Death in custody preventable: Coroner
A coroner in Victoria has found the death in custody of 30-year-old Aboriginal woman Heather Calgaret was preventable.
Ms Calgaret died in November 2021 after a doctor prescribed an opioid substitution drug buprenorphine, what the coroner Sarah Gebert declared was inappropriately prescribed medication.
“Not only was Heather’s passing preventable, she should never have passed in the manner she did,” Ms Gebert said.
Ms Gebert had sought access to opioid substitution therapies because she wanted to ensure she would stay off drugs once she was released from prison, the inquest was told.
Her sister Suzzane Calgaret, who was in the same prison, was unable to wake her and raised the alert.
Heather Gebert was rushed to Sunshine Hospital, but had already suffered an irreversible brain injury.
The coroner found the doctor who prescribed the opioid substitution drug buprenorphine did not follow the correct guidelines.
