113 results
70y · Female·Cause of death could not be determined - available evidence does not allow a fin…
A 70-year-old woman died unexpectedly at home in August 2017. Initially certified as hypertensive heart disease without autopsy, the death was later investigated as a potential homicide following allegations by her forme…
33y · Male·Prolonged epileptic seizure resulting in gastric content aspiration and cardiac …
Roy Roberts, a 33-year-old Aboriginal man, died at Long Bay Correctional Complex from a prolonged epileptic seizure resulting in aspiration and cardiac arrest. He had experienced three prior seizure-like episodes in Apri…
72y · Female·Pneumonia following cervical spine injuries sustained in an unwitnessed mechanic…
Valma Ann Tweedie, aged 72, died from pneumonia following cervical spine injuries sustained in an unwitnessed fall at a disability support facility. She had a known history of falls, mobility problems, and probable demen…
63y · Female·Escherichia coli septicaemia in a lady with multiple comorbidities
Helen Welsh, 63, died from E. coli septicaemia with multiple comorbidities. She presented with respiratory symptoms and underwent bronchoscopy. On discharge day, she deteriorated with fever, altered consciousness, and hy…
57y · Male·brainstem and cerebellar infarction due to vertebrobasilar artery thrombosis
A 57-year-old man with multiple cardiovascular risk factors presented to an ED with vertigo, blurred vision, and 'not feeling right' caused by an evolving posterior circulation stroke. A junior doctor discharged him afte…
76y · Male·Intracranial haemorrhage
Charles Bertram Squires, a 76-year-old prisoner on anticoagulant therapy (apixaban and aspirin), fell and struck his head on 26 January 2017. Nursing staff at the correctional facility inadequately assessed his traumatic…
83y · Female·Aspiration bronchopneumonia in a setting of cerebral infarction
Ms Patricia Grant, 83, died from aspiration bronchopneumonia following cerebral infarction while living with her son and daughter-in-law. She experienced severe neglect and elder abuse in her final years: cessation of ep…
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…
27y · Male·multiple organ failure due to or as a consequence of heat stroke
Olivier Caramin, a 27-year-old Belgian national on a working holiday visa, died from heat stroke while picking pumpkins on 31 October 2017 in Far North Queensland. He was just three days into farm work without proper acc…
28y · Female·Complications of a seizure in the setting of prescription drug abuse (pregabalin…
Samantha Leech, 28, died from complications of a seizure in the setting of prescription drug abuse, particularly pregabalin. She obtained approximately 4000 pregabalin tablets over three months by visiting multiple GPs, …
56y · Male·Complications of atraumatic bilateral femoral fractures (repaired) during a seiz…
Mark O'Brien, a 56-year-old man with Down syndrome and dementia, sustained multiple seizure-related bilateral femoral fractures. A subtle posterior cortical fracture to his left femur, sustained during a seizure on 15 Ju…
40y · Female·Cerebral oedema of unknown aetiology with probable contribution from Hashimoto's…
Sarah Louise Rose, aged 40, died from cerebral oedema of unknown aetiology with probable contribution from Hashimoto's encephalopathy. She had been diagnosed with Hashimoto's thyroiditis in late 2011 and prescribed thyro…
75y · Male·cerebral metastatic malignancy (lung cancer with brain metastases)
Kenneth Ballard, aged 75, died in prison custody from cerebral metastatic lung cancer. He had been diagnosed with chronic lymphocytic lymphoma in 2012 and managed at Mount Gambier Prison. In late 2014, Mr Ballard refused…
61y · Male·Creutzfeldt-Jakob disease
Christopher Raymond Hausler, a 61-year-old man, died from Creutzfeldt-Jakob disease (CJD) at the Royal Adelaide Hospital on 13 March 2018 while subject to a Level 2 Inpatient Treatment Order. He presented with rapidly pr…
5y · Female·aspiration of vomit with microscopic early pneumonia, in a child with a history …
A five-year-old girl with cerebral palsy and epilepsy resulting from non-accidental head injuries at two months old died from aspiration of vomit with early pneumonia. Critical lessons: bruising in non-ambulant infants i…
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…
71y · Male·disseminated fungal (Cryptococcus) infection of the lungs, brain and meninges
A 71-year-old man presented with fever, confusion, and gait disturbance in October 2017. A lung mass was identified on chest X-ray and presumed malignant, but inflammatory markers were unremarkable. Despite clinical dete…
51y · Male·hypoxic-ischemic encephalopathy due to hanging
Darren Brandon died by hanging in prison on 10 June 2018, two days after arriving at Melbourne Assessment Prison. He was a 51-year-old man with acquired brain injury from a 2003 motorcycle accident, depression, and histo…
35y · Male·subarachnoid haemorrhage with antecedent ruptured cerebral artery aneurysm
Eric Whittaker, a 35-year-old Aboriginal man, died from a subarachnoid haemorrhage caused by a ruptured cerebral artery aneurysm while in remand custody at Parklea Correctional Centre. On 2 July 2017, he made 20 emergenc…
63y · Male·Cerebral infarction complicating vertebral artery dissection following motor veh…
Keith Walter Sharp, 63, sustained a motor vehicle collision causing vertebral artery dissection and subsequent cerebral infarction. At Albury Base Hospital, initial CT imaging at 10:44am identified significant cervical s…
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