Inquest into unrelated deaths of brothers examines spit hood use, public guardian provision of care
A disabled man’s family is ‘appalled’ he was placed in a spit hood prior to his death, an inquest into his death has heard, with the same court hearing there is ‘insufficient evidence’ to justify their use in medical settings.
There is “insufficient evidence” to justify the use of spit hoods in hospitals, a court has heard, almost 18 months after a disabled man was placed in one in Alice Springs Hospital prior to his death.
A five day inquest into the unrelated deaths of two brothers has concluded in the Alice Springs Local Court.
In her closing submission, lawyer Sarah Love, representing the family of the brothers, told the court they were “appalled” to hear one of them was placed in a spit hood while in hospital.
“(The family) believe that this was not appropriate, especially given a hospital setting,” she said.
Appearing in court was a sister and one of the nieces of the brothers, who quietly sat in the gallery.
The men – who are being referred to as Big and Little Brother as per the family’s request – both died months apart in 2023.
The court previously heard Little Brother died in July after he took his own leave from the Alice Springs Hospital.
His cause of death was organ failure due to hypothermia.
Big Brother died later in September when he was in custody in Alice Springs Hospital.
He had cognitive disabilities and days before his death he was placed in a spit hood twice while in hospital, the court heard.
Big Brother died from pneumonia. He did not die in a spit hood.
In her closing statement on Friday, counsel assisting Fiona Kepert submitted to coroner Elisabeth Armitage there was “insufficient evidence in this coronial to justify the use of spit hoods in a hospital setting”.
“If corrections intend, as indicated, to continue making spit hoods available to officers, they should also undertake a review to properly understand and make sure of that risk,” she said.
“In my submission, if corrections continue to use spit hoods in hospital settings, your honour should give a recommendation that they must review policy and training to make clear that it is only permitted as a last resort.”
Ms Kepert said this recommendation should also seek to inform corrections officers about the harm spit hoods can cause and any potential health risks for prisoners.
Her recommendation also included corrections officers are supplied with other options such as PPE and a mask to protect them from being spat on, as well as providing “clear training” on strategies to “remove the spit hood as soon as possible”.
Lawyer Ian Read, representing the Department of Corrections, said a spit hood was already used as a “last resort”.
“It is for protective purposes only. It is only applied after there has been restraint; that it is to be there for the least period of time as possible, and while it is on, together with the advantage that it has got a see through mesh, the officers observe the prisoner to see if there are any adverse effects,” he said.
The inquest was also examining the provision of care under public guardianship.
Both brothers were under adult guardianship orders under the NT Public Guardian and Trustee and had NDIS plans, but were homeless, the court heard.
Ms Kepert recommended Ms Armitage make “specific recommendations that deal with prioritising strategy to improve the approach to understanding and meeting cultural needs of people under an adult guardianship order”.
Ms Armitage adjourned the inquest and will deliver her findings at a later date.
Man died of hypothermia after taking own leave from Red Centre hospital
Day four – March 6: A man who took his own leave from a Red Centre hospital was later found lying outside the facility and died of hypothermia, an inquest has heard.
The five-day inquest into the unrelated deaths of two brothers resumed in the Alice Springs Local Court on Thursday.
On Thursday the focus shifted away from examining the use of spit hoods in medical settings, instead turning its focus to a man’s final moments after taking his own leave from hospital.
At the request of the family, the brothers are being referred to as Big and Little Brother.
Aboriginal community Police Officer Phillip Adams gave evidence, recalling the moment he found Little Brother lying out the front of Alice Springs Hospital, where he looked “really unwell”.
Little Brother died in July 2023 after taking his own leave from the hospital.
Mr Adams told the court he was the “last person to hear about” Little Brother’s death and it made him “angry”.
“I helped Little Brother; put him on the ambulance … and then they took him away. And that was the last time I saw him,” he said.
Alice Springs Hospital Intensive Care Unit director Dr Brad Treloar also gave evidence, shedding more light on the death of Little Brother.
Under questioning from counsel assisting Fiona Kepert, he agreed with the pathologist’s view which put his cause of death as organ failure due to hypothermia.
“I think him taking his own leave and becoming hypothermia, when I presume he was outside of shelter and outside of warmth at that cold time of year, will have contributed to his demise on that morning,” he said.
Dr Treloar told the court he was on duty in the ICU when Little Brother was brought in.
No CPR was performed on Little Brother when he was brought in because Dr Treloar thought it would be “futile” he told the court.
“I had seen some images of his heart shortly before his very final terminal moments that showed a heart that was very thin – so the muscle of the heart was thin,” he said.
Ms Kepert said there were no issues with no CPR being performed.
Also giving evidence was Detective Senior Constable Christopher Ship, who spoke about the cultural barriers in notifying the next of kin.
Mr Ship told the court he investigated the death of Big Brother.
A different detective investigated the death of Little Brother, he said.
Both brothers died months apart in 2023.
Big Brother was in hospital with pneumonia while in custody and he died in September 2023.
The inquest has previously heard Big Brother was placed in a spit hood while in hospital, but was not wearing a spit hood when he died.
He was identified as having cognitive disabilities, the inquest heard.
Both brothers were in the care of the NT Public Guardian and Trustee and had NDIS plans.
Due to the transient nature of their lives, the inquest heard it was difficult to provide them with services.
The inquest continues.
Spit hood put on disabled man caused ‘acute stress’ reaction
Day three – March 5: A man with cognitive disabilities had an “acute stress response” when a spit hood was put on his head for 30 minutes, an inquest into his death has heard.
An inquest into the unrelated deaths of two brothers continued on Wednesday in the Alice Springs Local Court.
The eldest brother – referred to as Big Brother at the request of the family – died in the Alice Springs Hospital in 2023.
He had cognitive disabilities, was in custody, and days before his death was placed in a spit hood, the inquest has heard.
He was not in a spit hood when he died.
Appearing first as a witness via videolink was Dr Jennifer Delima, an addiction and clinical forensic medicine specialist, who told the court placing a spit hood on Big Brother “activated” an “acute stress response”.
“You’ve activated that acute stress response which is that fight, flight, fright and feign,” she said.
She said putting a spit hood on someone could “rapidly de-escalate the person” when commenting on how corrections officers dealt with Big Brother after he became violent in a shower.
The inquest previously heard how corrections officers restrained Big Brother and placed a spit hood on him after he spat in the mouth of an officer.
Dr Delima said health staff would have used “chemical sedatives” to deal with an aggressive patient, a point which Lawyer Ian Read, representing the Department of Corrections, questioned her on.
“The person is challenged in a cardiovascular respiratory sense, (the) administering of sedatives can be a bit tricky, part of it?” Mr Read asked.
“Generally in that sort of situation, you titrate it to the person’s response. So you give as little as you can to achieve your effect,” Dr Delima replied.
Alice Springs Hospital specialist physician in general and acute care Dr Anna Holwell appeared in person and gave evidence at the inquest, telling the court “I actually don’t think that there is any place for spit hoods in an acute hospital.”
“With the availability of PPE and the mitigation of the risk of infection in the hospital setting, I don’t believe that their use is appropriate.”
Dr Holwell told the court both her and some of her colleagues had been spat on while at work.
“Being spat on is a relatively unpleasant experience for anyone,” she said.
“But I would say that as a doctor and someone who works in an acute hospital, that kind of behaviour is not unexpected, particularly when you’ve got patients who are potentially quite distressed, cognitively impaired or in acute crises or acutely distressed states.”
Examining the case of Little Brother, the inquest will look into the provision of care under the public guardian, and through the NDIS.
The court heard from NDIS support co-ordinator Josh Brown who told the court Little Brother had led a transient life, making it difficult to track him down at times.
NT Public guardian and Trustee Central Australia team manager Michelle Alleman gave evidence on the complexities in providing care for those under the public guardianship.
In her opening statement on Monday, counsel assisting Fiona Kepert said the public guardian had authority to make decisions about both brothers.
The brothers’ family appeared in court on Wednesday.
The inquest continues on Thursday.
Couple’s baby dream impacted by spitting incident
Day two – March 4: A couple’s plan to have a baby was affected after one of them was spat on while at work, an inquest putting the use of spit hoods under the microscope has heard.
Day two of an inquest into the unrelated deaths of two brothers – who died months apart in 2023 – resumed in the Alice Springs Local Court on Tuesday.
At the family’s request, the two brothers are being referred to as Big Brother and Little Brother.
Alice Springs Correctional Centre general manager Bill Carroll spoke on the use of spit hoods by NT corrections officers.
The inquest previously heard that prior to his death, Big Brother was placed in a spit hood while in hospital.
Mr Carroll tendered a spit hood as evidence to the court, and told the inquest how corrections officers experienced a “significant detrimental impact” after they were spat on.
“If I give you an example, a young couple, husband and wife; the husband was spat on while they were trying to have a child … that certainly had a significant effect on those two staff,” he said.
Mr Carroll explained how after a corrections officer is spat on they have to undergo two blood tests, the first taking place immediately after they were spat on.
“Three months later, a person has a second secondary blood test and then they wait for the days of that blood test and get what has been, in most cases, the negative result,” he said.
Coroner Elisabeth Armitage questioned Mr Carroll if officers wear protective masks over their mouth and eyes when dealing with a prisoner who is known to spit.
Mr Carroll said it would be “difficult” for officers to do so, and said they would still have some of their skin exposed if they were wearing short sleeves.
On Monday, the inquest heard how Big Brother had been identified to have a number of cognitive impairments prior to his death.
Despite this, he was still placed in a spit hood multiple times in the lead up to his death, the court heard.
Eunioa Lane general manager Meghan Forsyth, an occupational therapist, gave evidence on the service provision for the two brothers through the NDIS while under public guardianship.
In her opening statement on Monday, counsel assisting Fiona Kepert said the inquest will also examine service provision by the NDIS and the public guardianship for the two brothers.
Then-Alice Springs Hospital general medicine registrar Dr Matthew Paltridge also gave evidence via videolink on Tuesday.
He told the inquest Big Brother died from pneumonia.
The inquest continues on Wednesday.
Former prison guard defends use of spit hood on man with ‘dementia’
Day one – March 3: A spit hood was placed on a man days after he lashed out over his inability to communicate his need to urinate in an Alice Springs hospital before his death, a court has heard.
A five day inquest headed by the Territory Coroner Elisabeth Armitage into the death of two brothers began in the Alice Springs Local Court on Monday.
The two brothers – who the family have asked to be referred to as Big Brother and Little Brother – died two months apart in 2023.
Both were in the Alice Springs hospital, but Big Brother was there under guard from the Alice Springs Correctional Centre.
Little Brother was not under guard by corrections.
On Monday morning counsel assisting Fiona Kepert outlined the two main points of interest for the inquest.
“The first is investigating and understanding the services provided through the public guardianship orders and NDIS funded services, and also the appropriateness of the use of spit hoods, in particular in a hospital context,” she said.
The first witness to take the stand was former corrections officer Ray Gobbert, who defended placing a spit hood on Big Brother days before his death, after he was spat on by him.
Mr Gobbert gave evidence via videolink and told the court how he had to restrain Big Brother while he was being showered by a female nurse in the hospital.
During his attempts to restrain him, Big Brother “spat straight in my mouth and face” he said.
“There was an incident where I believe (Big Brother) wanted to urinate … but I don’t think that was communicated or couldn’t be communicated to him that it would make him feel like he wanted to urinate,” Mr Gobbert said, describing an incident in the lead up to placing a spit hood on Big Brother.
“And I think he became very angry and frustrated that he couldn’t communicate that he wanted to urinate.”
After this incident, Mr Gobbert told the court Big Brother again tried to spit on him, and he placed a spit hood on him while in hospital to prevent him from doing so.
“I wasn’t trying to teach him (not to spit). I was trying to protect myself and others around me at that time; (that) was my primary objective,” Mr Gobbert said when asked if the use of spit hood taught Big Brother to not spit on people.
“I don’t think the spit hood’s designed as a teaching tool. It’s designed as a tool to protect people from getting infected.”
However, Mr Gobbert told the court he did not believe Big Brother acted out of malice given his deteriorating mental state.
“I believed he had some sort of dementia, having dealt with dementia patients before, and that’s the assessment that I basically done on him,” he said.
Mr Gobbert detailed times where the two would struggle to communicate, and Big Brother would get frustrated if he felt he wasn’t understood.
Ms Kepert asked if corrections officers had tried to use interpreters or Aboriginal Liaison Officers to help Big Brother communicate.
Mr Gobbert responded and said he was not aware of Aboriginal Liaison Officers at the hospital and did not witness the officers interact with Big Brother during his time watching him.
Representing the family was Sarah Love, who told the court both brothers were hardworking and introverted with a “great sense of humour”.
They were hard working stockmen who spoke Alyawarre and eastern Arrernte, she said.
Both had a deep connection to country which they prided themselves on, she told the court.
They were “role models for the younger generations” who lived a “transient lifestyle out bush” she said.
She requested an adjournment for the inquest to begin at a later date as most of the brothers’ family are unable to attend court due to cultural obligations.
The inquest continues.
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Originally published as Inquest into unrelated deaths of brothers examines spit hood use, public guardian provision of care
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