Inquest into the Death of Sandra Honey
Deceased
Sandra Honey
Demographics
56y, female
Date of death
2001-11-16
Finding date
2003-05-30
Cause of death
Multiple injuries including small and large bowel damage, mesenteric damage with blood in abdomen, lung contusions with blood in chest cavity, leading to compromised blood circulation, cerebellar and brain stem infarction, and asystolic arrest
AI-generated summary
Sandra Honey, aged 56, died on 16 November 2001 from multiple injuries sustained in a motor vehicle accident on 13 November 2001. She was a passenger in a vehicle driven by her daughter on the Coalfields Highway near Worsley when the vehicle lost traction on loose blue metal aggregate that had been applied during roadworks earlier that day. The vehicle collided with a tree. She sustained bowel and mesenteric injuries, lung contusions, and internal bleeding. Despite emergency surgery at Bunbury Regional Hospital and intensive care at Sir Charles Gairdner Hospital in Perth, she died from asystolic arrest. The coroner found the death arose by accident. Key findings were that excessive loose aggregate remained on the roadway creating a hazard; warning signage was inadequate and difficult for motorists to observe; and speed reduction signs were not required or provided despite the 110 km/h speed limit and hazardous conditions. RoadCare subsequently amended its Traffic Management Plan to require maintained signage and optional speed reduction signs for unattended worksites.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Specialties
Error types
Clinical conditions
Procedures
Contributing factors
- Excessive loose blue metal aggregate left on roadway creating loss of vehicle traction
- Inadequate and poorly visible roadworks warning signage
- Absence of speed reduction signs despite 110 km/h speed limit and hazardous road conditions
- Incomplete removal of excess aggregate from road surface before leaving worksite unattended
- Road topography and passing lane creating limited visibility of warning signs
- Afternoon sun creating shadow on roadworks section
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