Prisoner's brain bled
JAILED traffic offender Ian Klum died on June 14 last year when the pressure inside his skull from an "evolving subdural haemorrhage" became too much for his body to handle, a coronial inquest into Klum's death heard yesterday in Grafton.
The case began with a "knock-up" or emergency call from cell 219 in Grafton Correctional Centre's multi-purpose unit at 2.29am on June 10, 2010.
Though the inquest has heard repeatedly that assault was suspected in the case, Klum's cellmate Shane Johnson has not been charged with any offence relating to the case and has not yet been put on the stand.
The inquest, which began on Monday and is presided over by deputy state coroner Malcolm MacPherson, has focused on the treatment Klum received from prison officers and medical staff after a "knock-up call" was lodged from cell 219 at 2.29am on June 10, 2010.
Sydney-based emergency medicine professor Dr Gordian Fulde told the inquest (via audio-video link) that Klum's blood would not have been able to coagulate because of its high INR (international normalised ratio) level of 3.9 - a level brought on by blood-thinning medication warfarin.
"If a patient had a raised INR, the blood wouldn't clot so a bruise keeps expanding and blood keeps thinning ... it's particularly nasty in the skull because the skull is like a closed box and nothing can expand."
The INR level, said Dr Fulde, should have caused concern for Klum's GP Dr Keogh who should have "energetically pursued" the case to get the level under control.
The court heard Dr Keogh had dropped Klum's warfarin dosage on about May 31 but no follow-up test had been done to check the levels - possibly due to a broken INR testing machine at the jail.
His INR level when he was taken to Grafton Base Hospital on June 10 was 4.3.
"Once the INR goes over 4, the risk to the patient exceeds any benefit they have from anti-coagulation and there is a greater risk of bleeding complications."
Prison officer David Pearcey told the inquest on Tuesday that he had heard Klum moaning while in the detox area and saying the words: "My head hurts, I want to go to hospital."
Mr Pearcey said that before cutbacks were made about two years ago, a registered nurse would be on shift to accompany officers on every knock-up call.
Justice Health Nurse Nerye White, who assessed Klum's medical condition about 3.20am after being called into the centre, said she had been told that Klum had been involved in an incident in his cell and she noted a small amount of blood under his nose.
Under questioning from counsel assisting the coroner Warwick Hunt, Ms White said officers did not inform her that Mr Klum had not been able to walk from his cell to another cell (he crawled) and then had to be assisted down stairs to the detox area.
Nor had they told her, she said, that Klum had complained of vertigo or a headache.
She said had she known these factors she would have called for an ambulance sooner.
It is understood Mr Klum was taken by ambulance to GBH after 6am.
The inquest heard earlier from prison officer Matt Barnett who told the court he meant no disrespect to Klum by repeatedly ordering him to get up and walk from his temporary holding cell.