5,662 results
26y · Male·Drug toxicity (1,4 butanediol, gamma hydroxybutyrate, methylamphetamine, cocaine…
Jack Atkinson, 26 years old, died from mixed drug toxicity involving GHB/1,4-butanediol, methylamphetamine, cocaine, novel benzodiazepines (bromazolam, flubromazepam), nordiazepam, and ketamine. He had a history of subst…
41y · Male·Multiple traumatic injuries
This inquest examined the death of a 40-year-old man who died by suicide following a fall from a cliff. He had three involuntary admissions to mental health facilities in a fortnight before his death. Critical clinical l…
43y · Male·Hypoxic ischaemic encephalopathy, due to or as consequence of, cardiac arrest of…
A 43-year-old man with methamphetamine toxicity was restrained by police and given two doses of droperidol by paramedics who failed to recognize he was critically unwell. The first dose was clinically indicated, but the …
62y · Male·cardiac arrhythmia secondary to prolongation of the QT interval
NL, a 62-year-old man with schizoaffective disorder and hypothyroidism, died of cardiac arrhythmia secondary to QT prolongation while an involuntary mental health inpatient. He had a known history of non-compliance with …
86y · Female·Pulmonary thromboembolism in the setting of deep leg vein thrombosis, secondary …
Barbara Deal, 86, died from pulmonary embolism secondary to deep vein thrombosis 17 days after lumbar spinal fusion surgery. Critical failures included: no repeat VTE risk assessments despite policy requirements; inconsi…
48y · Male·Complications of human immunodeficiency virus infection with terminal palliative…
Travis Dion Baumgarten was a 48-year-old Aboriginal man serving a prison sentence at Acacia Prison in Western Australia who died on 5 December 2022 from complications of untreated HIV/AIDS. After HIV diagnosis in 1994, h…
66y · Female·Hypoxic-ischaemic encephalopathy
A 66-year-old woman with COPD, obstructive sleep apnoea, and obesity underwent routine knee surgery at Royal Darwin Hospital. Post-operative care was inadequate. Despite dropping oxygen saturations to 88% when sedated an…
53y · Male·massive head injury, upper thoracic fracture and dislocation, multiple rib fract…
A 53-year-old experienced cyclist died after losing control of his bicycle on loose gravel left on a roadway during utility works. He collided with an oncoming vehicle on a downhill left-hand bend at Kingston Beach. Fric…
66y · Male·Complications of excess alcohol intake in a man with heart disease
A 66-year-old man died from complications of excess alcohol intake in the setting of underlying heart disease. He had a 40+ year history of heavy daily alcohol consumption (12+ cans of beer plus whiskey daily), chronic p…
41y · Male·complications of acute ethanol toxicity
Mr RJ, a 41-year-old man with a history of progressive alcohol misuse and mental health conditions (anxiety and depression), died from complications of acute ethanol toxicity following cardiac arrest due to aspiration an…
45y · Male·atherosclerotic heart disease
Lex Gregory Maher, a 45-year-old Aboriginal man imprisoned at Greenough Regional Prison, died of atherosclerotic heart disease while playing basketball. He had abnormal ECGs detected in March and May 2022 and was appropr…
77y · Female·intracranial haemorrhage (subdural, intraventricular and brainstem)
A 77-year-old woman fell from a ladder on 12 December 2022, suffering loss of consciousness and rib fractures. No brain CT scan was performed at Mersey Community Hospital despite the mechanism of injury and unconsciousne…
59y · Male·Unascertained
Jonathan Townsend, a 59-year-old Navy veteran with PTSD, alcohol use disorder, and multiple psychiatric comorbidities, died at home on 5 November 2021. The cause of death was unascertained despite autopsy and toxicology.…
90y · Female·Surgical repair of fractured neck of femur sustained in a fall complicated by CO…
Maria Grazia Nardiello, aged 90, died following surgical repair of a fractured neck of femur sustained in a fall at an aged care facility, complicated by COVID-19 infection. She was pushed by another resident with dement…
90y · Male·Pneumonia complicating injuries sustained in a motor vehicle incident
A 90-year-old man died from pneumonia following injuries sustained in a motor vehicle collision. He had multiple reportable medical conditions including atrial fibrillation, coronary artery disease, chronic kidney diseas…
68y · Male·Head injuries
Stephen O'Brien, aged 68, died from head injuries inflicted by his adult son Scott in a family violence incident. Stephen had been the primary carer for Scott, who had untreated mental illness (suspected schizophrenia), …
22y · Male·ligature compression of the neck (hanging)
Ricky-Lee Cound, 22, an Aboriginal man with FASD, died by hanging in his Hakea Prison cell on 25 March 2022. At 4.11pm, Mr Cound called requesting a monitored safe cell to prevent self-harm, demonstrating clear risk perc…
32y · Male·Gunshot wound to the head
Mark Bombardieri, a 32-year-old man with a complex history of criminal behaviour, mental health disorders, polysubstance abuse, and multiple psychiatric admissions, died by suicide on 6 March 2019 via self-inflicted guns…
59y · Female·multiple injuries from fall from height
Fiona Turnbull, a 59-year-old woman with chronic schizophrenia on clozapine, died from multiple injuries after falling from her third-floor balcony on 12 October 2017 during a psychotic relapse. The death occurred shortl…
29y · Male·hanging
Muhammad Hafizuddin Bin Zaini, a 29-year-old detainee in immigration detention at Villawood, died by hanging on 12 December 2020. He had a history of substance-induced psychotic disorder and was prescribed antipsychotic …
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