home in Ardrossan. He gradually became more impaired, eventually losing the ability to communicate and follow instructions. He began to exhibit uncharacteristic aggression, related to his dementia, until after an incident of aggression in March 2016 it was untenable for him to live at home any longer.

5.2. In March 2016 Mr Knowles was first detained at the Ardrossan Hospital and then admitted to the Lyell McEwin Hospital. He was subject to the various Inpatient Treatment Orders referred to above. Investigations were undertaken into the underlying causes of his worsening dementia. He remained too agitated to return to community based care. During his admission, Mr Knowles required a catheter due to urinary retention but he repeatedly removed it. Some antipsychotic medication was required.

His renal function fluctuated, and a pulmonary embolism was detected during a CT scan.

5.3. Having regard to Mr Knowles’ overall deterioration, a palliative approach was adopted from 11 May 2016. He began to refuse food, and had significant swallowing problems.

5.4. Mr Knowles died at 3pm on 12 May 2016, in the presence of members of his family.

Mr Knowles' son, John Knowles, identified the body of his father and I accept the accuracy of that identification.

5.5. A police investigation was undertaken, as the death was a ‘death in custody’ as previously described. There were clearly no suspicious circumstances surrounding Mr Knowles’ death and no concerns were expressed, relating to his care or in relation to the Inpatient Treatment Orders.

6. Further findings 6.1. I find that the Inpatient Treatment Orders imposed upon Mr Knowles were lawful and imposed upon proper grounds.

6.2. I find that the care of Mr Knowles whilst subject to the Inpatient Treatment Orders was at all times appropriate.

6.3. I make no recommendations arising from this inquest.

Key Words: Death in Custody; Inpatient Treatment Order; Natural Causes In witness whereof the said Coroner has hereunto set and subscribed his hand and Seal the 10th day of January, 2020.

State Coroner Inquest Number 28/2019 (0875/2016)