Coronial
VICother

Finding into death of Odisseas Vekiaris

Deceased

Odisseas Vekiaris

Demographics

29y, male

Date of death

2009-12-21

Finding date

2015-12-18

Cause of death

Unascertained causes on a background of agitated delirium state

AI-generated summary

A 29-year-old man with a 12-year history of mental illness died in police custody during transport to a police station. He had stopped taking his antipsychotic medication (Risperidone 4mg daily) following GP advice to reduce it, without follow-up. On the day of death, he stabbed a member of the public, leading to police arrest involving oleoresin capsicum spray and physical restraint. Ambulance paramedics cleared him for transport to the police station. During the drive, officers noticed positional changes but did not stop to reassess. He was found unresponsive and pulseless upon arrival. Toxicology showed methamphetamine, cannabis, and medication metabolites. Clinical lessons: (1) GP Dr V. failed to follow up antipsychotic medication reduction plan and was unaware of illicit drug use, which should have prompted psychiatry consultation; (2) police monitoring of handcuffed prisoner in the divisional van was inadequate—officers could only see legs on camera, not torso or face; when position changed, officers should have stopped to check welfare rather than passively accepting monitoring limitations; (3) no automated external defibrillator was readily available or known to staff at the police station initially. The coroner rejected 'Excited Delirium' as an unrecognised medical diagnosis in Australia.

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

Contributing factors

  • cessation of antipsychotic medication (Risperidone)
  • consumption of methamphetamine and cannabis
  • violent agitated delirious state
  • chemical restraint with oleoresin capsicum spray
  • physical restraint by police
  • inadequate monitoring during transport in divisional van
  • pre-existing mental illness (psychotic symptoms)

Coroner's recommendations

  1. Victoria Police should remove reference to 'Excited Delirium' and 'Excited Delirium Syndrome' from training materials until such time as it is recognised by Australian medical professional bodies as a discrete medical condition
  2. Victoria Police and Ambulance Victoria should convene a working group in consultation with the Australasian College for Emergency Medicine to develop a joint clinical practice guideline/protocol for management of people presenting with delirium, agitation or acute behavioural disturbance, including development of a readily accessible reference tool such as a pocket card using DSM-5 nomenclature
  3. Victoria Police and Ambulance Victoria should develop a joint training package including scenario-based training focused on implementation of newly developed joint protocol and use of readily accessible reference tools
  4. Ambulance Victoria should review Police training materials on acute behavioural disturbance/Excited Delirium and implement training and continuing professional development to paramedics on constellation of presenting symptoms of persons experiencing delirium
Full text

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