Coroner's Finding: Lunson, Nathan

MAGISTRATES COURT of TASMANIA

CORONIAL DIVISION Record of Investigation into Death (Without Inquest) Coroners Act 1995 Coroners Rules 2006 Rule 11 I, Olivia McTaggart, Coroner, having investigated the death of Nathan Leigh Lunson Find, pursuant to Section 28(1) of the Coroners Act 1995, that: a) The identity of the deceased is Nathan Leigh Lunson; b) Mr Lunson died as a result of ingesting large quantities of prescription drugs and alcohol. I am not able to determine whether he ingested the substances with the intention of ending his life; c) The cause of Mr Lunson’s death was mixed ethanol and prescription drug toxicity; d) Mr Lunson died on 11 January 2015 at 8 Barrob Street, Old Beach, in Tasmania.

In making the above findings I have had regard to the evidence gained in the comprehensive investigation into the death of Nathan Leigh Lunson. The evidence comprises an opinion of the forensic pathologist who conducted the autopsy; relevant police and witness affidavits; medical records; reports from treating mental health professionals; and forensic evidence.

Background: Nathan Leigh Lunson was born on 15 June 1990 at Mersey Hospital, Devonport to Trudy and Leigh Lunson. He was aged 24 years at his death.

Mr Lunson grew up living with his family in Ulverstone. In 2008 he moved to Hobart where he worked at Woolworths and began studies as a disability support worker. He then left Woolworths after gaining employment as a disability support worker. He was employed in this occupation at the time of his death.

In January 2010 Mr Lunson commenced a relationship with Benjamin Jon Jago. In May 2014 they purchased a house together at 8 Barrob Street, Old Beach, where they both resided until Mr Lunson’s death. For the purpose of section 26 of the Coroners Act 1995, I determined, on the basis of evidence presented to me that Mr Lunson and Mr Jago were in a significant relationship at the time of Mr Lunson’s death.

Mr Lunson had a long history of mental health and physical health issues from his youth through to adulthood. He was being treated by psychiatrist, Dr Joanna Bakas, of the Hobart Clinic for his ongoing mental health issues. Dr Bakas diagnosed Mr Lunson with borderline

personality disorder and polysubstance dependence. He suffered unstable mood, distressing negative emotions and anxiety. Mr Lunson had difficulties with overuse of alcohol, medications and cannabis. Dr Bakas also reported in her statement for the investigation that Mr Lunson had a history of chronic suicidal ideation. She stated that he engaged in impulsive, deliberate self-harm, as well as overdoses where it was unclear if his goal was suicide or relief from tension. Dr Bakas had prescribed Mr Lunson a number of medications over this period to assist his symptoms.

Mr Lunson also consulted with psychologist, Dr Kate Savage, from 2010 until his death. Dr Savage saw Mr Lunson intermittently. Dr Savage advised that the consultations were mostly focused on finding ways to help him manage his alcohol abuse and strong negative emotions.

Mr Lunson was also under the care of his general practitioner, Dr Jim Conroy, who treated him from 2012 until his death.

Circumstances surrounding death: On 8 January 2015, three days before his death, Mr Lunson attended Dr Conroy regarding an exacerbation of shoulder pain due to a heavy workload. Dr Conroy prescribed tramadol, endone and diazepam. Dr Conroy reported that Mr Lunson’s mood was unremarkable and he was not agitated or overtly depressed at this consultation.

On Saturday 10 January 2015 Mr Lunson and Mr Jago consumed some alcohol together at home. At about 6.30pm they visited friends, including a Mr Kristian Alexander, in Bellerive. At about 10.30pm Mr Lunson, Mr Jago and Mr Alexander went out to a nightclub in Hobart.

They continued to consume alcohol. At both the residence in Bellerive and at the nightclub, Mr Lunson and Mr Jago engaged in verbal arguments. At 2.30am Mr Alexander witnessed a further argument between them, after which Mr Lunson walked out of the nightclub and took a taxi back to the Bellerive residence. Subsequently, Mr Jago and Mr Alexander also returned there. At that address they again argued verbally and also physically, mainly in the form of a prolonged wrestle. In the altercation Mr Lunson said to Mr Jago words to the effect “you don’t want me, I’m better off dead”. Whilst at the Bellerive address, Mr Lunson consumed further alcohol and a small quantity of prescription medication including valium, endone and tramadol. Mr Jago, in his affidavit for the investigation, stated that this was normal for Mr Lunson as he enjoyed the effects of mixing prescription medication with alcohol.

Shortly before 4.00am Mr Lunson and Mr Jago returned home from the Bellerive address.

Once home, they began to argue again, during which Mr Jago told Mr Lunson that he did not want to be with him anymore and that they would sell the house. Mr Lunson called Mr Jago “a crazy bastard,” and said that he was going to kill himself. Mr Jago did not take this seriously as he had said similar things in the past. Mr Jago decided to go to bed and assumed that Mr Lunson would also go to sleep in his own bedroom.

At approximately 11.45am on 11 January 2015 Mr Jago woke, went to the toilet and then entered the kitchen. He saw Mr Lunson lying on the floor in a state of partial undress. He initially believed that Mr Lunson was asleep and tried unsuccessfully to wake him, including by shaking him.

Mr Jago then noticed a small amount of blood on the floor near Mr Lunson’s nose. He went to move him again but found him to be cold. He could not detect a pulse and so called an ambulance. Ambulance personnel arrived quickly and determined that Mr Lunson was deceased.

Police officers also attended and commenced an investigation into the circumstances of Mr Lunson’s death.

Police officers located a handwritten note on the dining table which was directly adjacent to the kitchen and Nathan’s body. The note stated: “Ben please know I’m dead because of you only you. You made me do this hope it haunts you for rest of your life. Love you Indigo. Hope you rot in hell Ben. Tell my friends it’s all your fault”.

Police officers located a significant amount of Mr Lunson’s prescription medication throughout the lounge room and dining table, including several empty blister packs of medication at the scene, consistent with Mr Lunson taking a number of tablets prior to his death. The investigating officers also located an open bottle of whiskey on the floor next to the dining table and an empty glass water bottle on the kitchen floor near the fridge and Mr Lunson’s body.

On 12 January 2015 an autopsy was conducted upon Mr Lunson by forensic pathologist, Dr Donald Ritchey. Dr Ritchey also had regard to results of toxicological testing of Mr Lunson’s blood that indicated the presence of alcohol, tramadol, codeine, morphine, oxycodone, Diazepam, quetiapine, promethazine, valproic acid, ibuprofen, paracetamol and THC (cannabis).

Dr Ritchey formed the opinion that Mr Lunson’s death was due to mixed ethanol and prescription drug toxicity. I accept his opinion. The evidence of Mr Lunson’s consumption of drugs and alcohol during the previous evening and the empty prescription medication packets, together with the note left, indicates excessive consumption of alcohol and prescription medication by Mr Lunson. It appears that it is likely that he was accessing water from the fridge when he became unconscious and subsequently passed away. I am satisfied, on the basis of Dr Ritchey’s opinion, that Mr Lunson did not suffer physical injuries in the fight with Mr Jago that contributed to his death.

I am satisfied that neither Mr Jago nor any other person was involved in Mr Lunson’s manner of death and that he ingested the alcohol and medication voluntarily. I am also satisfied that the note was written by Mr Lunson voluntarily during the early morning of 11 January 2015 whilst he was intoxicated with the substances that he had consumed.

The content of the note and the statements made in arguments with Mr Jago during the evening and morning in question apparently indicated an intention to end his life. However, I cannot make an affirmative finding upon the evidence that Mr Lunson did actually intend to do so. Dr Bakas expressed the view that Mr Lunson appeared to have taken an “impulsive overdose”. Whilst he experienced suicidal ideation generally and suffered significant mental health difficulties, it is plausible that the alcohol and medication was consumed by Mr Lunson to gain relief from his distress rather than from a genuine suicidal intention. His indications to Mr Jago that he sought to end his life may well have arisen from anger and distress in the context of a history of misuse of drugs, rather than from a positive intention to die.

Mr Lunson’s sad death at a young age is directly connected to his most troubled mental state. Whilst the evidence indicates that he was receiving regular treatment for his mental health, he was not, unfortunately, able to overcome his mental anguish and excessive use of substances.

Comments and Recommendations: I extend my appreciation to investigating officer Constable Rhian Appleton for his thorough investigation and report.

The circumstances of Mr Lunson’s death are not such as to require me to make any comments or recommendations pursuant to section 28 of the Coroners Act 1995.

I convey my sincere condolences to the family and loved ones of Nathan Leigh Lunson.

Dated: 5 December 2016 at Hobart in the State of Tasmania.

Olivia McTaggart Coroner