A 31-year-old male prisoner with significant pre-existing cardiac disease (previous myocardial infarction with stenting, cardiomegaly, left ventricular hypertrophy, coronary atherosclerosis) and poorly controlled diabetes died of ischaemic heart disease in custody. Despite commendable efforts by the prison medical officer to optimise his health through cardiology referral, diabetic management pathways, specialist education, and lifestyle counselling, the deceased repeatedly refused to comply with prescribed medications, fluid restriction, dietary advice, smoking cessation, and weight management. He was transferred between prisons for rehabilitation programs and therapeutic reasons. Clinical lessons include the challenges of managing chronic disease in non-compliant patients and the limitations of medical intervention when patients actively resist lifestyle modifications necessary for their survival.
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