Jury rules death by natural causes

A Coroner’s Jury ruled last month
that the death of Alfred William Billes was by natural causes.  Mr. Billes, 71, died on 12 May, 2007.

During an inquest conducted by
Queen’s Coroner Nova Hall, the jury heard evidence from Dierdre Billes, the
third child of Mr. Billes.

Ms Billes said on 11 May 2007, her
father fell from the bed at his residence in Laguna Del

Her mother tried to call 911 but
was unsuccessful. She also tried to get in touch with the family doctor but was
unable to do so.

Mrs. Billes then contacted Dierdre,
who went to their home at about 8:10am and saw two ambulances. Her father was
on a stretcher but was conscious and talking to medics.

He was subsequently admitted to the
critical ward at the George Town

Ms Billes said on 12 May, she was
at Hospital when her father passed away at around 4.30am.

She added that he had a heart
attack in 1997 and was experiencing heart trouble, in addition to having major
knee surgery in 2004, 2005.

An autopsy listed his cause of
death as hypotension; pulmonary edema due to acute appendicitis with

Ms Billes related an incident that
occurred six months after her father’s death. It involved a tenant who consulted
the same doctor her father had been a patient of. The tenant went to the doctor,
was given medication and sent home.

The tenant then went to the Chrissie Tomlinson Memorial
Hospital, where Dr.
Stephen Tomlinson removed her appendix.

When asked by a juror why she had
mentioned her tenant’s plight, Ms Billes replied that the doctor “missed something
he shouldn’t have if he had been concentrating, and nowadays you can’t miss a
simple diagnosis.”

A statement from a police officer
who attended the hospital, as per protocol after a death, was also read into

The officer said he observed no
signs of trauma. He met with the wife of the deceased, who explained her
husband had a medical history of heart trouble and was experiencing abdominal
pains, as well as perspiring a lot. He said Mr. Billes’ widow added that she
had taken her husband to the doctor, who prescribed medication and sent him

Testimony was also given by Dr.
Shravan Joyti, pathologist at the George
Town Hospital.
He explained to the jury information contained in the autopsy report. The
autopsy itself had been performed by the previous pathologist, Dr. John

Mr. John had noted Mr. Billes’
medical history, which included an enlarged heart and calcified coronary
arteries. The deceased was also described as markedly obese, being six feet
tall and weighing between 350 and 375 pounds.

Mr Joyti described the process of
Mr. Billes’ death. He was asked whether the outcome would have been different
if the patient had been dealt with differently by his private physician.

Mr. Joyti said the appendix can
burst at any time in acute cases – up to 48 hours.

“But most of the time when proper
treatment is administered we don’t see rupture. Either a surgeon would take the
bold decision of cutting out the appendix or administering medication in the
form of antibiotics that can defer the surgery two to three weeks,” Mr. Joyti

He added that it was impossible to
tell what stage the patient was at when the doctor saw him and the decision to
conduct surgery or prescribe medication is up to the physician’s discretion.

Mr. Joyti also commented on the
report that Mr. Billes had been moving furniture before becoming ill. He said
that would not have caused the appendix to rupture.

After witness testimonies were
given, the coroner advised jurors they had to decide whether Mr. Billes died of
natural causes or by misadventure.

Suicide was ruled out as a possible
cause of death.

The Magistrate explained that
“misadventure” was meant in the context of things that do not occur in a
person’s everyday life. She asked that the jurors come back with a unanimous
verdict or a majority of six to one, five to two.

The courts do not accept a 4 to 3
verdict in coroner’s inquests, even though it is a majority. If jurors are unable
to come back with a verdict, they can deliver an “open verdict”.

After about 15 minutes of
deliberations, the jury came back with a verdict of death by natural causes.