Finding into death of Michael Metcalfe

56y · Male·Hepatorenal syndrome from end-stage liver disease (multifocal hepatocellular carcinoma, cirrhosis of the liver, hepatitis C)

Michael Metcalfe, a 56-year-old male prisoner with end-stage liver disease from hepatitis C cirrhosis and hepatocellular carcinoma, died from hepatorenal syndrome while in custody. He was transferred between prison facilities and received admission to St Augustine's Security Ward in November 2008. Palliative care was initiated on 2 December 2008 when terminal liver failure was recognised. The coroner's finding documents the progression of his illness and palliative care management. Clinical lessons include: early recognition of terminal decline in cirrhotic patients; appropriate involvement of palliative care teams; and ensuring continuity of care during inter-facility transfers. The case highlights the importance of discussing end-of-life goals with patients and families. While the death resulted from advanced malignancy and organ failure, timely palliative input and family communication appear to have been appropriately managed in the terminal phase.