Deceased
Alan David RATCLIFF
Demographics
65y, male
Coroner
Coroner Jenkin
Date of death
2022-06-20
Finding date
2024-04-10
Cause of death
complications of intracranial haemorrhage (hypertensive haemorrhage), with terminal palliative care
AI-generated summary
Alan David Ratcliff, a 65-year-old prisoner at Acacia Prison, died from complications of intracranial haemorrhage (hypertensive haemorrhage) on 20 June 2022. He collapsed on 12 June 2022 with stroke symptoms and was hospitalised at Sir Charles Gairdner Hospital, where he was managed palliatively. Key clinical lessons include: (1) an outstanding neurology referral for recurrent migraines with aura was never completed—an MRI may have identified an aneurysm amenable to monitoring or surgical intervention; (2) inappropriate use of restraints was initially applied during hospitalisation of a terminally ill patient, though departmental policy has since been updated; (3) COVID-19 infection two days before collapse may have contributed to vascular susceptibility through inflammation, though this remains speculative. Overall, medical care was of high standard and commensurate with community care, with the primary missed opportunity being completion of neurology review.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Clinical conditions
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