Coroner's Court of Western Australia

Inquest into the Death of Mamadou Hady DIALLO

Inquest into the Death of Mamadou Hady DIALLO

Delivered on :6 September 2017

Delivered at : Perth

Finding of : Coroner Linton

Recommendations :N/A

Orders/Rules : N/A

Suppression Order : N/A

Summary : At the time of the deceased’s death, the deceased was subject to a community treatment order under the Mental Health Act 1996 (WA) and was under the Supervision of a Consultant Psychiatrist.

The inquest focused primarily on the care provided to the deceased while on the community treatment order, as well as the circumstances of his death and his fitness to drive given his psychiatric disorder. The inquest was held in conjunction with the death of another person, Mr James Yung, who also died in a traffic collision in 2015 while subject to a Community Treatment Order.

The deceased migrated to Australia in 2005. On 18 November the deceased was admitted to Royal Perth Hospital with acute paranoid psychosis.  He was given medication to tranquilise him and was stabilised on risperidone and venlafaxine.  On discharge he was referred to Inner City Mental Health and admitted into the Community Recovery Program in April 2006.  He was diagnosed with Acute Polymorphic Psychotic Disorder.

On 7 May 2014 the deceased presented to the Bentley Mental Health Service due to his low mood, socially withdrawn behaviour and non-compliance with his medication. The deceased was placed on antidepressant and antipsychotic medication.  On 13 July 2014 the deceased was taken to Royal Perth Hospital and admitted to a locked ward after he made attempts to harm himself.  The deceased was transferred to Bentley Hospital on 20 July 2014 and placed on depot paliperidone.  He was discharged on 13 August 2014, but his paranoid schizophrenia relapsed and he was readmitted to the Bentley Hospital on 28 August 2014.  He was then discharged on a Community Treatment Order on 30 October 2014, which remained in place until the deceased’s death.

At the time of his death the deceased had appeared to be generally well and making plans for the future, including trying to obtain a commercial truck driver’s licence to create new job opportunities. The Coroner noted that although the process by which he was found fit to obtain a learners permit for commercial truck driving was flawed, in that his general practitioner mistakenly performed the assessment when he was not in fact qualified to do so, this error did not play any role in the deceased’s death.  The Coroner concluded the deceased was not driving a truck at the time he died, and there was no evidence prior to the crash to suggest that he was not fit to drive a private vehicle.

On 22 May 2015 the deceased was driving east on Great Eastern Highway, while at the same time a truck was travelling west in the opposite lane. As the vehicles approached each other the deceased’s car swerved into the path of the oncoming truck and they collided head on. The deceased sustained non-survivable injuries in the collision.  The Coroner concluded the cause of death to be multiple injuries and the manner of death occurred by way of suicide.

Catch Words : Community Treatment Order : Fitness to drive assessment guidelines : Communication : Motor Vehicle Accident : Suicide

Last updated: 30-Apr-2019

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