Coroners Act In the matter of Coronial Findings and Recommendation into the Death of Ms Souzana Afianos pursuant to section 46B dated 1 January 2004
Tabled paper 1394
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cancellation by his receptionist Nicole Cox at approximately 1.00pm that day. This was reliably confirmed by Ms Cox when she gave evidence. Dr Treacy said that he then made notes of what he had learnt that day. The note he made was in evidence. It was 2.00pm A p p t made by me - pat ient rang and cancel led - did not want to come. I will arrange review ASAP and told me has been eating Chinese fo o d !! > Told stay on liquids only - this may be causing her d iscom for t . He indicated that it was his intention then to call the Deceased to arrange to see her as soon as possible. He then indicated that he had a busy schedule the rest of the day and in fact was in surgery until approximately 10.00pm. 67. He said that the next thing relevant that occurred is that at approximately 6.00am the following morning, he was woken by his Registrar at home to be told that the Deceased was seriously unwell. He promptly went to the hospital and saw the Deceased. She was being resuscitated by Emergency staff and he was overseeing their actions and providing assistance. He was present when she was pronounced dead at 7.20am. 68. In relation to the issue of air in the band, Dr Treacy confirmed that there should not have been air in the band at the autopsy. As a preliminary he agreed that if the band was partly inflated it would cause a constriction which would lead to necrosis and would result in a greater risk of hemorrhaging. All this was very important in the context of the issues in the Inquest as Dr Treacy confirmed that one reason why the band is not adjusted for the first three months is to enable the healing process to occur and therefore to reduce the risk of necrosis and infection. He was asked to speculate if there was air in the band to the extent as indicated by photograph 24 and if it had been present over the four days between the time of the placement and the death, whether that would cause necrosis. He said that the band exerts low pressure only and he doubted that it, of itself, could lead to necrosis. He further refuted the suggestion that the placement of the band or compression caused by it while the tissues surrounding it are 28