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Coroner's Finding: PEARCE Heather Diane

Deceased

Heather Diane Pearce

Demographics

47y, female

Date of death

2018-01-13

Finding date

2020-01-10

Cause of death

Carbon monoxide toxicity

AI-generated summary

A 47-year-old woman died from carbon monoxide toxicity while showering in a bathroom equipped with a non-compliant, unflued instantaneous gas hot water heater installed circa 1996. The heater, at least 45 years old when installed, lacked required hood, funnel and flue connections mandated by regulations. Testing revealed dangerous carbon monoxide levels (960-2880 ppm). The metal plate blocking the heater's exhaust opening prevented proper combustion and flue gas expulsion. Clinicians should recognize that carbon monoxide poisoning requires high clinical suspicion in unexplained collapse; post-mortem examination revealed the cause. Public education about gas appliance compliance, professional installation, and regular servicing is critical to prevention.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Contributing factors

  • Non-compliant gas hot water heater installed without flue
  • Heater installed in bathroom contrary to regulations
  • Metal plate blocking exhaust opening
  • Incomplete combustion producing high levels of carbon monoxide
  • Inadequate bathroom ventilation
  • Heater never serviced
  • Second-hand heater lacking original hood and funnel

Coroner's recommendations

  1. The Office of the Technical Regulator should publish a warning to the public regarding the risk of death or serious injury presented by the use of instantaneous gas heaters which do not comply with or are not operated in accordance with technical and safety requirements
Full text

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This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.

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