311 results
16y · Female·obstructed breathing and heart arrhythmia secondary to severe obstructive sleep …
A 16-year-old Aboriginal girl with severe obstructive sleep apnoea died unexpectedly in her home one week before scheduled surgery. She had been symptomatic since age 13, but surgery was delayed for four years due to mul…
4y · Female·consequences of incarcerated congenital left diaphragmatic hernia
Madison Ormerod, aged 4 years, died from incarcerated congenital left diaphragmatic hernia. Over 3 months before death, she presented with persistent vomiting and abdominal pain to her GP and paediatrician. The paediatri…
15y · Female·Ligature compression of the neck (hanging)
A 15-year-old Aboriginal girl died by suicide by hanging on 29 November 2007. She had a transient lifestyle with unstable housing, moved frequently between relatives, was not regularly attending school, and engaged in su…
12y · Female·acute septicaemia resulting from osteomyelitis of the left femur
A 12-year-old Aboriginal girl died from septicaemia caused by untreated osteomyelitis of the left femur. Three weeks after a sports injury, despite evidence of severe and deteriorating illness including inability to walk…
0y · Male·failure to thrive due to insufficient caloric intake
Kalib died from failure to thrive due to insufficient caloric intake at 7 weeks old. He was born to a mother with a documented history of severe neglect and physical abuse of multiple children over 5 years, during which …
14y · Female·hanging
Sharkia Handy, a 14-year-old girl in out-of-home care, died by hanging in December 2007. She had significant unaddressed mental health concerns including suicidal ideation, self-harm, and grief following peer suicides. T…
14y · Male·gunshot wound to the head
Andrew Scott Anderson was a 14-year-old boy placed in Department of Child Safety care following his father's physical assault. He had a longstanding history of behavioral difficulties, ADHD, depression, and substance use…
1y · Female·pneumonia (staphylococcal pneumonia with bilateral bacterial pneumonia)
Jezelle Lisa Gordon, a 1-year-old child, died of staphylococcal pneumonia on 26 February 2006 in Port Hedland, Western Australia. She presented to Halls Creek Hospital on 25 February with fever, elevated respiratory rate…
15y · Female·Hanging (self-inflicted)
A 15-year-old Aboriginal girl in a remote Central Australian community died by suicide following a year marked by petrol sniffing, sexual abuse concerns, and reported suicide attempts. She suffered multiple sexually tran…
10y · Male·sepsis (fusobacterium necrophorum) complicating right otitis media
Jarrad Roberts, a 10-year-old with learning disabilities and likely ADHD, died from sepsis due to untreated right otitis media caused by Fusobacterium necrophorum. He had been acutely ill for 5-7 days before finally seei…
7y · Female·streptococcus pneumoniae sepsis complicating retropharyngeal abscess
A 7-week-old infant died from streptococcus pneumoniae sepsis complicating retropharyngeal abscess. Three days before death, a report was made to child protection services alleging the father had shaken the infants. A ge…
0y · Female·Organ failure caused by not receiving enough oxygen during labour (intrapartum h…
Georgia Rae Tilmouth was born at 35 weeks gestation after premature labour and died 13 hours later from perinatal asphyxia due to hypoxia during labour. The coroner found multiple deficiencies in obstetric care contribut…
14y · Female·blunt force head injury
A 14-year-old Aboriginal girl with newly diagnosed idiopathic thrombocytopenic purpura (ITP) and critically low platelet count (5,000/mm³) absconded from Alice Springs Hospital on 27 January 2006. Hospital staff failed t…
2y · Female·Drowning in an above-ground swimming pool
Hannah Plint, a 2½-year-old, died from drowning after accessing an above-ground pool by dragging a chair to the gate and opening it unsupervised. Her mother was inside with a younger sibling. The pool fence and gate sepa…
0y · Male·hypoxic ischaemic encephalopathy
Riley Krol, a 11-day-old male infant, died from hypoxic ischaemic encephalopathy following emergency caesarean section delivery on 1 March 2005. After artificial rupture of membranes during labour induction, the foetus d…
0y · Male·Positional asphyxia contributed to by bronchopneumonia and head injuries
Jakai Ryan Bond, a 10-week-old infant, died from positional asphyxia on 25-26 May 2006 while in his father's care. The father fell asleep holding the baby in a lounge chair; the infant was found face down on his father's…
14y · Female·Ligature compression of the neck (suicide)
Gabrielle Mia Tedeschi, a 14-year-old girl with longstanding oppositional and self-harm behaviours and subsequent depression, died by suicide on 14 October 2004 following a ligature compression injury sustained on 11 Oct…
1y · Female·sudden unexpected death in infancy due to hypoxic episode while co-bedding with …
Arisa Huber, a newborn, died from sudden unexpected death in infancy (SUDI) due to hypoxic episode while co-bedding with her exhausted mother in a postnatal ward. The infant was found without breathing or pulse at 6:45am…
0y · Female·combined effects of asphyxia and inhalation of gastric contents
Elizabeth Rose Edwards, a 9-month-old premature infant with perinatal brain injury, died of asphyxia and aspiration of gastric contents while in temporary foster care. She had been placed with carers (the Todds) with min…
9y · Male·Head injury (epidural haematoma with cerebral coning following craniotomy)
Dwayne Michael Jones, aged 9, had Trisomy 10, a rare congenital chromosomal disorder causing severe developmental delay and neurological abnormalities. On 11 April 2000, he fell from a computer desk and struck his head. …
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