Coroner's Court of Western Australia

Inquest into the Death of Hassan BECHARA

Inquest into the Death of Hassan BECHARA

Delivered on :24 April 2020

Delivered at : Perth

Finding of : Coroner Jenkin

Recommendations :N/A

Orders/Rules : N/A

Suppression Order : N/A

Summary : Hassan Bechara (Mr Bechara) died from ischaemic heart disease on 6 July 2017, he was 52 years of age. At the time of his death, Mr Bechara was a sentenced prisoner.

On 19 March 2015 Mr Bechara was received at Hakea Prison. During his reception interview, he denied any self-harm or suicidal ideation but did say he felt at risk in the prison because of the nature of his offences. Mr Bechara was assessed by a nurse and then, on 20 March 2015 by a doctor. His self-reported medical history was noted, however, records from his doctors in New South Wales were not then available. Although Mr Bechara listed several of the medications he was currently taking, he did not tell the prison doctor that had been prescribed cholesterol lowering medication (atorvastatin). Mr Bechara was not always compliant with medication in the community and in the days after his admission, he declined his prescribed medications on the basis that they made him feel sick.

Mr Bechara’s medical notes from New South Wales were subsequently received and although the notes contained a letter from Mr Bechara’s cardiologist in New South Wales, his GP’s progress notes were not comprehensive and did not refer to any cardiac concerns. The GP’s notes did refer to the fact that Mr Bechara was taking atorvastatin, but due to an oversight, Mr Bechara was not immediately prescribed this medication on his admission to prison.

On 27 October 2016, Mr Bechara was reviewed by the Head of Cardiology at Fiona Stanley Hospital (FSH) who considered that Mr Bechara was clinically stable and had cardiomyopathy, which was probably ischaemic. The treatment plan was for Mr Bechara to be reviewed in six to eight weeks after he had undergone an echocardiogram and blood test. Mr Bechara declined to have a coronary angiogram or to have an implantable cardioverter defibrillator fitted, both of which had been recommended. He also declined a suggested increase to his cholesterol lowering medication.

On 23 June 2017, Mr Bechara presented to the prison medical centre. He was grey, sweaty and looked unwell. He said he had vomited after lunch and felt dizzy. His pulse rate was elevated and his blood sugar level was low and he was taken to Armadale Kelmscott Memorial Hospital by ambulance. On admission, Mr Bechara’s pulse was very high and an ECG showed his heart was in an abnormal rhythm known as ventricular tachycardia. Mr Bechara was given some medication but he went into cardiac arrest. He was successfully defibrillated and his heart resumed a normal rhythm. An ECG showed signs of cardiac ischemia and following discussions with the cardiology team at Royal Perth Hospital (RPH) Mr Bechara was transferred to RPH for urgent treatment.

Mr Bechara underwent tests and doctors at RPH recommended he undergo coronary bypass graft surgery. Although he was reluctant to do so, Mr Bechara agreed to be transferred to FSH on 2 July 2017 for consideration of coronary bypass grafting. On 6 July 2017 Mr Bechara suffered a cardiac arrest. Prolonged CPR resulted in a spontaneous return of circulation and he underwent an emergency angiogram. Cardiologists reviewed the angiogram and considered that coronary stenting would not improve his prognosis given the results of the previous myocardial viability study and Mr Bechara’s long-standing cardiomyopathy. As Mr Bechara was being returned to the coronary care unit after the angiogram, he had a further cardiac arrest. Despite concerted resuscitation efforts Mr Bechara could not be revived.

After careful consideration of all the evidence the Coroner was satisfied that the standard of supervision, treatment and care that Mr Bechara received while he was in custody was adequate.

Catch Words : Death in Custody : Medical Management during Incarceration : Natural causes

Last updated: 12-May-2020

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