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QLDhospital2023-02-13

Hunter- Non-inquest findings

8y · Male·ischaemic bowel due to strangulated small bowel obstruction secondary to congeni…

An eight-year-old boy with autism spectrum disorder (level 1) died from ischaemic bowel due to strangulated small bowel obstruction from a rare congenital band adhesion. He presented to a regional hospital with abdominal…

surgerypaediatricsdiagnosticcommunicationondansetron
QLDhospital2023-01-24

Smith, David Frederick

45y · Male·Haemorrhagic transformation of cerebral infarction, due to bilateral internal ca…

David Smith, aged 45, died from haemorrhagic transformation of cerebral infarction secondary to essential thrombocytosis with bilateral internal carotid artery thrombosis. He developed an acute ischaemic stroke on 9 July…

haematologyneurologysystemrivaroxaban
NSW2022-11-22

Inquest into the death of Kai McEwan

25y · Male·Ruptured berry aneurysm and sequelae resulting in catastrophic subarachnoid and …

A 25-year-old Aboriginal man on remand in custody collapsed during a shower and was found to have suffered a catastrophic ruptured berry aneurysm causing massive subarachnoid and intracerebral haemorrhage with brain deat…

neurosurgeryintensive careaspirin
VIChome2022-07-20

Finding into death of Brian Kevin Scurrah

75y · Male·Complications of multiple myeloma (palliated)

Brian Kevin Scurrah, a 75-year-old man with intellectual disability living in a supported residential service, died from complications of multiple myeloma. He was diagnosed with advanced multiple myeloma in June 2021 fol…

oncologypalliative careamiodarone
QLDhospital2022-04-26

Jessen, Tyson Lee

28y · Male·Gunshot wounds of the neck, chest and abdomen

Tyson Jessen, a 28-year-old man wanted for armed robbery in Victoria, was arrested in Queensland and admitted to Ipswich Hospital with cardiac symptoms. While in police custody, he remained under guard in hospital. Senio…

emergency medicinecardiologycommunicationsystemmetoprolol
NSWhospital2022-03-25

Inquest into the death of Anthony Barrett

54y · Male·Bowel ischaemia resulting from acute thrombosis of superior mesenteric artery an…

Anthony Barrett died from bowel ischaemia caused by acute thrombosis of his superior mesenteric artery and coeliac artery stents post-operatively. He had undergone left total knee replacement surgery at Fairfield Hospita…

orthopaedic surgeryvascular surgerycommunicationdiagnosticclopidogrel
VIC2022-03-21

Finding into death of Nilofer Nezami

38y · Female·Unascertained

Nilofer Nezami, a 38-year-old Victorian resident, died on 7 January 2019 following cosmetic surgery in Iran. She underwent multiple procedures including eye, breast, arm and abdominal surgery. Post-operatively, she devel…

plastic and reconstructive surgeryanaesthesiasystemproceduralmorphine
VIChospital2021-11-17

Finding into death of H J

76y · Female·Undetermined (natural causes)

HJ, a 76-year-old woman with chronic psychotic disorder and paranoid delusions, presented with abdominal pain, vomiting, and small bowel obstruction. Imaging revealed bilateral adnexal masses. Due to her lack of insight …

general surgerypsychiatryaugmentin df
VIC2021-10-27

Finding into death of Michelle Lorraine Duque

52y · Female·Multiple injuries in a motor vehicle incident

Michelle Duque, a 52-year-old British expat of 19 months in Australia, died from multiple injuries sustained in a motor vehicle collision on the Western Freeway. She stopped her vehicle in an active traffic lane to prote…

ondansetron
VIChospital2021-08-16

Finding into death of David John Main

54y · Male·Toxic leukoencephalopathy (of uncertain aetiology)

David Main, 54, died from toxic leukoencephalopathy of uncertain aetiology following a ketamine-assisted oxycodone detoxification at Beleura Private Hospital. He had chronic pain from multiple injuries and opioid depende…

pain medicineanaesthesiaketamine
VIChospital2021-06-24

Finding into death of PT

46y · Male·Haemopericardium complicating aortic dissection

A 46-year-old man with untreated hypertension and smoking history presented to the ED with acute chest pain radiating to jaw and back. ECG showed changes initially interpreted as NSTEMI with troponin elevation. A cardiol…

cardiologyemergency medicinediagnosticcommunicationmorphine
VIChospital2021-03-29

Finding into death of Walentyna Huczyk

95y · Female·Complications post scooter versus car incident

A 95-year-old woman died from complications of injuries sustained in a collision between her motorised mobility scooter and a car while crossing Raymond Street in Sale. She suffered flail chest, hemopneumothorax, and spi…

intensive caretrauma surgerymorphine
VIChome2021

Finding into death of Tate Hobbs

36y · Male·Combined drug toxicity (pregabalin, morphine, amitriptyline)

A 36-year-old motor mechanic with chronic pain from a 2014 knee injury died from combined drug toxicity (pregabalin, morphine, amitriptyline). His general practitioner, Dr S., prescribed excessive amounts of multiple med…

general practicepain medicinemedicationcommunicationpregabalin
VICcommunity2020-08-28

Finding into death of Heather Telfer

69y · Female·Toxicity to pentobarbitone in circumstances where she intended to end her own li…

Heather Telfer, a 69-year-old woman with longstanding asthma, chronic health anxiety, and significant social isolation, died from pentobarbitone toxicity. She had a prior suicide attempt 12 years earlier and expressed su…

general practicerespiratory medicinecommunicationsystempentobarbitone
TAShospital2020-08-27

Coroner's Finding: Murray, Geoffrey Raymond

74y · Male·acute myocardial ischaemia related to stenosis of the right coronary artery

Geoffrey Raymond Murray, aged 74, presented to Launceston General Hospital ED on 24 February 2019 with fever, vomiting and dizziness. After triage at 6:27pm, he waited unattended for over 4 hours without further medical …

emergency medicinecardiologycommunicationsystemparacetamol
VIChospital2020-07-16

Finding into death of Lydia Maxfield

85y · Female·Multisystem failure complicating ischaemic heart disease and ischaemic bowel in …

Lydia Maxfield, 85, died 5 days after elective left total knee replacement at a private hospital from multisystem failure due to ischaemic heart disease and ischaemic bowel. Critical clinical lessons: (1) Multiple abnorm…

orthopaedic surgeryanaesthesiacommunicationsystemondansetron
VICaged care2020-07-06

Finding into death of Irene Florence Curran

79y · Female·Ischaemic bowel in the setting of cardiomegaly, pneumonia and chronic renal fail…

A 79-year-old woman died from ischaemic bowel in the setting of cardiomegaly, pneumonia and chronic renal failure, four days after discharge from hospital following a hysterectomy for endometrial cancer. Key clinical les…

gynaecologygeneral practicecommunicationsystemoxycodone
VIChospital2020-06-09

Finding into death of Lance Robert Nikkelson

47y · Male·Complications of cirrhosis and metastatic hepatocellular carcinoma

Lance Robert Nikkelson, a 47-year-old Aboriginal man in prison custody, died from complications of cirrhosis and metastatic hepatocellular carcinoma. He presented with abdominal pain in May 2019, initially assessed as co…

hepatologyoncologydiagnosticmethadone
VICcommunity2020-05-22

Finding into death of Christina Maree Chamberlain

60y · Female·Multiple injuries sustained in a motor vehicle incident (driver)

Christina Maree Chamberlain, aged 60, died when her vehicle drifted across lanes and collided with a tree on Great Alpine Road. She was taking multiple medications including oxycodone, amitriptyline, sertraline, diazepam…

emergency medicineforensic medicineoxycodone
VICcommunity2019-10-29

Finding into death of Giuseppe Luci

51y · Male·Lobar pneumonia

Giuseppe Luci, a 51-year-old man with severe Fragile X syndrome, epilepsy and hearing impairment living in a DHHS group home, died from lobar pneumonia. On 29 October, he presented with vomiting and diarrhoea; a GP diagn…

general practiceemergency medicinediagnosticondansetron

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