Coroner's Finding: Roy, William James

CORONERS ACT, 2003 SOUTH AUSTRALIA FINDING OF INQUEST An Inquest taken on behalf of our Sovereign King at Adelaide in the State of South Australia, on the 14th day of May and the 13th day of September 2024, by the Coroners Court of the said State, constituted of David Richard Latimer Whittle, State Coroner, into the death of William James Roy.

The said Court finds that William James Roy aged 71 years, late of 1/26 Boston Street, Port Lincoln, South Australia died at Port Lincoln, South Australia on or about the 5th day of June 2022 as a result of ischaemic heart disease due to coronary atherosclerosis. The said Court finds that the circumstances of his death were as follows:

1. Introduction and cause of death 1.1. Mr William James Roy was born on 19 January 1951 and was aged 71 years when he was located deceased on 5 June 2022 at his home address in Port Lincoln.

1.2. A post-mortem examination was conducted by Dr John Gilbert, forensic pathologist, of Forensic Science South Australia and the cause of death was given as ‘ischaemic heart disease due to coronary atherosclerosis’,1 which I find to be the cause of death.

2. Reason for inquest 2.1. Mr Roy’s death is deemed a death in custody as defined in section 3 of the Coroners Act 2003 (SA), as at the time of his death Mr Roy was on home detention bail. This was a mandatory inquest pursuant to Section 21 of that Act.

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3. Background 3.1. Mr Roy’s only known family member lives interstate and had been estranged from him for many years. They were unable to offer any relevant information as to his family or social background as part of the coronial investigation.

3.2. Mr Roy had a long-term friend, Mr Peter Gilbert,2 with whom he had a close relationship for approximately 20 years. Mr Gilbert would regularly attend Mr Roy’s home to check on him and assist him with cooking meals.

3.3. At the time of his death, Mr Roy was unemployed and had been for some time. He was on a disability pension. He suffered from knee trouble and his mobility was very poor, leading to him to rely on a mobility scooter.

4. Mr Roy’s medical history 4.1. Medical records seized as part of the coronial investigation indicate that Mr Roy was diagnosed with diabetes and gout in 2014, arthritis, depression and gastro-oesophageal reflux disease in 2015, retinal artery occlusion in 2016 and significant carotid atherosclerosis and peripheral artery disease in 2022.

4.2. At the time of his death he was prescribed Aspirin, citalopram, statin, metformin and ramipril.

5. Home detention order 5.1. On 6 January 2022 Mr Roy was arrested and remanded in custody at the Port Lincoln Prison, before being released on home detention bail on 14 January 2022. On 17 January 2022 Mr Kym Dorward3 was assigned as the case worker for Mr Roy.

5.2. He stated Mr Roy complied with his fortnightly reporting requirements and did not have any issues with illicit substances. He had a list of regular passes that he would apply for including for Centrelink, pharmacy, supermarkets, banks, the post office and medical centre attendance.

6. Circumstances of Mr Roy’s death 6.1. Mr Roy had been receiving assistance from West Coast Home Care Services since February 2020. That included social support every Tuesday, cleaning of his home once a week on a Thursday and gardening once a month on a Friday.

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6.2. At approximately 9:45am on Friday 3 June 2022, Mr Gilbert attended the home address of Mr Roy and observed he was pale. He asked Mr Roy if he was okay, to which Mr Roy replied that, other than pain in his knees, he was fine. Mr Gilbert then left the house.

6.3. On 5 June 2022 between 3:38pm and 3:39pm, Mr Roy telephoned Mr Gilbert three times. Mr Gilbert did not have his phone and missed all of those calls. No voice messages were left and no text messages were received.

6.4. On 6 June 2022 Mr Nathan Sanderson4 from West Coast Homecare Services attended Mr Roy’s home address after the business received a call from Port Lincoln Community Corrections. They requested a welfare check to be made on Mr Roy as he was not responding to their attempts to contact him regarding his home detention bracelet which was running low on battery.

6.5. Mr Sanderson found the unit to be unlocked and entered the home, where he located Mr Roy deceased in the bedroom.

7. Conclusion and recommendation 7.1. I find that Mr Roy was in in the lawful custody of the Department for Correctional Services at the time of his death.

7.2. I find that his death is not suspicious and does not indicate the involvement of any other party.

7.3. I make no recommendations.

Key Words: Death in Custody; Home Detention; Natural Causes In witness whereof the said Coroner has hereunto set and subscribed his hand and Seal the 13th day of September, 2024.

State Coroner Inquest Number 28/2024 (1326/2022) 4 Exhibit C4