A father of three killed in an unprovoked one-punch attack would likely not have died but for the failings at a Hobart hospital, a coroner has found.
University of Tasmania academic Stewart Williams died from brain damage suffered in the attack by Beau Wayne Kelly at a Hobart nightclub in the early hours of February 24, 2019.
Coroner Olivia McTaggart said doctors at Royal Hobart Hospital failed to identify bleeding at the rear of Dr William's nasal cavity until it was too late, with the unstemmed blood loss ultimately resulting in haemorrhagic shock and death.
"It is likely that, if the source of the bleeding had been detected and treated in a timely manner, as it should have been, Dr Williams would have survived," she said.
Ms McTaggart identified several missteps in the treatment of the 54-year-old.
Staff missed several signs that should have prompted them to treat the situation as an emergency.
They failed to record the extent of Dr Williams' blood loss, conduct an angiography to determine which blood vessels were impacted, apply a balloon tamponade to reduce bleeding and raise concerns with senior doctors until it was too late.
The coroner found there "ample opportunities" to properly assess and assertively treat Dr Williams' condition.
"Such opportunities were not taken," Ms McTaggart said.
She decided not make any recommendations for the hospital to change its processes as it had already implemented several changes following a review into its failings by the Tasmanian Health Service.
These include better fluid documentation, revised protocols for specialist escalation and improved training.
"The deficits in his treatment were not attributable to any one individual and there is no suggestion that the treating staff were not attempting to do their best in the circumstances," Ms McTaggart said.
Kelly, who was 18 at the time of the attack, pleaded guilty to one count of manslaughter and was sentenced to five years in jail with a non-parole period of two and a half years from April 2020.
Dr Williams, who was a senior lecturer in human geography and environmental planning, is survived by an adult son and two teenage children.
