Complications of a fall with contributing factors of respiratory failure, respiratory disease, coronary artery disease and acute kidney disease, further complicated by underlying schizoaffective disorder
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Irene Charlish, a 68-year-old woman with longstanding schizoaffective disorder and multiple comorbidities, fell at her residential facility on 6 June 2017, sustaining a pneumothorax and rib fracture. She was admitted to Ryde Hospital where she refused treatment, became aggressive, and resisted hydration and medication administration. Despite appropriate medical care, she died on 11 June 2017. Expert toxicology review confirmed clozapine levels reflected post-mortem redistribution, not overdose. The coroner found her death resulted from natural causes (likely respiratory failure, cardiac event, or pulmonary embolism) compounded by her complex medical and psychiatric conditions. Care was deemed appropriate; no preventable errors were identified. The case highlights challenges managing acutely unwell psychiatric patients refusing care.
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Specialties
emergency medicinepsychiatryrespiratory medicinegeneral medicine
No additional recommendations arise from this death. Changes already implemented at Ryde Hospital include: launch of e-Meds system (December 2017) with electronic alerts for venous thromboembolism prevention; improved awareness of Specialist Psychiatry Consultation Review program through updated Clinical Nurse Consultant role; and updated delirium screening process using Abbreviated Mental Test Score (AMTS).
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