3,476 results
51y · Male·Hanging
A 51-year-old man with mild intellectual disability from childhood head injury died by hanging following family violence separation. He perpetrated physical, emotional and verbal abuse against his wife and children over …
78y · Male·cardiorespiratory failure due to complications of tracheal stenosis
Bruce Hodges, a 78-year-old man with a 20-year-old tracheostomy following laryngeal cancer surgery, presented to hospital with progressive shortness of breath and tracheal stenosis. Over 48 hours of admission, his respir…
Unknown·Mr Christensen: stab wound to the chest. Mr Davy: blood loss caused by stab woun…
Two men died following stab wounds sustained while forcing entry to a dwelling in the early hours of 1 October 2018. The deceased had been misled about the circumstances of an injured woman they believed needed urgent as…
73y · Male·Disseminated malignancy (advanced lung carcinoma and mouth carcinoma) in a man w…
Robert Craig, aged 73, died from disseminated malignancy (advanced lung and mouth carcinoma) while in prison custody. He received suboptimal cancer treatment at Fiona Stanley Hospital due to communication failures betwee…
60y · Female·acute cerebral bleed resulting from blunt trauma and late haemorrhagic progressi…
Gwenith Elkington, aged 60, died from acute cerebral bleed resulting from haemorrhagic progression of a traumatic brain injury sustained in a bathroom fall on 21 September 2015. The injury caused a contre coup contusion …
42y · Female·Traumatic right subdural haematoma
A 42-year-old woman died from a traumatic right subdural haematoma sustained on 22 January 2015. She was found unresponsive at home with severe head and facial injuries after falls. Critical delays in medical assessment …
47y · Female·complications of rapidly progressing motor neurone disease
A 47-year-old woman with motor neurone disease died from respiratory complications while in immigration detention, residing in aged care. She collapsed at 1:00am with respiratory distress. Nursing staff did not attempt C…
37y · Male·Mixed Drug Toxicity (Oxycodone, Quetiapine, Pregabalin and Clonazepam)
A 37-year-old man died from mixed drug toxicity (oxycodone, quetiapine, pregabalin, clonazepam) after ingesting unknown quantities of his own medications in an ED. He presented with trauma symptoms four days post-motor v…
30y · Male·Multiple injuries sustained in a motor vehicle collision (driver)
Raymond Noel Thomas, a 30-year-old Aboriginal man, died from injuries sustained in a motor vehicle collision while being pursued by Victoria Police. Police initially conducted urgent duty driving at 134 kph without emerg…
varied: sudden unexpected death in infancy (unsafe sleeping environment); drowni…
Coroner's joint inquest into deaths of seven children (six infants and one child aged 16 years) between 2014 and 2018 in Tasmania. All families had history of Child Safety Services (CSS) involvement. Coroner found no dir…
3y · Female·Hypoxic-ischaemic encephalopathy due to chorioamnionitis due to Gardnerella Vagi…
Zamia Ely-Smith died at 3 days of age from hypoxic-ischaemic encephalopathy due to chorioamnionitis following home birth at term. Clinical lessons include: (1) decreased fetal movements at 39+ weeks gestation and hospita…
48y · Male·Gunshot wounds to the upper torso
Troy Van Den Bemt, 48, died from gunshot wounds sustained during an attempted armed robbery at a bottle shop in Park Orchards on 28 January 2018. An undercover State Surveillance Unit (SSU) operative fired six shots at V…
63y · Male·metastatic rectal carcinoma
Jeremy Scott, a 63-year-old prisoner, died from metastatic rectal carcinoma on 3 July 2017. From 2015 onwards, he reported rectal and anal symptoms including pain, bleeding, and palpable masses, which were repeatedly att…
49y · Female and male·Gunshot wound to head inflicted by spouse
Karina Lock was fatally shot by her husband Stephen Lock in a murder-suicide at a McDonald's restaurant on 10 September 2015. The coroner identified multiple systemic failures that failed to protect Ms Lock despite her h…
24y · Female·Shotgun injury to the head
Amy Wensley died from a shotgun wound to the head on 26 June 2014. Whether self-inflicted or inflicted by another remains undetermined. Detectives prematurely concluded suicide on the night of death without thorough inve…
38y · Male·Mixed drug toxicity
DA was a 38-year-old man who died from mixed drug toxicity involving sedating medications and alcohol. He had longstanding severe anxiety and became dependent on codeine and benzodiazepines, initially obtained from multi…
38y · Male·combined effects of acute-on-chronic respiratory disease and cardiomegaly
Marshall Ruben Edgill, a 38-year-old Indigenous man, died in custody from acute-on-chronic respiratory disease and cardiomegaly. He had longstanding obstructive sleep apnoea (OSA), obesity, asthma, and hypertension. Crit…
58y · Female·Enterococcus faecalis sepsis and acute renal failure
Robena Lloyd, a 58-year-old woman with intellectual disability and schizophrenia, died from enterococcus faecalis sepsis and acute renal failure on 7 August 2009. She presented to Angliss Hospital ED on 31 July with urin…
27y · Male·Effects of fire
Brendon Crippen, 27, died from severe burns sustained in a deliberately set fire at his family's property. He had recently absconded from a Tasmanian psychiatric unit where he was subject to a compulsory treatment order …
0y · Unknown·sepsis leading to multiple organ failure syndrome
A 48-day-old neonate with congenital heart defect presented to the ED with fever and vomiting on 20 September 2019. Initial triage as Category 3 was inappropriate; the child required urgent assessment. The ED intern saw …
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