Inquest into the death of Mootijah Douglas Andrew Shillingsworth

44y · Male·Complications of a Left Temporal Lobe Abscess

Mootijah was a 44-year-old Aboriginal man who died from a brain abscess originating from an untreated chronic ear infection. He had documented hearing impairment and a history of chronic ear disease requiring ENT specialist care, yet this was not identified or treated during his 11-month remand in custody. Despite multiple nursing observations of hearing difficulties and presentations with ear pain, fever, and lethargy, no comprehensive medical review occurred. Mental health symptoms masked the underlying physical illness, and systemic failures prevented proper screening and escalation to specialist care. The coroner found the death preventable, caused by: chronic disease screening not including ear disease; lack of nursing staff training in ear disease recognition; failure to perform thorough medical reviews despite multiple opportunities; and poor coordination between mental health and physical health services. Had his chronic ear disease been properly identified and managed through specialist assessment and timely treatment, his death would have been prevented. The case demonstrates critical systemic failures in health screening, staff training, and interdisciplinary communication in correctional settings.