237 results
45y · Male·focal coronary artery disease and cardiomegaly
Stratos Ioannidis, age 45, died at Maroondah Hospital on 28 March 2025 from focal coronary artery disease and cardiomegaly during an involuntary psychiatric admission. He presented with acute psychosis from bipolar disor…
51y · Female·Unintentional prescription drug poisoning due to central nervous system depressi…
A 51-year-old woman with chronic pain, depression, and longstanding medication misuse died from unintentional prescription drug poisoning. She had been prescribed high-risk combinations of opioids and benzodiazepines ove…
42y · Female·hypovolaemic shock due to an acute ruptured subcapsular splenic haematoma in the…
Eve Brown, a 42-year-old Aboriginal woman, died of hypovolaemic shock from a ruptured splenic haematoma in the context of urosepsis at a regional hospital. She presented with UTI symptoms and was admitted to Lightning Ri…
48y · Female·Unascertained; presumed sudden cardiac arrhythmia
A 48-year-old woman with cerebral palsy, intellectual disability, and multiple comorbidities died unexpectedly in residential care. Post-mortem examination showed acute pulmonary oedema and intra-alveolar haemorrhage wit…
57y · Male·Lung abscess and bronchopneumonia
Terrence Michael O'Sullivan, a 57-year-old man with intellectual disability, blindness, deafness and epilepsy, died from lung abscess and bronchopneumonia caused by Klebsiella oxytoca. He presented with a pressure wound …
30y · Male·pulmonary thromboembolism in an overweight man with comorbidities (including rec…
Karl Steinhauser, a 30-year-old man with schizoaffective disorder and polysubstance misuse, died from pulmonary thromboembolism on 12 March 2023 while under Mental Health Act care. After two weeks of increasingly challen…
14y · Male·epilepsy in a boy with Influenza B and COVID-19 infections
A 14-year-old Aboriginal boy with newly diagnosed epilepsy died unexpectedly on 24 August 2023 after an unwitnessed seizure while sleeping at his residential care home. He had been diagnosed with epilepsy in June 2023 fo…
48y · Female·Mixed drug toxicity (morphine, codeine, venlafaxine, amitriptyline and zopiclone…
A 48-year-old woman with depression, anxiety, and bipolar disorder died from mixed drug toxicity while on voluntary inpatient psychiatric admission. She had undisclosed significant illicit drug use, which was not identif…
64y · Male·acute myocardial infarction in association with coronary artery atherosclerosis
Leslie Charles Linton, a 64-year-old man with severe triple-vessel coronary artery disease, presented to Royal Perth Hospital on 15 December 2023 with an infected foot wound and acute psychosis. Initial troponin elevatio…
57y · Male·Complications following food aspiration in a man with multiple co-morbidities
Andrew Kursinskis, a 57-year-old man with intellectual disability, dysphagia, autism, epilepsy and pica, died from complications following aspiration of chicken schnitzel while living in supported disability accommodatio…
75y · Male·Aspiration pneumonia in the setting of epilepsy and cerebral palsy
Raymond Charles Levy, a 75-year-old man with cerebral palsy and epilepsy living in supported disability accommodation, died from aspiration pneumonia. He presented to hospital with fatigue, fever and cough on 18 October …
47y · Male·Unascertained; most likely cardiac arrhythmia possibly triggered by obstructive …
David Horne, a 47-year-old man with bipolar disorder, schizoaffective disorder, and severe obstructive sleep apnoea, died suddenly at Maroondah Hospital while under compulsory psychiatric treatment. He experienced two ep…
57y · Female·Multi-organ failure due to drug-induced liver injury caused by sodium valproate …
Mrs Doherty, a 57-year-old woman with CADASIL syndrome, was prescribed sodium valproate for migraine prophylaxis in November 2019. She developed acute hepatitis approximately 5 months later, presenting with jaundice, nau…
47y · Male·ischaemic heart disease with seizure disorder and schizophrenia being other sign…
Daniel Leehy, a 47-year-old man in custody, died from ischaemic heart disease with significant coronary artery narrowing (60-80%) identified at autopsy. He had a 42-year history of epilepsy and schizophrenia with frequen…
59y · Male·Urosepsis and aspiration pneumonia (with Trisomy 21 as underlying condition)
Donald Raymond Muir, a 59-year-old man with Trisomy 21, non-verbal autism, dementia and epilepsy living in specialist disability accommodation, died of urosepsis and aspiration pneumonia. He had experienced progressive f…
21y · Male·unascertained
Samaan Salah Tilmiz Elsamin, a 21-year-old with severe treatment-resistant schizophrenia, moderate-to-severe intellectual disability (IQ 57), and extremely challenging violent behaviours, died at Joondalup Health Campus …
62y · Male·Hypoxic ischaemic encephalopathy complicating cardiac arrest in setting of acute…
John Michael Jurdeczka, a 62-year-old man with autism, intellectual disability, and dysphagia, died from hypoxic ischaemic encephalopathy following cardiac arrest caused by acute upper airway obstruction from a food bolu…
50y · Male·in-hospital cardiac arrest on a background of seizures and atheroembolic cerebro…
A 50-year-old man with bipolar affective disorder, hypertension, anxiety, depression and history of alcohol abuse died from in-hospital cardiac arrest on a background of seizures and atheroembolic cerebrovascular disease…
3y · Female·Bilateral Bronchopneumonia (Streptococcus Pyogenes/Staphylococcus Aureus) with k…
Jade, a 3-year-old First Nations child, died from bilateral bronchopneumonia with neglect as a significant contributing factor. Her death was wholly preventable. The coroner identified critical failures: DCJ's Muswellbro…
47y · Male·Pneumonia
Shawn Farlech, a 47-year-old man with acquired brain injury from childhood encephalitis living in specialist disability accommodation, died from pneumonia with sepsis. He presented with fever on 8 April and was initially…
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