Family tells inquest young mother 'died of a broken heart' as system failed to protect her

The NSW Coroners Court has handed down the findings of an inquest into the 2023 death of a young Indigenous mother who, according to her family, "died of a broken heart".

During the inquest held in Port Macquarie in November, the court heard the woman died five weeks after she was assaulted at a licensed venue in northern New South Wales.

The court has restricted publication of the names of those involved.

Speaking after the inquest, a family member said the system failed to protect her.

The comment echoed medical evidence heard during the inquest, that the woman could have suffered takotsubo cardiomyopathy, also known as "broken-heart syndrome", caused by severe emotional or physical stress.

The inquest examined whether there was a causal link between the woman seeing the person who had previously assaulted her and the medical events leading to her death.

In her findings, Deputy State Coroner Rebecca Hosking said she could not rule in or rule out the possibility that the woman had a predisposition to ventricular fibrillation, a life-threatening irregular heart rhythm, which, combined with an accumulation of stressors, contributed to her collapse.

Assaulted

The inquest heard the woman was assaulted at the venue just before midnight in mid-2023 and appealed to a female employee, "help me, I am going to die".

The court was told the assailant made threats as she was being escorted from the venue, saying: "I am not done with you."

Counsel assisting the coroner Donna Ward said the assault was "nothing short of horrific".

Notes from the woman's initial hospital assessment stated her face was swollen and bruised and she had a laceration under her left eye.

She reported having a headache, but her neurological observations were normal and she was deemed safe to be discharged from hospital at 2:14am.

Emotional stress

The court heard that while the woman was in hospital, her mother called police to report the assailant was outside their house.

The inquest was told the woman became aware of a video of the assault that was circulating on social media the next day, and another video including death threats.

An apprehended personal violence order (APVO) was taken out, naming the woman as a person in need of protection.

The person subject to the order was prohibited from entering the street in which the woman lived, and the attacker was later convicted of assault over the incident at the venue.

The coroner noted that the day before the woman died, her brother was assaulted by someone known to the person who had previously assaulted her.

The inquest heard the woman and her mother had to sit against the door of their house as the second assailant banged on the door trying to get in.

Protection order breach

On the day the woman died, approximately five weeks after she had been assaulted, she was coming home from the supermarket with her mother, father and young son in the car.

Coming into their street, she saw the car of the person subject to the APVO.

The woman asked her mother to turn the car so she could capture footage to report the breach of the APVO to police.

She collapsed and dropped her phone while filming the incident, and the recording continued as she was driven to hospital.

Doctors cited the recording while giving evidence that the cause of death was cardiac arrhythmia, first confirmed as ventricular fibrillation.

Broken heart syndrome

The coroner noted the woman was suffering emotional and psychological distress as a result of her assault, the footage circulating in the community and her brother's assault.

The findings stated:

"These factors likely contributed to an adrenaline surge which peaked on seeing [her assailant] on the day of her death. This was the trigger for [her] collapse….That said, the adrenaline surge on its own does not explain why [she] fell into an arrhythmia this day"

Three doctors giving evidence to the inquest said the woman's death was caused by fatal cardiac arrhythmia triggered by severe emotional or mental distress, potentially due to an underlying predisposition to developing an arrhythmia.

Neurologist and epileptologist Mark Cook gave evidence that the woman had potentially suffered from a stress-induced syndrome such as takotsubo cardiomyopathy.

Known as "broken heart syndrome", it occurs when the heart muscle becomes suddenly stunned or weakened, often following severe emotional or physical stress

"The cardiac event may have been precipitated by extreme emotional stress, superimposed on a background of anxiety and trauma following the assault," Professor Cook said.

Cardiologist Mark Adams and emergency medicine specialist Anna Holdgate said takotsubo cardiomyopathy was unlikely as the woman would have complained of chest pains prior to her death, and there would have been changes to her heart evident during the post-mortem.

The coroner found that the "evidence ultimately was not persuasive in relation to takotsubo cardiomyopathy" and that while it was likely the woman suffered an underlying predisposition to arrhythmia, the nature of the predisposition was unclear.

Bereavement procedures

The family of the woman told the inquest her death was made more distressing by hospital procedures arising from police initially declaring the death suspicious.

The family had limited access to her body and they were not allowed to touch her.

A family member told the inquest:

The Northern NSW Local Health District is reviewing its policy on family access to loved ones after death, and how hospitals can care for a deceased person.

The coroner directed a copy of the inquest findings be provided to the local health district to help guide its policy as it was being drafted.