Inquest into the Death of Kevin Maxwell COLLINS

50y · Male·bronchitis (pandemic influenza A/H1N1 2009) in a man with chronic obstructive pulmonary disease

Kevin Maxwell Collins, a 50-year-old man with chronic schizophrenia, chronic obstructive pulmonary disease, and morbid obesity, died from bronchitis due to pandemic influenza A/H1N1 2009 while an involuntary patient at Graylands Hospital. He had recently been started on clozapine on 26 August 2010 for treatment-resistant psychosis. On 30 August, he developed a low-grade fever (38.2°C) which responded to paracetamol. Dr A. appropriately ordered four-hourly vital sign monitoring given clozapine's potential for serious adverse effects. However, when a nurse attempted vital sign checks at 1.00am on 31 August, the deceased refused cooperation. Hourly visual checks and audible snoring reassured staff he was stable. At 4.30am, a roommate reported abnormal breathing. Despite immediate resuscitation efforts, the deceased could not be revived. Postmortem examination confirmed influenza A/H1N1 bronchitis with underlying COPD as the fatal combination. The coroner found the supervision, treatment and care provided was reasonable and appropriate throughout.