1,172 results
58y · Female·Enterococcus faecalis sepsis and acute renal failure
Robena Lloyd, a 58-year-old woman with intellectual disability and schizophrenia, died from enterococcus faecalis sepsis and acute renal failure on 7 August 2009. She presented to Angliss Hospital ED on 31 July with urin…
61y · Female·Ligature neck compression in the setting of blunt force head trauma
A 61-year-old woman of Bulgarian descent was fatally assaulted by her estranged husband in a domestic violence incident. She died from ligature neck compression following blunt force head trauma. The perpetrator had mult…
47y · Male·Hanging
A 47-year-old man with chronic schizophrenia and alcohol dependence died by hanging at a rooming house. He had been non-compliant with antipsychotic medications for months, experiencing severe auditory hallucinations tha…
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, …
24y · Male·multiple stab wounds to the chest that he inflicted upon himself
A 24-year-old man with diagnosed schizophrenia experienced a relapse and engaged in a dangerous spree involving vehicle theft, assault, and police pursuit. Despite psychiatric treatment with antipsychotics, he stopped me…
37y · Male·Acute external and internal blood loss from single stab wound to upper left ches…
MWJ, aged 37, was fatally stabbed by his intimate partner EW on 24 December 2016 during an escalating domestic argument. The coroner identified significant systemic failures in Community Corrections management of both of…
75y · Female·Multiple injuries including stab wounds to the chest
A 75-year-old woman was fatally stabbed by her son during a family violence incident. Her son had a 20-year history of schizophrenia and schizoaffective disorder with poor medication compliance, documented aggression tow…
37y · Male·Combined drug toxicity (methadone, fentanyl, diazepam and pregabalin)
Daniel Joseph Herbert, aged 37, died from combined drug toxicity involving methadone, fentanyl, diazepam and pregabalin. He had a 17-year history of opioid dependence stemming from prescription OxyContin for a work-relat…
32y · Male·Multiple injuries sustained in a fall from a height
Adam Laufer, a 32-year-old man with longstanding bipolar disorder, died by suicide on 24 November 2016 when he jumped from the LaTrobe Street overpass in Melbourne. In the early hours of 24 November, his father called tr…
56y · Female·acute pentobarbitone toxicity
56-year-old woman died from acute pentobarbitone toxicity in her Sydney apartment on 27-28 May 2016. She had a long history of mental health issues, depression, substance use, and prior self-harm. She had recently obtain…
30y · Male·Hanging
Joshua Stachor, aged 30, died by hanging in Yatala Labour Prison on 19 November 2017. He was a remand prisoner on charges of domestic violence. The coroner found critical failures in his admission assessment on 6 Novembe…
40y · Female·Head injuries inflicted by axe blows in context of intimate partner domestic abu…
Teresa Bradford, aged 40, was killed by her husband David Bradford in a premeditated domestic homicide at their Pimpama home on 31 January 2017, followed by his suicide. She died from head injuries inflicted with an axe.…
46y · Male·congestive cardiac failure due to cardiomyopathy and coronary artery atheroscler…
A 46-year-old man with significant cardiac and medical comorbidities died of congestive cardiac failure due to cardiomyopathy and coronary artery atherosclerosis while in police custody. He was correctly categorized as H…
31y · Male·Gunshot wounds to the neck and chest
Liam Scorsese, 31, died from gunshot wounds inflicted by police during a confrontation at his estranged partner's parents' home in Queensland. He had a history of violence, substance abuse (methamphetamine, cocaine), and…
29y · Female·Mixed Drug Toxicity
A 29-year-old woman died from mixed drug toxicity after being found unresponsive at a residential parenting program. She had complex medical conditions including coproporphyria, epilepsy, and opioid use disorder. Critica…
56y · Female·Bronchopneumonia in the setting of supratherapeutic lithium levels
Julie-Anne Kettle, a 56-year-old woman with intellectual disabilities residing in a group home, died from bronchopneumonia in the setting of supratherapeutic lithium levels. She was on lithium 1250 mg/day for psychiatric…
8y · Male·Suffocation
Brodie Moran, an 8-year-old boy, died by suffocation at the hands of his mother, Ms Finch, on 8 March 2018. Ms Finch had a history of depression and anxiety, experiencing significant deterioration in mental health follow…
61y · Female·Multiple drug (tapentadol, morphine, diazepam, citalopram) intoxication
Margaret Cahill, a 61-year-old nurse assistant, died from multiple drug intoxication after a GP administered 60mg intramuscular morphine without knowing she had consumed tapentadol 1-2 hours earlier. The coroner identifi…
32y · Male·contact range gunshot wound to the forehead, self-inflicted
A 32-year-old male with long-standing depression and Asperger's syndrome died by firearm suicide. His medical care was appropriate and well-managed. However, critical systemic failures occurred in firearms licensing. He …
3y · Female·gunshot wound to the head
A 3-year-old girl was killed by her mother, who was experiencing a severe psychotic episode with suicidal and homicidal ideation. The mother had a history of Brief Psychotic Disorder (diagnosed 2015), was on olanzapine 1…
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