3,476 results
0y · Male·meconium aspiration syndrome complicated by persistent pulmonary hypertension
Baby C was born at 41 weeks and 2 days covered in thick meconium with respiratory distress. Key clinical failures included: (1) failure to respond to mother's request for induction at term+6 days; (2) failure to investig…
22y · Male·hypoxic ischaemic encephalopathy as a result of hanging
Tane Chatfield, a 22-year-old Aboriginal man, died by hanging in his prison cell at Tamworth Correctional Centre on 20 September 2017. He had been admitted to hospital the preceding night with seizures, assessed as unlik…
36y · Male·Unknown; presumed unsurvivable injuries or drowning following intentional cliff …
Liam D'Arcy, a 36-year-old man with schizophrenia, disappeared on 23 June 2019 and is presumed to have died by intentional cliff jumping at The Gap, Watson's Bay. He had been stable on clozapine for 15 years but experien…
22y · Female·Complications of blunt force trauma to head, neck and chest
Brittany Harvie, aged 22, was killed by her de facto partner Mataio Aleluia in June 2015 following a 15-minute violent assault involving repeated punching to the head, neck and chest. She died from complications of blunt…
18y · Female·multi-organ failure due to combined effects of environmental exposure (hyperther…
Jessica Jackson, 18, died from multi-organ failure due to combined hyperthermia and dehydration while weight-cutting for an amateur Muay Thai fight. She lost approximately 9 kg in the final week through water-loading, de…
29y · Male·Incised injury to the neck
Benjamin Browne, 29, died from a neck laceration sustained during acute behavioural disturbance in August 2018. He had diagnosed major depression with anxiety, prescribed mirtazapine but attended only two psychology sess…
22y · Female·bowel obstruction due to faecal impaction
Susan Windie, a 22-year-old with rare congenital abnormalities affecting bowel function, died from bowel obstruction due to faecal impaction complicated by abdominal compartment syndrome. She presented to Carnarvon Hospi…
13y · Female·Acute paracetamol toxicity
Angel Hensgen, aged 13, died from acute paracetamol toxicity following intentional self-harm with an excessive overdose. She was exposed to intense cyberbullying, distressed by family relationships, peer conflicts, and a…
74y · Male·gunshot wound to the head
A 74-year-old man died from a self-inflicted gunshot wound to the head during a police response to a domestic violence call. Officers were dispatched following his assault on his wife, who was injured. The primary clinic…
0y · Female·hypoxic ischaemic encephalopathy secondary to intrapartum hypoxia
A 2-day-old neonate, Laura Angela Willmett, died from hypoxic-ischaemic encephalopathy following intrapartum hypoxia. She was born by emergency caesarean section after a planned vaginal birth after caesarean (VBAC) at a …
34y · Female·multiple gunshot wounds to the head
Shirley Finn, a 34-year-old Perth brothel owner, was murdered on 22 June 1975, shot four times in the head in her car near Royal Perth Golf Club. The Deputy State Coroner found cause of death was multiple gunshot wounds …
31y · Male·Acute Myocardial Infarction
John Pocklington, aged 31, died of acute myocardial infarction while in remand custody. He had a long history of methamphetamine use and untreated cardiac damage. On 28 April 2015, he reported chest pain to a nurse, who …
47y · Male·mixed prescription drug toxicity (quetiapine, olanzapam, lorazepam and diazepam)
Matthew Clayton Lyons, a 47-year-old man with longstanding schizophrenia, severe anxiety, and substance abuse history, died from mixed prescription drug toxicity (quetiapine, olanzapam, lorazepam, diazepam). He had expre…
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…
17y · Female·ligature compression of the neck (hanging)
A 17-year-old girl in state care died by suicide on 16 April 2017 after being discharged from secure care. She had experienced complex developmental trauma, family violence, sexual abuse, and severe alcohol-related liver…
61y · Male·Undetermined
Gerard Guy Vaz, a 61-year-old man with bipolar disorder, obstructive sleep apnoea, and renal impairment, was admitted to Maroondah Hospital on 2 April 2015 with acute manic relapse with psychosis. He was administered zuc…
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…
37y · Female·Contact gunshot wound to the head
Olga Neubert, a 37-year-old woman from the Philippines, was shot fatally by her estranged husband Klaus Dieter Neubert on 14 May 2015 in Hobart, Tasmania. She had recently separated from him following escalating controll…
0y · Male·Head injury in the setting of labour
Baby Cai Wheeler-Trow was born at 36 weeks and 2 days following a failed instrumental delivery and emergency caesarean section. He developed a skull fracture and subgaleal haemorrhage, presenting with clinical deteriorat…
52y · Male·C2, C3, C4 spinal injury sustained from a fall secondary to seizures
A 52-year-old man with cerebral palsy, epilepsy, and intellectual disability living in disability accommodation fell in the bathroom after a seizure and sustained cervical spine fractures (C2-C3-C4). He was admitted to h…
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