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VIChome2014-05-15

Finding into death of Georgia Susan Cheal

31y · Female·Pneumonia; combined drug toxicity (including marijuana), smoking, pathological o…

Georgia Cheal, a 31-year-old with complex medical history including chronic pain, major depression, and obesity, died from pneumonia exacerbated by combined drug toxicity from multiple prescription medications, cannabis,…

general practicepsychiatrycommunicationsystemoxycodone
VICaged care2014-05-14

Finding into death of Norma Alice Bensley

92y · Female·Ischaemic heart disease in the setting of inappropriate administration of antihy…

Norma Bensley, a 92-year-old aged care resident, died from ischaemic heart disease after being inadvertently administered another resident's antihypertensive medications. A newly qualified nurse administered the wrong me…

geriatric medicinegeneral practicemedicationsystemantihypertensive medications
NSWhospital2014-05-09

Inquest into the death of Brendan BURNS

24y · Male·acute hydrocephalus due to undiagnosed colloid cyst of the third ventricle of th…

Brendan Burns, 24, died from acute hydrocephalus caused by an undiagnosed colloid cyst of the third ventricle. He presented with progressive severe occipital headaches, dizziness, blurred vision, nausea and vomiting over…

emergency medicineneurosurgerydiagnosticcommunicationmorphine
VICcommunity2014-05-06

Finding into death of Petroula Krassos

75y · Female·Mechanical asphyxia

A 75-year-old woman died from mechanical asphyxia when the car she was traveling in crashed into Merri Creek. Her daughter, Mary, was driving; Mary had uncontrolled epilepsy diagnosed in 1997 with seizures occurring at l…

general practiceemergency medicinecommunicationsystemcarbamazepine
VIChospital2014-05-05

Finding into death of Georg Manfred Braumuller

41y · Male·pneumonia in the setting of Lennox Gastaut Syndrome

A 41-year-old man with Lennox Gastaut Syndrome and significant physical disabilities died from pneumonia two days after presenting to his GP with fever and cough. The GP diagnosed a respiratory tract infection and prescr…

general practicerespiratory medicinesystemantibiotic medication
VICaged care2014-04-29

Finding into death of Marie Goder

84y · Female·Major cerebral infarct due to hypoglycaemia

Marie Goder, an 84-year-old with diabetes, developed severe hypoglycaemia following insulin administration at a nursing home on 1 November 2009, resulting in prolonged unconsciousness and bilateral cerebral infarcts. Aft…

general practicegeneral medicinediagnosticmedicationactrapid
SAaged care2014-04-17

Coroner's Finding: WERNER Cynthia Joy

76y · Female·colchicine toxicity

A 76-year-old woman with gout died from colchicine toxicity after being prescribed 500µg three times daily on 9 December 2010 for an acute attack. She developed diarrhoea from 15 December and died on 19 December with a p…

general practicegeriatric medicinemedicationsystemcolchicine
VICcommunity2014-04-07

Finding into death of Kirk Ardern

32y · Male·Multiple drug toxicity (including heroin)

Kirk Steven Ardern, a 32-year-old male with a long history of opioid dependence and substance abuse, died from multiple drug toxicity (including heroin) three days after release from prison. Two critical clinical failure…

general practiceaddiction medicinemedicationcommunicationheroin
VIChome2014-04-02

Finding into death of AB

34y · Female·Combined drug toxicity (propofol, sevoflurane and others)

A 34-year-old anaesthetist at Royal Melbourne Hospital died from combined drug toxicity involving propofol and sevoflurane—anaesthetic agents she accessed from unlocked theatre trolleys and administered to herself at hom…

anaesthesiageneral practicesystemcommunicationpropofol
VICaged care2014-03-31

Finding into death of Margaret Lurline Martyr-Paterson

87y · Female·Multiple injuries with ischaemic heart disease, antecedent cause being recent fa…

87-year-old Margaret Martyr-Paterson, a low-care resident with dementia and ischaemic heart disease at Shoreham House aged care facility, fell from her bedroom window on 17 February 2010 and died 11 days later from multi…

geriatric medicinegeneral practicecommunicationsystem
SAaged care2014-03-21

Coroner's Finding: MORGAN Beryl Jean

73y · Female·pneumonia and renal failure with hyperthermia

Beryl Jean Morgan, 73-year-old aged care resident, died from pneumonia and renal failure with hyperthermia after a brief hospital admission. She had been prescribed haloperidol for behavioural problems; while neuroleptic…

general practicegeriatric medicinediagnosticcommunicationhaloperidol
VIChospital2014-03-17

Finding into death of Mervyn Barry Maslin

67y · Male·Complications arising from multiple injuries — fall from a height

A 67-year-old man died from complications of multiple injuries sustained in a fall from a 3-metre ladder while conducting home roof repairs in Tasmania. He fell forward through polycarbonate roofing onto a paved veranda …

neurosurgerytrauma surgerysystem
SAcommunity2014-03-12

Coroner's Finding: MUNDY Michaela Jayne

15y · Female·neck compression due to hanging

Michaela Mundy, a 15-year-old with depression, was seen by CAMHS therapist Vina Hotich from July-November 2011, presenting with suicidal ideation, self-harm, and moderate-to-severe depressive symptoms. Despite evidence o…

psychiatrygeneral practicediagnosticcommunicationfluoxetine
VIChome2014-03-06

Finding into death of Melanie Jane Maher

36y · Female·Effects of fire (schizophrenic psychotic episode); for children: effects of fire…

This case involved the deaths of Kylie Fowler (36) and her three children—Samantha (18), Melanie (13), and Matthew (11)—in a house fire on 9 January 2011. Kylie, with an 18-year history of schizophrenia requiring five in…

psychiatrygeneral practicecommunicationsystemrisperidone
VIChome2014-03-06

Finding into death of Kylie Jane Fowler

36y · Female·Effects of Fire

A 36-year-old woman with a 18-year history of schizophrenia killed herself and her three children (ages 11, 13, and 18) in a house fire with stab wounds on 9 January 2011. Ms Fowler had five involuntary psychiatric admis…

psychiatrygeneral practicecommunicationsystemrisperidone
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
VIChospital2014-02-26

Finding into death of Dean Lovett

21y · Male·dilated cardiomyopathy

Dean Lovett, 21 years old, presented with fever, vomiting, cough and palpitations to his general practitioner on 6 September 2008. Dr G. identified clinical signs concerning for cardiac disease (tachycardia, finger clubb…

emergency medicinegeneral practicediagnosticdelaymethotrexate
VIChome2014-02-13

Finding into death of Daniel Malcolm John Anderson

33y · Male·toxic effects of oxycodone

A 33-year-old man died from oxycodone toxicity after his general practitioner prescribed escalating doses of the opioid for intermittent migraines over 14 months (5-30mg daily), despite a prior rejection of a pethidine a…

general practicepsychiatrydiagnosticmedicationoxycodone
NSWhome2014-02-06

Inquest into the death of Natalie Jean WOOD

79y · Female·Unascertained

Natalie Jean Wood, aged 79, was found deceased in her Surry Hills home in July 2011, approximately 7 years after her death in February 2004. She had lived alone in poor conditions without functioning utilities or telepho…

neurologygeneral practicesystem
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