Coroner's Court of Western Australia

Inquest into the Death of Kevin George HOWLETT

Inquest into the Death of Kevin George HOWLETT

Delivered on : 30 August 2023

Delivered at : Perth

Finding of : Coroner Jenkin

Recommendations : No

Orders/Rules : No

Suppression Order : No

Summary : Mr Kevin George Howlett (Mr Howlett) was 83-years of age when he died at Fiona Stanley Hospital (FSH) from complications of a ruptured abdominal aortic aneurysm on 24 February 2022.

At the time of his death Mr Howlett was a sentenced prisoner at Casuarina Prison (Casuarina), having been received there on 19 September 2011.  Mr Howlett had an extensive medical history including chronic renal impairment, chronic obstructive airways disease, ischaemic heart disease, high blood pressure and depression.  He regularly attended prison medical centres for treatment of minor issues and was the subject of electrocardiograms (ECG).  His chronic kidney disease and chronic obstructive airways disease were reviewed at regular intervals, and he had weekly blood pressure checks.

During his incarceration, Mr Howlett’s medical condition slowly deteriorated, and as a result he was transferred to the infirmary at Casuarina on 12 July 2021, where he was regularly reviewed by nursing and medical staff.  He was given a walking frame due to his history of falls.  Mr Howlett complained of back pain after a fall and he had an X-ray at FSH on 26 August 2021.  The X-ray found no acute compression fracture or bony lesion, but did identify lower lumbar degenerative disease and facet arthropathy.

However, the X-ray also found that Mr Howlett had a large abdominal aortic aneurysm (AAA), which is a swelling of bulge in the aorta.  AAA are usually asymptomatic and as in Mr Howlett’s case, identified incidentally.  Although a prison medical officer made a timely request for an ultrasound to confirm the presence and size of the AAA, the image request did not indicate any degree of urgency, and the ultrasound (and a CT scan) were not performed until 7 February 2022, some five months later.

At about 7.10 am on 23 February 2022, Mr Howlett collapsed in his cell and he complained of complained of spinal and generalised body pain.  He was taken to FSH were he was diagnosed with a ruptured AAA.  This is a medical catastrophe and about 50% of patients do not make it to hospital alive.  Of those that do, a further 50% die after surgery, making the mortality rate for a ruptured AAA about 75%.

Although Mr Howlett underwent emergency surgery and his ruptured aorta was successfully repaired, following the procedure he developed multi-organ failure, abdominal compartment syndrome and low blood pressure.  His condition continued to deteriorate and he was declared deceased at 4.49 am on 24 February 2022.

The Coroner concluded that although the management of Mr Howlett’s general health was of a good standard, the management of his AAA was sub-optimal.  The coroner concluded that Mr Howlett should have undergone confirmatory tests within a few weeks of the X-ray he had on 26 August 2021 which first identified he had a large AAA, and that the AAA should have been repaired (most likely by stenting) within a few months thereafter.  In view of various changes implemented by the Department of Justice since Mr Howlett’s death, the coroner determined that is was no necessary to make any recommendations in this case.

Catch Words : Death in Custody : Chronic Medical Conditions : Abdominal Aortic Aneurysm: Delayed assessment and repair : Natural Causes

Last updated: 18-Sep-2023

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