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QLDhospital2013-09-12

Bligh, William John - Non-inquest findings

9y · Male·Disseminated melioidosis

William Bligh, a 9-year-old boy from Palm Island, died from disseminated melioidosis on 24 February 2013. He presented with fever and cough from 2 February, initially assessed as viral illness. Over 11 days, he was revie…

paediatricsinfectious diseasessystemdelayibuprofen
SAhospital2013-08-19

Coroner's Finding: WEEKS Ronald Geoffrey

84y · Male·respiratory failure due to hospital-acquired pneumonia

Ronald Geoffrey Weeks, aged 84, died of respiratory failure due to hospital-acquired pneumonia following a hip fracture sustained in a fall at James Nash House psychiatric facility. He was serving an 8-year sentence for …

geriatric medicineorthopaedic surgerysystemdelay
VICcommunity2013-07-04

Finding into death of Rhys Andrew Rodger

16y · Male·Bacterial meningitis

A 16-year-old previously healthy boy died from bacterial meningitis after being misdiagnosed with gastroenteritis at a general practice. He presented with a 3-day history of vomiting, severe headache, and fever. The GP r…

general practiceinfectious diseasesdiagnosticcommunicationparacetamol
VIChospital2013-05-07

Finding into death of Karen Elizabeth Wilkinson

44y · Female·Lymphocytic choriomeningitis virus (LCMV)-like virus infection following failed …

A 44-year-old woman died on 1 January 2007, six days after receiving a cadaveric renal transplant. She was one of three organ recipients from the same donor who died within six days of each other from a novel lymphocytic…

transplant medicinenephrologycommunicationsystem
VIChospital2013-05-07

Finding into death of Carmelina Rachela Sirianni

63y · Female·Lymphocytic choriomeningitis virus (LCMV)-like virus infection; post failed rena…

A 63-year-old woman received a renal transplant from a cadaveric donor who had died of cerebral hemorrhage. She developed delayed graft function and deteriorated post-operatively, ultimately dying from a novel lymphocyti…

nephrologytransplant medicinecommunicationsystem
VIChospital2013-05-07

Finding into death of Gurpal Sandhu

64y · Female·Lymphocytic choriomeningitis virus (LCMV)-like arenavirus infection, post liver …

A 64-year-old woman died on 3 January 2007 from a lymphocytic choriomeningitis virus (LCMV)-like arenavirus acquired through cadaveric liver transplantation. The donor had recently returned from Serbia with unexplained w…

transplant medicinehepatologycommunicationsystem
VIChome2013-05-07

Finding into death of JOVO VRANJESEVIC

57y · Male·thalamic haemorrhage with ventricular extension

A 57-year-old man with hypertension and atrial fibrillation suffered a massive thalamic haemorrhage while at home and was declared brain dead at hospital. His organs were donated to three recipients who all died within s…

transplant medicineintensive care
SAhospital2013-03-27

Coroner's Finding: SMITH Norman Ebanezer John

54y · Male·Respiratory failure due to aspiration pneumonia and acute autonomic and sensory …

Norman Ebanezer John Smith, aged 54, a long-term psychiatric patient under guardianship, died of respiratory failure due to aspiration pneumonia and acute neuropathy complicating severe hyponatraemia (sodium 109). He pre…

psychiatryintensive caresystemcommunicationantipsychotics
SAhospital2013-02-08

Coroner's Finding: FENSOM Angela Catherine and TAANKINK Johaanes Andrew

Unknown·Ms Fensom: influenza A (H1N1 2009, pandemic swine flu) with myocarditis causing …

Two deaths from H1N1 influenza in 2009. Ms Fensom (41) died from myocarditis complicating swine flu after inadequate recognition and management of persistent hypotension at Millicent Hospital. Her condition required esca…

emergency medicinegeneral practicediagnosticcommunicationoseltamivir
VIChospital2012-12-13

Finding into death of William Andrew Poskitt

31y · Male·Injuries sustained in a fall from height

William Poskitt, a 31-year-old man with recently diagnosed HIV and Pneumocystis carinii pneumonia, died by suicide during a 4-day hospital admission. Despite requesting psychiatric assessment three times and displaying c…

infectious diseasespsychiatrycommunicationdiagnostictrimethoprim
QLDhome2012-12-06

Bramble, Julie Anne

50y · Female·septicaemia

Julie Anne Bramble, a 50-year-old woman with alcohol dependence and recent drug use, died from septicaemia on 1 April 2011 at her home in Bundaberg. Over 4-5 days prior to death, she developed progressive symptoms includ…

emergency medicineparamedicinedelaycommunicationmethamphetamine
SAhospital2012-11-15

Coroner's Finding: Davis Tracy-Lee

34y · Female·hypoxic ischaemic encephalopathy due to anaphylactic shock due to antibiotic all…

A 34-year-old woman died from anaphylactic shock to Ceclor, a cephalosporin antibiotic prescribed for otitis externa. Her medical records clearly documented allergies to cephalosporins (Ibilex) and sulphur-based antibiot…

general practiceemergency medicinediagnosticmedicationceclor
SAcommunity2012-11-15

Coroner's Finding: Edgar Lauren Michelle

28y · Female·Multi-organ failure due to Clostridium perfringens myonecrosis complicating lipo…

Lauren Edgar, a 28-year-old woman, died of multi-organ failure from Clostridium perfringens myonecrosis (gas gangrene) following a liposuction procedure performed by Dr K. on 5 March 2008. She presented to hospital on 8 …

plastic and reconstructive surgerygeneral practicediagnosticcommunicationpanadol/paracetamol
NThospital2012-10-29

Inquest into the death of Ben James Witham

17y · Male·Multi-organ failure with terminal fungal sepsis (Aspergillus) on a background of…

Ben Witham, a 17-year-old with acute lymphoblastic leukaemia, died from multi-organ failure with terminal fungal sepsis. The critical issue identified was a substantial delay in investigating acute severe abdominal pain …

oncologyhaematologydiagnosticdelaymorphine
VIChospital2012-09-11

Finding into death of Robert Anderson

50y · Male·Complications of right buttock necrotising fasciitis secondary to chronic right …

50-year-old male with chronic pain from jockey injuries became dependent on morphine. General practitioner prescribed intramuscular (IM) morphine for self-administration at home from 2005–2007 at doses of 120–240mg daily…

general practicepsychiatrydiagnosticmedicationmorphine sulphate
VIChospital2012-07-03

Finding into death of Pruseyus Lily Sharp

0y · Female·Hypoxic brain injury secondary to pneumonia and pulmonary haemorrhage

Pruseyus Sharp was a 39-day-old neonate who died from hypoxic brain injury secondary to pneumonia and pulmonary haemorrhage caused by picornavirus infection. She presented with severe apnoea and minimal preceding symptom…

paediatricsneonatologydelay
VICaged care2012-06-25

Finding into death of Broughton Hall Inquest

Salmonella infection contributing to deaths in gastroenteritis outbreak

Four elderly residents of Broughton Hall aged care facility died during a 2007 Salmonella gastroenteritis outbreak. A three-day delay in notifying the Department of Health (April 7 to April 10) prevented early identifica…

infectious diseasesgeriatric medicinediagnosticcommunication
WAhospital2012-05-31

Inquest into the Death of GARRETT

52y · Male·HIV infection complicated by basal and squamous cell carcinoma of the head and n…

Bruce Jason Garrett, a 52-year-old prisoner detained under the Dangerous Sexual Offenders Act, died at Royal Perth Hospital on 2 October 2010 from HIV infection complicated by basal and squamous cell carcinoma of the hea…

emergency medicineintensive careheparin
WAhospital2012-05-18

Inquest into the Death of Allan

16y · Male·Pneumonia complicating influenza A (H1N1) infection with secondary Staphylococcu…

Andrew Allan, a 16-year-old student, died from pneumonia complicating influenza A (H1N1) infection with secondary Staphylococcus aureus septicaemia. He presented to Northam Regional Hospital Emergency Department on 16 Se…

emergency medicinegeneral practicediagnosticcommunicationmethylphenidate
SAhospital2012-03-07

Coroner's Finding: MILLER Allan Kenneth

56y · Male·disseminated nocardiosis involving central nervous system, kidneys, liver and th…

Allan Kenneth Miller, 56, died from disseminated nocardiosis (rare bacterial infection) that was not diagnosed during his 12-day RAH admission. Clinicians initially suspected metastatic lung cancer based on presentation …

respiratory medicineinfectious diseasesdiagnosticdelayenoxaparin

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