Coroner's Finding: Miller, Melinda Shirley

58y · Female·cardiac arrhythmia caused by a combination of pre-existing myocarditis and the acute action of clozapine and/or olanzapine

Melinda Miller, aged 58, died unexpectedly at home on 21-22 August 2013 while receiving treatment-resistant bipolar disorder management with clozapine and olanzapine. Her death was investigated thoroughly following detection of elevated drug levels at autopsy. However, these elevated levels were attributed to post-mortem redistribution rather than overdose, as medication was strictly supervised via daily dispensing by community mental health staff. Ms Miller had appropriate cardiometabolic monitoring while on clozapine. Autopsy revealed pre-existing myocarditis and atherosclerotic coronary artery disease. The coroner concluded the most likely cause of death was cardiac arrhythmia caused by the combination of pre-existing myocarditis and the acute action of clozapine and/or olanzapine. No healthcare professional was criticised, and all clozapine prescribing and monitoring protocols were appropriately followed. The key clinical lesson relates to improved post-mortem sampling procedures for patients on clozapine.