Coroner's Finding: PLAYFORD Aldona Mariana

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 29th 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 Aldona Mariana Playford.

The said Court finds that Aldona Mariana Playford aged 84 years, late of 13 Barr Smith Drive, Urrbrae, South Australia died at the Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia on the 8th day of August 2016 as a result of sepsis and cardiac failure in a woman with hypertensive ischaemic and valvular heart disease, chronic renal failure and bilateral cellulitis of the legs. The said Court finds that the circumstances of her death were as follows:

1. Introduction 1.1. Aldona Mariana Playford was born on 1 January 1932 in Lithuania and died on 8 August 2016 at the Flinders Medical Centre. She was 84 years old.

2. Cause of death 2.1. A pathology review by Dr Ian McIntyre, who consulted Associate Professor Neil Langlois, forensic pathologist, states that the cause of death was sepsis and cardiac failure in a woman with hypertensive ischaemic and valvular heart disease, chronic renal failure and bilateral cellulitis of the legs. I find the cause of Mrs Playford’s death to have been as stated by Dr McIntyre.

3. Mandatory inquest 3.1. This is a mandatory inquest pursuant to section 21 of the Coroners Act 2003 as Mrs Playford was subject to an Inpatient Treatment Order under the Mental Health Act 2009 at the time of her death.

3.2. The first was a Level 1 Inpatient Treatment Order, which was made by Dr Christopher on 14 July 2016 because Mrs Playford was anxious and agitated and diagnosed to be suffering paranoid psychosis. On 21 July 2016 Dr Rene Pols extended the order as a Level 2 Inpatient Treatment Order, to apply until 1 September 2016. This order was current at the time of her death.

3.3. No concerns have been expressed regarding the lawfulness or appropriateness of those inpatient treatment orders.

4. Background 4.1. Mrs Playford was born in Lithuania and spent five to six years in camps in Germany during the Second World War. She came to Australia at the age of about 14. She spoke a number of languages and quickly learnt English. She was a junior national table tennis champion. After achieving good results at school, she commenced studying medicine at the University of Adelaide but after two years withdrew to care for her mother, who had cancer. She married in 1959 and had three children. The family lived interstate, at Norton Summit and then at Urrbrae, where Mrs Playford lived for the rest of her life, following the death of her husband in the mid-1990s. She worked for the Australian Dictionary of Biography, and for the State Library. She was predeceased by her son John, who died of leukaemia in 2015. Her daughter Vanessa lives interstate, and her son Peter, who lives in Adelaide, checked on her regularly and provided care.

4.2. Mrs Playford had an extensive medical history that included breast cancer (treated) in 1985, ischaemic heart disease with coronary bypass surgery that was performed in 1995, a heart attack in the year 2000, chronic congestive cardiac failure, severe biventricular dysfunction from 2016, pulmonary hypertension, rheumatic fever, chronic obstructive airways, childhood tuberculosis, hypertension, chronic renal failure, peptic ulcer disease and bilateral leg oedema.

4.3. Mrs Playford was intelligent and independent and made her own decisions. However, her various conditions led to a cycle of hospitalisation from time to time, followed by transition back to her home, via aged care. She was inclined to discharge herself without necessarily referring to family members involved with her care.

5. Final hospital admission and treatment 5.1. Mrs Playford was admitted to the Flinders Medical Centre on 25 June 2016 suffering from chest pain and decompensated cardiac failure. Treatment with diuretics was given and she began to stabilise.

5.2. The admission was complicated by the development of a paranoid psychosis for which the Inpatient Treatment Orders were made and psychiatric advice obtained. She was diagnosed as suffering from a schizoaffective disorder.

5.3. On 14 July 2016 when the first Inpatient Treatment Order was made, it was considered that there was an immediate risk to her life as she was unable to cooperate with medical care, in particular in relation to medication. Doctors were particularly concerned that she was resisting taking frusemide, which was crucial in relieving swelling in her legs, which was extending all the way to her neck.

5.4. When the Order was extended on 21 July 2016 she was exhibiting symptoms typical of acute psychosis.

5.5. On 7 August 2016 Mrs Playford became hypotensive and complained of painful urination and warmth in her oedematous legs. She was diagnosed as suffering from shock due to sepsis and cardiac failure. Mrs Playford was treated with intravenous antibiotics and transferred to the intensive care unit. Her son Peter was consulted and it was decided, in accordance with her wishes, to administer comfort care and no invasive therapy, and not to resuscitate.

5.6. Mrs Playford did not respond to treatment and was kept comfortable until her death.

She died at 12:05pm on 8 August 2016.

6. Police investigation 6.1. A detailed police investigation was conducted, as required in the case of a death in custody, and a helpful report was prepared by Brevet Sergeant Monique Vickery, who

concluded that the circumstances surrounding the death were not suspicious and raised no other reasons for concern.

7. Conclusions 7.1. Mrs Playford was lawfully subject to an Inpatient Treatment Order which was imposed and extended upon proper grounds. She received appropriate medical care at all times.

She died of natural causes.

7.2. I make no recommendations.

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 30/2019 (1497/2016)