Medicopolitical

Coroner laments lack of cardiology specialist services in Tasmania


A Tasmanian coroner has cited the lack of cardiology specialist services in the state as a factor in the death of a 54-year old man after being discharged from the Launceston General Hospital (LGH) with severe heart disease.

An inquest has heard that the man had been diagnosed with acute myocardial infarction on 5 July 2019 and underwent a procedure for the placement of a stent in an occluded right coronary artery.

The procedure was successful and he was discharged from the hospital three days later on a range of medications including a beta-blocker, double antiplatelet agents, statin and an angiotensin receptor blocker medications.

However he was soon brought back to the LGH by paramedics after he went into ventricular tachycardia.

On his second hospital admission the man was treated with anti-arrhythmic medication and admitted to the hospital’s critical care area for monitoring.

However the inquest heard that he was discharged home the following day when he appeared stable and his clinical observations were unremarkable.  He collapsed and died at about the same evening and an autopsy identified he had died of myocardial infraction.

A medical advisor to the coroner, cardiologist Dr Luke Galligan, said it appeared that the risk posed by the periods of ventricular tachycardia three days post infarction had not been recognised by the hospital.

These events posed a “much more threatening prognosis than ventricular arrhythmias occurring in the initial hours of infarction,” he said.

“At the very least, Mr Mitchell should have been monitored in hospital for a longer period. There is a strong argument for the insertion of a defibrillator – something that does not appear to have even been considered,” the coroner noted.

The inquest also heard that the hospital did not respond to requests from the court to provide feedback on the initial findings.

The coroner highlighted the cardiologist adviser’s observation that Launceston was similar to many parts of rural Australia in not having routine access to specialist cardiological advice and intervention.

Dr Galligan suggested that “with modern technology it would be relatively easy to have a system where an immediate review of patients’ ECGs and clinical scenario [is] provided by one or two cardiologists covering the whole country after hours.”

The coroner concluded: “National arrangements for cardiological (or other specialist medical) review are not within my jurisdiction, however I comment that I consider there is much to be said for such an arrangement being implemented in this state.”

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