'Walking time bomb': Health expert testifies in death in custody inquest

That is how Associate Professor and specialist cardiologist Mark Adams described Brandon Rich's health.

The 29-year-old is at the centre of a coronial inquest into his death that took place on December 29, 2021, while in police custody.

On Monday, November 27, 2023, the cardiologist took to the stand via audio visual link in Dubbo Coronial Court to describe the outcome of Mr Rich's autopsy.

Dr Adams said he was "almost certain" Mr Rich died of cardiac arrhythmia after going into cardiac arrest.

As a smoker, occasional drug user and classified as overweight, Mr Rich had a number of risk factors, Dr Adams told the court.

"He could have died at any time, if he was in my office I would be telling him many things...not to do any sort of exercise at all because he was a walking time bomb," he said.

Dr Adams told the court that someone with his level of cardiac arrhythmia should not be exerting himself because he wouldn't have enough blood to function normally.

"Stress and anxiety leads to an increased need for the heart to pump," he said.

"If you're very hot and overheating, this puts demand on the heart...we redirect blood flow to the skin to keep us cool, which makes the heart beat faster... we see people die from heat exhaustion, it's a real problem."

Dr Adams told the court if Mr Rich had been referred for a coronary bypass surgery it would have improved his blood flow, improved his life span and stopped potential heart attacks.

"Unfortunately it wasn't picked up, but I have to say a lot of people are walking around with this disease," he said.

"With coronary artery disease it takes a long time to build up but once it reaches a certain level it proceeds quite quickly...people who die suddenly with no warning at all...it's normally from a heart attack."

Dr Adams said he didn't think there was enough evidence to say the use of pepper spray on Mr Rich would have enough effect for sudden death or cardiac arrest.

"It would add to anxiety and stress the person is under, which becomes a problem," he said.

"He would have been under a lot of physical stress, he was a big man who was struggling to get away, so it would have been a lot of physical activity for him."

The court heard that in high stress situations, people tend to exert large amounts of adrenaline which increases your cardiac output.

"Anything that causes anxiety and fear can lead to the effect of a flight or fight response," Dr Adams said.

"It's a primal reflex in our body and this is not helpful and can be problematic and increase anxiety and can have adverse cardiac effects."

Nicholas Broadbent, counsel representing Mr Rich's family, asked if one of the police officers who held Mr Rich in an alleged rugby tackle hold would have restricted Mr Rich's ability to breathe.

"If you have a lot of pressure in the stomach or fluid in the abdominal cavity, the diaphragm can't move down then it does limit the volume of the chest cavity," Dr Adams told the court.

"He would have been suffering from exertion at that time and would have needed a lot of air at that time."

Mr Rich, as an Indigenous man, was already in a minority group.

"What we do know is there is unfortunately a gap with our Indigenous people who suffer from primary heart disease," Dr Adams said.

One of the many reasons is access to specialists and long wait times for general practitioners in regional and rural areas.

"It's difficult to diagnose heart disease when people don't have access to health care, because a GP could have given Mr Rich advice about what he could do to lower his risk," he said.

"At 29 people think they're bullet proof and wouldn't have something like that."

Dr Adams told the court there needs to be better access to health care.

"Obviously there is a real problem with access to these things [heart disease screen tests] around Australia and people in regional areas are the ones who suffer the most," he said.