Record of Investigation into Death (Without Inquest)
Coroners Act 1995
Coroners Rules 1996
I, Glenn Hay, Coroner, having investigated the death of
Christine Alainie Arkinstall
WITHOUT HOLDING AN INQUEST
Find that :
(a) Christine Alaine Arkinstall (Ms Arkinstall) died on 31 October 2009 in the Royal Hobart Hospital (RHH), Tasmania
(b) Ms Arkinstall was born in New South Wales on 22 March 1966. She had one adult daughter and two younger sons, and had been in a de facto relationship for about 12 years; and
(c) Ms Arkinstall died as a result of hypoxic brain injury following an anaphylactic reaction.
Ms Arkinstall had moved to Tasmania with her family as a child and grew up in the Margate area. Her daughter, Bianca Herlihy (Miss Herlihy) was born in 1988 from a first relationship, and her two sons were born in 1997 and 2000 with her current partner, Leon White (Mr White). Ms Arkinstall and Mr White have resided at their address in Benboyd Circle in Rokeby for a period of about 5 years and have been together for twelve years.
Ms Arkinstall appeared to be in a happy relationship with Mr White. She had suffered from some medical problems during her life, including emphysema, asthma and a severe egg allergy. She had been a patient of Dr Hugh Mestitz, a respiratory physician, for a number of years and during 2009 had been reviewed by him about every three months. Dr Mestitz last saw Ms arkinstall on 16 september and noted his concern that her asthma was poorly controlled. He recommended reintroduction of corticosteroid therapy. He also observed she had a severe and poorly reversible airway obstruction. Ms Arkinstall was careful not to consume egg or egg based products and she had informed others she had been provided with an ‘epipen’ to treat anaphylactic episodes in the event of egg consumption. Mr white believed she may have been given the ‘epipen’. However, there was no medical evidence available to suggest such a device had ever been prescribed for her.
She had no known or diagnosed allergy to seafood although Miss Herlihy reports that her mother believed she was allergic to shellfish but "would often eat 1 to 2 prawns on occasions such as Christmas, so as not to be left out. She sometimes commented that she felt funny after this." This was confirnmed by Mr White who added that he had never observed her have any reaction to seafood.
Circumstances Surrounding the Death :
During the evening of 27 October 2009, Ms Arkinstall and Mr White were at home together preparing dinner. Their sons had gone to stay for the night with Ms Herlihy. Miss Herlihy noted her mother "was quite down and in a really bad mood and quite sulky". Mr White had earlier purchased steak for Ms Arkinstall and prawns for his dinner. When he returned home after 5:00pm, Mr White cooked the prawns by boiling them, and then proceeded to shell them. Ms Arkinstall helped him shell the prawns, consuming some while doing so. Mr White noted she was eating more than were going onto the plate. Unfortunately it would seem Mr White did not discourage Ms Arkinstall fom eating any prawns at all, although he did tell her to stop and go and sit down. After this Ms Arkinstall went to the lounge room while Mr White then cooked the steak.
A short while later Ms Arkinstall returned to the kitchen saying she was feeling sick. She took an anti-histamine tablet which had been in the fridge. They then sat down for the meal, of which Ms Arkinstall consumed only some before saying she felt unwell and sat down in the lounge room. Unfortunatley there was no discussion about Ms Arkinstall utilising any ‘epipen’ and there is no evidence she did so or even had one in her possession.
Mr White asked Ms Arkinstall if she was sick enough to go to the hospital, to which she replied she was. Mr White put both meals into the fridge and then went outside to start his car and open the driveway gate. Ms Arkinstall was at the front door but unable to walk to the car. Mr White assisted her to his vehicle and then drove toward the Royal Hobart Hospital (RHH).
While driving toward the hospital Ms Arkinstall was speaking with Mr White, however as they were in the vicinity of the hill at Mornington Ms Arkinstall’s head went back and she was foaming at her mouth and unresponsive. Mr White thought she had died and drove quickly to the RHH emergency section.
On arrival at the emergency section, Mr White pulled Ms Arkinstall from his car. Medical personnel provided assistance in the car park, found her to be in pulseless electriacl activity and commenced CPR at 8:15pm. Spontaneous circulation returned at 8:26pm. Medical record notes Ms Arkinstall had been actively cool at that time. She remained ventilator dependent.
Ms Arkinstall was admitted to the Intensive Care Unit (ICU) comatose and ventilator dependent. MRC and EEG showed and were consistent with severe and global hypoxic brain injury. Ms Arkinstall suffered ongoing seizures despite administration of multiple anti-seizure therapy.
On 31 October 2009 discussions were held by medical staff from Intensive Care and neurologist consulted with the family of Ms Arkinstall. A decision was made to provide palliative care for Ms Arkinstall.
Ms Arkinstall died on 31 October 2009 at 11:20pm at the Royal Hobart Hospital. I accept the opinion of the State Forensic Pathologist that her death was caused as a result of hypoxic brain injury following an anaphylactic reaction. It is also noted that she had marked smoking-related lung disease.
Findings, Comments and Recommendations :
Police investigated her death on my behalf and I accept their evidence that there were no suspicious circumstances surrounding her death.
I find that the decision by Mr White to continue to drive with haste to the hospital following Ms Arkinstall becoming unresponsive was appropriate in all the circumstances.
During my investigation, several witnesses suggested that Ms Arkinstall had been depressed for quite some time and there was a possibility she may have intended to take her own life by eating an excessive amount of seafood. There was a clinical history of depression and anxiety. While I cannot rule out entirely that possibility, there was no evidence upon which I could make any reasonable finding that she intended to take her own life by her actions.
I accept the opinion of the State Forensic Pathologist that the autopsy, consideration of the circumstances surrounding her death and biochemical testing failed to elucidate the specific offending allergen. While it is possible that the ingestion of seafood was the inciting event for the anaphylaxis, I cannot rule out the likelihood of other elements causing the reaction. It is to be noted that significant contributing factors to her death were emphysema and heavy smoking.
I conclude this matter by conveying my sincere condolences to Ms Arkinstall’s family.
Dated 19 May 2011 at Hobart in Tasmania.