Thread by @dhadjowa

Day 8 of the inquest into Veronica Nelson's death in custody. Dr Sean Runacres who undertook the prison intake medical assessment as DPFC and overruled the view of registered nurse Hills to send Veronica to go to hospital is giving evidence this morning #JusticeForVeronicaNelson

Head down to the coroner's court today if you can. If you are unable to attend physically here is the link to view the inquest livestream: csvic.webex.com/csvic/onstage/…

#JusticeForVeronicaNelson

Counsel Assisting begins questioning of the witness. The witness is asked about his professional history and how long he worked at DPFC. We are told that the witness worked at DPFC for 2 years part-time and another 2 years in a locum capacity
#JusticeForVeronicaNelson

Dr Runacres is asked about the reception medical assessment he conducted with Veronica the day that she arrived at DPFC

R: I don't recall the assessment
CA: So you say that you don't recall assessing Veronica?
R: Yes
#JusticeForVeronicaNelson

Counsel Assisting ask a series of qs about initial prison health assessments

CA: In terms of hierarchy...is the Dr in charge of what happens in that assessment?
Runacres: The Dr is in charge of the assessment. Their role is to ascertain what should be assessed and recorded

CA: Is it right to say you are unable to say now how Veronica presented?
R: Prior to seeing the CCTV I wouldn’t have been able to tell you anything
CA: Now that you have seen the CCTV does that change your ability to recall?
R: I have very scant if any detail of the assessment

Counsel Assisting: So when you wrote your statement that's been provided?

Dr Runacres: I was relying on notes

#JusticeForVeronicaNelson

Counsel Assisting makes references to Dr Runacres notes from the medical assessment he conducted where he has described Veronica as looking "generally well, was alert, not drowsy and not toxic looking"

#JusticeForVeronicaNelson

CA: Can I ask you what you meant by "not toxic looking"?

Dr Runacres: This is a required standardised documentation we use on all prisoners. “Toxic looking” = significantly unwell, signs, symptoms, that maybe of concern for her health

#JusticeForVeronicaNelson

CA: By noting that she was "not toxic looking", is that you noting that she is not obviously unwell?
R: toxic is not a word I use but it’s a form document that’s generated
CA: And you say you don't remember now how [Veronica] presented?
R: No

#JusticeForVeronicaNelson

Counsel Assisting ask the witness a no. of qs relating to the medical notes he took during his assessment w Veronica

CA: You recognise the purpose, or 1 of the purposes of these notes, is for there to be a record that can be relied upon for med treatment in the future?

R: Yes

CA directs the witness to view documentation completed by another med officer when Veronica was at DFPC 9 months earlier

CA: If we go to the exam section the top 3 entries...are identical to those that appear in your exam..Is it possible you have cut+paste them from this entry?

Counsel Assisting: There are pre-populated entries that remain unchanged based on any assessment that you've made.

Runacres: I accept that there are other errors in the document

#JusticeForVeronicaNelson

CA: Ms Hills has given evidence that says Veronica did not look generally well. She rather said she appeared extremely unwell. Are you able to agree or disagree with Ms Hills on that?

R: From what I’ve seen from the CCTV I see a generally well person

#JusticeForVeronicaNelson

Counsel Assisting: Would you say as to whether or not [Veronica] was generally well or extremely unwell?

Dr Runacres making reference to CCTV: An extremely unwell person wouldn't walk down the corridor with hands on the hip

#JusticeForVeronicaNelson

CA: A nurse who was present in the room said she was extremely unwell and describes a number of features which I'll take you to is the case that you are unable to contradict that

Runacres: I don't have a lot of faith in Ms Hills clinical accuracy

#JusticeForVeronicaNelson

Counsel Assisting asks Dr Runacres about a no. of procedures which are supposed to take place during the initial medical assessment.

Hills, the registered nurse present for the medical assessment, has previously given evidence that a no. of these procedures did not occur

CA: Nurse Hill says that none of these three things occurred [in the initial medical assessment]

Dr Runacres: Ms Hills is a liar

CA: She has told this inquest that you did not get out of your chair

Dr Runacres: Ms Hills is a liar

#JusticeForVeronicaNelson

CA asks the witness if he made a formal assessment of Veronica's level of consciousness using the Glasgow Coma Scale.

The witness gives evidence that the accepted way you would measure consciousness is to ask the patient to talk with you and walk down a corridor with you

CA: You've seen some footage of her walking around, but you don't have any info to rely on that she was talking to you do?

Dr Runacres: There is a document that she signed

Yesterday Ms Hills gave evidence that she had to assist Veronica in signing the medical consent form

CA: As far as you're concerned, do your records indicate to you that [Veronica] was well enough to go to prison [rather than being transferred to hospital]?

W: Yes. Well enough to go into the prison

#JusticeForVeronicaNelson

CA: Ms Hills has told the court that [Veronica] was not asked questions about alcohol and smoking. Is it possible that in fact you just repopulated or pre- populated that [section of the assessment and] you haven't asked those questions?

Runacres: Yes

#JusticeForVeronicaNelson

We are told that Veronica's weight was recorded at 40.7kg in the med assessment conducted by Dr Runacres

CA: How was that figure arrived at?
R: Scale in the room
CA: Nurse hills has told us that Veronica did not get weighed
R: I don’t make up data - that is reprehensible to say

Counsel Assisting: Nurse Hills has said that while Veronica was in the assessment she was unable to sit up in the chair and she was slumped over. Is there something you wish to say in response to that now?

Dr Runacres: No

#JusticeForVeronicaNelson

CA: Nurse Hills has said she had to physically support [Veronica] in order to take her blood pressure

Dr Runacres: I don’t recall the assessment, so I can’t comment on what Ms Hills did

#JusticeForVeronicaNelson

Counsel Assisting: Nurse hills said that she was fading in and out of consciousness.

Runacres: that’s a ridiculous statement

#JusticeForVeronicaNelson

CA: As we understand it, you agree that you had a conversation with nurse Hills about the potential escalation of [Veronica's] care?

R: I don’t recall that convo. I found Nurse Hills to be excitable easily. Alarmed easily. I don’t place a lot of value on her medical judgement

Dr Runacres states he does have some memory of a convo with Hills about escalating Veronica's care

CA asks if he said to Hills "I'm the doctor, I will make the decisions"

R: I don’t believe I said that to her. I would go back to what I said that Hills is easily excitable

CA: there was no notation by you that [Veronica] required any special observation is that right?
Runacres: thats correct
CA: And no record by you that she needed any further medical review?
Runacres: I did not direct any further review
#JusticeForVeronicaNelson

Counsel Assisting: Do you accept that opiate withdrawal can be fatal?

Dr Runacres: I don’t believe you can die from an opiate withdrawal, but I would need to take some advice on that. It would be very rare and very unlikely.

#JusticeForVeronicaNelson

We hear evidence about the meds that Dr Runacres prescribed to Veronica in his med assessment - paracetamol, anti nausea meds and suboxone

CA: So twice a day Panadol effectively if she needs...to alleviate the pain of heroin withdrawal... as part of withdrawal
R: Absolutely

Counsel Assisting asks about Veronica's dose of suboxone

CA: Does the dosing that you provide have any relationship to Veroncia’s length/extent of drug addiction?
R: One size fits

We hear there is a standard dose according to the Correct Care Opioid replacement policy

CA is now asking questions about the medical consent form

CA: This is a consent to medical treatment form that would normally be signed in the assessment. Nurse Hills told us that Veronica had troubled singing the document

Runacres: I don’t recall

#JusticeForVeronicaNelson

Counsel Assisting: We have evidence from a CO that they said to a Dr that Veronica was very sick

Runacres: I don’t recall that

Counsel Assisting: Officer Watts asserts that you said in response “how many prisoners do we see withdrawing”

#JusticeForVeronicaNelson

CA puts to Dr Runacres that docs indicate that Veronica's med assessment took a total of 13 mins

R: I disagree
CA: You say that it went longer?
R: I saw her in the assessment hall, thats part of the assessment. I walked down the hall with her which is part the assessment

Counsel (Q) Andrew Woods, representing Percy Lovett, Veronica’s Partner is now asking Dr Runacres questions

Q: Do you recall when you found out that Veronica had passed away?

Runacres: I don’t recall

#JusticeForVeronicaNelson

Q: Did you record any statements upon hearing that Veroncia had died?
R: No
Q: On the 19th of Sept when you made your statement, you didn't have any memory of saying Veronica?
R: No
#JusticeForVeronicaNelson

Q: Hills has a specific memory and on this occasion she said to you Veronica needed to go to hospital?
R: I am aware she has made that statement
Q: Are you aware that Hills took notes pretty much immediately after hearing about Veronica’s death
R: No
#JusticeForVeronicaNelson

Q: Given Nurse Hill's specific recollection of a convo with you, given the fact that you don't have a memory of the convo...given that Nurse Hills took notes shortly after Veronica died would you defer to her...as correct?
R: Nurse Hills and I had a very fractious relationship

Counsel puts to Runacres that 2 COs and a psychiatric nurse have given statements of Veronica being very unwell in time proximate to Hill’s observation

R:...She is withdrawing from heroin and it’s uncomfortable but I wouldn’t send her to hospital based on those symptoms

Counsel: You are aware that Hills was so concerned that after you left for the evening she essentially overrode your decision to allow Veronica go into the Yarra unit and said she should stay the night in the medical unit?

Runacres: Yes

#JusticeForVeronicaNelson

The initial med assessment took place on 31 Dec

Q: Do you recall what you were doing on NYE in 2019?
R: I would have been home and in bed by 10pm
Q: Have you checked emails and texts...to consider whether or not you were going off to a social function?
R: I don’t celebrate NYE

Q: 1 of the things the Coroner has to grapple with in this proceeding is whether [Veronica's] treatment was impacted by her drug use, her Aboriginality, and her criminal history. I suggest...that Veronica did present as unwell as nurse Hills said...I take it you disagree?
R: Yes

Q: With your approval of sending [Veronica] to the Yarra Unit, you did so in part because of an innate view that you held as to her being an inferior or unimportant person because of her Aboriginality. Do you accept that?
Runacres: No
#JusticeForVeronicaNelson

Q: I'd also suggest to you that the decision that you made in relation to approval to move [Veronica] to the Yarra Unit and not go to hospital was affected by your view of Veronica as being inferior and unimportant because of a history of drug abuse, yes or no?
R: No

W: I'd suggest to you that your decisions were affected by your view of Veronica as inferior and unimportant because of her criminal history, yes or no?
R: I didn’t know her criminal history
#JusticeForVeronicaNelson

Stella Gold, Counsel for Aunty Donna, Veronica's Mum, is now asking qs

Q: We've heard quite a lot of evidence from you today about not remembering at all...Is there nothing at all you remember about her sitting here today, you just can't recall a single thing?

R: No ma'am

Q: We've heard from more than 1 witness that they were shocked when they saw [Veronica] because of her physical condition...this isn't a medical opinion, this is a human reaction....Your evidence is you...just didn't didn't create a memory at all?

R: I didn’t create a memory

Q: I want to focus in on when you first learned of Veronica's passing and I think your evidence just a moment ago was that it was weeks after Veronica died?

Runacres : Possibly, I don't know.

#JusticeForVeronicaNelson

Gold asks further qs about when Dr Runacres recalls learning about Veronica's death

Q: Do you think it's likely it's the next time you went back to work in the prison?

R: It could have been

Q: Are you able to tell us when you next had your shift in the prison?

Q: No

Q: There was a formal debriefing on the 16th Jan...Were you invited?
R: I don’t know
Q: Did you attend that formal debriefing?
R: I don't remember
Q: I’d suggest you would remember if you'd attended, or that's also something you've forgotten?
R: I've just said I don't remember

The witness gives evidence that he recalls having a discussion with the Chief Medical Officer (Dr Blair) about Veronica's cause of death

Q: Did that cause you at that time to go back and pull up [Veronica's] records?

R: I don’t recall

#JusticeForVeronicaNelson

Counsel for Aunty Donna asks if Dr Runacres can picture in his mind what Veronica looked liked

Explaining why he has no such memory, "This wasn’t a traumatic event for me. I saw somebody that I thought was unwell, that I prescribed some medications for. I never saw them again"

Q: You've given evidence that...you didn't have a personal recollection of Veronica. Why don't you say that in the statement?

R: I don’t know

Q: I want to suggest to you that reading it, it seems...it's written in a narrative form by someone who has a personal recollection

Q: Given your memory is as it is...the best record is the notes?
R: Yes
G: You accept with respect to the JCare notes you have not complied with your professional obligation to take accurate notes?
R: Yes
#JusticeForVeronicaNelson

Q: What I want to suggest to you is...minutes after your consultation, Veronica vomits profusely. Did you know that before you left?
R: I knew she was vomiting
Q:Where's that in your notes?
R: Its not
Q: So is that a recollection?
R: Everyone had told me

Q: You've given evidence that opioid withdrawal is rarely fatal
R: Yes
Q: You must know that dehydration can be fatal
R: Yes
Q: Would you agree that someone who can't keep down fluids orally needs to be escalated?
R: If the medication works I don’t need to escalate

Earlier Runacres used a car analogy explaining his call not to escalate Veronica's care:
If your car broke down and a mechanic said you need petrol...you wouldn't have the car towed until you tried the petrol. It's appropriate that Veronica had the meds before [going] to hospital

Counsel for Aunty Donna: The submission that we will be making ultimately...is that the 13-14 minutes that you were with Veronica was an insufficient amount of time to do all the things that you have recorded that you have done

Dr Runacres: I disagree

#JusticeForVeronicaNelson

Counsel for Aunty Donna: The better explanation for that is in fact what Ms. Hills says, that you just didn't do it.

Dr Runacres: I have rejected the assertions of Ms Hills

#JusticeForVeronicaNelson

Counsel For Aunty Donna: Aunty Donna will likely submit that you failed your duty of care of providing a basic level of medical care. Would you agree with that?

Dr Runacres: I reject her position politely.

#JusticeForVeronicaNelson

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