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VIChome2014-03-06

Finding into death of Matthew Patrick James Maher

36y · Female·Effects of fire and stab wounds (for Matthew Maher); effects of fire (for Kylie …

Kylie Fowler, a 36-year-old woman with a 18-year history of schizophrenia requiring five involuntary psychiatric admissions, killed herself and her three children (Melanie, 13; Matthew, 11; Samantha, 18) on 9 January 201…

psychiatrypaediatricscommunicationsystemrisperidone
VIChome2014-03-06

Finding into death of Samantha Jane Fowler

36y · Female·Effects of fire and stab wounds (Kylie Fowler); effects of fire (Melanie Maher);…

Kylie Fowler, a 36-year-old woman with severe schizophrenia and a 18-year history of involuntary psychiatric admissions, killed her three children (Samantha 18, Melanie 13, Matthew 11) and herself by stabbing and fire on…

psychiatrypaediatricscommunicationsystemrisperidone
SAhome2014-01-31

Coroner's Finding: HADLEY Duke Zenon

2y · Male·Asphyxiation due to neck and/or chest compression

A 2-year-old boy died from asphyxiation due to chest and neck compression inflicted by his mother during an acute manic psychotic episode. The mother had been admitted to psychiatric care in December 2008 with psychosis …

psychiatryemergency medicinecommunicationsystemrisperidone
VIChospital2014-01-29

Finding into death of Renee Andrea Treen

24y · Female·multiple injuries from jumping off Bulla Road overpass onto Tullamarine Freeway

Renee Treen, aged 24, died by suicide from the Bulla Road overpass while an involuntary psychiatric patient. Critical failures included: inadequate assessment of suicide risk (prior freeway-adjacent behaviour not weighte…

psychiatrydiagnosticsystemrisperidone
VICprison2014-01-24

Finding into death of Adam Sasha Omerovic

40y · Male·Ligature compression of the neck in circumstances of being hanged

Adam Omerovic, a 40-year-old man with a long history of depression, substance abuse, and prior suicide attempts, died by hanging in a Melbourne Assessment Prison cell on 23 March 2010. He had been remanded on armed robbe…

psychiatrycorrectional healthdiagnosticsystemescitalopram
NSWhome2014-01-10

Inquest into the deaths of Nicholas WATERLOW and Chloe HEUSTON - Reasons for Findings

Unknown·Injuries sustained in violent attack by Antony Waterlow (stab wounds caused by k…

Nicholas Waterlow and his daughter Chloe Heuston were fatally attacked by Antony Waterlow, Nicholas's son and Chloe's brother, in November 2009. Antony suffered from untreated paranoid schizophrenia, characterized by per…

psychiatryemergency medicinesystemdelay
VIChome2014

Finding into death of Kathy Louise Tranter

48y · Female·head injuries from multiple blunt force trauma including punching, elbowing and …

A 48-year-old woman, Kathy Tranter, was killed by her 20-year-old son who was an involuntary psychiatric patient at Orygen Youth Health (OYH) with acute paranoid schizophrenia. The son was granted overnight leave on 3 Ma…

psychiatryemergency medicinediagnosticcommunicationrisperidone
WAmental health- 11 April 2014

Inquest into the Death of Robert Kenneth SCOTT

28y · Male·ligature compression of the neck (hanging)

Robert Kenneth Scott, a 28-year-old man with schizophrenia, died by hanging on 22 May 2008 after absconding from Graylands Hospital where he was an involuntary patient. He was last seen at 4:30pm on an open ward with 60-…

psychiatrydelayclozapine
WAprison- 31 January 2014

Inquest into the Death of Amy TINKER

33y · Female·multiple organ failure complicating sepsis in a woman with cirrhosis of the live…

Amy Tinker, a 33-year-old Aboriginal woman with unrecognised cirrhosis from chronic alcohol abuse, died from sepsis-related multi-organ failure while imprisoned. She had been admitted to Royal Perth Hospital in 2004 with…

general practicehepatologycommunicationsystem
WAhome- 15 May 2014

Inquest into the Death of Helen Barbara MINETT

55y · Female·Multiple drug toxicity in a woman with coronary artery atherosclerosis

A 55-year-old woman with complex medical history including chronic pain, previous multiple abdominal surgeries, gastrointestinal disorders, mental health issues including DID, and suicidal ideation died from multiple dru…

general practicepain medicinediagnosticcommunicationmorphine hydrochloride
WA- 12 September 2014

Inquest into the Death of Peter Philip HUMES

38y · Male·Ligature compression of the neck (hanging)

Peter Philip Humes, a 38-year-old Aboriginal man, died by suicide by hanging in Hakea Prison while on remand. He was assessed by prison officer Trevena and nurse Lee on admission using the MR011 'At-Risk' checklist and d…

general practicecorrectional healthsystemdelaymirtazapine
WAmental health- 11 April 2014

Inquest into the Death of Amanda Alison GILBERT

47y · Female·bronchopneumonia in context of ischaemic heart disease, chronic renal failure, a…

Amanda Gilbert, aged 47, died from bronchopneumonia with background ischaemic heart disease, chronic renal failure, and hypoxic brain injury from a 1985 hanging attempt. She had been an involuntary patient at Graylands H…

psychiatrygeneral medicinesystemdelaylithium
WAmental health- 11 April 2014

Inquest into the Death of Tom FOSKI

51y · Male·congestive cardiac failure in association with ischaemic and hypertensive heart …

Tom Foski, a 51-year-old man with chronic schizophrenia, died from congestive cardiac failure associated with ischaemic and hypertensive heart disease. He had multiple medical comorbidities including diabetes, COPD, prev…

psychiatrycardiologycommunicationdelayantipsychotic medications
WAmental health- 11 April 2014

Inquest into the Death of Luke Isaac FORKIN

28y · Male·ligature compression of the neck (hanging)

Luke Isaac Forkin, a 28-year-old man with a long history of substance abuse and mental health issues, died by suicide while absent without leave from Graylands Hospital. He had been admitted involuntarily due to psychoti…

psychiatrysystemdelayamphetamine
VIC2013-12-31

Finding into death of Wayne Joannou

26y · Male·Gunshot wound to head

Wayne Joannou, 26, died from a gunshot wound to the head on 18 February 2005 when the Special Operations Group attempted his arrest. He was a known violent offender with a 10-year criminal history and substance abuse iss…

addiction medicinepsychiatrysystemcommunicationheroin
VIC2013-12-20

Finding into death of Niel Fraser Buckton

40y · Male·Unascertained

Niel Buckton, a 40-year-old qualified civil engineer, died after entering a live sewer access chamber at the Blue Hills Estate in Pakenham on 25 January 2005. He was directed by his supervisor to inspect rectification wo…

occupational and environmental healthpsychiatrydiagnosticsystem
QLD2013-12-11

Woods, Gavin Lyle

46y · Male·Consistent with exhaust fumes toxicity (suicide by carbon monoxide)

A 46-year-old teacher, Gavin Lyle Woods, died by suicide after prolonged workplace stress and an undertreated major depressive disorder. He had been a deputy principal at Burpengary State School for only five months. Cli…

psychiatrygeneral practicecommunicationsystemescitalopram
NThome2013-10-15

Inquest into the death of Gwyyneth Cassiopeia-Roennfeldt

36y · Female·Internal injuries consequent on being stabbed repeatedly by Rocky Manu, a man wi…

Jasmine Roennfeldt, a 36-year-old woman with schizoaffective disorder being treated at a community mental health clinic, died from stab wounds inflicted by her flatmate Rocky Manu, who had paranoid schizophrenia. Rocky h…

psychiatrysystemcommunicationantipsychotic medication
VIChospital2013-09-17

Finding into death of Richard Hilton

27y · Male·Hanging

Richard Hilton, a 27-year-old with longstanding bipolar affective disorder and benzodiazepine dependence, presented to Werribee ED three times in two months with suicidal ideation and self-harm attempts. Each time he was…

psychiatryemergency medicinediagnosticcommunicationalprazolam
VIChome2013-08-21

Finding into death of Katarina Sonia Novakovic

47y · Female·INCISED INJURY TO THE NECK

A 47-year-old woman with schizophrenia and recent depressive symptoms died by intentional incised injury to the neck. She had been prescribed escitalopam on 10 September 2010 for emerging depressive illness following her…

psychiatrygeneral practicecommunicationdelayolanzapine
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