Robert Skilton, aged 73, died of advanced squamous cell carcinoma of the lung while in prison custody. He had a 59-year smoking history and consistently declined medical care throughout 43 years of incarceration, with up to 5-year gaps between appointments. A trade instructor persuaded him to see a doctor in April 2018 when respiratory symptoms developed. Dr Janssens appropriately diagnosed advanced lung malignancy and referred him to hospital. An administrative delay of 9 days in processing imaging did not affect outcome. At Princess Alexandra Hospital, palliative care was promptly engaged with bronchoscopy confirming terminal squamous cell carcinoma. The coroner found no missed diagnostic opportunities, no outcome-changing delays, and that medical care met community standards. Management aligned with the patient's documented wishes for comfort-focused end-of-life care.
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Specialties
respiratory medicineoncologypalliative careemergency medicinecorrectional health
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