Record of Investigation into Death (Without Inquest)
Coroners Act 1995
Coroners Rules 2006
Rule 11
I, Stephen Raymond Carey, Coroner, having investigated the death of
Maxine Frances HOLLOWAY
WITHOUT HOLDING AN INQUEST
Find :
(a) The identity of the deceased is Maxine Frances HOLLOWAY (Ms Holloway) who died between 1 August 2010 and 4 August 2010 at her residence in Southern Tasmania.
(b) Ms Holloway was born on 20 September 1959, was aged 50 years and was a divorced woman.
(c) Ms Holloway was in receipt of a disability pension at the time of her death.
(d) Ms Holloway died as a result of a prescription drug overdose (quetiapine) with contributory factors being depression and paranoid delusions.
Circumstances Surrounding the Death :
Ms Holloway married twice. Following her first divorce in 1989 she met John Winstyn and together they had a son, Austen Holloway-Winstyn. They subsequently married and moved to Texas, USA. In early 2000 Ms Holloway returned to Tasmania with Austen following the breakdown of that marriage.
Upon her return to Tasmania her mental health deteriorated. She was in receipt of medical treatment throughout this period and eventually diagnosed with paranoid schizophrenia. This necessitated two hospital admissions in 2009 and ongoing psychiatric review with appropriate treatment with anti-psychotic and anti-depressant medication in addition to community psychiatric support.
Ms Holloway’s sister-in-law, Alexandra Holloway states that in 2008 Austen returned to Texas to live with his father which contributed to deterioration in Ms Holloway’s condition. The only contact Ms Holloway had with Austen was over the phone and limitations had been placed on this by Austen’s father as it was felt she was "hasseling" them. Mrs Alexandra Holloway also advised that Ms Holloday had received a letter from Centrelink stating that they would be reviewing her entitlements and capacity for work.
Mrs Alexandra Holloway last spoke to Ms Holloway on Sunday 1 August 2010 by telephone. In that conversation Ms Holloway advised that she had just spoken to Austen and sounded happy. She said that she had an appointment with Centrelink the following day and had attended her Doctor who had prescribed medication to assist with sleep.
Ms Holloway’s brother, Steven Holloway also reports that Ms Holloway’s condition deteriorated following Austen’s return to Texas. He was also aware that in the months prior to her death Ms Holloway had been contacted by Centrelink with a view to considering whether she was fit to "join the workforce". He believed that this was putting a lot of pressure on her. He last spoke to Ms Holloway on 30 July 2010 at Ms Holloway’s home. He comments that "she appeared to be very distraught and distracted when I was with her and she generally speaking did not look in good health."
Records of the Royal Hobart Hospital reveal a history of past psychiatric consultations for paranoid delusional disorder and suicide attempts in addition to fibromyalgia and Ehlers Danolos Syndrome.
Dr Flecker, who was Ms Holloday’s treating General Practitioner, reports the main treatment issues as Ms Holloway’s neurodermatitis and her paranoid schizophrenia. In particular he states that Ms Holloway was affected by "loss with her son Austin returning to the USA to his father". Dr Flecker’s notes refer to Seroquel 25mg tablets being a current medication prescribed to Ms Holloway.
Ms Holloway last consulted Dr Flecker on 30 July 2010. At that time he reports that "she was not suicidal, quite lucid and appeared to be coping as well as she normally did".
Ms Holloway had been a client of Mr Christopher Michael York, Case Manager/Registered Nurse with the Department of Health and Human Services, since May 2010. He states that;
"access to her son in particular causes distress. ….. She was diagnosed recently with schizo-affective disorder, meaning that she shows some symptoms of psychotic behaviour (paranoia) and some symptoms of depressed mood".
Mr York notes that he had made attempts to contact Ms Holloway since 2 August 2010 and became concerned when she failed to attend a weekly knitting session on 3 August 2010. On 4 August 2010 having been unable to contact Ms Holloway he attended Ms Holloway’s home together with another Community Case Manager and a Student Nurse. They noted the property to be in darkness with closed blinds. The front door was deadlocked and Ms Holloway’s car was parked in the car park. Mr York subsequently contacted Police.
On arrival at Ms Holloway’s home Tasmania Police found the property secure. All blinds were down/closed and vigorous knocking on the door and windows failed to raise a response. A door knock of adjacent units revealed that those occupants had not seen Ms Holloway for several days. Eric Percy in Unit 1 stated that he had last seen Ms Holloway after lunch on 1 August 2010. A bedroom window was broken to gain entry. Ms Holloway was found in bed. No signs of life could be detected. Tas Ambulance attended and confirmed her to be deceased.
Tasmania Police conducted a thorough search of Ms Holloway’s unit and located a variety of prescription drugs, amongst those medications was an empty packet of Seroquel (quetiapine) TAS 100mg 90.
A note was located which stated:
"you’ve left me no choice but to… Your thinking was too negative. So, now, it is going to be negative all the way. Very negative + it will hurt BIG time – you will know true pain. "
Dr Donald Ritchey, Forensic Pathologist, Statewide Forensic Medical Services performed the post-mortem on Ms Holloway. He reports;
"The cause of death of this 50 year old woman, was prescription drug overdose (quetiapine). Significant contributing factors were a complex psycho-social disorder (paranoid delusions and depression)……. The autopsy revealed a well developed, well nourished adult Caucasian woman with copious capsule contents within the gastric fluid. Toxicology testing of blood obtained at autopsy revealed a fatal concentration of the anti-psychotic drug quetiapine. Quetiapine overdose causes death by central nervous system depression resulting in respiratory and cardiac arrest."
Andrew James Griffiths, Forensic Scientist at Forensic Science Service Tasmania, carried out toxicology testing and reports the presence of quetiapine at a level of 23 mg/L (within reported fatal range). The presence of nordiazepam was also present. Mr Griffiths reports;
"Quetiapine is an atypical sedating antipsychotic agent used in the treatment of schizophrenia and has fewer extrapyramidal effects than other antipsychotics………The most commonly reported symptoms of overdose are extensions of the drugs central nervous system depressant effects and include; drowsiness, sedation to coma, tachycardia and hypotension."
Comments :
I am satisfied that a full and detailed investigation has been undertaken in relation to the death of Ms Holloway and that there are no suspicious circumstances.
I am not able to make a precise finding in respect of the date of Ms Holloway’s death save that it occurred during the period 1 – 4 August 2010.
I find that Ms Holloway died as a result of result of a prescription drug overdose (quetiapine) with contributory factors being depression and paranoid delusions. Significant contributing factors to her death were the ongoing health issues associated with a diagnosis of paranoid schizophrenia.
It is apparent that there were a number of stressors in Ms Holloway’s life that impacted on her medical condition ie contact with her son and a pending review of her Centrelink benefits. I am satisfied that due to a combination of factors Ms Holloway sadly felt unable to cope and made the decision to end her life.
I wish to conclude by conveying my sincere condolences to the family of Ms Holloway.
DATED: 3 May 2011 at Hobart in the State of Tasmania.