Inquest into the death of Robert Sievers

CORONERS COURT OF NEW SOUTH WALES Inquest: Inquest into the death of Robert Theo Sievers Hearing dates: 15 September 2025 Date of findings: 15 September 2025 Place of findings: Coroners Court of NSW, Lidcombe Findings of: Magistrate Harriet Grahame, Deputy State Coroner Catchwords: CORONIAL LAW – mandatory inquest – death in custody – aged and frail inmate – Kevin Waller Unit – Aged Care and Rehabilitation Unit File Number: 2023/00155101 Representation: Assisting team: Sophie Williams, instructed by Lara Shepherd Justice Health Forensic Mental Health Network: Katharine Guilford Corrective Services NSW: Phillip Nixon

Non publication orders: Non publication orders were made on 15 September 2025 A copy of the orders can be obtained on application to the Coroners Court registry.

Findings Identity The person who died was Robert Theo Sievers Date of death He died 12 May 2023 Place of death He died at the Aged Care and Rehabilitation Unit (ACRU) at the Long Bay Hospital, within the Long Bay Correctional Complex, Malabar NSW Cause of death He died of Covid - 19 infection on a background of Type 2 Diabetes and end stage chronic kidney disease Manner of death Mr Sievers died of natural disease while in lawful custody in a NSW Correctional Centre

Table of Contents

Introduction

1. This inquest concerns the death of Robert Theo Sievers.

2. Mr Sievers was 81 years of age when he died on 12 May 2023.

3. Mr Sievers died at the Aged Care and Rehabilitation Unit (ACRU) at the Long Bay Hospital (LBH), within the Long Bay Correctional complex, at Malabar NSW. Mr Sievers was a long term inmate at that facility.

4. At the time of his death Mr Sievers had been in continuous custody since June 2001. He was serving a sentence for the murder of a young woman with whom he had been in a domestic relationship.

5. It appears that Mr Sievers had little contact with the world outside the custodial environment. Towards the end of his life, a social worker from the Justice Health and Forensic Mental Health Network (JHFMHN) facilitated contact with his family and Mr Sievers was reported to have been pleased to speak with his son before he died.

6. Mr Sievers’ family declined to be involved in the inquest process.

7. I offer my sincere condolences to all those who miss Mr Sievers.

The role of the coroner and the scope of the inquest

8. The role of the coroner is to make findings as to the identity of the nominated person and in relation to the place and date of their death. The coroner is also to address issues concerning the manner and cause of the person’s death.1 A coroner may make recommendations, arising from the evidence, in relation to matters that have the capacity to improve public health and safety in the future.2

9. It should be noted that when a person dies in custody in NSW, it is mandatory that an inquest is held.3 The inquest must be conducted by a senior coroner.4 When a person is detained the State is responsible for his or her safety and medical treatment. Given that inmates are not free to seek out and obtain the medical treatment of their choice it is especially important that the care they are offered is of an appropriate standard. Inmates should be provided with the same quality of care that they could access in the community.

1 Section 81 Coroners Act 2009 (NSW).

2 Section 82 Coroners Act 2009 (NSW).

3 Section 23 (1)(a) and 27(1)(b) Coroners Act 2009 (NSW).

4 Section 23 Coroners Act 2009 (NSW).

10. The provision of appropriate services for frail and aged inmates in an issue of considerable importance, particularly as the aged cohort in custody continues to grow in size. The Court was informed that there has been a significant increase in the age of both the custodial and forensic population over the last 10 years.5 JHFMHN acknowledges in its strategic planning that there is a need for improving the availability of suitable aged care accommodation for prisoners. While the Kevin Waller Unit (KWU) and the Aged Care Rehabilitation Unit (ACRU) provides support for a small number of prisoners located in Sydney, other units are clearly required. Care should be provided right across NSW so that prisoners may stay near their families or supports. There should also be an option for accommodation at a purpose-built aged care unit or nursing home for older prisoners, who do not necessarily require daily or high-level hospital care, but who would benefit from living and sleeping in an environment that is comfortable and safe for older people.

11. The general provisioning of appropriate aged care accommodation or nursing home type facilities was beyond the scope of this inquest. For this reason, the Court is unaware of Corrective Services NSW’s most recent planning in relation to this longstanding and important issue.

The evidence

12. The Court took brief oral evidence from the Detective Senior Constable Bonnie James, who was the officer in charge of the investigation. The Court also received extensive documentary material. This material included witness statements, medical and custodial records, photographs, operational documents, policies and procedures, comprising of four volumes.

13. While I am unable to refer specifically to all the available material in detail in my reasons, it has been comprehensively reviewed and assessed.

14. A list of issues was prepared before the proceedings commenced. This issues list noted that there was no apparent controversy in relation to the appropriate s 81 findings. At the same time the assisting team compiled a summary of facts in relation to Mr Sievers’ background and death. That document was circulated to the parties who were asked for their input or comment. A final “Agreed Facts” document was produced. I accept that this document accurately summarises much of the important evidence before me. I adopt its content and have incorporated it into my written reasons. A “Medical Chronology” was prepared by the assisting team and circulated to the parties. The document summarises the medical care that Mr Sievers obtained whilst in custody from February 2016 until his death. The Medical Chronology is annexed to my reasons.

5 See for example, Tab 35 A c “2021-2025 Strategic Plan for Aged Care in Secure Settings”

Personal Background

15. Robert Theo Sievers was born on 17 February 1942. Mr Sievers reportedly grew up in Maitland. His childhood was difficult. A report of Dr Olav Nielssen, dated 18 October 2002, prepared for the purpose of sentencing proceedings states: He reported exposure to violence by his father towards his mother and also physical and emotional abuse by his father. There was a history of admissions to psychiatric hospitals as a teenager and during his early adult life.

16. As a child, Mr Sievers spent time in a boys’ home. I accept that his childhood was at times violent and certainly traumatic. His disadvantage was very significant and is likely to have impacted every area of his life. I have no doubt his trauma background drove his early contact with the criminal justice system.

17. Over the years, Mr Sievers had multiple children with whom he lost contact. In more recent times he had occasional contact with one of his sons. Mr Sievers spoke to his son by telephone in the last weeks of his life.

18. Corrective Services records indicate that Mr Sievers identified as Aboriginal and had occasional contact with Aboriginal Services & Programs Officers during his incarceration.

However limited information is available as to Mr Sievers’ ties and connection to culture.

Criminal History

19. Mr Sievers’ criminal history commenced in 1956, as a juvenile. His criminal offending included, but was not limited to, the following matters.

20. In 1967, Mr Sievers was sentenced to imprisonment for 2 years and 6 months for the malicious wounding of his brother.

21. In 1969, Mr Sievers was sentenced to imprisonment for 2 years for an offence of common assault. The circumstances of the offence were that Mr Sievers entered the home of a sleeping woman, and pulled a blanket off her. After a struggle, the woman ran from the house, carrying her baby. Police found three feet of nylon rope on the bed.

22. On 10 April 1980, Mr Sievers murdered his estranged wife, by the infliction of multiple gun shot wounds. Mr Sievers initially received a life sentence for this offence. On 21 August 1992, his sentence was redetermined by Justice Wood , to one of imprisonment for 12 ½ years, with an additional term of 5 years.

23. On 7 June 2000, Mr Sievers was sentenced in the District Court for supply of cannabis in a quantity not less than the prescribed traffickable quantity. He was sentenced to imprisonment for 18 months to date from 6 June 2000, suspended upon entering into a good behaviour bond for a term of 18 months.

24. On 31 October 2002, Mr Sievers was convicted by a jury for the stabbing murder of Michelle Campbell, a young woman with whom he had been living in a domestic relationship. The murder occurred on 4 July 2000. Mr Sievers received a sentence of life imprisonment. Mr Sievers was granted bail shortly after his arrest for that offence. He returned to custody on 9 June 2001 and has been in continuous custody since that date.

Medical History and Custodial Management

25. At the time of Mr Sievers’ death, elderly inmates were managed by Corrective Services at the following locations: a. The Kevin Waller Unit (KWU), a 26 bed supported living environment within the Metropolitan Special Programs Centre at Long Bay. Security and supervision arrangements at the KWU are the same as for other maximum-security inmates.

However, the KWU was adapted to cater for elderly inmates who require low to medium assistance. JHFMHNprovided medical services to inmates housed in KWU due to their age and medical conditions. The KWU had a satellite clinic attached to the unit to allow for a quicker and more efficient medical response.

b. Long Bay Hospital Aged Care and Rehabilitation Unit (ACRU), sometimes referred to as the Aged Care Unit (ACU), a 15 bed clinic unit that provides inpatient (specialty) aged care assessment and aged care rehabilitation services. The ACRU has operational management of the KWU.

c. MSPC Area 2 – 4 Wing.

26. Mr Sievers had a number of active chronic health conditions. He had been receiving medical attention for each of these conditions for a number of years prior to his death. Mr Sievers had received a neuropsychological assessment in 2017 and there was no evidence of cognitive decline or dementia identified at that time. He retained mental capacity to make his own decisions and as will become clear, at times refused treatment or medical follow up that was recommended.

27. Most significantly, Mr Sievers had end stage kidney disease (first been diagnosed with chronic kidney disease in 2002), Type 2 diabetes (diagnosed in 2009), and congestive heart failure (diagnosed in March 2020).

28. Other active health concerns at the time of Mr Seivers’ death included hypertension, bladder cancer, for which he received a stoma in 2009, and generalised anxiety disorder and depression.

29. Mr Sievers had a history of non-compliance with prescribed medications, and of declining and delaying recommended health care transfers, both within custody and to external hospital settings. He would sometimes refuse food or medication, particularly insulin, if

unhappy, such as with recommendations as to his placement. The opinion of his treating team was that he retained capacity to refuse treatment.

30. Mr Sievers had repeatedly declined to be vaccinated against Covid-19. On 8 March 2022, he was spoken to by Elizabeth Twomey, Nurse Unit Manager of the Aged Care Unit, and advised that his treating team recommended vaccination due to his health conditions. Mr Sievers stated: “what’s the point, I don’t want to prolong being here and I’m never getting out.”

31. Mr Sievers was managed by the JHFMHN Aged Care and Palliative Care Services team from approximately July 2021.

32. On about 3 March 2022, Mr Sievers was referred to the Aged Care Bed Demand Committee (ACBDC) for consideration of admission into the ACRU. The referral was made due to a noted functional decline requiring increased assistance that was unable to be provided in the general population. Mr Sievers was admitted to the ACRU on 4 March 2022.

33. Following assessment by the medical, allied health and nursing teams at ACRU, Mr Sievers was discharged to the KWU on 15 April 2022. While housed at KWU, Mr Sievers remained under the care of Aged Care and Palliative Care Services.

34. In 2022, Mr Sievers was admitted to Long Bay Hospital on two occasions. His six week admission in March to April 2022, was for a febrile illness with hypotension and functional decline.

35. The records disclose that while Mr Sievers wanted to be housed in the KWU, he faced a number of issues. There is evidence that he had ongoing challenges with mobility, falls and showering. He was reluctant to use a shower chair and refused showering at times.

The management of his stoma was challenging, and he experienced oedema but declined the use of compression socks.

36. In November 2022, Mr Sievers twice declined advice that he should be referred to the ACRU given his increased frailty and medical needs. He had two recent falls. Ultimately the transfer occurred on 21 November 2022 against his wishes. Once there, Mr Sievers refused his insulin, stating that he wouldn’t take it unless he was returned to KWU. In consultation with Dr Sim, Mr Sievers was cleared to return to KWU in late December, on the condition he comply with his medications.

37. On 27 February 2023, Mark Thorsby, JHFMHN Social Worker (Palliative Care), met with Mr Sievers, together with Occupational Therapist Anai Mackenzie. Notes of the meeting record “[Mr Sievers] reported that he does not feel the medical and nursing staff care about his wellbeing and that he rarely gets seen when he is unwell”. Mr Sievers was offered

assistance and information about lodging a formal complaint should he wish to do so. A plan was made to follow up on various health concerns Mr Sievers had raised. Mr Sievers was agreeable to Mr Thorsby attempting to contact his family members and sharing information with them about his health status. Mr Thorsby also agreed to reach out to a former inmate with whom Mr Sievers had shared a close bond.

38. Mr Thorsby was successful in contacting Mr Sievers’ granddaughter and son, David Sievers. On 8 March 2023, Mr Thorsby facilitated a phone call between Mr Sievers and David Sievers.

39. Mr Thorsby attended the inquest by telephone link. It was clear that he had spent considerable time with Mr Sievers in the last months of his life. He took his complaints seriously and his respectful approach meant that they had developed a rapport. Mr Thorsby did what he could to facilitate contact with Mr Sievers’ family. I acknowledge his compassion and diligence.

40. On 3 April 2023, Mr Sievers was discussed at the Palliative Care Multi-Disciplinary Team meeting. He was noted to be stable, and a plan was made for social work to liaise with his family, and for ongoing palliative care input.

41. At the time of his death, Mr Sievers had an active not for resuscitation order, made on 2 November 2021, and updated on 25 October 2022, and 15 November 2022. The file makes it clear Mr Sievers understood the meaning of these declarations.

Events leading up to Mr Sievers’ death: 1 – 12 May 2023

42. On 1 May 2023, Mr Sievers tested positive for Covid-19. He was prescribed anti-viral medication, which he consented to taking. He declined to be transferred from KWU to the Medical Sub-acute Unit (MSU) at Long Bay Hospital.

43. Mr Sievers initially experienced mild Covid-19 symptoms. However, over subsequent days his condition deteriorated. He was non-compliant with his insulin, behaviour which was not unusual for him from time to time. He was frustrated at being kept in isolation.

44. On the morning of 6 May 2023, Mr Sievers had a fall in his cell. He declined transfer to the Prince of Wales Hospital or Long Bay Hospital, where he could receive 24 hour care and supervision.

45. On 8 May 2023, he expressed some suicidal thoughts and was reviewed by a psychiatrist, to whom he denied any specific plans.

46. On the morning of 9 May 2023, he had a further fall. He resisted advice that he should be transferred to the ACRU at Long Bay Hospital, or the MSU. He was permitted to remain at the KWU, provided he agreed to take his insulin and prescribed medications. Mr Thorsby

spoke with Mr Sievers about his decision to remain at KWU. He stated that he felt that the ACRU would not help him.

47. On 9 May 2023, a Palliative Care Summary Sheet was completed. It is clear from the form it was subsequently updated. The palliative diagnoses listed on the form were as follows: COVID + for 10 days (11/5/23) End stage Kidney disease eGFR 9, non-dialysis pathway Ischemic Heart Disease Possible haematological malignancy with nephrotic range paraproteinemia

48. The form noted Mr Sievers had declined to make an Advanced Care Directive, and that he did not want to leave the Long Bay complex for any reason including lifesaving medical support. It recorded he was aware he had an end stage disease but preferred to “focus on present and limit EOLC discussions”.

49. On 10 May 2023, Mr Sievers continued to decline transfer to the ACRU in the morning, however consented to be transferred to the ACRU in the afternoon, acknowledging he needed more care and support. That night, his condition deteriorated rapidly.

50. An entry on Mr Sievers’ Justice Health electronic record (JHeHS) made at 4:25 am on 11 May 2023 noted he had been unsettled overnight and knocked up multiple times complaining of back pain. It noted he had been administered his regular analgesic with some effect. Reassurance and emotional support had been provided.

51. On the morning of 11 May 2023, he was given morphine, oxycodone, and midazolam by phone orders.

52. A JHeHS entry made at 12:33 pm noted Mr Sievers was agitated and swearing intermittently, complaining of ongoing pain, and “incoherent most of the time.” He was not tolerating food and fluid intake was minimal.

53. He was reviewed by Medical Officer Dr Welkee Sim at approximately 1.30 pm. Dr Sim was responsible for the clinical management of elderly patients in the ACRU and KWU. Dr Sim noted “acute deterioration this morning with increased agitation, hypoxia and generalised pain.” On examination Mr Sievers was breathless and “looked terminal”. He was more settled after receiving morphine.

54. Dr Sim documented a plan that Mr Sievers was for palliation and was not appropriate for CPR, ICU, intubation or antibiotics. Observations were to cease.

55. At 2 pm, a Comfort Observation and Symptom Assessment Chart (COSA) was commenced. Morphine was to be administered for pain and palliation, in the amount of 2.5

mg every 4 hours. Midazolam, for agitation, was prescribed in the amount of 2.5 mg every 6 hours.

56. At 3.15 pm, Mr Sievers was reviewed by a Palliative Care Team nurse. He was noted to be in “terminal phase AKPS 20”. This assignation means that death is likely in a matter of days and no acute intervention is planned or required. It reflects that a patient is totally bedfast and requiring extensive nursing care. The documented end of life care plan was for regular morphine and midazolam, to commence the COSA (Comfort Observation and Symptom Assessment), cease observations, undertake regular turns and contact his son.

57. At 4.10 pm Mr Sievers’ regular medications stopped. He was no longer able to take medications for cholesterol and hypertension as he was “nil by mouth”. His insulin was noted to be “no longer required”.

58. At about 4.30 pm, telephone contact was facilitated between Mr Sievers and his son, David. Mr Thorsby, the Justice Health social worker, then spent about an hour with Mr Sievers to provide company and support.

59. At 4.45 pm, Dr Sim prescribed additional morphine and midazolam on a PRN basis, or as needed, upon indication of pain and shortness of breath.

60. Throughout the evening and overnight, Mr Sievers received comfort care and attention from JHFMHN nurses approximately at least every 2 hours.

61. At 11:04 pm on 11 May 2023, Registered Nurse Prakesh Gc made the following entry in Mr Sievers’ JHeHS: Pt was given regular morphine at 22:25 hrs as charted via butterfly on L abdomen.

S/C butterfly day 0. VIP score 0.

Pt looks comfortable, nil sign of pain and distress. PAC attended with assist x 2 nursing staff.

Oral and eye care also attended, looks comfortable ATOR

62. At 3:15 am, RN Gc made the following JHeHS entry: Patient was checked for his comfort. Pt denied of any pain when asked – said no.

Pts PAC attended – turned to L side. Pts oral and eye care also attended. Pt was slightly hot to touch and sweaty – extra blanket removed.

Pt looks comfortable ATOR.

63. At 5:01 am, RN Gc made the following JHeHS entry: Pts respiratory rate bit high- Oral cavity get try very quick as patient breathing through mouth. Same moisturized. PAC attended. Looks comfortable.

64. At approximately 5.10 am, RN Gc attended Mr Sievers’ cell and assessed that Mr Sievers had passed away. CO Erik Landman, shift supervisor, was called to attend. RN Gc conducted a physical examination in the presence of CO Landman and confirmed Mr Sievers was deceased at 5.15 am. A life extinct declaration form was certified by RN Gc.

65. Having reviewed the records of this terminal phase of care, I find it was appropriate in all the circumstances.

Events following Mr Sievers’ death

66. At 5.15 am, a Death in Custody Time Log was commenced. A body cam facing the cell was activated, and the cell was secured. Police were notified of the death at approximately 5.20 am, via contact with Maroubra Police Station.

67. At approximately 5.35 am, Functional Manager Brian Gough was notified of the death.

68. At 6.35 am, general duties police and investigators attached to Eastern Beaches Command attended the Long Bay complex. At 7.26 am, Police Officers attended the cell in which Mr Sievers was housed at the ACRU.

69. At 10.31 am, Mr Sievers’ body was removed from the Long Bay complex by contractors.

The cell in which Mr Sievers had been housed was locked and secured by Police.

Post mortem examination

70. On 16 May 2023, a post-mortem examination was carried out on by Dr Jennifer Pokorny.

Her findings noted:

1. History of end stage kidney disease, with changes in kidneys in keeping with a history of chronic kidney disease seen on post-mortem CT scan

2. Type 2 diabetes mellitus: medication refusal with increase blood glucose and ketones, and

3. Covid-19 infection, with bilateral lung consolidation present on post-mortem CT.

4. Dr Pokorny had access to the medical records. She identified the direct cause of death as Covid-19 infection on a background of Type 2 diabetes and end stage chronic kidney disease. I accept her opinion.

Relevant policies and procedures

72. Corrective Services Custodial Operations Policies and Procedures (COPP 3.10) “Aged and frail inmates” was relevant to the management of Mr Sievers in custody. Mr Sievers

met the definition of an “aged and frail inmate” within subsection 1.1 of this policy. In accordance with the policy, Mr Sievers had been the subject of assessment by the ACBDC. Placement decisions for all aged and frail inmates are made by the ACBDC. The implementation of case plans for aged and frail inmates is the joint responsibility of Corrective Services and JHFMHN.

73. The Offender Management & Programs policy for the “Placement of Aged and Frail Inmates” also applied to Mr Sievers. It provides further detail surrounding the identification, assessment, eligibility and referral of inmates to the ACBDC.

74. The following Sections of the COPP applied to Mr Sievers death and the surrounding circumstances: a. 13.1 Serious Incident Reporting; b. 13.2 Medical Emergencies; c. 13.3 Deaths in Custody; d. 13.8 Crime Scene Preservation.

75. Following Mr Sievers’ death, COPP Section 6.13, End of Life Care for Inmates, was published on 24 November 2023. This policy provides for the application of various considerations for an inmate approaching end of life, and introduces policies and procedures in relation to Voluntary Assisted Dying.

76. The Justice Health End of Life Care, Resuscitation Plans and Advance Care Directives policy dated July 2018 applied to the management of Mr Seivers’ end of life care decisions.

This policy was updated in July 2023.

77. Other relevant JHFMHN policies and procedures in place at the time of Mr Sievers’ death include: a. Palliative Care Model of Care, February 2022; b. Managing Patients with a Chronic Condition in Custody, February 2021 (updated in October 2023); c. Consent to Medical Treatment – Patient Information, November 2019; d. Immunisation of Patients; e. Long Bay Hospital Admission Policy (Referral, Admission and Assessment), January 2019 (updated November 2023).

78. I have reviewed the policies provided and it appears that Mr Sievers’ medical care was managed in line with the relevant policies in place at the time.

Was the final care offered to Mr Sievers appropriate?

79. As previously stated, the court is aware that the number of aged, frail and chronically ill inmates in NSW is increasing both in absolute numbers and as a proportion of the prisoner population. The care of this cohort in a custodial environment presents challenges to both custodial and health staff. In recent years there have been calls to provide better overall services for aged people in gaol. It is clear, for example, that the hard beds and the basic bathrooms facilities present real difficulties for aged prisoners even those without acute or life threatening medical issues.

80. Mr Sievers clearly met the definition of an aged and frail inmate within the relevant policy.6 He was appropriately referred to the Aged Care Bed Demand Committee. Once he was identified as requiring palliative care, he was treated in accordance with the relevant policies, including the Palliative Care Model of Care.

81. It appears clear that Mr Sievers had a history of refusing or delaying recommended health care transfers. At times this may have exacerbated his health issues. He also refused treatment at times, including vaccination for Covid-19, a disease which ultimately contributed to his death.

82. He was managed by the Aged Care and Palliative team from July 2021, and when he was referred for consideration for admission to the ACRU early the following year, the admission was rapid. Once assessed he was discharged to the KWU, in accordance with his very strong preference. It appears from the evidence that from that time Mr Sievers remained reluctant to leave the KWU, and aside from the two admissions described above, he remained there until his transfer to the ACRU on 10 May 2023.

83. Mr Sievers received appropriate medical care in the period preceding his death.

Findings and Recommendations

84. For reasons stated above I make the following formal findings pursuant to section 81 of the Coroners Act: Identity The person who died was Robert Theo Sievers Date of death He died on 12 May 2023 Place of death 6 Subsection 1.1, Chapter 3.10 COPP

He died at the Aged Care and Rehabilitation Unit (ACRU) at the Long Bay Hospital, within the Long Bay Correctional Centre Cause of death He died of Covid-19 infection on a background of Type 2 Diabetes and end stage chronic kidney disease Manner of death Mr Sievers died of natural disease while in lawful custody in a NSW Correctional Centre.

Conclusion

85. Finally, I offer my condolences to those affected by the death of Robert Sievers. I acknowledge the compassionate work of his social worker, Mr Mark Thorsby. I accept Mr Thorsby developed a rapport with Mr Sievers and I thank him for his care for this vulnerable man.

86. I thank the officer in charge, Detective Senior Constable Bonnie James for her thorough investigation.

87. I thank the assisting team Mr Sophie Williams and Ms Lara Shepherd for their hard work preparing this inquest.

88. I close this inquest.

Magistrate Harriet Grahame Deputy State Coroner, NSW State Coroner’s Court, Lidcombe 15 September 2025

Inquest into the death of Robert Sievers Medical Chronology:7 May 2023 – February 2016 2023 Incident/witness At approx. 5:30, Night Senior, Senior Correctional Officer Erik report, p.874-877 (12 Landman, at Long Bay Hospital (‘LBH’) informed staff that Sievers May 2023) – had been declared life extinct by Justice Health (‘JH’).

Tab10(HF) Sievers was housed in the Aged Care Rehabilitation Unit (‘ACRU’) cell 6.

General Note, 11 May Sievers in unstable phase – likely terminal 2023 – p. 243-244 – Sievers stated he wants to stay at Long Bay and not wanting Tab 36 hospital transfer General Note, 11 May Sievers given 5mg oxycodone and 2.5mg morphine – given nasal 2023 – p. 245-247 – prong oxygen at 0.5L/mind Tab 36 Decreased consciousness; unable to move limbs independently General Note, 11 May Sievers has notable work of breathing and using accessory 2023 – p. 256-257 – muscles to breathe Tab 36 Sievers for comfort measures only – Endone given with poor effect; morphine given with good effect; Midaz given with good effect General Note, 11 May Sievers knocked up multiple times overnight. Reported back pain.

2023 – p. 227 – Tab Attended to multiple times and provided ‘reassurance and 36 emotional support’.

General Note, 11 May Phone order taken for stat dose of 2.5mg morphine for back pain 2023 – p. 230 – Tab SOAP, 11 May 2023 – Sievers agitated and swearing intermittently – words incoherent p. 233-235 – Tab 36 Not tolerating food intake and minimal fluid intake Observed, mouth breathing, short staggered breath/gasps Health deteriorating – to be attended 2 hourly, mouth care to be attended General note, 11 May Sievers refusing his food and medication, especially insulin 2023 – p. 238-239 – Did not want to be transferred to Prince of Wales Hospital Tab 36 (‘POWH’) Sievers had an acute deterioration of his condition since transferring to ACRU –appears breathless and terminal Plan to start regular morphine and midaz SOAP, 10 May 2023 – Sievers transferred from Ken Waller Unit (‘KWU’) to ACRU in p. 225-226 – Tab 36 wheelchair 7 This is a summary of medical records contained in the brief of evidence. This summary does not refer to all entries in the medical records.

General Note, 10 May 2023 – p. 221 – Tab General note, 10 May Sievers stated he needs more care and support and is ready to 2023 – p. 222 – Tab be transferred from KWU - transfer to occur when bed available General Note, 10 May Sievers stated he has not eaten but is tolerating fluids 2023 – p. 219-220 – Sievers reports thoughts of self harm to Corrective Services NSW Tab 36 (‘CSNSW’) staff Sievers continues to refuse transfer from KWU to ACRU – reassurance given with little effect Case Note Report, After Risk Intervention Team (‘RIT’) review was conducted, the p.955 (10 May 2023) KWU Nurse Unit Manager (‘NUM’) made a referral to move – Tab 10HH Sievers to LBH ACRU palliative care due to his physical health declining.

General Note, 9 May Sievers had fall overnight – Sievers knocked up in the morning 2023 – p. 199 – Tab requesting painkiller. Endone given 36 Sievers refused vitamin supplements and insulin Sievers verbalised frustration with care General Note, 9 May Sievers’ mood deteriorated – he externalised his frustration by 2023 – p. 200-202 – intermittently refusing medication and/or insulin.

Tab 36 Sievers had fall overnight – NUM discussed transfer to ACRU where he can receive 24 hour nursing care – Sievers refused Sievers denied current suicidal ideation but stated he had had enough as no one looks after him/does anything for him and he cannot receive pain relief through the night NUM stated that if he transfers to ACRU nursing staff could assist him through the night – Sievers refused General Note, 9 May Sievers reviewed at KWU by Dr Sim, Corrective Nurse Clinician, 2023 – p. 203-204 – NUM Liz Twomey, Registered Nurse (‘RN’) and Palliative Care Tab 36 Social Worker Plan: Sievers to remain at KWU as agreeable to taking medication/insulin as required; further review by Palliative Care team; and Endone for 1 week General Note, 9 May Staff recommended transfer to LBH for monitoring and 2023 – p. 205-206 – management – Sievers refused stating “I will do something if you Tab 36 send me” “I want to be let out of here” “you are treating me like a dog” “nobody cares here" Sievers counselled re need to accept treatment to maintain health Sievers continues to refuse insulin General Note, 9 May Importance of compliance with insulin and risks of non2023 – p. 207-208 – compliance discussed with Sievers – 50u given as charted Tab 36 Sievers advised he will only remain compliant if he can remain at

KWU General Note, 9 May Sievers states he does not want to go to LBH MSU as he has 2023 – p. 209-211 – been told he will be treated badly and won’t got to LBH ACRU as Tab 36 it is boring Sievers to remain in KWU – 3 camera cell – on constant monitoring with 15-min physical observations

General Note, 8 May Sievers continuing to decline insulin, also appeared in distress + 2023 – p. 191 – Tab rigors in the AM 36 Sievers reports pain from fall “the other day” Sievers’ unsupervised meds observed on table – states he will only take his meds once he is removed from isolation – NUM informed re same General Note, 8 May NUM noted Sievers in pain due to fall – Sievers refuses to take 2023 – p. 188-190 – Panadol as it “doesn’t work” Tab 36 Discussed need for closer supervision to ensure Sievers is monitored closely – transfer to LBH recommended however Sievers refused Refusal to be transferred from KWU to be discussed with Palliative Care Team NSW Department of Sievers stated that he was tired and that the nurse doesn't care Corrective Services about him, he may as well be dead for all the care the nurse has Incident Details - shown him. (p.1061) Cooper, 8 May 2023 - Tab10(HN) SOAP, 9 May 2023 – RN received call from Metropolitan Special Purpose Centre – p. 215-216 – Tab 36 Area 1 (‘MSPC1’) as Sievers had fallen out of bed and slid onto floor. Sievers states his mobility has reduced, denies hitting head and reported of pain in left foot Case Note Report, Sievers stated to nurse that he wants to take his own life. Sievers p.954 9 May 2023 – unable to eat, looks pale. Sievers to remain on 15min physical Tab 10HH observations and constant electronic obs.

General Note, 8 May Sievers seen by psych – Sievers denying acute suicidal intent and 2023 – p. 196-198 – has reduced mobility/means to complete, he is at risk due to Tab 36 acute situational stressors in the context of multiple medical comorbidities, general physical decline and prison sentence.

Sievers to be in camera cell o/night and psych to flag urgent review for AM General Note, 8 May RN reported that Sievers has expressed suicidal thoughts – 2023 – p. 193 – Tab ROAMS Psych phones Sievers General Note, 8 May Sievers was screaming and calling out due to frustration and 2023 – p. 194 – Tab stated he is in pain – Endone given 36 Sievers states he was having suicidal thoughts – 24 hour monitoring and RIT placement until review by mental health (‘MH’) nurse in the AM Correctional Officer (‘CO’) informed that Sievers to be placed on RIT – CO reluctant re same and will discuss with after-hours nurse manager SOAP, 7 May 2023 – Sievers continued to refuse insulin and stated he had not eaten p. 184-185 – Tab 36 that day due to having no appetite Sievers advised to push fluids Sievers informed that if his condition worsens he will be transferred to POWH

SOAP, 7 May 2023 – Sievers refused AM insulin and stated he was not going to take p. 182-183 – Tab 36 any tablets that day as “they don’t work and get stuck in my throat”. Sievers was advised he can dissolve them in water Urostomy bag was observed to be full and JH nurse offered to empty – Sievers declined SOAP – 6 May 2023 – Sievers refusing evening insulin - informed that he may be p. 179-180 – Tab 36 transfer to LBH or POWH if he doesn’t have any insulin, and that he may become unconscious or die if he continues to refuse – Sievers states “I don’t care” SOAP, 6 May 2023 – Sievers accepted 10u of Novomix 30- (“that’s all I’m having”) – p. 175-176 – Tab 36 usual AM dose is 50u.

Dr Sim informed re Sievers being hyperglycaemic SOAP, 6 May 2023 – Sievers encouraged to take insulin – he refused.

p. 177-178 – Tab 36 Sievers informed that he may need to be transferred to LBH – states “I won’t take a fucking thing if you move me there. I told Liz that.” Dr Sim informed by phone re blood sugar level results and states Sievers should take min 6u of Novomix – Sievers informed of same and agrees to have 6u.

SOAP, 6 May 2023 – Sievers seen by nurse again at 9.30am -offered insulin and p. 171-172 – Tab 36 informed his ketones are high – Sievers refused insulin CSNSW confirms that cell is monitored by CCTV; states that Sievers had a blanket and was lying on the floor SOAP, 6 May 2023 – KWU spoke with CSNSW officer in 7 Wing re what was seen on p. 173-174 – Tab 36 camera overnight CO states that he was advised that Sievers put himself on the ground and was lying there with his blankets Sievers continuing to refuse insulin – informed by JH nurse that he should have insulin regardless of appetite as ketones are high SOAP, 6 May 2023 – Nurse called to cell at 6.30am by CSNSW as Sievers was found p. 168-170 – Tab 36 on the floor. Sievers assisted to bed by CSNSW Sievers states that he fell when he got up to get some water and could not reach knock-up button Sievers encouraged to have insulin as he has continuously refused Sievers offered transfer to POWH or LBH for 24hr supervision – stated: “fuck that. I’m not going to either of them. I’m better off here.” SOAP, 4 May 2023 – Sievers states he has poor appetite and has declined morning p. 161-162 – Tab 36 insulin General Note, 4 May 2023 – p. 163; SOAP, 5 May 2023 – p. 165166; General Note, 5 May 2023 – p. 167 – Tab 36

General Note, 1 May Sievers covid positive and symptomatic 2023 – p. 150 – Tab Sievers refused transfer to Medical Sub-acute Unit General Note, 28 April Sievers refused to have his weekly observations done 2023 – p. 145 – Tab SOAP, 21 April 2023 Left foot observed to be slightly swollen – Sievers reports its – p. 132-133 – Tab 36 ongoing but denies any pain or discomfort.

Sievers advised to elevate legs when sitting down and advised to notify if symptoms worsen SOAP, 14 April 2023 Sievers states he wants to see GP not nurse practitioner (‘NP’) as – p. 121-122 – Tab 36 he has whole body pain– Sievers reported he also wants his medication reviewed by GP.

Sievers’ name placed on PAS waitlist for GP review General Note, 12 April Sievers’ ostomy supply located by CSNSW – Sievers requested 2023 – p. 116 – Tab to keep 2-month supply in room – supplies provided to Sievers.

36 Sievers’ compliance with insulin discussed – Sievers dismissive of same – advised of complications with increased blood sugar levels SOAP, 11 April 2023, Sievers advised of issues with stoma supplies – Sievers reported p. 113-114 – Tab 36 they are liars and he doesn’t trust JH Sievers advised he has 7 bags left and so gave warning that if JH do not supply stoma stock on Friday he will go off medication (including insulin) General Note, 10 April Sievers’ sacrum assessed in clinic – pressure injury stage 1 still 2023 – p. 111 – Tab present – Sievers encouraged to apply dx, but he declined as he 36 “does not need it” General Note, 8 April Blood sugar level checked at 2100hrs – Sievers refused 2023 – p. 108 – Tab supplementary insulin and was annoyed at being disturbed.

General Note, 8 April Sievers attended clinic for blood sugar level and insulin – walking 2023 – p. 107 – Tab as normal and did not complain of feet/leg pains 36 Sievers refused extra insulin as per chart – advised to knock-up if he feels anything abnormal Handover to night nurse to check on Sievers later tonight General Note, 8 April Sievers refused to attend clinic in PM as feet are painful and clinic 2023 – p. 106 – Tab is too far 36 Plan to see Sievers at dinner if feet still painful.

Blood sugar level to be checked and insulin administered in room General Note, 8 April Sievers refused to have blood sugar level checked – insulin not 2023 – p. 105 – Tab administered General Note, 6 April CSNSW unable to locate ostomy supplies – reordered as urgent – 2023 – p. 101 – Tab for delivery early next week SOAP, 5 April 2023 – Sievers refused dressing for pressure injury – nurse examined – p. 97-98 – Tab 36 advised protective dressing recommended, Sievers adamant on not having dressing

Sievers advised to change position to avoid pressure sore and to keep the area clean and dry General Note, 4 April Medical officer (‘MO’) states Sievers’ renal function is at 9% - 2023 – p. 91 – Tab 36 states gradual decline of kidney function – hesitant to prescribe any more medication. MO on leave for 12 months and Sievers will see another specialist during this time.

General Note, 4 April Sievers seen in clinic – continues to refuse insulin – states he will 2023 – p. 91 – Tab 36 take it tonight.

Sievers continues to refuse insulin until his ostomy bags arrive – explained that they should arrive next week – Sievers is concerned as he only has 10 left Sievers advised that he will be put on a RIT if he continues to refuse due to health risk – escalated to NUM General Note, 4 April Sievers’ ostomy supplies sent to CSNSW PO Box – Aus Post 2023 – p. 94 – Tab 36 confirmed same collected – unknown location at present – requested assistance with location of same General Note, 4 April Attended KWU – Sievers continues to refuse insulin – upset re 2023 – p. 95 – Tab 36 ostomy supplies – Sievers advised items ordered and have been delivered to CSNSW but unknown location at present General Note, 4 April RN to call Sievers for phone consult with renal at 10.15am. At 2023 – p. 89 – Tab 36 12.00pm reception called again (called at 11.25 and 11.35) – receptionist asked RN to stop calling. Sievers returned to cell at 12.10pm. RN still awaiting call at time of review (‘ATOR’) General Note, 4 April Sievers refusing to attend diabetic clinic. Problem with supply of 2023 – p. 88 – Tab 36 stoma bags and Sievers refusing insulin. Sievers encouraged to have insulin but still refused. NUM aware.

General Note, 3 April Sievers continues to decline sacrum diagnosis. Sacrum site 2023 – p. 87 – Tab 36 assessed: redness and stage 1 pressure injury still present.

Sievers was told that being diabetic, there are potential consequences re open wounds. Sievers said he is good and not having dressing on.

General Note, 31 Palliative Care OT review – Sievers declined review of pressure March 2023 – p. 77 – area and does not want to use gel pressure cushion for chair.

Tab 36 Equagel previous trialled – Sievers does not like. Education provided on strategies to manage pressure area.

General Note, 30 Sievers complained of pain in sacrum area in clinic. Sievers March 2023 – p. 75 – assessed and stage 1 pressure injury noted. OT emailed re Tab 36 review of pressure relief mattress and cushion.

General Note, 28 Sievers continues to decline any input re shoulder pain and has March 2023 – p. 70 – defeatist attitude.

Tab 36 General Note, 8 Palliative Care Physiotherapy Review – Sievers hasn’t been March 2023 – p. 38- walking much or completing exercises – said: “what’s the point” 39 – Tab 36 and “I’m too lazy” Sievers has received physio treatment for left shoulder pain but didn’t want to do the exercises, stating “I knew they wouldn’t work so didn’t bother”. When challenged about this (“how could you know if you didn’t try them?”) Sievers became antagonistic stating “I just knew ok? Stop bothering me, I know my body”

General Note, 27 Sievers explained to social worker his dissatisfaction with the February 2023 – p. health care he was receiving. Reported that he did not feel the 22-24 – Tab 36 medical and nursing staff care about his wellbeing and that he rarely gets seen when he is unwell.

SW spoke with NUM Liz following visit with Sievers. NUM reported that Sievers is able to visit the clinic if required and is seen by RNs daily.

General Note, 20 Palliative Care Dietician Review Assessment – noted Sievers was February 2023 – p. underweight; signs of moderate subcutaneous fat and muscle 12-14 – Tab 36 wasting globally.

Sievers reports that he does not like meals. Eats 2-3 times per day and sometimes skips lunch.

Sievers has inadequate oral intake – only meeting 30% energy and 60% protein requirements. Sievers encouraged to not skip meals to ensure consistent oral intake General Note, 15 Sievers advised of the complications with non-compliance re February 2023 – p. 3 medications – unwell/pain. Sievers advised that he is compliant – Tab 36 and takes all meds as given by RN daily.

General Note, 7 Sievers seen by POWH endocrinology reg February 2023 – p. Current insulin reviewed – Novomix 30 – 50 units mane and 10 249 – Tab 37 units nocte with evening meal if BGL >14 – RN advised of same via phone Issues re eyes addressed – Polytears eyedrops given General Note, 7 Palliative Care Multi-Disciplinary Team Meeting - Sievers agreed February 2023 – p. to high-risk foot clinic 251 – Tab 37 Type 2 Diabetes poorly managed as Sievers often non-compliant with meds.

General Note, 6 Sievers attended clinic for blood sugar level and insulin – blood February 2023 – p. sugar level at 9.5 pre-dinner; Sievers refused his regular insulin – 247 – Tab 37 this is stated to be normal for him.

Sievers is upset due to nothing being done re eyes and previous eyedrops not effective – Sievers offered Chlorsig but refused same; Sievers requesting to be seen by eye specialist General Note, 3 Blood sugar level 11.5 pre-dinner; Sievers due for 26u – took half February 2023 – p. dose. Sievers states he will eat dinner tonight and has HypoPak 242 – Tab 37 in cell General Note, 2 Blood sugar level 5.3 at 17.00 – Sievers refused insulin as “I won’t February 2023 – p. eat dinner tonight” 240 – Tab 37 Sievers informed to knock-up if he changes his mind and wants insulin – Sievers agrees to same General Note, 29 Sievers refused insulin the whole day; Mircera injection January 2023 – p. 230 administered (next due 1 March 2023) – Tab 37 General Note, 28 Sievers refused Mircera injection and stated “I will have it January 2023 – p. 228 tomorrow” – Tab 37 (Note: Mircera is used to treat symptoms of chronic kidney disease)

General Note, 27 Sievers seen in clinic for blood sugar level and insulin; blood January 2023 – p. 225 sugar level pre-dinner 8.3 – refused insulin and states “I’m not – Tab 37 taking any chances, I know my body” GP/NP to review insulin when next in unit General Note, 24 Sievers refused to have regular insulin as he is not having dinner January 2023 – p. 220 – Dr Sim contacted re same – Tab 37 General Note, 23 Pre-dinner blood sugar level check attended to; Sievers refused January 2023 – p. 217 regular insulin or blood sugar level re-check – Tab 37 Sievers states he is fine and will have dinner in cell; Sievers aware of hypo-symptoms and has hypo kit in cell SOAP, 1 January Sievers refused nocte insulin and states he “may or may not eat 2023 – p. 197-198; dinner”; Sievers refused insulin due to risk of hypoglycaemia – “I SOAP, 16 January won’t eat and then I’ll be hypo in the night” 2023 – p. 202-203 – Sievers advised of need to ensure adequate oral intake or carbs Tab 37 to reduce risk of hypoglycaemia General Note, 14 Sievers informed nurse that he would refuse insulin if his blood January 2023 – p. 195 sugar level was below 10 and stated “I won’t be eating that dinner – Tab 37 tonight” Blood sugar level 7.9 – Sievers refused insulin; unable to convince Sievers to take dose or part dose General Note, 11 Sievers did not receive insulin in AM due to CSNSW lock-in and January 2023 – p. 190 RN overlooking Sievers’ name on list given to CSNSW; Sievers – Tab 37 did not knock-up or inform officers of same Sievers upset by situation; RN apologised Sievers refusing insulin or stat-dose of fast-acting insulin; ROAMS informed of same. Sievers requested note to state that insulin has been withheld rather than refused.

2022 General Note, 29 Dr Sim reviewed Sievers – has not been having insulin regularly December 2022 – p. and has been fussy with food 164 – Tab 37 Novomix 30 decreased to 60 units mane and 26 units nocte; sliding scale charted General Note, 28 NUM spoke with Sievers re recent blood sugar levels – he December 2022 – p. advised he does not like the lunches provided 160-161 – Tab 37 NUM discussed with Sievers recent LBH admission where he was unhappy with diet and wished to return to KWU, also discussed that there has been no change in CSNSW diet and he has been happy to supplement same for many years with buy-ups NUM discussed management of conditions with Sievers and he was advised that erratic changes to compliance may result in the need transfer to hospital SOAP, 26 December Sievers requested RN attend to vitals as he feels dizzy; vitals 2022 – p. 153-154 – attended to - appeared to be at his baseline Tab 37 Pre-dinner blood sugar level attended to; Sievers declined recheck post-dinner and evening insulin General Note, 24 Sievers refused pre-dinner insulin; encouraged to have his dinner December 2022 – p. – said he will have it when he goes to cell 149 – Tab 37

RN attempted to contact ROAMS but could not get through; spoke to Dr Sim re above – Dr suggested withhold insulin Palliative Care Sievers to receive conservative management (non-dialysis Summary Sheet, LBH, pathway); Erythopoietin stimulating agent monthly and 3-monthly 20 December 2022 – bloods p. 7-8; 46-47 – Tab Sievers does not want to leave LBH for any reason – including 30A lifesaving medical support. Sievers aware he has end-stage disease, but wants to limit end of life discussions SOAP, 20 December Sievers compliant with all meds; transfer back to KWU once 2022 – p. 130-131 – stable Tab 37 General Note, 20 Dr Sim clears Sievers for discharge from ACRU December 2022 – p.

132 – Tab 37 General Note, 20 Sievers seen by Nurse Practitioner – NP stated he is looking well December 2022 – p. but has lots of frustration over incarceration-related issues.

137-138 – Tab 37 Wound on left foot examined – has soggy dressing and macerated underneath; no visible signs of infection. Inadine to be ceased; iodine and foam island dressing to commence Cramps improved; weight stable; no pedal oedema Sievers to be reviewed monthly; to see renal specialist and renal supportive care General Note, 19 NUM spoke with Sievers – Sievers advised he wanted to return to December - p. 123 – KWU; NUM informed Sievers that he will need to be cleared for Tab 37 discharge by Dr Sim Sievers happy with plan and insulin administered as charted; Sievers informed that he will need to be compliant with meds to ensure fit return to KWU SOAP, 18 December Sievers refused mane insulin; “I’m not taking it until I go back to 2022 – p. 116-117 – Kevin Waller” and “I don’t like it here” Tab 37 Vitals observed to be “between the flags”; Sievers reported “I feel like I always do”; Sievers informed of the possible consequences of not takin insulin – Sievers stated “I know all that” SOAP, 17 December Sievers states “I don’t want my insulin today”; does not like it in 2022 – p.109-110 – ACRU (“they’re all mad here. I’ve got no-one to talk to”). Will Tab 37 refuse insulin until he is moved back to KWU Sievers informed that transfers don’t occur over weekend and that he would require more frequent monitoring if he refused insulin and may need camera cell. Sievers informed that if he wanted transfer that he should speak to management through week Sievers then agreed to take insulin over weekend and speak to NUM through the week Case Note Report, Author witnessed nurses attend Sievers’ cell to administer Insulin p.953, – 16 December and Supply him his dinner. Sievers was verbally aggressive 2022 – Tab 10HH towards nurses and demanded a higher quality of dinner. Sievers then refused to take his insulin. Sievers was told that this is all the dinner that will be available to him and the food was left by his bed.

SOAP, 30 November Sievers complained about quality of jail meals; stated he will not 2022 – p. 8-9 – Tab take insulin until he has been reviewed by a dietitian 37 NUM informed of above – NUM spoke with Sievers who later agreed to have regular insulin General Note, 30 Sievers moved to ACRU for assessment purposes after 2 recent November 2022 – p. falls. Refused to take Ordine 13-15 – Tab 37 Complained about food in ACRU – Sievers advised no current dietitian within JH General Note, 8 Sievers stated he missed KWU; not happy with mattress as he December 2022 – p. has difficulty getting in and out of bed 53-54 – Tab 37 Stated “I’m not happy I want out of here” – this is observed to be incongruent to his affect and conversation General Note, 24 Sievers attended telehealth appt with Dr Sands (renal support at November 2022 – p. POWH), reported that he experiences breathlessness; Dr Sands 355-356 – Tab 38 suggested trial of small does of ordine to assist with this – Sievers happy to try same.

(Ordine – oral liquid morphine used to manage dyspnoea (laboured breathing)) General Note, 22 MO (Dr Sim) reviewed Sievers re ACRU admission – issues November 2022 – p. noted which include: Sievers is not for resuscitation, not for 339-340 – Tab 38 transfer to POWH; has no contact with family and has a history of hypos when in ACRU due to decreased oral intake and dislike of food provided.

SOAP, 21 November Sievers transferred from KWU to ACRU; Sievers reported to be 2022 – p. 332-333 – unhappy about this.

Tab 38 Noted Sievers was hypoglycaemic in PM due to poor oral intake General Note, 21 Sievers states he has not had dinner as “[he] won’t eat the food November 2022 – p. here” – Dr Sim contacted re insulin dose 142 – Tab 36 Case Note Report, Sievers had a fall with his walking frame at approximately p.953, 17 November 09.30am and scraped his arms and elbows, seen by JH RN and 2022 – p. 953 Tab KWU supervisor informed of incident.

10HH General Note, 17 Sievers advised he should transfer to ACRU due to increased November 2022 – p. frailty; Sievers declined.

322 – Tab 38 NUM to speak to CSNSW re how Sievers is to be managed at ACRU to encourage transfer.

SOAP, 17 November Clinical Nurse Specialist (‘CNS’) called to yard by inmate as 2022 – p. 320-321 – Sievers had fallen; on arrival Sievers was sitting on floor with Tab 38 blood coming from right arm. Sievers stated that he “got up and then fell over”, however, denies loss of consciousness and dizziness. Sievers states he fell “because [he] was wearing thongs and tripped over”.

General Note, 10 Sievers reviewed at KWU – Sievers refusing MS Contin as it November 2022 – p. makes him feel sedated.

303 – Tab 38 Sievers reports poor appetite due to gaol diet NP attempted to discuss end stage chronic renal failure – Sievers declined to discuss as “its depressing”. Sievers advised that skin issues may be secondary to CRF

General Note, 8 NP Palliative Care review following renal support care appt – November 2022 – p. Sievers’ diagnoses and presenting issues noted.

314-316 – Tab 38 MS Contin for shortness of breath discontinued by Sievers.

Sievers’ mood assessed by Dr Watts; no evidence of significant depression and Sievers confirms not wanting to restart Mirtazapine.

Sievers not wanting to discuss advanced care planning General Note, 8 Sievers met with NUM in KWU – Sievers reported had not November 2022 – p. showered in 65 days; advised needs help washing and drying 296-297 – Tab 38 back and feet area. Sievers agreed to shower x2 per week.

Urostomy bag changed; dressings to both feet attended to.

General Note, 3 Sievers reviewed by OT in KWU clinic – OT to arrange for gel November 2022 – p. chair cushion and H5 waffle mattress for bed.

283-284 – Tab 38 Sievers’ recent fall discussed – reported to be environmental trigger, however does feel unsteady often.

Referral to ACRU discussed – Sievers declined.

Sievers reported to not use showers as does not want to shower with others – OT offered to move Sievers to 2 out cell with shower – Sievers declined.

Barthel index = 60/100 General Note, 3 Sievers seen by NUM and MO (Dr Sim) – noted that Sievers has November 2022 – p. swollen, deformed feet.

281-282 – Tab 38 Sievers reported he has not showered for 64 days.

Sievers stated he is happy to continue MS Contin and does not want to go to POWH clinic – Sievers explained the importance of foot review and Sievers reluctantly agreed to be referred.

General Note, 2 Sievers seen in KWU clinic by CNS – Sievers denied issues with November 2022 – p. stoma, however, complained of stoma seal (wants Hollister 8805 276-277 – Tab 38 seals again). CNS explained to Sievers that multiple confirmations from Sievers were expressed before Coloplast seals were ordered as he was previously complaining about the 8805 seals.

CNS explained to Sievers that it is their preference that Sievers consider being referred to high-risk foot clinic due to comorbidities and risk with diabetic foot ulcer. Sievers states he refuses to attend external appointments but will have foot x-ray if GP happy to refer.

General Note, 31 Dr Sands (Palliative Care) ordered for Sievers’ Frusemide to be October 2022 – p. 268 stopped; Lasix to be increased to 120mg mane and midi; MS – Tab 38 Contin to be commenced at 5mg daily (Note: Frusemide and Lasix are used to treat fluid retention/oedema; MS Contin is morphine) General Note, 27 Sievers had renal telehealth appt; noted Sievers had non-healing October 2022 – p. ulcer on left foot and bipedal oedema pitting to mid-shin.

249-251 – Tab 38 Sievers’ mood symptoms noted; to be reviewed by Old Persons’ Mental Health (‘OPMH’).

General Note, 25 Palliative Care NP Review – noted Sievers has slight reduction in October 2022 – p. function and would be suitable for shower supervision (Sievers 243-245 – Tab 38 refuses to shower in standard available hours as is frustrated with shower set-up and sharing).

Sievers is not for resuscitation from November 2021; refuses medical tests and appointments.

SOAP, 12 October Sievers’ blood sugar levels checked; were low and Sievers given 2022 – p. 217-218 – hypokit and Nepro drink.

Tab 38 Sievers reports that he is not eating provided meals as he doesn’t like the food.

Blood sugar levels re-checked after dinner – still low Dr Sim informed and advised to withhold usual does of Novomix (55 units) and administer 30 units General Note, 10 Palliative Care OT review – Sievers seen due to issues with October 2022 – p. 212 sacral area. Sievers provided with gel cushion; Sievers requested – Tab 38 donut cushion.

OT discussed with Sievers why donut cushions no longer recommended.

Equagel cushion provided; Sievers prefers this over gel cushion.

General Note, 7 Palliative Care NP review – noted decline in Sievers’ functional October 2022 – p. ability; shortness of breath on exertion; not using showers.

203-205 – Tab 38 To be provided comfort care – Sievers aware he has significant life limiting illness but does not want to discuss or leave LBH for any reason.

Appt Cancellation by Sievers cancelled his in-person renal support care appts and Patient, 6 October reported that he will only attend via telehealth.

2022 – p. 219 – Tab General Note, 6 Sievers informed of upcoming face-to-face renal appt at POWH; October 2022 – p. 199 advised he is only willing to attend apps via telehealth.

– Tab 38 Sievers informed this appt must be in-person; advised he is not willing to attend.

Appt cancelled; Medical Assessment Unit (‘MAU’) advised they will liaise with POWH renal team to see if appt can be telehealth General Note, 5 Sievers complained of painful coccyx from sitting; to be referred to October 2022 – p. 198 OT for cushion to relieve pressure on sacral area – Tab 38 SOAP, 27 September Sievers seen in KWU clinic for stoma review and ankle-brachial 2022 – p. 177-178 – pressure index (a non-invasive method of assessing peripheral Tab 38 arterial perfusion in lower limbs)– Sievers finds that Coloplast protective seal works well. Received urostomy pouches and seals and expecting a further 10 sets.

Noted that Sievers was not happy with treating peristomal ulcer with stoma powder; education and explanation provided.

Instruction, demonstration and sample of stoma powder provided.

Noted Sievers requires podiatry review semi-urgently.

General Note, 15 Sievers seen in cell by PCOT and PCPT – reported oedema in September 2022 – p. leg decreased but experiences cramps in calf. Sievers also 151-152 – Tab 38 reported he has not been showering and using body wipes.

Sievers reports that stoma fills with water when showering and would shower regularly if he could do so alone - embarrassed about stoma.

2 out cell with internal shower discussed - Sievers declined same.

Notes current communal showers suit functional needs.

General Note, 15 Sievers fell trying to get out of bed on two occasions in past few September 2022 – p. years; Sievers denies falls from standing height.

153-154 – Tab 38 Sievers rarely leaves cell due to worsening mobility and generally feeling weak.

Physio discussed goals of therapy and importance of exercise – states Sievers would benefit from exercise program, daily mobility and regular physio.

General Note, 13 Sievers attended telehealth consult with CNS re urostomy bags September 2022 – p. leaking – Sievers: “sick of the leaking”. CNS discussed using 146-148 – Tab 38 paste and use of extension tape to cover naval area.

NUM discussed possibility of RN assisting with change of bag; Sievers wants to remain as independent as possible. NUM reviewed site and replaced bag while Sievers in clinic.

NUM noted excoriated skin; Sievers advised he was aware of same and that it “stings”. Swab taken and area cleaned. Stoma powder recommended for use on excoriated site.

General Note, 30 Sievers seen by stoma CNS and Palliative Care NP in KWU – August 2022 – p. 117- Sievers educated and encouraged to use stoma belt provided to 118, and p.121-123 – prevent leakage.

Tab 38 Sievers insistent on trying convex seals – he was provided same and given stoma extension tapes to try to prevent leakage.

Sievers stated he does not want to leave Long Bay Correctional Centre (‘LBCC’) for any reason and does not want any investigation that requires visit to hospital. Sievers is aware he has possible blood cancer, heart issues and diabetes-related complications.

Sievers has anaemia due to chronic kidney disease and undiagnosed haematological disease.

General Note, 29 NUM met with Sievers in KWU – non-compliance with medication August 2022 – p. 114- discussed.

115 – Tab 38 Sievers advised he ceased diuretic for approx.10 days and has been compliant since 26/8/22 NUM discussed fluid retention and increase in weight and oedema – advised Sievers that it is his right to declined medication, but he must advise nursing staff and return meds.

Sievers advised he wants change in stoma bag – NUM advised that multiple samples have been provided.

SOAP, 26 August Sievers advised he has stopped taking Lasix – this was 2022 – p. 104-105 – discussed. Sievers stopped taking it weeks ago due to too much Tab 38 urinary output causing his urostomy bag to leak. NUM advised of same.

It was noted that Sievers had gained weight and had pitting oedema in bottom half of both legs (Note: Lasix is a diuretic that helps to reduce the amount of excess fluid in the body.) General Note, 24 Sievers reviewed by dietitian – previous meal plan not carried August 2022 – p. 97- across to KWU; discussed Sievers’ dislike of CSI provided meals.

99 – Tab 38

Sievers possibly has inadequate intake and poor dietary quality as he is reliant on buy-ups to substitute diet Food preferences and limitations of CSI diet discussed; high protein options encouraged.

General Note, 18 OT review – Sievers reported increased swelling in legs; offered August 2022 – p. 87 – compression socks and Sievers agreeable.

Tab 38 Shower set-up discussed – Sievers agreeable with set-up (nonslip flooring, shower chair, and grabrail) but reluctant to use.

General Note, 17 NUM attended KWU re supervised shower – Sievers stated he is August 2022 – p. 82- hesitant to shower due to access issues – no grab rails/flooring/no 83 – Tab 38 room.

Sievers attended communal shower area – large, grab rails on wall, access to shower chair, and ease of access. Sievers agreed there were nil issues with access/use of shower area.

NUM advised that Sievers’ placement may need to be reviewed due to hygiene needs – Sievers stated this not required and he would commence showering in KWU.

General Note, 10 Sievers seen by MO re wound on foot and shoulder pain – states August 2022 – p. 70- he would like a steroid injection into left shoulder, but does not 71 – Tab 38 want to go to POWH for this.

Sievers has Chronic Kidney Disease and possible underlying haematological condition - declined further investigation.

Sievers states he has been unable to shower General Note, 9 Sievers seen in KWU clinic – Sievers complained of nerve pain to August 2022 – p. 68 – right shoulder and blister to right toe and wanting to be reviewed Tab 38 by GP. Sievers placed on waitlist and email sent to Aged Care CNS as FYI; Sievers is known to them.

Sievers reports that ileostomy leaking and wanting to be seen by stoma nurse for change of products – email sent to stoma CNS General Note, 3 Sievers seen in KWU clinic re stoma supply. Stoma supplies were August 2022 – p. 57- explained to Sievers and a stoma belt for him to wear (for extra 58 – Tab 38 security) to be arranged.

General Note, 25 July Compression socks arrived for Sievers – Sievers declined and 2022 – p. 42 – Tab 38 stated current level of oedema isn’t bothering him. OT offered to have sweeper assist with putting compression socks on – Sievers declined.

Sievers still not using showers and is using personal wipes instead. OT advised Sievers that shower chair, rails and HHSH available if Sievers chooses to shower.

SOAP, 22 July 2022 – Sievers complained of stoma bag leaking; concerns passed onto p. 37-38 – Tab 38 stoma CNS General Note, 18 July Sievers complained that urostomy bag leaking due to poor bag 2022 – p. 25 – Tab 38 seal; Sievers requested to see stoma nurse re same General Note, 11 July Sievers seen by OT - Sievers reported fell out of bed “the other 2022 – p. 15-16 – Tab night” and states beds are too narrow 38 Sievers is not showering as it is too cold and there are too many walking frames down there and “you can’t move around” OT discussed bed options with Sievers and suggested using other bed in cell with grabrail on wall; he declined

OT discussed trial of compression socks and Sievers encouraged to mobilise and complete calf exercises to promote update of oedema General Note, 9 June Sievers reports recent fall; he is not showering as he is worried 2022 – p. 381-382 – about falling. Presently using wipes to clean himself.

Tab 39 General Note, 1 June Sievers seen by RN following unwitnessed fall. Sievers reported 2022 – p. 368 – Tab that he had fallen out of bed but denies hitting head.

39 Plan to monitor Sievers’ skin tear re infection.

General Note, 18 May Sievers reports that he is not taking his Fenofibrate because he is 2022 – p. 343 – Tab unsure why he should be taking it.

39 Provided with a copy of Fenofibrate information – states he will read it and speak to staff if needed.

(Note: Fenofibrate is used to reduce and treat high cholesterol levels in the blood) General Note, 10 May Sievers was seen in KWU clinic – refused insulin in protest as he 2022 – p. 319 – Tab was concerned of access to medications due to CSNSW 39 lockdown. Sievers requested his morning meds be provided as takeaway.

General Note, 9 May Sievers seen by OT in clinic. Sievers stated that he has only 2022 – p. 316-317 – showered once since being in KWU due to no grabrails in shower.

Tab 39 OT reviewed with Sievers and grabrails were present.

Sievers reported mild swelling, however, compression garments were declined.

General Note, 26 April Sievers’ medication changed post-renal appt – pregabalin 2022 – p. 291 – Tab increased from 50mg to 75mg nocte; rosuvastatin decreased from 39 40mg to 10mg (previous dose caused Sievers to be at risk of myopathy). Plan to possibly switch to atorvastatin.

General Note, 26 April Sievers attended renal telehealth appt – dose of Frusemide to be 2022 – p. 293 – Tab increased to 120mg; Sievers still anaemic but Mivcera injection 39 cannot be increased.

General Note, 15 April Sievers arrived at KWU from MSU 2022 – p. 269 – Tab SOAP, 14 April 2022 NUM discussed discharge from hospital with Sievers and advised – p. 260-261 – Tab 39 transfer to KWU and discussion with aged care team. Noted - Sievers has previously refused to transfer to KWU, however, is agreeable to transfer if single cell available, stated “I’m a lifer – I don’t want to be with anyone” General Note, 14 April MO (Dr Sim) reports that Sievers’ dose of Novomix 30 is to be 2022 – p. 264 – Tab increased to 60u mane and 40u nocte. Sievers to be discharged 39 from MSU.

General Note, 12 April Sievers is seen by MO (Dr Sim) due to ongoing hyperglycaemia.

2022 – p. 253 – Tab Sievers has been referred to Endocrine Outpatient Dept but does 39 not have appt yet.

Noted that Sievers is presently on Optisulin 50u BD; plan to trial Novomix 30 50u mane and 30u pre-dinner.

General Note, 5 April Shower chair provided to Sievers; Sievers declined use of over 2022 – p. 222 – Tab toilet aid and requested it be removed from cell.

General Note, 4 April Sievers seen by OT in clinic – Sievers stated that he had trialled 2022 – p. 213 – Tab the shower commode, declined using again, and requested 39 shower chair.

OT confirmed that no shower chairs were available but would follow up with NUM. Sievers declined using wheeled commode until shower chair is available.

Sievers reported increased difficulty with bed transfers and mobilising.

SOAP, 3 April 2022 – Sievers’ blood sugar levels noted to be 24.5; declined further p. 207-208 – Tab 39 insulin and declined EN’s offer to call duty MO.

Sievers happy to monitor self overnight and will report to nursing staff if any issues.

General Note, 1 April Sievers was seen by Stoma CNS in MSU clinic re concerns with 2022 – p. 200 – Tab stoma. Sievers reported blood clots in urine.

39 Sievers reassured by CNS that it may be slight bleed from stoma as they are very fragile. Sievers advised to continue to observe and to notify nurse if more blood clots.

General Note, 29 Sievers seen by diabetes CNS – Sievers queried whether there March 2022 – p. 185- was an alternative insulin option as he had been using Lantus for 186 – Tab 39 10 years.

CNS informed Sievers re age-appropriate glycaemic target, quality of life and insulin requirements re chronic kidney disease.

Informed of options, however, CNS was reluctant to advocate change as Sievers was due to see POWH Endo. CNS queried whether Endo would recommend trajenta as oral glucose lowering agent to maintain glycaemic control.

General Note, 28 Sievers had a fall and was found on his floor conscious.

March 2022 – p. 180 Sievers stated that he was unpacking his belongings from ACRU – Tab 39 when he fell.

He was seen by JH RN. Denied hitting his head and had small Case Note Report, graze on right elbow, though denied it was from the fall. Dressing p.953, 28 March 2022 was applied to graze.

– Tab 10HH RN assisted Sievers into chair. Sievers was alert and orientated.

MO and NUM notified. Was not required to be sent to hospital.

General Note, Sievers reviewed by OT. Sievers requested shower chair, 28 March 2022 – p. however, was advised there were nil available ATOR. OT offered 179 – Tab 39 Sievers wheeled commode until shower chair arrives to which Sievers declined. Over toiled aid was also offered and also declined.

General Note, 28 Sievers seen by NUM re transfer to MSU; Sievers agreeable to March 2022 – p. 175- same - voiced complaints about diet and requested review by 176 – Tab 39 optometry, stoma CNS, dietician, and diabetes CNS.

SOAP, 27 March Dr Sim informed that Sievers is refusing 30u of optisulin and that 2022 – p. 170-171 – he wants 44u charted. Phone order was given for 44u of optisulin Tab 39 BD; to be reviewed in few days.

General Note, 27 Sievers seen for mane med round. Optisulin insulin pen contained March 2022 – p. 169 exactly 30u and given to Sievers for self-administration. Sievers – Tab 39 tried to increase insulin to 44u.

Sievers started swearing and stated “fuck I need more insulin and doctors don’t know anything”.

Sievers was reminded that he was only charted for 30u. Sievers swearing and trying to intimidate RN for new insulin pen. Sievers refused to have 30u unless he was given 44u.

Sievers placed in lockdown for intimidating and rude behaviour.

General Note, 26 Sievers informed that Optisulin script has been re-written; 30u March 2022 – p. 162 mane charted and Sievers generally self-administers same.

– Tab 39 Sievers annoyed and stated “the doctors don’t know anything about me and are trying to kill me”.

Optisulin pen with 30u given to Sievers for self-administration; Sievers adjusted to 44u and self-administered same while venting frustration with insulin regime.

SOAP, 26 March Sievers refused increased nocte Optisulin; reassurance given by 2022 – p. 159-160 – RN with little effect.

Tab 39 General Note, 25 NP notes that Sievers has longstanding glycaemic control and March 2022 – p. 155 non-adherence to dietary restrictions.

– Tab 39 NP and MO have plan re increasing insulin regime, however, Sievers not happy with this. Optisulin 30u mane and 50u nocte to continue until reviewed by MO.

SOAP, 25 March Sievers states that he is annoyed with his diabetic management 2022 – p. 153-154 – and stated “the doctors want to kill me.” Tab 39 Bedtime blood sugar level was 20.0; Sievers was charted for 50 units of Optisulin. Sievers stated that he was annoyed with the insulin regime and self-administered 44 units of Optisulin.

General Note, 23 Sievers’ blood sugar level was stated to be 27.2, ketones 0.2, and March 2022 – p. 146 asymptomatic. Dr Sim informed and phone order for Novorapid 15 – Tab 39 units stat to be given.

General Note, 22 Sievers reviewed in ACRU by MO (Dr Sim) – noted his blood March 2022 – p. 138 sugar level remains high; Optisulin increased to 24 units mane – Tab 39 and 48 units nocte General Note, 15 Sievers seen by dietician following referral from NUM – Sievers March 2022 – p. 103- stated that he does not have buy-ups in ACRU yet so is reliant on 105 – Tab 39 meals provided. Sievers reported that he has a general dislike of CSNSW food and relies on buy-ups to substitute dietary intake.

Dietician discussed Sievers’ food preferences and limitations of CSNSW; meal plan to be created for Sievers while in ACRU SOAP, 11 March Sievers reported he is unhappy with the diet in ACRU and is 2022 – p. 77-78 – Tab reluctant to take regular meds due to concerns with meals.

39 Sievers stated that he wants to boycott all meds until he is reviewed by a dietician.

Sievers informed that there are no dietician services available overnight or over the weekend; Sievers later agreed to have meds and insulin.

General Note, 10 Sievers seen by Stoma CNS in ACRU – noted Sievers was not March 2022 – p. 70 – engaged and would not get up for review.

Tab 39 It was again explained to Sievers that he must pull skin flat when applying stoma bag to avoid leakage and that using a stoma belt would assist in securing bag. Sievers stated he has a belt and knows how to use it; CNS offered to retrieve and supervise application of belt – Sievers refused. CNS offered Sievers new belt; also refused.

General Note, 8 Sievers seen by MO (Dr Sim) and NUM –explained to him that his March 2022 – p. 52- renal function had worsened and resonium needs to be 53 – Tab 39 commenced. Noted that Metoprolol was withheld for a few days due to low blood pressure; Metoprolol to be re-commenced.

Mirtazapine to be ceased.

(Note: Resonium is used to treat high levels of potassium, which is noted to be a symptom of chronic kidney disease).

General Note, 8 NUM spoke with Sievers re Covid vaccinations. Sievers offered March 2022 – p. 59 – Pfizer vaccine but declined stating “what’s the point…I don’t want Tab 39 to prolong being here and I’m never getting out.” SOAP, 7 March 2022 Sievers refused to take Metoprolol, Mirtazapine and Insulin; – p. 33-34 – Tab 39 stated he won’t take the insulin as “[he doesn’t] eat gaol food.

[He’ll] take it again when [his] buy-ups come”.

General Note, 7 NUM spoke with Sievers in cell – noted he was upset with diet March 2022 – p. 35- provision by CSNSW in LBH and Wing 10 (noted Sievers is eating 36 – Tab 39 bread roll with butter and jam, and cereal with milk and orange juice).

NUM discussed with Sievers reason for admission – with Sievers initially stating “nobody told me”, however, he acknowledged consults with medical and palliative care staff.

Sievers placed on waitlist for dietician and Palliative Care OT review.

SOAP, 6 March 2022 Sievers refused Metoprolol mane dose and Furosemide midi dose – p. 29-30 – Tab 39 – MO made aware and stated that Sievers has the right to refuse medications.

SOAP, 6 March 2022 Sievers knocked up and stated “there is piss everywhere”.

– p. 26-27 – Tab 39 Urostomy bag found leaking and Sievers did not have any bags as his supply is with belongings at MSPC1.

Sievers’ sheets were changed and given blueys. Sievers was also given tape to reinforce urostomy bag.

General Note, 4 Sievers refused Mirtazapine and Metoprolol at nocte medication March 2022 – p. 16 – round. Sievers stated that he stopped taking Mirtazapine “a while Tab 39 ago” when in wing but did not inform JH. Sievers also stated “the doctor stopped [the metoprolol] a few days ago…”.

(Note: Metoprolol – beta blocker used to treat, inter alia, high blood pressure by relaxing blood vessels and slowing HR.

Mirtazapine – antidepressant used for treatment of major depressive disorders) SOAP, 4 March 2022 Sievers transfer from MSPC1 to ACRU – nil issues Sievers – p. 13-15 – Tab 39 appears stable

General Note, 4 Sievers seen in MSPC1 by Wound and Stoma CNS – noted that March 2022 – p. 10- Sievers has complained of stoma issues (redness to surrounding 11 – Tab 39 skin). Sievers given stoma powder.

Noted that there is a small amount of leakage; CNS notes this may be due to recent weight gain and abdo skin crease.

Noted Sievers was not sitting up straight when changing bag due to being on lower bunk and it is difficult for him to do so standing.

General Note, 3 MSU done - Sievers had urine infection; Sievers commenced on March 2022 – p. 2-3 – OAB.

Tab 39 Reported that Sievers not getting out of cell and struggles to get out of the bed.

Noted that he needs to be moved to MSU or ACRU for 24/7 care and monitoring; Sievers does not want to be transferred to

POWH.

LBH aged care NUM and NP notified of same via email; RN to attend Aged Care Bed Demand meeting in PM to discuss Sievers’ placement.

General Note, 3 Sievers has reported fever, runny nose, sore throat and urinary March 2022 – p. 5-6 symptoms – commenced on oral Keflex for presumed UTI.

Sievers possibly has sepsis secondary to UTI.

Sievers flagged for ongoing deteriorating mobility by OT, Physio and nursing staff. Sievers refused transfer to ACRU.

Sievers has Anaemia for Chronic Disease (‘ACD’) – ‘not for resuscitation’ (‘NFR’); comfort measures only if deteriorates further.

General Note, 2 Sievers continues to appear very weak; RN discussed with March 2022 – p. 361- Sievers potential placement in observation/camera cell overnight 362 – Tab 40 so he can be monitored.

Sievers was advised that his care could be impacted if he is too weak to reach knock up system.

Sievers refused to be placed in camera cell; noted that CSNSW have advised against camera cell as has poor air flow. CSNSW reported that they can do hourly checks. RNs have advised against this.

General Note, 23 Sievers seen by RN in the AM – Sievers is finding it hard to get February 2022 – p. out of his cell - JH staff need to go to cell for medication and blood 357 – Tab 40 sugar level checks.

Sievers informed that JH/CSNSW are looking at transferring him somewhere he can get more assistance.

NSW Department of MSPC 1 - Advised by JH Sievers required to be conveyed to Corrective Services POWH by CSNSW vehicle for treatment not available at the Incident Details - Centre. Two Centre staff redeployed to facilitate unscheduled Bortolazzo, 10 hospital escort. (p.1059) February 2021 - Tab10(HN) General Note, 25 Sievers had telehealth consult with Dr Keung (nephrologist) – only January 2022 – p. 48- issue of concern was fatigue; Dr Keung advised this was related 49 – Tab 39 to chronic kidney disease which is presently stable.

Micera to be increased to 360mcg monthly and Sievers is to be referred to Dr Gigi (renal support care at POWH)

General Note, 21 Sievers reviewed by Palliative Care NP – noted that Sievers is January 2022 – p. 46- happy to see the Aged Care MH Team.

47 – Tab 39 Noted Sievers happier in 10 Wing; is not showering as he cannot get into shower. Sievers states that he needs early morning showers so he can change urostomy bag; currently doing self-bed baths.

General Note, 14 Diabetes education and management with CNS – noted that January 2022 – p. Sievers has one episode of hypo a month and does not have 334-336 – Tab 40 blood sugar level checked if he is symptomatic with hypos.

Sievers denied frequently skipping main meals (will make sandwich if he does not like food offered) and reported that he had no issues with insulin regime.

General Note, 7 Sievers cancelled physio appointment as he “[couldn’t] be January 2022 – p. 330 bothered to walk in the rain”.

– Tab 40 2021 General Note, 18 Sievers’ blood sugar level 22.3 at 17.00 – Sievers said blood December 2021 – p. sugar level high due to not taking midday insulin.

326 – Tab 40 Sievers refused ketone check; contact to GP for dose adjustment; and follow-up test.

General Note, 16 Sievers offered Covid vaccination and declined.

December 2021 – p. It was explained to Sievers the high-risk of infection; Sievers 325 – Tab 40 aware but still declined General Note, 14 Palliative Care NP review – noted that Sievers is to have showers December 2021 – p. before other inmates released; Sievers to remain in MSPC1, 323-324 – Tab 40 however, transfer for infusion bloods may be needed; Sievers refuses to leave LBCC for appts (all are via telehealth).

Ongoing Specialist Mental Health Services for Older People (‘SMHSOP’) and Diabetes review; noted not known to Stoma CNS as Sievers has declined visit.

General Note, 1 Sievers seen by CNS – noted that Sievers does not want to December 2021 – p. transfer to ACRU as “food will be bad” and will be locked in 313-314 – Tab 40 longer.

Sievers reported fatigue; CNS suggested iron transfusion may help however Sievers appeared indifferent.

Noted that Sievers has definite ideas on where he wants to be and the treatment he should receive.

General Note, 30 Sievers reviewed by Physio – noted that Sievers has difficulty with November 2021 – p. activities of daily life and struggles to self-propel. Physio noted 310-312 – Tab 40 that Sievers will need OT assistance re activities of daily life and showering.

General Note, 19 Palliative Care Review by NP – noted that Sievers due for November 2021 – p. discharge transfer to ACRU in future. Sievers advised he will be 306 – Tab 40 considered for ACRU in next week’s meeting.

General Note, 9 Palliative Care Review by NP – noted that CSNSW and JH staff November 2021 – p. have expressed concerns about Sievers’ deterioration.

297-299 – Tab 40 Sievers reaffirmed not wanting to go to hospital for anything and wants end of life care at LBCC. Risk of fall/injury re deterioration

in health discussed and hospital admission may result – Sievers stated he was happy to think about ACRU transfer.

General Note, 2 Palliative Care review by NP – noted that Sievers has mild November 2021 – p. shortness of breath; slower mobility and increasing nocte cramps.

286 – Tab 40 Resuscitation plan complete (NFR) – Sievers is clear that he does not want to discuss end of life or CPR matters any further.

Case Note Report, While Sievers was returning to his cell from having a shower this p.950 9 October 2021 morning around 8.30am, he had a fall out the front of cell 23. JH – Tab 10HH nurse informed.

General Note, 9 Palliative Care multi-disciplinary team (‘MDT’) meeting via September 2021 – p. teleconference – Dr noted that Sievers’ kidneys will fail meaning 257-258 – Tab 40 he is not suitable for CPR, chest compressions or assisted breathing. Noted Sievers agrees with this. Sievers has been advised that his care will focus on comfort and symptom management, not cure.

Noted that change in appetite common with renal disease.

Sievers advised to purchase canned meat or vegies.

Appt Cancellation by Sievers cancelled his bone scan appointment due to agoraphobia Patient, 11 August and because he is not interested in attending appointments.

2021 – p. 168 – Tab Sievers has signed the document and indicates that he 41 understands that this decision will impact his healthcare, treatment and quality of life.

General Note, 11 Sievers assessed by forensic psychiatrist – noted that Sievers August 2021 – p. 246 presented with low mood due to current placement (cold, lack of – Tab 40 activities, inability to exercise, and frustrated re placement in metro gaols). Sievers observed to have mild depressive symptoms however no adjustment needed to current Mirtazapine dose.

Psychiatrist opined that Sievers has capacity to make medical decisions and aware of pros/cons re treatment.

General Note, 4 Sievers saw MO re asked-to-see-patient (‘ATSP’) and end-of-life August 2021 – p. 236- care – discussion re the importance of link with nephology; 237 – Tab 40 Sievers agreed to video conference but refuses to go to hospital due to cold weather.

Sievers reported that Justice Health Forensic Mental Health Network (‘JHFMHN’) are responsible for renal failure as he has no access to diabetic meals.

General Note, 30 July Sievers reported that he felt weak and slow to react in AM – 2021 – p, 204 – Tab denied fall, loss of consciousness, or recent major injury.

40 RN suggested Sievers stay in assessment cell for observation or escort to external hospital; Sievers refused both.

GP suggested camera cell placement; Sievers refused.

General Note, 30 July Electrocardiogram) (‘ECG’) conducted on Sievers; sinus 2021 – p. 207 – Tab bradycardia detected.

40 RN discussed transfer to POWH, however, Sievers continued to refuse, stated “I don’t want anything done…I don’t want to go there”.

General Note, 30 July Sievers seen by RN due to muscle weakness and slurred speech; 2021 – p. 209-210 – Sievers was observed by CSNSW staff to be ‘glazed’ and unable Tab 40

to walk or stand. Sievers stated that his condition was due to him having nocte medication at midday yesterday.

Sievers refused camera cell and two out cell placement, also refused medical intervention and transfer to POWH.

ROAMS GP contacted and stated Sievers should be in two out cell; GP informed of Sievers’ aggression and refusal to go to

KWU.

GP suspects transient ischemic attack and referral to MH and psych needed.

General Note, 30 July Sievers’ file presented at GP tele-round; Sievers not seen by MO 2021 – p. 213-214 – as he is known to her.

Tab 40 Recent issues re worsening chronic kidney disease, MGUS, and sclerotic changes noted. It is also noted that Sievers is refusing multiple appointments.

Plan – for GP review ASAP re medical issues.

General Note, 29 July Palliative Care NP review – noted that Sievers continues to refuse 2021 – p. 240-242 – external appts due to it being too cold and because he suffers Tab 40 anxiety when leaving LBCC.

Advance Care Planning (‘ACP’) discussed, however, Sievers not keen to discuss future health. Sievers reports he understands that this means his life will end sooner but that he does not mind.

Sievers states that he wants to remain in control of decision making and when he can no longer do this he is happy for the Drs and Nurses to do so.

General Note, 26 July Sievers seen by Aged Care NP – noted that Sievers has declined 2021 – p. 201-203 – dialysis for chronic kidney disease as his kidneys have been Tab 40 damaged due to not having access to diabetic diet while in gaol.

Sievers believes JHFMHN are responsible for his renal failure and stated “I’m not getting out of here anyway”.

Sievers stated that he is “depressed all the time” as he is bored and has nothing to do. Sievers reported he talks to his dead brother as he holds him responsible for being in gaol.

Sievers reports that he will not transfer to MSPC1 as it is too cold and he doesn’t have enough warm clothing. Sievers does not want to transfer to KWU as he doesn’t want to “hang around a bunch of paedophiles”. Sievers stated that “if I have to share [a cell] with anyone, one of us will be coming out in a body bag”.

General Note, 14 July Palliative Care NP Initial Assessment – noted that Sievers has 2021 – p. 194-197 – history of declining medical follow-up; Sievers admitted that he Tab 40 gets anxiety when leaving known environment and declines care due to not wanting to change cell placement or conditions, as well as having general dislike for medical help. NP to assist with renal support care and to review over few weeks.

SOAP, 5 June 2021 – Sievers reported to clinic due to feeling hot/cold and having p. 178-180 – Tab 40 productive cough for 2 days – no shortness of breath, chest pain or other Covid symptoms. Sievers was observed to have ‘heavy’ breathing in lower lungs and slight wheezing.

GP advised sending Sievers to POWH; Sievers refused escort to external hospital stating “if you force me to hospital, I refuse all treatment” and “I just want to take antibiotic”. Dr Holt explained health condition and treatment plan via phone; Sievers refused to move out of cell and signed form to refuse to be sent to POWH.

General Note, 4 June Sievers refused to have ketones checked after breakfast despite 2021 – p. 177 – Tab health risk explained to him. Plan is to recheck blood sugar level 40 at 10.30am before lunch.

General Note, 25 May Sievers is not seen by mental health specialist; Avanza 30mg 2021 – p. 173 – Tab written up as he is on mental health list.

40 (Avanza is used to treat episodes of major depression.) General Note, 20 May Sievers states that left leg has swollen since returning from 2021 – p. 171 – Tab hospital. Mild swelling is noted. Sievers advised to elevate leg and 40 will be reviewed if needed.

General Note, 27 April RN observed Sievers to have “blood shut left eye”. Sievers denied 2021 – p. 164; 165 – any falls or injuries and stated that it started a couple of days ago Tab 40 when he awoke. Sievers reports nil headache or other pain. For GP review following day.

MO diagnoses Sievers w/ left subconjunctival haemorrhage; referral for bone scan as spinal lesion observed on X-ray.

General Note, 12 Sievers discharged from POWH; POWH changed medication February 2021 – p.

149 – Tab 40 General Note, 10 Recent chest x-ray shows congestion in lungs; bilateral ankle February 2021 – p. oedema and chest crepitations bilaterally with no added sounds.

147 – Tab 40 Sievers sent to POWH emergency department for further management.

General Notes, 9 Sievers observed to be “working very hard” in PM. Sievers January 2021 – p. 142 reported that he felt tired and had only had a small amount of oral – Tab 40 intake. Sievers refused all insulin today; glucose powder issued.

Sievers refused further blood sugar level and refused to wait.

Plan: call GP and conduct welfare check in cell in 1-2hrs.

2020 Appt Cancellation by Sievers cancelled his cardiology follow-up due to shortness of Patient, 9 December breath and mobility problems. Sievers said, “problem will not be 2020 – p. 95 – Tab 41 fixed by doctors”.

General Note, 22 Sievers visited by OT in AM at MSPC1 re mobility. OT supplied December 2020 – p. Sievers with new four-wheel-walker.

137 – Tab 40 General Note, 25 Sievers discharged from POWH; reported to feel “much better” November 2020 – p. and no chest pain/shortness of breath.

131; 132 – Tab 40 NSW Department of Sievers was housed in the Annex at POW, at about 11.15, Corrective Services reported that Sievers may have had a heart attack and maybe Incident Details - sent down to a ward for test. At 12.00, informed that Sievers will Geesing, 15 be going to need tests, and requested staff to facilitate. 2 staff November 2020 - were sent to that location and informed that Sievers was admitted Tab10(HN) to Dickinson 3 North Bed 2.(p.1058) General Note, 14 Sievers transferred to POWH ED for assessment and treatment of November 2020 – p. potassium levels (6.7) as too difficult to treat in custodial setting 120 – Tab 40 over weekend

General Note, 17 Sievers still refusing dialysis; for possible angiogram later in November 2020 – p. week.

125 – Tab 40 General Note, 21 Sievers due to attend POWH renal clinic, however, refused to October 2020 – p. 115 attend because of “difficulty in transport and too long to walk”.

– Tab 40 NUM contacted medical transport unit for special transport arrangement.

MO did not support medical certificate for “taking off foot chuffer”.

General Note, 15 Sievers reported he did not want to go to POWH or appointments September 2020 – p. due to feeling unfit to attend. Sievers requested referral to physio 109 – Tab 40 re breathing.

Sievers signed cancellation form and signalled ongoing refusal despite being told the importance of attending.

General Note, 10 Sievers is given education re hygiene, poor nutrition, proper rest September 2020 – p. and sleep, social distancing and to report if unwell.

107 – Tab 40 General Note, 17 Sievers seen by NP re Aged Health Review – Sievers stated he August 2020 – p. 98- has been “freezing cold all morning”; his cell is cold, clothes 100 – Tab 40 provide no warmth, and he is sitting outside waiting a lot for insulin.

Sievers reported he does not want to be transfer to KWU as he has been there before and doesn’t get along with the other inmates.

Nursing certificate given re heater due to fragility and health issues.

General Note, 7 July Sievers complained of increasing shortness of breath on exertion 2020 – p. 79-80 – Tab and bilateral leg swelling; MO suspects worsening of chronic 40 kidney failure.

MO states Sievers needs urea and electrolyte tests monthly, referred for Echo and Cardiology review.

General Note, 3 July Sievers seen by RN in the PM and complained of lower leg pain.

2020 – p. 78 – Tab 40 Noted that Sievers had cellulitis on the left leg and commenced Keflex before changing to Clindamycin.

Observed Sievers’ lower legs were swollen; pitting oedema evident. Sievers reported pins and needles and pain.

Sievers placed on GP list for return visit.

General Note, 16 Sievers seen by MO re possible skin infection to lower left leg; not June 2020 – p. 68 – improving with Cephalexin. For trial for Clindamycin; will need ED Tab 40 assessment if no improvement.

General Note, 11 Sievers reported pain to left foot and ankle which increases when June 2020 – p. 66 – he bears weight and moves. Sievers’ vitals were attended to, was Tab 40 given pressure bandage to provide support, and placed on waitlist for further check.

General Note, 25 May Sievers seen by MO re ongoing hypertension. Noted Sievers sat 2020 – p. 47-48 – Tab outside in the cold for 1.5 hour before being seen by nurses and 40 that this affected him.

General Note, 13 Sievers transferred from Parklea to MSPC1 Clinic.

March 2020 – p. 29; 32-33 – Tab 40

General Note, 4 Sievers seen by MO in Clinic re shortness of breath – MO stated March 2020 – p. 11- this is likely due to congestive heart failure and/or deteriorating 12 – Tab 40 renal function. Sievers to trial Frusemide 20mg for 7/7.

Sievers complained about poor food quality and cost of buy-ups.

General Note, 9 Sievers seen by MO as he has been refusing Ticagrelor/Aspirin – February 2020 – p. MO discussed with Sievers the need for anti-coagulants and that 748 – Tab 41 the specialist advice is that these continue. Sievers agreeable.

Sievers unwilling to look at insulin dosing; MO explained the risk of poorly controlled diabetes including cardiac risk General Note, 29 Sievers presented to clinic with rose coloured urine in ostomy bag January 2020 – p. 715 and stated that he should not be on blood thinners. MO notified of – Tab 41 same and asked for Aspirin and Ticagrelor to be withheld.

General Note, 26 Sievers seen by MO in clinic – MO reports that Sievers has his January 2020 -p. 708 own interpretation of insulin regime and that this very fixed. MO – Tab 41 states that Sievers has been educated on the need for short acting insulin as Sievers continues to refuse.

2019 General Note, 25 Sievers did not receive lunchtime insulin as no one took/escorted December 2019 – p. him to clinic.

638 – Tab 41 General Note, 8 Sievers initially refused insulin in AM; Dr provided education and December 2019, p. then Sievers was compliant with meds.

596 – Tab 41 Case Note Report, Sievers refused to go to clinic for his insulin, stating "I can't walk p.947, 12 October up there, my knees are painful and the nurse said she would 2019 – Tab 10HH come here". Sievers was informed that there was no nurse available to come to the wing and he still refused to go to the clinic.

Case Note Report, Sievers has been admitted to Blacktown Hospital and is currently p.947 1 September out on a section 24. IRM to be updated if any changes of 2019 – Tab 10HH conditions NSW Department of At approximately 0805 hours, staff attended Cell 5 Area 2C and Corrective Services saw Sievers on the ground of the cell. Sievers was conscious and Incident Details - yelling out to unit staff that he had collapsed. CERT medical was Toilolo, 31 August activated and the door was unlocked to establish better contact.

2019 - Tab10(HN) Nursing staff soon attended and assessed Sievers in the cell.

Sievers was escorted to the main clinic for further observations (p.1055).

On Saturday 31/08/2019 approximately 1542 hrs, Sievers, was escorted to Blacktown Hospital. Sievers presented to the Clinic with issues breathing. St. Vincent Nurses stated Sievers required further medical treatment. Sievers was escorted via ambulance, followed by a secured armed vehicle. Governor, CSNSW Monitor notified. Sievers returned to centre at 1742 hrs on Friday 13/09/2019. (p.1056) Case Note Report, Declined insulin – 2/6/19, 3/6/19 and 19/8/19.

p.947 June – August 2019 – Tab 10HH

Case Note Report, p. Sievers was let out at 0910 hours and had the opportunity to 946, 25 March 2019 attend the main clinic to receive his morning insulin. Author was – Tab 10HH contacted by JH Nurses at about 1030 requesting if Sievers could be sent to the main clinic as he had not attended this morning for his insulin. Author requested that Sievers attend the clinic for his insulin to which Sievers adamantly replied "It's too late. I'm not going. I'm just going to go at 5" and continued on to abuse JH staff that they are not doing their job. Author advised JH Nurses to which JH continued to request that staff send him up or Sievers will be subject to RIT placement. JH Nurse attended to Sievers onsite where a mutual agreement was met that Sievers would attend at 5pm for his insulin.

Case Note Report, Sievers attended the main clinic today for his insulin injection.

p.944 (18 January Sievers is elderly and has trouble standing; a chair for Sievers to

2019. – Tab 10HH sit on whilst waiting for the JH nurses was obtained.

2018 Case Note Report, Sievers reported ongoing annoyance with custodial and JH p.943 (17 December procedures related to his diabetic status.

2018. – Tab 10HH Case Note Report, Sievers was escorted to the Main Clinic to receive his 1800 hrs p.941 (2 October Insulin shot after using the gaol stenophone system to alert

2019. – Tab 10HH officers that he was feeling ill.

Case Note Report, 28 Sievers refused to go main clinic for insulin. He stated "what’s the July 2018 - Tab point I don’t get a decent breakfast anymore, and anyway they've 10HH been overdosing me so. Main clinic officers have called for him and the nurse but inmate refuses to go. (p.939) Case Note Report, 19 Sievers attended the clinic for insulin, when informed he may July 2018 - Tab need to wait a short time for the nurse he then left and returned to 10HH the 2A/C yard. When asked to attend again he refused and said he would return after lunch. Nurses continued to ask for him but he refused. (p.939) Progress Notes, 17 Sievers angry stating that the diet is crap and he is going to be July 2018, p.31-32 eating biscuits. Sievers refused to take his charted dose of novomix 30/70 – 22 mls. He took 18 units and stated he knew himself and no-one was going to change the way he took his insulin. Sievers walked out while author was explaining importance of taking his insulin dose as prescribed by CP.

Case Note Report, 7 Clinic staff called for Sievers on numerous occasions, followed by July 2018 - Tab contacting Area 2 staff to send Sievers down to the clinic for 10HH insulin. Sievers yet to attend for insulin (p.938) Whilst conducting Insulin run Sievers began to raise his voice at JH nurses complaining about there services and swearing saying "fuck youse" and told a nurse to "get fucked you slag". Sievers was asked by to "calm down and stop speaking to the nurses like that or he will be charged". Sievers immediately stopped and the was escorted out of the treatment room back into a holding cell.

(p.939) Sievers refused to go to the clinic for his morning insulin. Sievers explained that he does not eat the cereal and cannot eat after insulin and believes that the amount of insulin he is receiving is 'not right'. The clinic was contacted in regard to this. (p.939)

Mental health triage, 3 Probable major depression recorded July 2018, p.46-47 Case Note Report, 13 Sievers was reminded by unit staff to attend insulin this June 2018– Tab morning/midday where Sievers replied words to the effect of "I'm 10HH not going down" whilst further alleging that there is no routine with his insulin/medication. Nurse attended unit and spoke to Sievers and questioned why Sievers was refusing his insulin. Sievers took medication given to him by onsite Nurse, however continued to make allegations that there was "no routine" and continued to allege that his medication was "wrong". (p.937) Medical Sievers has an ileostomy which requires ongoing medical officer/nursing supplies from external provider.

certificate, p.23 (8 Recommended he be allowed to receive this stock from Ostomy June 2018) – NSW.

Tab10(DU) Case Note Report, 8 Sievers advised that he was anxious and stressed due to his May 2018– Tab 10HH environment, his limited mobility and his Urostomy Bag.

Psychology discussed the above issues with Sievers. Sievers advised that he had struggled with lack of energy and that during his time in LBCC he was referred to see a dietitian. Sievers advised that he had completed a JH referral last week. Sievers was advised that JH referrals can take some time to complete.

(p.936) Appointment Cancelled all forthcoming and future appointment for mobility cancellation by problems, “I have no wish to go back to Long Bay as Justice patient, p.38 (8 May Health had every opportunity to cater for my health problems for

2018. – Tab10(BJ) the last 2 years.” Progress Note, 7 May Sievers presented with multiple complaints and concerns, none 2018, p.17-18– Tab specific to Parklea. Sievers was informed that Parklea were 41 unable to explain the actions of other health care centres and that the staff at Parklea are now responsible for his health care Sievers referred to psychology as he reported he had “traumatic” incidents whilst at Long Bay Sievers came to clinic in am to submit cancellation form for all upcoming and future appts at Long Bay. Was noted Sievers wanted to cancel all appointments but will not accept any responsibility. Sievers was told that if he declines to attend appts, JH will not accept responsibility and that is the purpose of the cancellation form…he was adamant that he does not want to travel to Long Bay for any appointments at all Sievers was called down to clinic for nocte blood sugar level and nocte insulin; he refused to come down Sievers attended clinic for insulin. Blood sugar level reported.

Sievers took 18mg Novomix and returned to cell. Sievers refusing to come back to clinic to get correct dose. Sievers returned from cell reluctantly and additional 4 novamix given as charter. Sievers reminded he must come for morning insulin doses. Recommend for diabetes education Inmate Profile Transfer from MSPC to Parklea CC Document, 1 May 2018 – Tab 10A

2017 Inmate Profile 12/07/17 Neuropsychological assessment referral form received.

Document, p.30-38 Added to referral list.

(15 November 2020) 11/10/17 Dementia assessment completed. Results pending.

– Tab10(EP) 08/11/17 Neuropsychological assessment completed. On assessment, Sievers displayed intact performance in all assessed cognitive domains. Based on his premorbid estimates, there is no evidence of any decline in functioning which would indicate a dementing process. Therefore, Sievers does not currently meet criteria for dementia or any other cognitive impairment.

Patient self-referral, 1 Sievers reported aches and pains – were referred previously August 2017, p.70; along with the other aches and pains and no treatment other than Patient referrals p.41- a vitamin tablet for malnourishment was been provided 73 - Tab 41 Case Note Report, Sievers was seen in Area 1 in relation to the referral: "Would like p.932 - 934 (7 July to follow up with psychology on previous visit." He was last seen 2017 – 12 July 2017) by psychology on 2/03/2017. (p.932) – Tab 10HH Consult with NUM Area 1 clinic following email requesting neuropsychological assessment. Mr Nair confirmed that he believes that Sievers is experiencing a degenerative disorder/ dementia or similar and this is compounding problems in his current treatment plan. Mr Nair confirmed that he has completed the necessary paperwork and submitted to state-wide disability service (‘SDS’) for further attention. (p.933) Patient self-referral, 9 Sievers’ order was placed on 18 May 2017 and at the time was 8 June 2017, p.69– Tab days overdue.

Patient self-referral, 1 Sievers reported that he had 3 stoma bags left & as of 4/5/17, will May 2017, p.62– Tab have none Patient self-referral, 8 Recorded: ONL Ostomy NSW Limited will only process orders at April 2017, p.67-68– the first of the month Tab 41 Patient self-referral, 3 Sievers reported he has no urostomy bags, no sting wipes, and April 2017, p.58– Tab has been surviving on two emergency bags. Sievers stated that it 41 is an ongoing problem and gets very little information.

Patient self-referral, Sievers reported that he needs to talk to someone in regards of 23/3/17-2/5/17, p.61– the cramps in legs, elbow, ankles and wrists. Sievers reported Tab 41 that he has asked about this issue previously to no avail and it also adds to his stress and depression.

Case Note Report, Sievers reported "stuff crawling under my skin" and seeing p.929 2 March 2017 – "elephants coming through the wall" and "cockroaches Tab10(HH) everywhere". He attributed these visual phenomena to stress and stated that he had been experiencing it for the last 2 years and was not concerned about it. He said that he had reported it to JH.

(p.928) Sievers was encouraged to get in contact with the psychology team by speaking to a Corrective Services Officer if he has any other immediate concerns within this time. (p.929)

Sievers stated that his concerns included: not being seen by JH, the "monotony" of having no programs to do in Area 1 and having to share a cell.

Patient self-referral, Urostomy supplies - Sievers placed monthly order on the 6 24 February 2017, February 2017, due on the 20 or 21 February 2017 providing the p.65-66– Tab 41 order was sent. Sievers requested matter to be resolved as it occurs every month for the last 12 months.

Patient self-referral, Sievers would like to be issued with monthly urostomy supplies 23 February 2017, which were due on the 22 February 2017 p.64– Tab 41 Patient self-referral, 2 Sievers had concerns of not receiving urostomy supplies February 2017, p.5152– Tab 41 Case Note Report, Sievers stated he was frustrated and angry that JH were not p.928-929 11 allowing him to receive his diabetes medication at a clinic closer January 2017– to 10 Wing. When he received his lunchtime medication from the Tab10(HH) clinic near 7 Wing and 9 Wing he stated he had to wait outside for up to 15 minutes. During this time the inmates in 7 Wing and 9 Wing call him a "paedophile" and throw hot water over the fence at him. Because this is so unpleasant Sievers stopped going to the clinic meaning he has not been receiving his lunchtime insulin.

As a result, Sievers is concerned about his health. He stated that he has submitted complaints to JH, the Ombudsman and Healthcare Complaints Line. He stated that if this issue was not resolved soon, he would employ Legal Aid to pursue this. (p.928) Patient self-referral, 5 Sievers complained of a problem for the last 10 months regarding January 2017, (p.48) Urostomy supplies, stating it only occurs at this centre’s clinic – Tab 41 2016 Management Plan, Just prior to ‘Let-go hour,’ Sievers is to be escorted by an officer p.424-425 (25 August to KWU to interact with other aged/frail inmates there. Sievers to

2016. – Tab10(CN) be showered and given access to telephone calls and exercise at KWU. Sievers to be escorted by an officer to 7 Wing, just prior to KWU lock-in.

Medical interaction to be conducted through MSPC1 Main Clinic, unless an emergency situation.

Letter, 17 May 2016 Due to continuous complaints/self-referrals, MSPC1 nursing staff (p.235) – Tab 41 will not engage with Sievers to discuss order. Sievers is to speak with NUM re any concerns about orders & meet with NUM start of each month to be given month worth of products.

Progress/clinical Sievers refused to discuss abdominal pain, refused assessment notes, 11 May 2016 – which nurse offered. Sievers refused to read letter from Nursing 16 August 2017(p.13 - Manager regarding his management plan. Sievers threw away the

28. – Tab 41 letter on nursing station and stated “nonsense”. (p.14) Discharge letter received…importantly, the suggestions of cease of Onglyza and decrease dosage of insulin are made based on wrong current insulin dosage. Dr Depczynski has been contacted, stated that letter cannot be explained through phone call and a typing letter will be sent in weeks…also, Sievers has put on GP list to review (p.14)

Sievers refused to attend midday clinic blood sugar level at clinic twice (p.17) Sievers refused & insulin withheld after lunch (p.19) Emergency Response Sievers fell from chair. He was placed on observation cell for 4 Form, 7 May 2017 hours (p.29) – Tab 41 Mental Health Sievers angry that stoma bags have been provided and are not Assessment, 24 April the right ones. Staff ordered the correct bags (p.51) 2016– Tab 41 D/C & psychiatrist & possible treatment ½ anti-depressants for mood (p.58) Appointment Regarding diabetes management - “I don’t believe I’ll get any cancellation by better if I see them (in Sydney). I would rather manage it myself.” patient, 4 March 2016 (p.15) – Tab 41 Progress/Clinical Appointment for diabetic arranged - Sievers refused to attend notes, 5 February 2015 – 22 April 2016 (p.44) – Tab 41 Inmate Profile Transfer from Lithgow CC to MSPC Document, 4 March 2016 – Tab 10A Medical Sievers to receive extra fruits plus extra milk (due to medical Officer/Nursing condition: unstable diabetes) Certificate, 5 February 2016 (p.28) – Tab 41 Inmate Profile Transfer from MSPC to Lithgow Correctional Centre Document, 5 February 2016 - Tab 10A