Coronial
WAhospital

Inquest into the Death of Zappacosta, Palmerino

Deceased

Zappacosta, Palmerino

Demographics

86y, male

Date of death

2012-02-16

Finding date

2013

Cause of death

Sepsis associated with a pericolic abscess, complicated by terminal large intestinal haemorrhage

AI-generated summary

An 86-year-old life-sentenced prisoner died from sepsis associated with a pericolic abscess complicated by terminal gastrointestinal haemorrhage. He had extensive comorbidities including bilateral amputations, cardiac failure, and respiratory failure, with a long history of medical non-compliance and challenging behaviour. The coroner found his care in custody was appropriate, with adequate medical assessment, nursing care, and specialist review. Key clinical lessons include: recognising that elderly prisoners with multiple comorbidities require ongoing vigilance despite apparent stability; managing patients who refuse standard treatments (he refused BiPAP); recognising that diverticular disease can lead to pericolic abscess and sepsis; and understanding that palliative care was ultimately appropriate when curative options were exhausted and refused. Better assessment of his acute deterioration in February 2012 and earlier recognition of his terminal status might have clarified goals of care, though his non-compliance limited intervention options.

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

Specialties

emergency medicinegeneral medicineinfectious diseasescardiologygeriatric medicinecorrectional healthpsychiatrypathology

Drugs involved

venlafaxineantibioticsantibioticsdiureticssalbutamolopioidscodeine

Clinical conditions

sepsispericolic abscessdiverticular diseasegastrointestinal haemorrhagecardiac failurerespiratory failuretype 2 respiratory failurecoronary artery atherosclerosisurinary tract infectionlower limb amputationdementiachronic stump painwound infectioncellulitisgoutacute renal failureseptic shockchest infection

Procedures

amputationsurgical revision of amputation stumpbelow-knee amputationbig toe amputationultrasoundspecialist appointments

Contributing factors

  • Diverticular disease of the large bowel
  • Pericolic abscess formation
  • Coronary artery atherosclerosis
  • Multiple comorbid medical conditions
  • Patient non-compliance and refusal of treatment
  • Bilateral lower limb amputations
  • Chronic infections and sepsis
  • Cardiac failure and respiratory failure
  • Dementia and cognitive impairment
  • Recurrent urinary tract infections
Full text

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