Coroner's Finding: Lampkin, Christopher Maxwell

MAGISTRATES COURT of TASMANIA

CORONIAL DIVISION Record of Investigation into Death (Without Inquest) Coroners Act 1995 Coroners Rules 2006 Rule 11 I, Robert Webster, Coroner, having investigated the death of Christopher Maxwell Lampkin Find, pursuant to Section 28(1) of the Coroners Act 1995, that a) The identity of the deceased is Christopher Maxwell Lampkin (Mr Lampkin); b) Mr Lampkin died as a result of action taken by him alone, with the intention of ending his own life; c) Mr Lampkin’s cause of death was hanging; and d) Mr Lampkin died between 25 and the 31 July 2021 at Collinsvale, Tasmania.

In making the above findings I have had regard to the evidence gained in the comprehensive investigation into Mr Lampkin’s death. The evidence includes:  Police Report of Death for the Coroner;  Affidavits confirming identification and life extinct;  Affidavit of Dr Donald Ritchey, Forensic Pathologist;  Forensic Science Service Tasmania toxicological and analytical report;  Affidavit of Mr Wayne Lampkin;  Affidavit of Mr Peter Knapp,  Affidavit of Senior Constable Darren Williams;  Affidavits of First Class Constable Alice Brouwer;  Affidavit of First Class Constable Dean Walker;  Medical records of Mr Lampkin obtained from Mr Lampkin’s general practitioner;  Medical records of Mr Lampkin obtained from the Royal Hobart Hospital (RHH) and Alcohol and Drugs Service (ADS); and  Photographs, body worn camera footage and forensic evidence.

Background Mr Lampkin was born in Hobart on 28 November 1963. He grew up in Lutana with his parents and older brother Wayne. Both Mr Lampkin’s parents are now deceased and their loss, especially that of his father, had a big impact on him.

Mr Lampkin had 2 siblings, his brother Wayne and his older sister Rhonda Vermay. Both Wayne Lampkin and Mr Lampkin had not spoken to their sister for over 20 years. Mr Lampkin went to school at Bowen Road Primary School and then to Newtown High School where he completed year 10. Following school he commenced work as an apprentice butcher and continued working as a butcher for 10 to 12 years. Subsequently he worked in a number of orchards and as a labourer and then as a cleaner at International Catamarans. As an adult he completed an apprenticeship in welding and for the last 10 years or so he worked on off as a landscaper/gardener for Mr Grant McDermott.1 In his 20s Mr Lampkin married Evelyn Marshall and shortly thereafter the couple moved to Richmond in Tasmania and built a house. They were married for in excess of 10 years before they divorced. They had no children. After his divorce Mr Lampkin had another significant relationship which lasted for in excess of 7 years. Again he did not have any children in that relationship and he did not marry his then partner. They separated when Mr Lampkin was approximately 47 years of age.

After the separation Mr Lampkin bought a block of land at Tunnack which he lived on for a while before he moved into a chalet on the property belonging to his long-term friend Mr Knapp.2 Mr Knapp lived in a home on the same property. Mr Lampkin lived on the property for approximately 10 years but he would keep to himself and see Mr Knapp 2 to 3 times per week. He did not engage in social gatherings at the property and preferred to spend his time alone in his chalet. Mr Lampkin’s brother says Mr Lampkin never wanted to socialise. For example Mr Lampkin’s brother would invite him to Christmas functions but he would not attend. Both Wayne Lampkin and Mr Knapp knew Mr Lampkin suffered from depression for many years and he was prescribed medication for that condition. He also had difficulties with drinking alcohol to excess. Mr Knapp says Mr Lampkin had spoken to close friends about suicide on multiple occasions over the years however he was not aware of any attempts of suicide or self-harm. There is no evidence Mr Lampkin was in any financial difficulty.

1 Mr Grant McDermott is the brother of Mr Knapp’s neighbour, Mr Brendan McDermott referred to below.

2 Mr Lampkin and Mr Knapp went to Bowen Road Primary School together.

Health The records of Mr Lampkin’s general practitioner cover the period from April 2006 until February 2021. His last attendance on 4 February 2021 was for prescription medication.

These records confirm the prescription of medication to control blood pressure, gout and to treat depression. Depression is first mentioned in the records in August 2009 whereas problems with recurring binge drinking are evident from July 2011. From July 2012 until December 2013 there are Centrelink certificates on file which indicate Mr Lampkin is totally incapacitated for work because of a social anxiety disorder and lower back pain.

A note in the general practitioner’s records dated 9 October 2019 is written in hand and appears to be from Mr Lampkin. In that note he outlined that since the age of about 5 years he can remember laying in bed at night thinking ‘about stuff’. He was nervous going to school, he never wanted to go and as a result he pretended to be sick and he had a lot of sick days. He was extremely shy and became embarrassed easily. He tried to study for exams and could not remember anything. Accordingly he started to self-medicate with alcohol from about the age of 16. That note also outlines a number of other challenges he faced in everyday life which included difficulties with concentration, short-term memory and being able to express himself.

Records from the ADS indicate he sought the assistance of that service and he attended 7 appointments between 1 July and 22 September 2011. The initial intake note indicates Mr Lampkin is able to abstain from alcohol for about 2 weeks, before progressing to drinking “full-time” and becoming a “raving alcoholic” for nearly 24 hours. On stopping he experiences withdrawal symptoms and is unable to sleep for approximately 4 days. Mr Knapp and his neighbour, Mr McDermott, advised police when they attended Mr Lampkin could drink alcohol excessively for up to a month at a time and then not drink alcohol for a period of 6 months or more. When drinking he could drink 2 cartons of beer per day, then spirits and then wine.

Mr Lampkin was assessed by the psychiatrist Dr Philip Reid in August 2009 and he was treated by the psychologist Mr Peter Nelson between July and at least October 2013. Dr Reid reports Mr Lampkin’s psychiatric history is mainly comprised of depressive reactions after relationship breakdowns. He was anxious as a child and he has had a life history of anxiety in social situations. In the past he used alcohol excessively for a social phobia. It appears he was referred to Dr Reid because of what Dr Reid termed “a minor overdose.” Mr Nelson has reported on the same difficulties. When Mr Lampkin was drinking alcohol his intake was significant. In October 2019 Mr Lampkin mentioned to his general practitioner he had seen a psychologist previously and he would like to return to that psychologist for

further treatment. The notes record Mr Lampkin was to find out who the psychologist was and he was to return for a mental health plan and a referral to that psychologist. It is likely given the contents of the medical records the psychologist was Mr Nelson. It appears from the notes a re-referral to Mr Nelson did not eventuate.

The RHH records reveal Mr Lampkin was assaulted in March 2018 and he sustained a left orbital floor fracture. He was admitted to hospital and that fracture was repaired. In June 2018 he underwent an inguinal hernia repair. In May 2020 he was admitted for three days for treatment due to abdominal pain and bleeding after recent binge alcohol drinking and paracetamol use. The paracetamol had apparently been used to assist him to sleep.

Subsequently he suffered 2 days of vomiting. A gastroscopy was performed and that revealed oesophagitis and duodenitis with 2 superficial duodenal ulcers. A further gastroscopy was performed on 20 July 2020.

Circumstances Leading to Death Mr Knapp was away from his home for work from 25 July 2021. He told police he last saw Mr Lampkin at approximately 3.00pm that day. He said his daughter comes and goes from his property but he does not believe she saw Mr Lampkin in Mr Knapp’s absence. Although an exact date cannot be provided Mr Wayne Lampkin says a couple of days prior to 31 July 2021 he spoke to his brother on the telephone but he did not say anything that suggested he was going to commit suicide. They also texted each other a couple of times.3 Mr Knapp returned home at approximately 4.40pm on 31 July 2021 and located a note on a chair inside his residence. The note was addressed to Mr Knapp and he read it. He interpreted the note as a suicide note. Emergency services were called. Mr Knapp was asked to locate Mr Lampkin to see if he was alright. Mr Knapp contacted his friend Mr Brendan McDermott who attended to assist. They entered one of the sheds located on the property and found Mr Lampkin upstairs in a home gym area hanging from a support beam by a rope.

Police were advised and were tasked to attend at approximately 5.00pm.

Investigation Police arrived at Mr Lampkin’s home at approximately 5.20pm on 31 July 2021. There they met Mr Knapp and Mr McDermott. Police were directed to a large two-storey shed. On the first floor the shed contained workbenches and tools. Police proceeded to the upper level where they located a large open room containing home gym equipment. Police located Mr 3 It appears from the forensic evidence this call and a text were made on 25 July 2021.

Lampkin and his dog. A wooden chair was laying on its side near Mr Lampkin’s feet. No other items of relevance were located in that room.

Police then proceeded to Mr Knapp’s home and observed the suicide note which sets out Mr Lampkin’s intentions and how he wished his property to be distributed. A sum of money was also located and the purpose of that money is referenced in the note; it was left by Mr Lampkin to pay a power bill. Police then inspected Mr Lampkin’s chalet where they observed several beer cans and bottles and a wine bladder on and around a small table which was located in front of a lounge chair. Mr Lampkin’s laptop computer, his phone and prescription medication along with his vehicle were also located. Forensics and officers from the Criminal Investigation Branch were tasked to attend.

As a result of the police investigation and search of the premises no evidence was located which indicated any other person was involved in Mr Lampkin’s death. I agree with First Class Constable Walker’s conclusion that the suicide note and money which Mr Lampkin left confirm he intended to take his own life.

Dr Ritchey conducted a post mortem on 3 August 2021. Dr Ritchey examined the rope ligature around Mr Lampkin’s neck and the abrasion on his neck. Dr Ritchey confirmed the braid pattern on the neck matched that on the rope ligature. He therefore came to the conclusion that the cause of Mr Lampkin’s death was hanging. He noted significant contributing factors were depression and alcohol dependence. Toxicological testing revealed a high level of alcohol of 0.153 g in 100 mL of vitreos humour.4 Detected in the blood sample was a metabolite of an antidepressant which was prescribed to Mr Lampkin. That metabolite was detected at a sub therapeutic level.

Comments and Recommendations I am satisfied there are no suspicious circumstances surrounding Mr Lampkin’s death. I find he took the action of hanging himself alone and with the intention of ending his life. It seems from the evidence in this case Mr Lampkin suffered from depression and excessive alcohol consumption for many years. He was a very private person by nature and it seems that despite the treatment he received he was unable to seek the necessary help and support from his family and health professionals. I find it all times he was treated appropriately by those medical practitioners he came into contact with. In these circumstances his death could not have been foreseen or prevented.

4 In this case not enough blood was submitted for alcohol testing so testing was conducted on vitreous humour fluid. The concentration of alcohol in vitreous humour is expected to be higher than that in an equal volume of whole blood by a factor of approximately 1.2 to 1.

The circumstances of Mr Lampkin’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 extend my appreciation to investigating officer Constable Alice Brouwer for her thorough investigation and report.

I convey my sincere condolences to the family and loved ones of Mr Lampkin.

Dated: 31 October 2022 at Hobart in the State of Tasmania.

Robert Webster Coroner