Coronial
QLDother

Civic, Mirko

Deceased

Mirko Civic

Demographics

70y, male

Coroner

Ryan

Date of death

2018-09-16

Finding date

2023-01-25

Cause of death

Coronary atherosclerosis

AI-generated summary

Mirko Civic, a 70-year-old prisoner with a significant cardiac history including prior myocardial infarction, hypertension, and ischaemic heart disease, died of coronary atherosclerosis in September 2018. Critical clinical lessons include: (1) Aspirin was not prescribed for over 6 years despite documented prior MI and cardiac risk factors—aspirin for secondary prevention should have been initiated at admission; (2) Antihypertensive medications were discontinued in 2011 when the patient refused them due to side effects and were not resumed for years, despite hypertension being a major modifiable cardiovascular risk factor; (3) No consistent long-term management plan existed across multiple correctional facilities; (4) Regular blood pressure monitoring and follow-up were inadequate. While expert cardiologists opined the secondary preventive care was 'imperfect but acceptable,' the case illustrates the importance of persistent attempts to engage difficult patients in medication compliance, obtaining collateral clinical information, and maintaining structured chronic disease management protocols for high-risk cardiac patients, even in custodial settings.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

cardiologygeneral practiceemergency medicinecorrectional health

Error types

diagnosticmedicationdelay

Drugs involved

aspirinamlodipineprazosinramiprilmetoprololmetoprololparacetamolpiroxicam

Clinical conditions

coronary atherosclerosisischaemic heart diseasemyocardial infarctionhypertensioncardiac arrhythmiaasthmaprostate carcinomapost-traumatic stress disorderdepressiondormant tuberculosis

Contributing factors

  • Failure to prescribe aspirin for secondary prevention despite documented prior myocardial infarction
  • Cessation of antihypertensive medications in November 2011 due to patient refusal and non-resumption for approximately 5.5 years
  • Inadequate monitoring and follow-up of blood pressure across multiple correctional facilities
  • Lack of consistent long-term management plan for chronic cardiac conditions
  • No ordering of regular blood tests to monitor cardiovascular risk
  • Patient medication non-compliance and refusal due to side effects
  • Incomplete collateral information gathering regarding prior cardiac history

Coroner's recommendations

  1. Woodford Correctional Centre Prison Health Services to adopt Primary Clinical Care Manual (PCCM) including guidelines for high/low blood pressure management with escalation processes—implemented November 2022
  2. Prison Health Services staff to be informed and aware of PCCM guidelines for clinical decision-making regarding blood pressure management in patients with complex comorbidities
  3. Staff to be encouraged to access PCCM online training module
  4. Palen Creek Prison Health Centre to incorporate PCCM in clinical decision-making for patients with history of heart attack
  5. Implementation of documented procedures relating to chest pain management and clinical escalation between Prison Health Centre and Beaudesert Hospital
  6. Standing order for prescribing aspirin established at Palen Creek Prison Health Centre
  7. Regular monitoring of cardiac patients against baseline with ECG, escalation to medical officer, and QAS contact for hospital transfer when clinically indicated
Full text
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Source and disclaimer

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