Finding into death of QB T

64y · Male·Complications of congestive cardiac failure on a background of cardiac hypertrophy

QBT, a 64-year-old man with complex medical and psychiatric history including schizophrenia, COPD, and hypertension, was admitted to Bendigo Hospital on an Assessment Order after police concerns about mental health deterioration. During his 8-day admission, he developed progressive shortness of breath, hypoxia, and multiorgan failure despite appropriate clinical responses including MET calls and investigations. Autopsy revealed congestive cardiac failure with cardiac hypertrophy as the primary cause. The Coroners Prevention Unit noted his initial presenting signs were atypical for cardiac failure and it remained unclear why he deteriorated so rapidly. Clinicians appropriately recognised and responded to his clinical deterioration with timely escalations and investigations, though no reversible cause was identified to explain his acute decompensation.