2,427 results
13y · Male·Hanging
Lachlan John Howe, aged 13, died by hanging at his home on 18 May 2018 after being transported to Royal Children's Hospital. He had experienced significant family violence from his father, including emotional abuse, cont…
30y · Male·Drowning due to jumping from the Batman Bridge
A 30-year-old man with opioid use disorder, anxiety, and depression died by suicide from jumping the Batman Bridge. He had been prescribed escalating doses of clonazepam (1-8mg daily) over three years by general practiti…
0y · Female·Head injury
Lily Grace Arbuckle, a 9-week-old infant, died from head injury sustained when her mother placed her on train tracks during what was determined to be infanticide. The mother had severe untreated postnatal depression and …
37y · Male·Sudden unexpected death in epilepsy (SUDEP) in the setting of acquired brain inj…
Kieran McGuinness, 37, died of sudden unexpected death in epilepsy (SUDEP) following acquired brain injury with post-traumatic epilepsy. He was found unresponsive on his apartment floor on 11 September 2022, having been …
1y · Female·Neonatal pneumonia, meconium aspiration and chorioamnionitis secondary to prolon…
Baby E died at home one day after birth at 40+ weeks gestation following a prolonged labour in a hired plastic birthing pool. The mother had no antenatal care, no midwifery support, and her Group B Streptococcus status w…
59y · Male·Gunshot wound of head
A 59-year-old police officer with 40 years service died by self-inflicted gunshot wound at his police station following severe financial stress related to property investment losses. He had received counselling and GP ma…
20y · Female·Stab wound to the left mid-anterior of the chest in the context of multiple othe…
A 20-year-old Aboriginal woman was fatally stabbed by her intimate partner during an escalating domestic violence relationship. She sustained a stab wound to the chest perforating her heart, causing cardiac tamponade and…
47y · Female·Multiple blunt force injuries
A 47-year-old Aboriginal woman died from multiple blunt force injuries sustained during a prolonged violent attack by her domestic partner at a bush camp in Karama, NT on 17 January 2022. She had a documented history of …
46y · Male·sepsis following haemorrhoidectomy
46-year-old Justin Mark Dobson died from sepsis following a routine haemorrhoidectomy on 17 July 2019. He was discharged to the ward overnight but deteriorated significantly from 11:00 am on 18 July, showing hypotension,…
41y · Male·Ligature compression of the neck (hanging)
Shane Nathan Roberts, aged 41, died by ligature compression (hanging) in Hakea Prison on 24 June 2019. He had pre-existing depression and anxiety treated with citalopram. A prison doctor referred him to the Mental Health…
32y · Female·Unknown
Tina Louise Greer, 32, disappeared on 18 January 2012 and is presumed deceased, killed by her partner Leslie Sharman who was involved in her coercive and controlling relationship, including domestic violence. The coroner…
16y · Male·Hypoxic/ischaemic encephalopathy in the context of diabetic ketoacidosis
A 16-year-old with Type 1 Diabetes died from diabetic ketoacidosis (DKA) precipitated by acute gastroenteritis acquired while on a school trip to Vietnam. Despite reporting vomiting at 8am on 26 September 2019, Lachlan w…
33y · Male·Hanging
CC, a 33-year-old First Nations man with methamphetamine-induced bipolar disorder and psychosis, was admitted to the High Dependency Unit at Nepean Hospital on 7 June 2022 under involuntary mental health detention. Over …
26y · Female·meningococcal infection (Neisseria meningitidis W strain) causing septicaemia
Ashleigh Rebecca Hunter, a previously healthy 26-year-old, died from meningococcal septicaemia (W strain) within 3 hours of arriving at Royal Perth Hospital. She presented with severe generalised pain (10/10), tachycardi…
43y · Male·exsanguination from incised wounds to the arms - self inflicted
A 43-year-old man with schizophrenia, PTSD, and methamphetamine use died from exsanguination following self-inflicted incised wounds to both arms. He had been discharged from psychiatric inpatient care on 1 February 2020…
47y · Male·Complications of acute agitation in the setting of a prolonged struggle in an ac…
Ricky Broughton, a 47-year-old man with chronic treatment-resistant schizophrenia, died during police restraint while being transferred for involuntary psychiatric assessment. After moving from Geelong to Ballarat in Feb…
37y · Male·mixed drug toxicity with fentanyl as the principal agent
37-year-old Jason Cullen died from mixed drug toxicity with fentanyl as the principal agent. He had chronic idiopathic intracranial hypertension requiring multiple neurosurgeries and was prescribed opioids and benzodiaze…
36y · Female·Blunt force injuries to the neck due to a motor vehicle accident
Delvene Thompson, 36, died in a motor vehicle crash on Trower Road, Darwin, after the driver (Peter Lynch) evaded police during a traffic stop and pursued at extreme speed through red lights. The coroner found the crash …
17y · Female·Gamma hydroxybutyrate (GHB) toxicity
JZA, a 17-year-old in residential out-of-home care, died from GHB toxicity after returning to her residential unit intoxicated in the early morning. She was monitored by residential support workers throughout the day but…
59y · Female·Asphyxial aspiration with upper airways obstruction by vomitus
Ms Prenc, a 59-year-old woman with spina bifida, died from asphyxial aspiration with upper airway obstruction by vomitus while hospitalised for urosepsis. The critical clinical issue was a Goals of Care (GOC) document co…
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