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today, on the eighth day of his inquest, we will hear from Nathan Reynolds' family. outside the court, his sisters Taleah and Makayla delivered their statement. 'On the 1st September 2018, we lost our much-loved brother Nathan Reynolds.' #JusticeForNathanReynolds
'He died in custody, after an asthma attack — just one week before he was due to be released [...] Our brother should still be here. Today we stand here to be Nathan’s voice and to ensure that there is accountability for his death [...] We must ensure this never happens again.'
You can read their full media statement here — https://www.alsnswact.org.au/reynolds_family_-_media_statement #JusticeForNathanReynolds
We're now hearing in Court from RN Pant — on prescriptions, information and management of chronic asthma inside prisons. #JusticeForNathanReynolds
Q: 'In May 2018, you didn't realise it was mandatory for an asthma management plan to be made?'
A: 'Yes.'
#JusticeForNathanReynolds
A: 'Yes.'
#JusticeForNathanReynolds
Q: 'I take it you didn't know that requirement existed when you saw Nathan in August and didn't provide him with asthma medication?'
A: 'Not everybody who uses ventolin needs a plan, some only use it once a month. I would ask them: how are you going? How often do you use it?'
A: 'Not everybody who uses ventolin needs a plan, some only use it once a month. I would ask them: how are you going? How often do you use it?'
Q: 'If someone's got asthma, they require diagnosis by a doctor?'
A: 'Obviously, yes.'
Q: 'It's not a decision you can make about whether someone needs this plan or not?'
A: 'Yes.'
A: 'Obviously, yes.'
Q: 'It's not a decision you can make about whether someone needs this plan or not?'
A: 'Yes.'
Q: 'What this inquest would like to know is if things have changed since 2018. If you saw an inmate in a transfer process and you could see no indication on file of a chronic health screening, would you make an appointment?'
A: 'We do now.'
A: 'We do now.'
Q: 'When you're communicating and handing over puffers at the 'pill parade' you have the screen between you and the patient, and other inmates around?'
A: 'Yes.'
Q: 'In some respect, that's not a place for an in-depth assessment?'
A: 'No.'
A: 'Yes.'
Q: 'In some respect, that's not a place for an in-depth assessment?'
A: 'No.'
Q: 'Do you know how many puffs a Ventolin puffer has?'
A: '200.'
Q: 'Nathan using 200 puffs in one week is a real alarm bell in relation to the severity of his asthma?'
A: 'Yes.'
A: '200.'
Q: 'Nathan using 200 puffs in one week is a real alarm bell in relation to the severity of his asthma?'
A: 'Yes.'
Q: 'Across that six week period, it appears on this record that Nathan had been dispensed five Ventolin puffers, is that correct?'
A: 'Yes.'
Q: 'So it's likely that he was attending to replace used puffers on four occasions, and possibly a lost one on one occasion?'
A: 'Yes.'
A: 'Yes.'
Q: 'So it's likely that he was attending to replace used puffers on four occasions, and possibly a lost one on one occasion?'
A: 'Yes.'
Q: 'That roughly equates to 20 puffs a day over that period. Would that be a red flag?'
A: 'Yes.'
Q: 'If you saw on Nathan's file that he'd used five or four puffers over a six-week period, you would refer him on?'
A: 'Yes.'
A: 'Yes.'
Q: 'If you saw on Nathan's file that he'd used five or four puffers over a six-week period, you would refer him on?'
A: 'Yes.'
Q: 'You didn't have access to a computer or even a chair at [the pill parade]?'
A: 'No.'
Q: 'You didn't have patient confidentiality?'
A: 'No.'
A: 'No.'
Q: 'You didn't have patient confidentiality?'
A: 'No.'
Q: 'You didn't have files?'
A: 'No.'
Q: 'What did you have?'
A: 'Nothing.'
Q: 'What did you physically write on?'
A: 'A piece of paper that I had.'
A: 'No.'
Q: 'What did you have?'
A: 'Nothing.'
Q: 'What did you physically write on?'
A: 'A piece of paper that I had.'
Q: 'I understood your evidence to be that you can't recall meeting Nathan in August. When you were asked if he had breathing issues, how can you say?'
A: 'If someone had presented like that, I would have remembered. I would have documented an examination in the clinic.'
A: 'If someone had presented like that, I would have remembered. I would have documented an examination in the clinic.'
RN Pant is now excused.
Dr Gregory King has now been called to give evidence. He has produced two expert reports. He's a specialist, Director of Lung Function and Asthma Services. #JusticeForNathanReynolds
Q: 'In identifying a patient at risk of severe asthma, what are the key indicators?'
A: Frequent symptoms, using Ventolin most days of the week, escalating attacks, overnight hospital stays, ICU admissions, using prednisone — all this 'indicates uncontrollable severe asthma'.
A: Frequent symptoms, using Ventolin most days of the week, escalating attacks, overnight hospital stays, ICU admissions, using prednisone — all this 'indicates uncontrollable severe asthma'.
(These are all indicators that we've heard on prior evidence that Nathan experienced.)
Q: 'What are the barriers to compliance with puffer use?'
A: Perceived lack of immediate efficacy of preventer, knowing that it's a steroid and fearing side-effects, and actual side-effects (mouth irritation, infection, voice changes).
A: Perceived lack of immediate efficacy of preventer, knowing that it's a steroid and fearing side-effects, and actual side-effects (mouth irritation, infection, voice changes).
Q: 'If Nathan had come into your clinic, would you have identified him as someone at high risk?'
A: 'Absolutely.'
Q: 'Would GPs not have an appreciation of his risk and what a specialist could offer?'
A: 'My experience is that GPs would recognise the severity and refer promptly.'
A: 'Absolutely.'
Q: 'Would GPs not have an appreciation of his risk and what a specialist could offer?'
A: 'My experience is that GPs would recognise the severity and refer promptly.'
Q: 'Have you had referrals to your clinic from GPs working in [NSW prisons]?'
A: 'Not that I'm aware.'
Q: 'Are you aware of [asthma and similar respiratory] specialists going into [NSW prisons] to carry out care?'
A: 'No.'
#JusticeForNathanReynolds
A: 'Not that I'm aware.'
Q: 'Are you aware of [asthma and similar respiratory] specialists going into [NSW prisons] to carry out care?'
A: 'No.'
#JusticeForNathanReynolds
Q: 'There isn't any evidence that he has preventer medication in the days before his death. How important is it for someone to use preventer medication?'
A: 'It's very important, and it's part of an action plan. The second part is giving prednisone early when it's needed.'
A: 'It's very important, and it's part of an action plan. The second part is giving prednisone early when it's needed.'
Q: 'If Nathan was using the preventer medication and received the prednisone, what's the likelihood that this would have averted the serious event' that resulted in his death?
A: 'I can only speculate. It probably would have had some effect on the outcome.'
A: 'I can only speculate. It probably would have had some effect on the outcome.'
We're now going through the close detail of what treatment might have saved Nathan's life and when it could have done so — with the guards arriving at delay, and the nurse arriving at further delay. It's quite distressing, and very dense, so won't be detailed here.
Back in court, now with the counsel for Nathan Reynold's family.
Q: 'Nathan's scenario might be uncommon?'
A: 'Yes, but in risk stratification you have to assume it's the worst case.'
Q: 'Nathan's scenario might be uncommon?'
A: 'Yes, but in risk stratification you have to assume it's the worst case.'
Q: 'And it's not as if responding to others as emergency situations is a disadvantage to that person. The risk is that it's the uncommon case that'll be disadvantaged if we don't?'
A: 'That's right. If a person says: I'm having an attack, you have to assume it's really bad.'
A: 'That's right. If a person says: I'm having an attack, you have to assume it's really bad.'
Q: 'Is movement, of limbs like legs or arms [as COs observed as evidence of life], a reliable indicator of breathing?'
A: 'In such situations, you may expect unconscious movement.'
Q: 'The only way you can assess breathing is to be close observe the chest & air moving?'
A: 'Yes.'
A: 'In such situations, you may expect unconscious movement.'
Q: 'The only way you can assess breathing is to be close observe the chest & air moving?'
A: 'Yes.'
Q: 'So CPR should have started at that point [when Nathan had effectively stopped breathing]?'
A: 'Yes.'
A: 'Yes.'
Q: 'The sooner the care that could be provided by paramedics was provided, the greater chance Nathan had of getting through this asthma attack?'
A: 'Yes.'
A: 'Yes.'
Q: 'Once the paramedics were called, they took 22 minutes to attend. An average response would be 15. If a call to 000 occurred at the first knock-up, and we got the average response time, would that mean they would arrive before Nathan went into respiratory arrest?'
A: 'Yes.'
A: 'Yes.'
Q: 'And if they could intubate and administer adrenaline, then Nathan's prospects of survival would increase exponentially?'
A: 'Yes. There might have been a chance, had they arrived before [he was unconscious and being observed by the COs].'
A: 'Yes. There might have been a chance, had they arrived before [he was unconscious and being observed by the COs].'
Q (from another party): 'The window of opportunity for Nathan in this case — was it the normal one of 20 minutes, or a matter of minutes?'
A: 'The opportunity occurred when the knock up call was made. With every minute that passed, the chances for survival lessened.'
A: 'The opportunity occurred when the knock up call was made. With every minute that passed, the chances for survival lessened.'
Q (from counsel for Justice Health): 'One positive outcome from this death is that it could be used to promote the management of asthma?'
A: 'Yes.'
A: 'Yes.'
Q: 'Nathan was a classic asthma patient with respect as to his underappreciation of his own illness, do you agree?'
A: 'We can't talk to him and know what his attitudes were.'
A: 'We can't talk to him and know what his attitudes were.'
A line of questioning now on colour-coding asthma action plans.
Dr King has now been dismissed. This inquest will sit again for a witness (on healthcare for First Nations people inside NSW Prisons) on December 11.
Nathan Reynold's eldest step-daughter sharing a statement now. She shares a story about the time Nathan caught an 11-hour train just to watch her OzTag game. 'To think he won't be around anymore to make ridiculous memories breaks my heart.' #JusticeForNathanReynolds
Now hearing from Nathan's daughter: 'My dad always made me smile. My dad was creative and fun. He taught me how to ride a bike. He's the reason I love nature and the outdoors. I was nine when he died. My life has changed forever. I love you so much dad.' #JusticeForNathanReynolds
Taleah and Makayla Reynolds (Nathan's sisters) now take the stand — acknowledging Darug Country and Elders. 'I am the proud sister of Nathan. I'm here to speak on behalf of our family and those that loved him.' #JusticeForNathanReynolds
Taleah: 'Taking on the role of the support person, leading the way to find out what happened to him has been incredibly trying. It's something I do with pride, consideration & care. I had to emotionally disconnect myself to make it through the inquest.' #JusticeForNathanReynolds
Taleah: 'As we got closer to the inquest, I realised I couldn't protect my family anymore from hearing the details of Nathan's final moments. How do I prepare my family to hear these heartbreaking details?' #JusticeForNathanReynolds
Taleah: 'Our family would like to acknowledge Jeremy, Aaron and Brendan. Those three showed tremendous courage, consideration and strength in giving their evidence. It helped to provide a better understanding of what happened in Nathan’s final hours.' #JusticeForNathanReynolds
Taleah: 'We are forever grateful to all the inmates that provided friendship and support to Nathan, during his time inside, on the night of his passing, and we want to acknowledge the strength it would have taken to attend his funeral.' #justicefornathanreynolds
Taleah: 'We also would like to express our gratitude for the inmates who passed on their condolences via a card not long after his death, their condolences at that time was appreciated. It helped confirmed what we already knew that Nathan was a likeable man who will be missed.'
Taleah: 'There are a number of family members including our father, our grandfather, our aunties, uncles, cousins and friends that wanted to attend this inquest, however they have expressed that it is far too traumatic for them to hear the details of Nathan's final moments.'
'I also want to acknowledge Koorine. She's been literally my backbone this whole time since the beginning. I'm proud of all my family for sitting through this last week. It's been hard.' #JusticeForNathanReynolds
We're hearing a phone call between Taleah & Nathan in 2018, just before he passed. They're talking about their mum ('I tried to call — she never answers her phone!', laughs from the Reynolds), Taleah's new job, & getting out. He was due home in a week. #JusticeForNathanReynolds
Taleah: 'I could never had imagined that was the last conversation I'd have with Nathan.' #JusticeForNathanReynolds
'He was the eldest child and grandchild. He was spoilt. Our aunties who would do anything for him. He held a special status in the family — Nathan could do no wrong.' #JusticeForNathanReynolds
'He started working at 16, working hard to provide for his family. Any time you saw Nathan he would have plaster somewhere on him. He was a big softie. He would always end a call with 'love you!'' #JusticeForNathanReynolds
'His commitment to our family was evident. He was always doing things for his siblings and cousins. He would take them bowling, fishing, camping.' #JusticeForNathanReynolds
'He loudly and proudly supported his step-kids and kids. It wasn't unusual for him to gloat about them. Their bond will remain forever strong.' #JusticeForNathanReynolds
'They say they love and miss him, learned from him how to treat other people. They don't know how they'll live the rest of their lives without him. Nathan told them that they were his best achievements in life.' #JusticeForNathanReynolds
'His love is evident in every interaction we had. Nathan had deep respect for family.' #JusticeForNathanReynolds
'He'd sit with Pop in hospital, he'd help Nan around the house. He broke her soap dish the last time he helped around the house, he said he'd be back to fix it. He didn't get the chance. She still can't bring herself to fix it.' #JusticeForNathanReynolds
'Nathan is more than a statistic. He is more than a hashtag. We will work hard to make sure that his death will not be in vain.' #JusticeForNathanReynolds
Formidable strength and pride from the Reynolds family today, and all days of this inquest. The inquest is now adjourned. #JusticeForNathanReynolds
