Coroner's Finding: MILLER Allan Kenneth

56y · Male·disseminated nocardiosis involving central nervous system, kidneys, liver and thyroid with bilateral lower lobe pneumonia

Allan Kenneth Miller, 56, died from disseminated nocardiosis (rare bacterial infection) that was not diagnosed during his 12-day RAH admission. Clinicians initially suspected metastatic lung cancer based on presentation and imaging, which was objectively reasonable. Two CT-guided biopsies on 8-9 November were attempted but unsuccessful due to patient intolerance; further biopsy under sedation/anaesthesia was planned for Monday 12 November. Over the weekend, Mr Miller's cognitive function deteriorated, precluding his consent. His wife did not consent to further invasive procedures. The coroner found the clinical team acted appropriately and the wife's decision was reasonable, but noted a possible preventable element: if anaesthetic services had been immediately available on Friday 9 November for a sedated/anaesthetised biopsy while the patient could still consent, nocardiosis might have been diagnosed and treated before dissemination to the brain, potentially altering outcome.