Finding into death of Jock Allan Adams

Rule 60(1)

Court reference: 87/08

FORM 37

FINDING INTO DEATH WITH INQUEST

Section 67 of the Coroners Act 2008"

Inquest into the Death of JOCK ALLAN ADAMS

Delivered On: Delivered At: Hearing Dates:

Findings of:

Representation:

5 March 2010

Melbourne

5 March 2010

AUDREY JAMIESON, Coroner

LAS/C Greigory McFarlane, SCAU, Assisting the Coroner

1 of 4

FORM 37 Rule 60(1) .

FINDING INTO DEATH WITH INQUEST Section 67 of the Coroners Act 2008

Court reference: 87/08 In the Coroners Court of Victoria at Melbourne I, AUDREY JAMIESON, Coroner having investigated the death of: Details of deceased:

Surname: ADAMS

Firstname: JOCK ALLAN

Address: Port Phillip Prison

. AND having held an inquest in relation to this death on 5 March 2010 at Melbourne

find that the identity of the deceased was JOCK ALLAN ADAMS and death occurred on 5 January 2008 at St Augustine’s Ward, St Vincent’s Hospital, Victoria Parade, East Melbourne

from:

la. PNEUMONIA DUE TO 1b. BOWEL OBSTRUCTION DUE TO ic, FOLLICULAR LYMPHOMA

. 2. DIABETES, ISCHAEMIC HEART DISEASE, PARKINSON'S DISEASE

in the following circumstances:

1. Mr JOCK ALLAN ADAMS was born on 10 April 1939. He was 68 years old at the time of his

death.

2. In 2006, Mr Adams was sentenced to a 6 year period of imprisonment with a non parole ‘period of 4 years 6 months. He was eligible for parole on 16 September 2010. He was located at Port Phillip Prison. He had a criminal history of 13 prior convictions resulting in 2 terms of

imprisonment.

3. Mr Adams had a medical history that included diabetes, schizophrenia treated with antipsychotic medication and early onset dementia, He was diagnosed with follicular lymphoma

approximately 12 months prior to his death and had been treated with chemotherapy.

2o0f 4

4, On 16 July 2007, he was accommodated in the St John’s Secure Ward of Port Phillip Prison due to deteriorating health. On several occasions he required admission to St Vincent’s Hospital for treatment.

5. On 7 December 2007, Mr Adams was admitted to St Vincent’s Hospital with a small bowel obstruction. He was accommodated in the St Augustine’s secure ward. Initially, he was treated ‘conservatively, his records indicating that he was ambivalent about treatment. He indicated that he did not wish to be resuscitated in the event it was necessary to preserve his life. A "Not for

Resuscitation" notation was made on his file.

6. On 27 December 2007, Mr Adams consented to a laparotomy and an ilcocaecal resection was performed. Post operatively he refused food and fluids. Intravenous therapy and naso-gastric feeds were implemented.

7, Mr Adams’ condition deteriorated overnight from 4 January 2008 - 5 January 2008. A provisional diagnosis of pneumonia was made. At approximately 11.20am a Medical Emergency Team (M.E.T,) call was made when he was observed by nursing staff to have deteriorated further. In line with Mr Adams’ specific request, no active treatment was implemented .

8. Mr Adams died at approximately 11.20am on 5 January 2008.

9, Mr Adams’ death was reportable! because immediately before his death, he was a person held in care? as defined in section 3 Coroners Act 1985.

10. Dr Shelley Robertson, Forensic Pathologist, at the Victorian Institute of Forensic Medicine, performed an external examination and reported to the coroner that there was nothing to suggest that death was due to anything other than natural causes.

COMMENTS: .

Pursuant to section 67(3) of the Coroners Act 2008, I make the following comment connected with the death:

1. Lam satisfied that there is no relationship between Mr Adams death and the fact that immediately before his death, he was a person held in care.

I"yeportable death” means a death-

(a) where the body is in Victoria; or.

(b) that occurred in Victoria; or

(c) the cause of which occurred in Victoria; or

(d) of a person who ordinarily resided in Victoria at the time of deathbeing a death- ,

(e) that appears to have been unexpected, unnatural or violent or to have resulted, directly or indirectly,

2"erson held in care" means-

(a) a person under the control, care or custody of the Secretary to the Department of Human Services; or

(ab) a person-

(i) in the legal custody of the Secretary to the Department of Justice or the Chicf Commissioner of Police;

3 0f 4

Finding: I accept and adopt the medical cause of death identified by Dr Shelley Robertson and find that JOCK ALLAN ADAMS died from natural causes related to follicular lymphoma.

Signature:

AUDREY JAMIESON COR!

5th March, 2010

Distribution of Findings

• Mr Ray McDonald

• Department of Justice, Office of Correctional Services Review

4of4