Deceased
Antony John Howard
Demographics
59y, male
Coroner
Coroner Simon McGregor
Date of death
2022-06-18
Finding date
2023-02-23
Cause of death
Aspiration pneumonia and non-ST elevation myocardial infarction in a man with intellectual disability; COVID-19 as contributing cause
AI-generated summary
A 59-year-old man with intellectual disability, autism, and visual impairment died from aspiration pneumonia and non-ST elevation myocardial infarction complicated by COVID-19. He presented to the ED febrile with elevated troponin and was admitted under cardiology. Despite MET calls for deteriorating oxygen saturations and haemodynamic instability, clinical management included antibiotics and supportive care. Goals of care discussions with family preceded comfort-based management. The coroner found death resulted from natural causes. No preventable errors or system failures were identified. Key clinical lessons include recognising aspiration risk in patients with intellectual disability and coordinating multi-system illness management (cardiac, respiratory, infectious).
AI-generated summary — refer to original finding for legal purposes. Report an inaccuracy.
Specialties
IN THE CORONERS COURT COR 2022 003307 OF VICTORIA AT MELBOURNE FINDING INTO DEATH WITHOUT INQUEST Form 38 Rule 63(2) Section 67 of the Coroners Act 2008 Findings of: Coroner Simon McGregor Deceased: Antony John Howard Date of birth: 27 September 1962 Date of death: 18 June 2022 Cause of death: 1(a) Aspiration pneumonia and non-ST elevation myocardial infarction in a man with intellectual disability
2 COVID-19 Place of death: Austin Hospital 145 Studley Road, Heidelberg, Victoria, 3084 Keywords: Austin Hospital, Palmyra Care Facility, National Disability Insurance Scheme, COVID-19, NSTEMI, aspiration pneumonia.
On 18 June 2022, Antony John Howard was 59 years old when he died at the Austin Hospital (Austin) in Heidelberg. At the time of his death, Antony lived at 6 Palmyra Court, Greensborough, at the Palmyra Care Facility (Palmyra), a specialist residential service.
Antony’s medical history included an intellectual disability, autism, and a visual impairment secondary to glaucoma.1 Antony was supported in his daily activities by carers from “Life Without Barriers” through National Disability Insurance Scheme funding.2
As a child, Antony attended a special needs school in Ormond and was initially placed in Janefield care facility in Bundoora before moving to Palmyra following Janefield’s closure in
According to his father, Peter Howard, despite his disability, Antony led a “relatively healthy life” until his death.3
Antony’s death was reported to the Coroner as it fell within the definition of a reportable death in the Coroners Act 2008 (the Act). Reportable deaths include deaths that are unexpected, unnatural or violent or result from accident or injury.
The death of a person in care or custody is a mandatory report to the coroner, even if the death appears to have been from natural causes. Whilst a coroner must normally hold an inquest following the death of a person placed in custody or care,4 an inquest is not mandatory if the coroner finds that the death was due to natural causes.5
The role of a coroner is to independently investigate reportable deaths to establish, if possible, identity, medical cause of death, and surrounding circumstances. Surrounding circumstances are limited to events which are sufficiently proximate and causally related to the death. The purpose of a coronial investigation is to establish the facts, not to cast blame or determine criminal or civil liability.
1 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, page 1.
2 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, page 1.
3 Coronial brief, statement of Peter Howard dated 16 November 2022, page 1.
4 Coroners Act 2008, section 2(b).
5 Ibid, section 3A.
Under the Act, coroners also have the important functions of helping to prevent deaths and promoting public health and safety and the administration of justice through the making of comments or recommendations in appropriate cases about any matter connected to the death under investigation.
Victoria Police assigned an officer to be the Coroner’s Investigator for the investigation of Antony’s death. The Coroner’s Investigator conducted inquiries on my behalf, including taking statements from witnesses – such as family, the forensic pathologist, treating clinicians and investigating officers – and submitted a coronial brief of evidence.
This finding draws on the totality of the coronial investigation into the death of Antony John Howard including evidence contained in the coronial brief. Whilst I have reviewed all the material, I will only refer to that which is directly relevant to my findings or necessary for narrative clarity. In the coronial jurisdiction, facts must be established on the balance of probabilities.6
In considering the issues associated with this finding, I have been mindful of Antony’s basic human rights to dignity and wellbeing, as espoused in the Charter of Human Rights and Responsibilities Act 2006, in particular sections 8, 9 and 10.
MATTERS IN RELATION TO WHICH A FINDING MUST, IF POSSIBLE, BE MADE Circumstances in which the death occurred
On 15 June 2022, Antony tested positive to COVID-19 on a Rapid Antigen Test after suffering from a cough and a fever.7
On 16 June 2022 at 5.49pm, Antony was transported to the Austin Emergency Department (ED) where he was found to be febrile with a temperature of 38.8 degrees, a heart rate of 150, and low blood pressure. Antony was referred to the cardiology unit after further investigations noted the presence of high troponin8 levels.9 A chest X-ray was unremarkable.10 6 Subject to the principles enunciated in Briginshaw v Briginshaw (1938) 60 CLR 336. The effect of this and similar authorities is that coroners should not make adverse findings against, or comments about, individuals unless the evidence provides a comfortable level of satisfaction as to those matters taking into account the consequences of such findings or comments.
7 Medical Deposition dated 18 June 2022, page 1.
8 A protein released in response to damage to heart muscle (and other muscles).
9 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, page 2.
10 Medical Deposition dated 18 June 2022, page 1.
On 17 June 2022, Antony was reviewed and found to have a “mild COVID illness” with a plan for admission under cardiology and further tests to take place later that morning however, at approximately 7.35am a Medical Emergency Team (MET) alert was made after Antony was found to have an increased heart rate, decreased oxygen saturations, and drowsiness.11 Scans showed signs that indicated aspiration pneumonitis, however there was no pulmonary embolus noted. Antony was then commenced on intravenous antibiotics.12
At 12.11pm, Antony’s condition was reviewed by Dr Stephen Cain, general medical registrar, who noted Antony appeared to be suffering from aspiration pneumonitis, COVID-19, a nonST elevation myocardial infarction (NSTEMI),13 and thrombocytopaenia14. Dr Cain had extensive discussions with Antony’s father regarding his Goals of Care (GoC) who expressed a preference for full measures to be undertaken in the event of an acute deterioration.15
On 18 June 2022 at approximately 5.15am, a second MET call was made after Antony was found to have significant worsening of his oxygen saturations and blood pressure. Despite intensive therapies, Antony’s condition continued to deteriorate, with staff attempting to contact his family to discuss his condition and ongoing GoC.16
Following Antony’s deterioration, a meeting was held between the General Medicine and Infectious Diseases/COVID teams who noted that Antony’s condition was likely a result of aspiration pneumonitis, sepsis, or an NSTEMI.
Clinicians discussed Antony’s condition with his parents, explaining that, despite intensive treatments, his death appeared imminent. Further invasive therapies, including intubation, were not recommended due to Antony’s high risk of complications and prognosis. Dr Cain stated that Antony’s family “understood the medical update and likely trajectory” and accepted the use of comfort-based management.17
11 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, page 2.
12 Medical Deposition dated 18 June 2022, page 2.
13 A type of heart attack.
14 Low platelet count, which can result in issues with bleeding.
15 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, page 3.
16 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, pages 3-4.
17 Coronial brief, statement of Dr Stephen Cain and Dr Chris Leung dated 5 December 2022, pages 4-5.
Identity of the deceased
Medical cause of death
Forensic Pathologist Dr Gregory Young from the Victorian Institute of Forensic Medicine (VIFM) conducted an examination on 20 June 2022 and provided a written report of his findings dated 22 June 2022.
The post-mortem computed tomography (CT) scan confirmed the presence of right lower lung lobe consolidation, and patchy infective changes throughout both lungs. There were also pleural effusions. Contrast was seen within the urinary bladder. No unexpected signs of trauma were noted during the examination.
A post-mortem nasopharyngeal swab was positive for COVID-19/SARS-CoV-2 on PCR testing.
Toxicological analysis of post-mortem samples was not indicated and was not performed.
Dr Young noted that aspiration pneumonia is infection of the lungs that occurs after inhaling (aspirating) foreign material, such as food or vomitus. In this case, the diagnosis was made clinically, and supported by imaging. In combination with myocardial infarction, this has resulted in a cardiorespiratory arrest.
Dr Young provided an opinion that the medical cause of death was from 1 (a) aspiration pneumonia and non-ST elevation myocardial infarction in a man with an intellectual disability.
I convey my sincere condolences to Antony’s family for their loss.
Pursuant to section 73(1B) of the Act, I order that this finding be published on the Coroners Court of Victoria website in accordance with the rules.
I direct that a copy of this finding be provided to the following: Peter And Jo Howard, Senior Next of Kin Robyn Shea, Austin Health Scott Shelly, Barry Nilsson Lawyers Senior Constable Jessica Pappin, Victoria Police, Coroner’s Investigator Signature: ___________________________________ Coroner Simon McGregor Date : 23 February 2023 NOTE: Under section 83 of the Coroners Act 2008 ('the Act'), a person with sufficient interest in an investigation may appeal to the Trial Division of the Supreme Court against the findings of a coroner in respect of a death after an investigation. An appeal must be made within 6 months after the day
on which the determination is made, unless the Supreme Court grants leave to appeal out of time under section 86 of the Act.
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