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NSW2024-12-19

Inquest into the death of Ian Turner

35y · Male·multi-drug toxicity

CPL Ian Turner, a 35-year-old Special Forces soldier with combat-related PTSD, died from multi-drug toxicity in July 2017. His death followed multiple deployments to Afghanistan and Iraq, domestic violence incidents, dis…

psychiatrygeneral practicediagnosticcommunicationamitriptyline
VICcommunity2024-11-15

Finding into death of Benjamin James Ralston

31y · Male·Mixed alcohol and drug toxicity (heroin, promethazine, benzodiazepines, 3-fluoro…

Benjamin Ralston, 31-year-old, died from mixed alcohol and drug toxicity involving heroin, promethazine, benzodiazepines, and 3-fluoromethamphetamine (3-FA). He was found unresponsive on a street after socialising and dr…

heroin
WAcommunity2024-10-22

Inquest into the Death of Karl Jonathan TURNER

49y · Male·combined drug toxicity

Karl Turner, a 49-year-old man with schizoaffective disorder and chronic polysubstance use, died from combined drug toxicity (heroin, morphine, pregabalin, methylamphetamine, and cannabis). He was managed on a Community …

psychiatryintensive caresystemdelaymorphine
QLDaged care2024-10-10

Non-inquest findings into the death of Diane Margaret Crowther

76y · Female·multiple organ failure due to abdominal wall cellulitis (surgically treated)

Mrs Crowther, a 76-year-old obese woman with multiple comorbidities in residential aged care, died from multiple organ failure secondary to abdominal wall cellulitis. A critical care failure occurred when an old dressing…

geriatric medicineplastic and reconstructive surgerydiagnosticcommunicationhydrozole cream
VIChome2024-08-28

Finding into death of Ryley Ann Cox

Unknown·Sodium nitrite toxicity

Two deaths from sodium nitrite toxicity: Laurence Cox (63) and his daughter Ryley Cox (32). Laurence had a history of depression, anxiety, chronic pain, and medical conditions including emphysema and legal blindness, and…

psychiatrypsychologysodium nitrite
VIChome2024-08-28

Finding into death of Laurence John Cox

Sodium nitrite toxicity

A 63-year-old man with a history of depression, anxiety, and chronic medical conditions including emphysema and blindness, and his 32-year-old daughter with depression, anorexia, and substance abuse, died from sodium nit…

psychiatrypsychologysodium nitrite
VIC2024-08-12

Finding into death of Danielle Cadan

51y · Female·Methemoglobinemia in the context of lignocaine use

Danielle Cadan, 51, died from methemoglobinemia following a tooth extraction under lignocaine anaesthetic at a regional health service. The lignocaine was administered in normal therapeutic dose but triggered this rare l…

dentistryanaesthesiacommunicationsystemlidocaine
VIChome2024-05-24

Finding into death of L I

16y · Male·mixed drug toxicity (codeine, morphine, tramadol, alprazolam and desmethylvenlaf…

LI, a 16-year-old with borderline personality disorder, factitious disorder, and opioid use disorder, died from mixed drug toxicity (codeine, morphine, tramadol, alprazolam, desmethylvenlafaxine) after obtaining prescrip…

general practicepsychiatrymedicationdiagnosticcodeine
VICcommunity2024-05-15

Finding into death of Denise Lucina Roberts

63y · Female·Combined features of bronchopneumonia, emphysema and ischaemic heart disease on …

A 63-year-old woman with depression, anxiety, liver cirrhosis, and chronic drug use died from bronchopneumonia, emphysema, and ischaemic heart disease following a prolonged lie on the ground with hypothermia. She missed …

general practiceaddiction medicinecommunicationsystemdiazepam
QLD2024-05-13

HARVEY, Thompson

33y · Male·Neck compression (hanging)

Thompson James Harvey, aged 33, died by hanging in his cell at Capricornia Correctional Centre on 13 November 2017, four days after remand for serious offences including attempted murder. He had a recent suicide attempt …

psychiatrypsychologycommunicationdiagnosticmorphine
NSWcommunity2024-04-17

Inquest into the death of Michael Murray

44y · Male·Multiple blunt force injuries from fall from height

Michael Murray, aged 44, died following a fall from Landslide Lookout in the Blue Mountains. He had been diagnosed with borderline personality disorder (BPD) and chronic suicidality. His death highlighted critical gaps i…

psychiatrygeneral practicesystemdelaydiazepam
NSW2024-03-13

Inquest into the death of O A

44y · Male·multiple injuries from fall from cliff

A 44-year-old man with familial Mediterranean fever (FMF) and bipolar affective disorder with drug-induced psychosis died following a fall from a cliff at Vaucluse during a police rescue operation. He had been managing s…

rheumatologyallergy and immunologycommunicationsystemoxycodone
VIChome2024-03-07

Finding into death of Claire Louise Carroll

45y · Female·Neck compression secondary to hanging

Claire Louise Carroll, 45, died by hanging while experiencing severe untreated psychotic symptoms including auditory hallucinations, paranoid delusions, and persecutory ideation. She had complex mental health diagnoses (…

psychiatrygeneral practicesystemcommunicationclonazepam
NSWmental health2024-03-06

Inquest into the death of RA

64y · Female·hypoxic ischemic encephalopathy caused by neck compression and hanging

A 64-year-old woman with a history of childhood trauma, anxiety and depression was admitted to an acute mental health unit (Kurrajong Unit) under involuntary care following a suicide attempt. Within 24 hours, she accesse…

psychiatryemergency medicinesystemproceduralmirtazapine
VIC2024-02-21

Finding into death of Tai Van Tran

43y · Male·Unascertained - attributed to metabolic/physiological derangement in context of …

Tai Van Tran, a 43-year-old man with daily heroin use, was arrested and remanded in police custody. He disclosed heroin use during intake assessment and was appropriately scheduled for medical review. On the following da…

emergency medicinecorrectional healthheroin
TAScommunity2024-01-22

Coroner's Finding: de-identified TX

30y · Male·Drowning due to jumping from the Batman Bridge

A 30-year-old man with opioid use disorder, anxiety, and depression died by suicide from jumping the Batman Bridge. He had been prescribed escalating doses of clonazepam (1-8mg daily) over three years by general practiti…

general practicepsychiatrydiagnosticsystemclonazepam
SAhome2023-12-06

Coroner's Finding: Cullen, Jason Mark

37y · Male·mixed drug toxicity with fentanyl as the principal agent

37-year-old Jason Cullen died from mixed drug toxicity with fentanyl as the principal agent. He had chronic idiopathic intracranial hypertension requiring multiple neurosurgeries and was prescribed opioids and benzodiaze…

neurosurgerypsychiatrycommunicationsystemfentanyl
WAhospital2023-11-29

Inquest into the Death of Samuel Edward ASHBY

46y · Male·Aspiration pneumonia in an obese man with a history of diabetes mellitus, obstru…

Samuel Edward Ashby, a 46-year-old prisoner with treatment-resistant schizophrenia, died from aspiration pneumonia complicated by clozapine effect. Key clinical lessons: (1) smoking cessation dramatically increases cloza…

psychiatrygeneral medicinediagnosticsystemclozapine
QLD2023-11-17

MOLAYEE, Omid

43y · Male·Gunshot wounds to the chest, with other significant conditions noted as thermal …

Omid Molayee, a 43-year-old Iranian-born Australian resident, died from gunshot wounds to the chest on 6 April 2020 after a domestic violence incident escalated into a confrontation with police. Following an argument wit…

systemcommunicationmethamphetamine
WAhome2023-11-10

Inquest into the Death of Child ML (Name Subject to Suppression Order)

7y · Female·Pneumonia complicating a viral respiratory illness with acute combined drug effe…

Child ML, aged 7, died of pneumonia complicating viral respiratory illness with acute combined drug effect. She had severe cerebral palsy with complex care needs including PEJ tube feeding and multiple medications. At th…

paediatricsrespiratory medicinemedicationsystemcodeine

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