Inquest into the Death of Monique Jacinta GOMEZ
Deceased
Monique Jacinta Gomez
Demographics
48y, female
Date of death
2023-05-29
Finding date
2025-07-11
Cause of death
intracerebral haemorrhage on a background of anticoagulation therapy for a recent embolic stroke in a woman with a mechanical aortic valve
AI-generated summary
Monique Gomez, 48, died from a spontaneous intracerebral haemorrhage during hospitalization for stroke rehabilitation and treatment of schizoaffective disorder. An initial ischaemic stroke resulted from non-compliance with warfarin (required for her mechanical aortic valve). During rehabilitation at Fiona Stanley Hospital, she refused both anticoagulant and antipsychotic medications due to her psychiatric condition. The treating team appropriately invoked involuntary mental health powers to administer injectable anticoagulation (enoxaparin) and antipsychotic therapy (paliperidone). This avoided both stroke recurrence and psychiatric decompensation. However, anticoagulation carried known risk of intracerebral bleeding. Days after clinical improvement, she suffered a fatal spontaneous brain bleed—an unavoidable complication. The coroner found all treatment decisions appropriate. This case illustrates the tragic intersection of competing medical risks in complex patients: preventing stroke whilst managing anticoagulation-related bleeding in someone with treatment-resistant mental illness unable to self-advocate. It highlights the need for careful risk communication with surrogate decision-makers.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Drugs involved
Clinical conditions
Procedures
Contributing factors
- non-compliance with warfarin medication prior to initial stroke
- schizoaffective disorder with medication refusal and treatment resistance
- anticoagulation therapy required for stroke prevention but carrying risk of intracranial bleeding
- mechanical aortic valve requiring lifelong anticoagulation
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