Submission to the State Coroner, Queensland

Background and Overview

My 78 y/o father, Barry Peter Ryan, had Parkinson’s disease with some cognitive impairment and associated severe speech difficulties and difficulty swallowing. I was appointed as Enduring Power of Attorney (EPOA) for my father alongside my aunt, Barb, who was my father’s former sister-in-law. She was chosen to assist because she lived nearby and had prior experience managing EPOA arrangements. At the time, I was residing in New York, and both my father and I trusted Barb to manage local administrative processes and assist with his care on my behalf.

My sister, Michelle, has been largely estranged from our father for most of her adult life. Other than assisting with the sale of his home, and providing temporary accommodation around this time period while helping with certain financial matters during that period.

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Timeline of Medical Events in 2025

Up until only a few days before his acute hospital admission in April 2025, my father, Barry Peter Ryan, remained his usual self, cheerful, using a wheelchair but occasionally walking short distances with support from a handrail, communicative, eating well and socially engaged. He did complain of daytime drowsiness after receiving his parkinsons medications. His acute decline started in the days after a routine doctor’s appointment on April 13. 

Upon admission to the Mater Hospital for this initial acute medical event, Barb provided collateral information to hospital staff asserting that he was at “end-stage dementia” and “end-stage Parkinson’s disease.” Dad also had a cancer diagnosis entered into his records. I have been unable to find clinical evidence to support that diagnosis in the medical records made available to me. On the first night of admission, Barb formally approved a “Comfort Care” plan, thereby authorising the treating team to regard my father as being at end of life and not requiring medical treatment (see ARP document below). Barb did not disclose to the treating team that I was also an appointed Enduring Power of Attorney and next of kin. Shortly after his admission, she departed on a caravan trip and was largely absent for several weeks.

During this first acute episode, in April, I had a FaceTime call with him. At that time, he had received no Parkinson’s medication for more than 24 hours, and the treating team had inserted a nasogastric (NG) tube for the purpose of administering his Parkinson’s medications. This tube was not being used to provide nutrition.

During the call, I was struck by how responsive and alert my father appeared, even though he had not yet received his Parkinson’s medication, as the team was waiting for an X-ray to confirm the tube’s placement. His level of responsiveness in the absence of medication suggested that the previous dosing regimen may have been overly sedating. Based on these observations, I requested that his treating team reduce the dose of his sedating Parkinson’s medications.

In 2019, my father completed a Statement of Choices, in which he explicitly indicated his wish to receive active medical treatment, including artificial feeding if necessary. (See medical notes below)

My father explicitly informed hospital staff that he wanted me to make medical decisions on his behalf (see medical notes from May 2025 below).  During April and May 2025, and despite my objections, my father’s treating team continued to promote a “comfort care” approach rather than pursuing rehabilitative or restorative treatment. My father remained overly sedated, often unable to eat or drink enough to sustain himself, and experienced progressive weight loss and physical decline. He required multiple hospital admissions following periods of minimal oral intake, during which he became increasingly weak and occasionally choked while eating.

Importantly, there were no X-ray-confirmed episodes of aspiration pneumonia recorded in 2025, nor was any bacterial growth identified on culture, despite repeated notations of “recurrent infections” in his medical records. These findings indicate that his deterioration was more consistent with malnutrition, dehydration, and medication effects than with any proven infectious or terminal process.

The video below recorded on 4 June 2025 at the Princess Alexandra Hospital shows my father on “comfort care” in an emaciated and severely weakened condition. In the footage, he appears depressed, unable to move his arms or legs, and struggling to speak, eat, or drink. At that time, he was under-hydrated, malnourished, and over-sedated.

My father was finding it harder to speak but when he could he repeatedly told me that he was too sedated to eat or drink, that he felt hungry and thirsty, and that he disliked the “comfort care” mouth swabs being used. 

Following a family meeting on the 6th of June, I again requested, as I had on multiple prior occasions, that my father’s sedating Parkinson’s medications be significantly reduced. On this occasion, the consulting neurologist agreed to the adjustment.

Following the reduction of his sedating Parkinson’s medication in early June 2025, I observed a marked improvement in his alertness, responsiveness, and ability to communicate. The video recorded on 11 June 2025 (below) demonstrates these changes clearly, taken only a few days after the medication adjustment. In this footage, my father appears brighter, more engaged, and able to interact both verbally and nonverbally, reflecting a significant positive response to reduced sedation from the Parkinson's medications. He also thanks me for advocating on his behalf and asks that I continue doing so, indicating awareness and insight into his own situation.

Dad was discharged back to the nursing home in mid June 2025 (see video below, where my father is watching television with me at the nursing home), he was initially in good spirits and continued to show gradual improvement in mood and responsiveness.

However, nursing home staff mistakenly believed my father was constipated and subsequently administered excessive amounts of bowel medication. This was deeply concerning, as he had already spent several weeks losing weight due to sedation and poor oral intake, leaving him emaciated and extremely frail.

My father told me directly that he was experiencing copious watery bowel motions and severe abdominal pain, which I immediately reported to staff. Despite this, his reports were dismissed or not acted upon. In the following days and weeks, he developed increasing physical weakness, further weight loss, intermittent episodes of reduced consciousness, choking, and was admitted to hospital on multiple occasions with documented life-threatening hypokalaemia (low potassium).

In late June/early July 2025, he was readmitted to the Princess Alexandra hospital after nursing home staff gave dad a glass of liquid bowel medication despite being advised that he was too fatigued to swallow. The liquid was suctioned from his oropharynx in the accident and emergency department.

A subsequent abdominal X-ray (see below) confirmed that he was not constipated at all, corroborating his earlier reports of frequent watery stools. In view of his profound fatigue and signs of malnutrition, I requested that the treating doctor commence nutritional support via a nasogastric feeding tube to stabilise his condition and restore essential nutrients. 

Following sustained refeeding, my father exhibited marked gains in weight, physical strength, and mental clarity, demonstrating that adequate nutrition and hydration were critical to his recovery and that his earlier decline was both reversible and responsive to proper medical support.

In the video recorded on 20 July 2025 (below), my father can be heard complaining of soreness due to skin irritation resulting from the excessive use of laxatives. Notably, he does not express any discomfort related to the nasogastric tube and appears comfortable and settled with it in place.

This video was taken during week three of nasogastric refeeding and shows clear, measurable improvements in fine motor movement, cognition, and speech. He recognizes me and follows our conversation, behaviour with marked improvements that is inconsistent with the presentation of end-stage Parkinsons or end-stage dementia.

These outcomes demonstrate that my father was suffering from malnutrition, dehydration, and over-sedation. His improvement following appropriate medical intervention confirms that his condition had been misinterpreted as irreversible decline when it was, in fact, largely iatrogenic and reversible.

By late July 2025, my father had started to feed himself again (see below). His level of awareness, fine motor movement, engagement, and physical ability during this period provides clear evidence that he was not in the end stages of dementia or Parkinson’s disease, as had been previously asserted. A consulting neurologist reviewed dad around the 23rd of July and confirmed that my father was not dying and was a suitable candidate for artificial PEG-tube feeding.

Deterioration After EPOA Suspension

At the end of July 2025, following a QCAT interim order, my authority as Enduring Power of Attorney was suspended at the request of my aunt, Barb, who alleged that I was “spending too much time” with my father. Soon after, his sedating Parkinson’s medication dosage was increased by approximately 250 percent.

Following this change, my father became profoundly sedated and lost the improvements he had made in his ability to speak, move, eat, and drink. When he was confused he removed his nasogastric tube, staff declined to replace it. 

Conversation Prior to Death

On 25 September 2025, just days before his death, I spoke with my father by telephone. At that time, he was eating and drinking very little, becoming weaker, and his swallowing reflex was declining. Despite this, he was responsive and recognised me. Although his speech was markedly impaired, he was very talkative and clearly ended the call by saying, “I love you, Teen,” as he always did. This demonstrated cognitive awareness, emotional connection, and communicative intent, evidence that he was not in the “end stage” of a neurodegenerative disease. In the days that followed, staff administered large doses of narcotics to which he was unaccustomed, and he did not wake to eat or drink sufficiently, resulting in his death.

Evidence Contradicting “End-Stage” Labels

• No formal clinical diagnosis of end-stage dementia or end-stage Parkinson’s disease exists in his records prior to April 2025.

• Neurology review (8 July 2025) noted cognitive testing for Dementia was not able to be assessed after April 2025. (See Below)

• Radiology showed no evidence of stroke or pneumonia.

• Pathology revealed no bacterial infection.

• No clinical history of Cancer was provided. 

• Video and photographic evidence show measurable improvements in my father’s alertness, interaction, and mobility following refeeding and medication adjustments, findings that are inconsistent with an end-stage Parkinson’s disease diagnosis.

These findings indicate that the withdrawal of nutrition and hydration was based on incorrect assumptions rather than verified medical evidence.

Conclusion

My father was not “end-stage.” He had Parkinson’s disease and dysarthria, with some cognitive impairment and what he required was ongoing nutrition, hydration, and therapeutic support, not sedation and starvation. His decline was preventable. The available records, pathology results, and  observations collectively demonstrate that he retained meaningful potential for recovery, and that treatment was withdrawn prematurely as a result of misinformation and misrepresentation.

My father suffered profoundly through unnecessary sedation, prolonged hunger, thirst, and the imposition of so-called “comfort care” measures that denied him the opportunity to recover. He wanted to live. Throughout his life, he was a man who thrived on challenge, resilience, and determination, he would never have chosen to give up.

This submission represents my personal account and interpretation of events based on the records, correspondence, and evidence currently available to me. It is provided in good faith and remains subject to review, correction, and verification should additional information become available. Any individuals or institutions referenced are invited to respond or provide clarification to ensure accuracy and fairness. This material is shared for transparency and accountability purposes and should not be reproduced or widely distributed without appropriate legal or editorial review.