Deceased
Trevor John Smith
Demographics
62y, male
Date of death
2011-03-18
Finding date
2013-07-22
Cause of death
extensive small cell lung cancer
AI-generated summary
Trevor John Smith, aged 62, died from extensive small cell lung cancer at Royal Adelaide Hospital on 18 March 2011. He was under Mental Health Act detention when he developed delusions and delirium during his final illness. The coroner found no clinical errors contributed to his death; the delusions appeared related to his advanced malignancy rather than medication. However, a significant administrative failure occurred: hospital staff did not report his death to the coroner until three days after his death despite his detention status requiring mandatory reporting. This delay caused substantial distress and financial hardship to his family who had arranged funeral services based on incorrect information. The case highlights the importance of ensuring all hospital staff understand their legal obligations regarding timely coroner notification of deaths in custody.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Clinical conditions
Procedures
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