Finding into death of Con Koumis

43y · Male·complications of decompensated liver failure due to occult sepsis and retroperitoneal haemorrhage; cirrhosis secondary to blood transfusion; beta-thalassaemia major

Con Koumis, a 43-year-old man with beta-thalassaemia major requiring regular blood transfusions, died from decompensated liver failure complicated by occult sepsis and retroperitoneal haemorrhage. He was remanded in custody at the time. Con had refused earlier transfusions to avoid COVID-19 quarantine protocols upon return to prison, though he understood the risks. He was admitted to hospital on 1 February 2022 with chest pain, dyspnoea, and dizziness, and deteriorated despite treatment. A MET call was made and he was deemed unsuitable for ICU based on his life-limiting conditions and goals of care. The coroner found custodial health management was appropriate and did not cause or contribute to the death. The outcome would not have differed had Con accepted earlier transfusions.