Inquest into the death of Shane McMillan

40y · Male·Acute methylamphetamine toxicity

Shane McMillan, aged 40, died from acute methylamphetamine toxicity while in police custody. He was arrested for domestic violence offences on 1 December 2022 and presented to Orange Health Service twice that day with suspected drug ingestion. On both occasions, assessment included appropriate observations, ECG, and blood tests, all normal. After 6+ hours observation on first admission, he was appropriately discharged with clear instructions. On second admission for chest pain (14 hours post-ingestion), investigations were again normal and appropriate, justifying discharge. He deteriorated fatally the following morning. The coroner found the toxidrome assessment, observation periods, and discharge decisions appropriate. Clinical lessons: methylamphetamine toxicity assessment by experienced emergency physicians using sympathomimetic toxidrome evaluation was sound; the delayed absorption from a swallowed packet explained the late fatal presentation; toxicology consultation was not indicated given asymptomatic presentation and normal investigations.