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TAShome2020-06-30

Coroner's Finding: Hinley, David John

74y · Male·Mixed prescription drug toxicity (codeine, paracetamol, mirtazapine, promethazin…

A 74-year-old man with multiple chronic conditions including cerebellar ataxia, COPD, depression and anxiety died from mixed prescription drug toxicity. He had cognitive impairment affecting medication management and hab…

general practicepsychiatrycommunicationsystemcodeine
TAShospital2020-06-30

Coroner's Finding: Shrimpton, Dallas Brooks

54y · Male·carbon monoxide asphyxia

Dallas Brooks Shrimpton, a 54-year-old man with severe alcohol dependence, chronic depression, and multiple previous suicide attempts, died by carbon monoxide asphyxiation. He presented to Royal Hobart Hospital ED on 16 …

psychiatryemergency medicinecommunicationsystemalcohol
QLDPodcast2020-06-30

Ayliffe-Chung, Mia Mishka Annie and; Jackson, Thomas Leslie - Non-inquest findings

Unknown·Mia: Stab wound to heart; Thomas: Stab wound to brain

Two young UK backpackers, Mia Ayliffe-Chung (20) and Thomas Jackson (30), were fatally stabbed at a Queensland hostel on 23 August 2016 by a French backpacker, Smail Ayad, who was psychotic and cannabis-intoxicated. Ayad…

psychiatryemergency medicinesystemcommunicationcannabis
QLDmental health2020-06-29

Rangi, Taare Tamakehu

44y · Male·Cardiac arrhythmia during physical restraint

Taare Rangi, a 44-year-old man with bipolar affective disorder, died from cardiac arrhythmia during physical restraint in a mental health unit. Critical failures occurred at multiple levels: (1) the decision to acutely s…

psychiatryemergency medicinediagnosticprocedurallorazepam
VIChospital2020-06-29

Finding into death of Baby AA

0y · Female·Disseminated Herpes Simplex Virus (HSV 1)

An 11-day-old neonate died from disseminated HSV-1 infection acquired perinatally. She presented with sepsis-like symptoms including lethargy, poor feeding, fever and respiratory signs. Clinical management was appropriat…

neonatologypaediatricsdiagnosticcommunicationbenzyl penicillin
QLDcommunityPodcast2020-06-26

Nyholt, Nicole Sonia and Clark, Margaret Louisa

Female·Burns due to gas explosion due to motor vehicle collision with building

A 60-year-old man with a long-standing history of seizures experienced an epileptic seizure while driving and lost control of his vehicle. It collided with an LPG gas cylinder outside a café, triggering an explosion that…

emergency medicineneurologycommunicationsystem
WAcommunity2020-06-15

Inquest into the Death of Thorvald Anthony NIELSEN

29y · Male·multiple gunshot wounds

A 29-year-old male died from multiple gunshot wounds inflicted by police Tactical Response Group (TRG) officers during a failed arrest operation. The deceased had stolen firearms, was suspected of being armed, and had ex…

emergency medicinetrauma surgerycommunicationsystemamphetamine
VIChome2020-06-12

Finding into death of Daniel Isaac Semple

39y · Male·Multiple drug toxicity (methadone, diazepam, oxazepam, carbamazepine, levetirace…

A 39-year-old man with epilepsy and opioid dependence died from multiple drug toxicity involving methadone, benzodiazepines (diazepam, oxazepam), antiepileptics (carbamazepine, levetiracetam), and mirtazapine. He was pre…

general practiceaddiction medicinediagnosticmedicationmethadone
QLD2020-06-08

Betts, Christopher

34y · Male·Gunshot wound to the head

Christopher Betts, a 34-year-old Australian private security contractor deployed to Iraq, died from a self-inflicted gunshot wound to the head on 12 May 2016. While on leave between deployments, Betts was in a colleague'…

systemcommunicationalcohol
TAShospital2020-06-05

Coroner's Finding: Dickinson, Mary Marguerite

58y · Female·pneumonia, likely aspiration pneumonia

Mary Marguerite Dickinson, aged 58, died of pneumonia on 20 January 2018 at the Roy Fagan Centre after admission with a complex scapula fracture and severe cognitive decline from alcoholic dementia. The coroner found her…

geriatric medicineemergency medicinecommunicationsystemmorphine
VIChome2020-06-05

Finding into death of Gregory Allen Floyd

43y · Male·Gunshot wound to the head

Gregory Allen Floyd, aged 43, died from a self-inflicted gunshot wound following the killing of his partner Ora Holt. In the months preceding the deaths, Mr Floyd exhibited delusional beliefs that Ms Holt was having affa…

general practicepsychologydiagnosticsystemcodeine
VICaged care2020-06-03

Finding into death of Annette Lee Douglass

60y · Female·Respiratory arrest in the setting of aspiration pneumonia; seizures associated w…

A 60-year-old woman with Down syndrome, Alzheimer's dementia, and epilepsy died from respiratory arrest due to aspiration pneumonia after a seizure. A multi-day delay in anticonvulsant medication (phenytoin) occurred due…

general practiceneurologycommunicationsystemphenytoin
QLDhome2020-06-02

Lee, Mason Jet

1y · Male·Abdominal injuries (perforation of small bowel and mesentery with peritonitis pr…

Mason Lee, aged 22 months, died on 11 June 2016 from abdominal injuries inflicted by his mother's partner, William O'Sullivan, combined with severe neglect. Mason was admitted to hospital in February 2016 with severe per…

paediatricsinfectious diseasesdiagnosticsystemmethamphetamine
NSWhome2020-06-01

Inquest into the death of A P

2y · Female·drowning

A 2-year-old child died by drowning at her home in September 2016. Her mother was suffering from acute psychosis and had stopped taking antipsychotic medication days before the death. Critical failures occurred: the chil…

general practicepsychiatrycommunicationsystemtriflouperazine
VIChome2020-05-29

Finding into death of Ronald John Wood

68y · Male·Pulmonary thromboembolus secondary to deep vein thrombosis

Ronald Wood, a 68-year-old with complex medical history including prior pulmonary emboli, was treated for rectal cancer requiring chemotherapy and major surgery. Warfarin anticoagulation was appropriately ceased due to b…

colorectal surgerygastroenterologycommunicationsystemwarfarin
WA2020-05-28

Inquest into the Suspected Death of Michael PETA

36y · Male·Unknown – Open Finding

Michael Peta, a Papua New Guinean national employed in Western Australia, disappeared from the Catholic Presbytery in Broome on 15 January 1975 at age 36–37. The coroner established beyond reasonable doubt that he is dec…

communicationsystem
VIChospital2020-05-27

Finding into death of Ms T

46y · Female·Hanging

A 46-year-old woman with a history of depression, anxiety, and alcohol dependence died by hanging. She was transported to Box Hill Hospital on 27 January 2016 under Mental Health Act section 351 following suicidal ideati…

emergency medicinepsychiatrycommunicationsystemalcohol
WAcommunity2020-05-27

Inquest into the Suspected Death of Sylvina TARI

72y · Female·Unknown - could be natural or accidental; no cause determined

Sylvina Tari, an elderly Aboriginal woman aged approximately 72, disappeared from Kalumburu Mission in Western Australia in August 1977. She was found to have died between late 1981 and early 1982, but her death was neve…

systemcommunication
WAcommunity2020-05-27

Inquest into the Suspected Death of Edward John GIBBARD

51y · Male·Undetermined - Open Finding

Edward John Gibbard, a 51-year-old British merchant seaman, disappeared on the night of 23 December 1976 after leaving Lake Argyle Inn in Western Australia's Kimberley region to drive to Kununurra for a flight to Perth. …

communicationdelay
QLDhome2020-05-26

Mr M - Non-inquest findings

50y · Male·Stab wounds to chest and upper left limb

A 50-year-old man was stabbed to death by his partner's ex-partner, Mr F, in a premeditated attack at his home on 6 April 2015. The deceased and his partner had reported multiple threats and breaches of domestic violence…

diagnosticcommunication

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