Finding into death of Colin John Rafferty

IN THE CORONERS COURT OF VICTORIA AT MELBOURNE

Court Reference: 2013 / 5494

FINDING INTO DEATH WITH INQUEST

Form 37 Rule 60(1) Section 67 of the Coroners Act 2008

Inquest into the Death of: Colin John Rafferty Delivered On: 1 December 2014

Delivered At: : Coroners Court of Victoria

Level 11, 222 Exhibition Street, Melbourne Hearing Dates: 1 December 2014

Findings of: PHILLIP BYRNE

Police Coronial Support Unit Senior Constable Paul Collins

Page | of 3

I, PHILLIP BYRNE, Coroner, having investigated the death of [given name/s] [surname]

AND having held an inquest in relation to this death on [date]

at MELBOURNE

find that the identity of the deceased was COLIN JOHN RAFFERTY born on 7 January 1956

and the death occurred between 30 November and 1 December 2013 at 14 Emerald Avenue, Wodonga

from:

1 (a) GASTROINTESTINAL HAEMORRHAGE DUE TO A DUODENAL ULCER IN

THE SETTING OF RECENT NEPHRECTOMY FOR RENAL CARCINOMA

in the following circumstances:

1. Mr Colin Rafferty, known as John, was 57 years of age at the time of his death and

resided in DHS supported accommodation at 14 Emerald Avenue, Wodonga.

2. Mr Rafferty and his twin sister Mrs Jenny Ferguson were born on 7 January 1956. Mr Rafferty suffered an acquired brain injury at a very young age following contracting

pneumonia.

3. In 2006 Mr Rafferty moved to supported accommodation at 14 Emerald Avenue, Wodonga, which was run by Mrs Judy and Mr Michael Cooper. By all accounts Mr

Rafferty enjoyed living at Emerald Avenue and made a number of strong friendships.

4. On 18 November 2013 Mr Rafferty underwent a left nephrectomy at Pemberton Place Private Hospital in Albury NSW following the discovery of renal cell carcinoma. The operation to remove his kidney was reported to go well and no post-operative

complications were observed.

5. On 23 November 2013 Mr Rafferty was discharged from hospital and returned to the

Emerald Avenue address.

6. Mr Michael Cooper last saw Mr Rafferty alive at approximately 10.00pm on 30 November 2013.

7. On 1 December 2013 at approximately 7.10am Mr Cooper found Mr Rafferty sitting at

the kitchen table, deceased.

8. As the death was closely related, in time, to a medical procedure the matter was referred to the Coroner’s Court. The Coroner directed that a full autopsy be performed in order to establish the cause of death. That examination was carried out at the Victoria Institute

of Forensic Medicine by Forensic Pathologist Dr Heinrich Bouwer.

9. Dr Bouwer noted;

“At autopsy there was a bleeding duodenal ulcer with approximately 900ml of clotted blood within the stomach and bowel. There was evidence of a recent left

nephrectomy with no intra-abdominal haemorrhage as a result of the surgery. There

was no pulmonary thromboembolism. In_my:view_the_death_is_not_a_direct

consequence of the recent surgery” (my emphasis).

10. On the basis of Dr Bouwer’s findings, which I accept, I find no causal connection between the earlier surgery and the cause of death; those events are, in my view, purely coincidental. Consequently I have concluded no further investigation is warranted as death was due to natural causes. I finalise the matter by way of this short finding

subsequent to a mandatory Summary Inquest.

I direct that a copy of this finding be provided to the following:

Mrs Jenny Ferguson

Signature: )

PHILLIP BYRNE _ CORONER_/

te: 1 December 2014