Finding into death of Marilyn

62y · Female·Unascertained

Marilyn, a 62-year-old woman with schizophrenia and intellectual disability, died at Caulfield Hospital on 27 October 2019 with an unascertained cause. She was admitted via the ED under mental health legislation with deteriorating mental state and poor oral intake. During her 7-week acute aged psychiatry admission, she received unilateral electroconvulsive therapy and antipsychotic medications. She was found unresponsive at 7:30am after being given olanzapine 2.5mg at 1:00am the previous night. Despite CPR, she remained in asystole and died. No autopsy was performed due to family religious objections. The coroner identified no clear departures from clinical standards. Key lessons include careful monitoring of sinus tachycardia in psychiatric patients, consideration of ECT safety protocols, and vigilance for sudden deterioration in medically vulnerable psychiatric patients.