Coronial
VIChospital

Finding into death of Craig Vincent Douthie

Deceased

Craig Vincent Douthie

Demographics

52y, male

Date of death

2018-02-13

Finding date

2020-07-02

Cause of death

C2, C3, C4 spinal injury sustained from a fall secondary to seizures

AI-generated summary

A 52-year-old man with cerebral palsy, epilepsy, and intellectual disability living in disability accommodation fell in the bathroom after a seizure and sustained cervical spine fractures (C2-C3-C4). He was admitted to hospital with initially appropriate vital signs and neurological presentation. CT scanning was delayed by more than 15 hours due to difficulty understanding his neurological baseline, communication challenges, and technical issues with catheter insertion. The coroner found the diagnostic delay was not causal to his death and did not represent a missed opportunity for intervention. Earlier diagnosis would have been preferable and consistent with good practice, but his multiple comorbidities meant the outcome would not have changed. The disability accommodation staff provided appropriate immediate care. No systemic failures contributing to death were identified.

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

Contributing factors

  • fall in bathroom after seizure
  • underlying cerebral palsy with quadriplegia
  • pre-existing osteoporosis
  • seizure disorder
  • delayed CT imaging
  • difficult catheter insertion
  • communication difficulties related to intellectual disability
  • uncertainty regarding patient baseline neurological status

Coroner's recommendations

  1. Bendigo Health should contact Brendan Douthie to discuss the concern raised regarding pain medication administration during the final days of his brother's care
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