Inquest into the Death of Zappacosta, Palmerino

86y · Male·Sepsis associated with a pericolic abscess, complicated by terminal large intestinal haemorrhage

An 86-year-old life-sentenced prisoner died from sepsis associated with a pericolic abscess complicated by terminal gastrointestinal haemorrhage. He had extensive comorbidities including bilateral amputations, cardiac failure, and respiratory failure, with a long history of medical non-compliance and challenging behaviour. The coroner found his care in custody was appropriate, with adequate medical assessment, nursing care, and specialist review. Key clinical lessons include: recognising that elderly prisoners with multiple comorbidities require ongoing vigilance despite apparent stability; managing patients who refuse standard treatments (he refused BiPAP); recognising that diverticular disease can lead to pericolic abscess and sepsis; and understanding that palliative care was ultimately appropriate when curative options were exhausted and refused. Better assessment of his acute deterioration in February 2012 and earlier recognition of his terminal status might have clarified goals of care, though his non-compliance limited intervention options.