Coroner's Court of Western Australia

Inquest into the Death of Colin George GRAHAM

Inquest into the Death of Colin George GRAHAM

Delivered on :31 May 2019

Delivered at : Perth

Finding of : State Coroner Fogliani

Recommendations :N/A

Orders/Rules : N/A

Suppression Order : N/A

Summary : The deceased at the time of his death was a sentenced prisoner at Casuarina Prison. He was a 56 year old Aboriginal man who died at St John of God Hospice in Murdoch on 24 January 2016 while receiving palliative care for advanced metastatic lung cancer.

In 2011 the deceased was eligible for assessment to be considered for parole while residing at Acacia Prison. Attempts to assess him for parole suitability were hampered by his reluctance to engage in that assessment. In keeping with his ongoing expressed wished not to be out in the community, the deceased signed waivers excluding him from all prison treatment programs. He made a written request to the effect that parole or participation in a Re-Socialisation Program be denied.

The deceased was a heavy smoker and had developed severe emphysema and chronic obstructive pulmonary disease. In 2012 he was diagnosed with lung cancer.

The deceased had regular medical assessments during his incarceration and on 6 November 2014, while still at Acacia Prison, he was assessed as no longer being fit for work, and he was identified as a terminally ill prisoner due to his severe underlying lung disease and carcinoma of the right lung.

On 7 May 2015 the deceased was transferred to Casuarina Prison infirmary due to his compromised health, and he continued to reside at the infirmary for additional treatment and care. By November 2015 following regular assessments, it was noted that the deceased displayed new symptoms suggestive of brain metastases. In early January 2016, the deceased was diagnosed with renal metastases. Over this period he was frequently transferred to hospital for treatment. On 11 January 2016 the deceased was re-admitted to Fiona Stanley Hospital for palliative care. Permission for removal of his restraints was granted on 12 January 2016.

On 20 January 2016 the deceased was conveyed to St John of God Murdoch Community Hospice for terminal palliative care where his deterioration continued and the deceased died.

The State Coroner found the deceased’s mental and physical health needs were managed and treated to a high standard while in the care and custody of the Department of Justice.

Catch Words : Death in Custody : Supervision, Treatment and Care : Natural Causes.


Last updated: 13-Jun-2019

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