A 79-year-old man with vascular dementia, cerebrovascular disease, and a history of violent behaviour was placed under a non-custodial supervision order following a mental impairment finding. Approved leave to visit family in Bosnia Herzegovina in February 2014 was extended when he failed to return. Medical records from overseas indicated significant deterioration including cerebellar lesions, spastic paresis, and embolic cerebrovascular events. He died on 29 December 2014 in Bosnia Herzegovina. The precise cause could not be established due to geographical limitations and inability to obtain Bosnian medical records. Clinical lessons: careful risk assessment before approving extended overseas leave for patients with complex medical and psychiatric conditions; clear communication and documentation of clinical status during overseas treatment; ensuring adequate medical oversight and communication between treating teams across international borders.
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