Deceased
Patrick Paul
Demographics
68y, male
Coroner
Coroner Dr Jane Hendtlass
Date of death
2009-08-27
Finding date
2011-10-04
Cause of death
Ischaemic heart disease and coronary artery atherosclerosis
AI-generated summary
Patrick Paul, a 68-year-old man with significant cardiac history including prior myocardial infarction and coronary stents, died of ischaemic heart disease while in prison custody. He presented to hospital with symptoms suggestive of acute coronary syndrome (epigastric pain radiating to back, chest pain, dyspnoea, sweating) but was diagnosed as alcohol withdrawal by the assessing doctor. His troponin was negative and ECG unchanged, leading to discharge back to prison with aspirin. He died the following day. Key clinical lessons: (1) in patients with established ischaemic heart disease presenting with chest pain and constitutional symptoms, acute coronary syndrome must remain high on the differential diagnosis regardless of recent alcohol cessation; (2) negative troponin at presentation does not exclude evolving myocardial infarction, particularly in the early hours; (3) serial troponins and ECGs should be considered; (4) the attribution of all symptoms to alcohol withdrawal may result in anchoring bias, missing organic pathology.
AI-generated summary — refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Rule 60(1)
Court reference: 4187/09
Section 67 of the Coroners Act 2008
Inquest into the Death of PATRICK PAUL
Delivered On: Delivered At: Hearing Dates: Findings of: Representation:
Place of death:
4 October 2011 Melboume
4 October 2011
JANE HENDTLASS Sgt David Dimsey
Melbourne Assessment Prison, 317 Spencer Street, Melbourne West, Victoria 3000
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FORM 37 Rule 60(1)
FINDING INTO DEATH WITH INQUEST Section 67 of the Coroners Act 2008 Court reference: 4187/09
Inquest into the Death of PATRICK PAUL
Delivered On: 4 October 2011
Delivered At: Melbourne
Hearing Dates: 4 October 2011
Findings of: JANE HENDTLASS
Representation: Sgt David Dimsey
Place of death: Melbourne Assessment Prison, 317 Spencer Street, Melbourne
West, Victoria 3000
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FORM 37 Rule 60(1)
FINDING INTO DEATH WITH INQUEST Section 67 of the Coroners Act 2008
Court reference: 4187/09 In the Coroners Court of Victoria at Melbourne I, JANE HENDTLASS, Coroner having investigated the death of: Details of deceased:
Surname: PAUL
Firstname: PATRICK
Address: 179 Princess Drive, Morwell AND having held an inquest in relation to this death on 4 October 2011 at Melbourne find that the identity of the deceased was PATRICK PAUL aka PATERIKT PAORA and death occurred on 27th August, 2009 at Melbourne Assessment Prison, 317 Spencer Street, Melbourne West, Victoria 3000
from
la. ISCHAEMIC HEART DISEASE 1b. CORONARY ARTERY ATHEROSCLEROSIS
in the following circumstances:
Patrick Paul was 68 years old when he died. He was also known as Pateriki Paora, Mr Paul migrated from New Zealand and lived in Melbourne for more than 25 years. He lived at 179 Princess Drive in Morwell.
Mr Paul’s medical history included prior acute myocardial infarction with two coronary stents, hypertension, post traumatic stress disorder, gout, alcohol abuse, liver cirrhosis, depression and anxiety and exposure to herbicides during the Vietnam war. Mr Paul was prescribed metoprolol, amlodipine, telmisartan, atorvastatin, pantoprazole, sertraline, allopurinol and had a glyceryl nitrate patch. Mr Paul’s general practitioner was Dr Peter Tiedall in Kyabram.
His post traumatic stress disorder was managed through Veterans Affairs at the Austin Hospital.
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4, On 30 June 2009, Mr Paul was sentenced on appeal to the Shepparton County Court to 18 months in prison with the sentence wholly suspended for two years. His licence was cancelled and he was disqualified from driving for four years.
His licensed was cancelled and he was disqualified from obtaining a licence for five years,
Despite his history of drink-driving offences, he did not provide the admitting medical review with any evidence of on-going alcohol abuse but the medical officer recorded that he suffered a medical condition requiring six or more medications and regular or on-going treatment. This rating was not recorded on the E*Justice system.
On 19 August 2009, Mr Paul was transferred to the Melbourne Assessment Prison. At 4.00pm, he was alveady feeling unwell and vomiting. He had not received his medications for two days. Mr Paul was placed under observation and, by 5.05pm, he seemed much improved in the medical cell.
On 20 August 2009, Mr Paul was taken to St Vincent’s Hospital for tests. He was assessed by Dr Jordan Kamel, Mr Paul reported a three day history of epigastric pain radiating through to his back, left sided chest pain, shortness of breath, poor exercise. tolerance, sweating, tremor and constipation. He had not had an alcoholic drink for three days and had not had his regular medications during the first two of these days in custody. -
Dr Kamel observed that Mr Paul’s electrocardiogram did not show any obvious ischacmic changes and was consistent with earlier investigations, his troponin levels did not indicate further recent myocardial infarction, his chest pain had remained constant during the three days and he responded to oral antacids, i
Dr Kamel attributed Mr Paul’s illness to possible alcohol withdrawal symptoms.
Accordingly, Justice Health has recommended that all prisoners with reported drug and alcohol
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intake are to be reassessed by an appropriately qualified health professional within seven days of custody for signs and/or symptoms of drug or alcohol withdrawal.
-Mr Paul was discharged back to the Melbourne Assessment Prison on the same day with a loading dose of anticoagulant aspirin and advice for its maintenance.
On 26 August 2009, Mr Paul reported feeling 6/10 in concentration and energy but said he would seek help if required. He was referred to the psychiatry registrar for review of his
medication,
14, At 11.25am on 27 August 2009, Patrick Paul died.
The forensic pathologist who performed the autopsy formed the opinion that the cause of death was ischaemic heart disease and coronary artery atherosclerosis, Toxicological analysis detected 0.4mg/L sertaline, which is consistent with therapeutic use.
Accordingly, I find that Patrick Paul aka Pateriki Paora died of ischaemic heart disease
and coronary artery atherosclerosis.
Signature” . a a _ aan
Dr i ne Hendtlass Cotoner 4 October 2011
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