Deceased
JULIE ANNETTE STEPHENS
Demographics
54y, female
Coroner
Deputy State Coroner Iain West
Date of death
2008-12-19
Finding date
2008-03-20
Cause of death
sepsis
AI-generated summary
Ms Julie Stephens, aged 54, was admitted to Frankston Hospital on 5 December 2008 with a chest infection and multiple comorbidities including cardiac failure, respiratory failure, and obesity. She deteriorated with septic shock secondary to pneumonia and was transferred to ICU where she was intubated and given morphine sedation despite documented morphine allergy—a significant oversight not identified until 11 December. She developed ARDS, acute renal failure, and abdominal sepsis, ultimately dying from sepsis on 19 December. Post-mortem examination found no evidence of anaphylaxis from morphine exposure. The coroner found hospital management within reasonable parameters but criticised the failure to identify and prominently display the allergy before medication administration, recommending allergy stickers on medical record covers.
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
74y · Male·Acute myocardial infarction complicated by multiple organ failure
Ronald William Beaumont, 74, died from acute myocardial infarction complicated by multiple organ failure following a second shoulder washout procedure. Key clinical lessons: (1) Despite inadvertent withholding of dual an…
70y · Male·intracranial haemorrhage secondary to haemorrhagic transformation of ischaemic s…
A 70-year-old man with chronic small vessel cerebral ischaemia died from intracranial haemorrhage following haemorrhagic transformation of an ischaemic stroke while in prison custody. He presented with acute stroke sympt…
75y · Female·Ischaemic heart disease in the setting of unstable type 2 diabetes mellitus and …
Veronica Roberts, 75, died from ischaemic heart disease complicated by unstable diabetes and a medication error. On 4 October 2020, her insulin dose was increased to 20 units daily, but due to Electronic Medical Record (…
Source and disclaimer
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.
Content may be incomplete, reformatted, or summarised. Some material may have been redacted or restricted by court order or privacy requirements. Always refer to the original court publication for the authoritative record.
Copyright in original materials remains with the relevant government jurisdiction. AI-generated summaries and tagging are for educational purposes only, may contain inaccuracies, and must not be treated as legal documents. We welcome feedback for correction — report an inaccuracy here.