Deceased
Lillian Rose Thomas
Demographics
21y, female
Coroner
Coroner Catherine Fitzgerald
Date of death
2021-11-17
Finding date
2025-08-13
Cause of death
Compression of the neck secondary to hanging
AI-generated summary
Lillian Rose Thomas, 21, died by hanging on 17 November 2021 at her home in Kyabram, Victoria. She had complex mental health conditions including CPTSD, anxiety, depression, OCD, and personality disorder traits, with a history of chronic suicidality, self-harm, and a prior suicide attempt. In the early morning of her death, she contacted Lifeline crisis support and her former teacher Ms Heale, disclosing medication overdose. Ms Heale called 000 at 5:31 am. The call was triaged as Priority 3 (non-urgent) and referred to ambulance Secondary Triage service. Despite multiple attempted contacts, ambulance paramedics could not reach Lily, and no ambulance resources were available for dispatch. Police attended 1 hour 19 minutes later and found her deceased. The coroner could not establish whether earlier ambulance attendance would have prevented death, given the lethality of hanging and uncertainty about timing. The finding highlights critical ambulance resourcing issues in Victoria that delayed emergency response, though causation to death remains undetermined.
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
44y · Female·Hypoxic ischaemic encephalopathy complicating cardiac arrest in the setting of p…
Elizabeth Ferris, a 44-year-old woman with schizoaffective disorder and polysubstance use disorder, died from hypoxic ischaemic encephalopathy following cardiac arrest in the setting of presumed drug toxicity. She was fo…
38y · Female·Multiple injuries sustained when struck by a train
Natasha Stojkoski, a 38-year-old sales assistant at The Good Guys, sustained a workplace injury in October 2018 involving a Work Assisted Vehicle incident affecting her back, shoulders and neck. Subsequently, she reporte…
25y · Male·Combined drug toxicity
Harrison William Ladd, 25, died from combined drug toxicity involving clonazepam, dexamphetamine, codeine, diazepam and pholcodine. He had complex mental health and substance use disorder requiring specialist addiction c…
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.