17 results
75y · Female·multiple organ failure due to severe anaemia secondary to blood loss post electi…
A 75-year-old woman died from multiple organ failure due to severe anaemia after elective hysterectomy surgery. Critical failures occurred: the surgical and anaesthetic teams held conflicting understandings about whether…
71y · Female·complications of metastatic endometrial carcinoma, treated palliatively
Corazon Contreras Keeley, a 71-year-old woman with postmenopausal bleeding, was investigated for possible endometrial cancer. Dr K. performed a hysteroscopy with dilation and curettage (HDC) on 29 November 2019, observin…
Female·Not definitively stated in judgment; death followed complications from initial s…
This judgment concerns a pre-inquest motion by the Christian Congregation of Jehovah's Witnesses challenging the scope of a coronial inquiry into Heather Winchester's death. Mrs Winchester died following emergency surger…
27y · Female·multiple injuries sustained from fall from 30-storey building
Ms L, a 27-year-old German national, died by suicide on 4 March 2021 after jumping from a 30-storey building in Perth. She had experienced depression since 2016, exacerbated by recent diagnoses of chlamydia and HPV16 in …
62y · Female·Hypovolaemic and cardiogenic shock (hysterectomy) in the context of cardiomegaly…
A 62-year-old woman with significant comorbidities (cirrhosis, cardiomegaly, thrombocytopenia, chronic kidney disease, COPD) died from hypovolaemic and cardiogenic shock during elective total laparoscopic hysterectomy fo…
79y · Female·Ischaemic bowel in the setting of cardiomegaly, pneumonia and chronic renal fail…
A 79-year-old woman died from ischaemic bowel in the setting of cardiomegaly, pneumonia and chronic renal failure, four days after discharge from hospital following a hysterectomy for endometrial cancer. Key clinical les…
38y · Female·neck compression (hanging)
RR, a 38-year-old woman with complex mental health history including PTSD, substance use disorder, and borderline personality traits, was admitted to Bloomfield Hospital on 12 April 2015 following an overdose with stated…
34y · Female·Mixed drug toxicity
Diane Maria Hillgrove, a 34-year-old woman with chronic pain, PTSD, anxiety and substance abuse history, died from mixed drug toxicity on 7 July 2018. Post-mortem toxicology revealed elevated pregabalin (51 mg/L), morphi…
29y · Female·Exsanguination post tubal ligation procedure
A 29-year-old woman died from exsanguination following an iatrogenic injury during elective laparoscopic tubal ligation at a regional hospital. A vascular injury to the right external iliac artery occurred during the pro…
33y · Female·Compression of the neck
Ms Marzieh Rahimi, a 33-year-old Afghan refugee, died from compression of the neck following an incident with her husband. She had disclosed a history of extensive physical, verbal, financial and emotional abuse. In the …
79y · Female·aspiration pneumonia caused by aspiration of emesis secondary to small bowel obs…
Mrs Little, 79, died from aspiration pneumonia caused by small bowel obstruction post-hysterectomy surgery. The obstruction resulted from both pre-existing adhesions and a post-operative haematoma at the surgical site. C…
70y · Female·Hypoxic/Ischaemic Encephalopathy consequent upon Cardiorespiratory Arrest and Co…
Beverly Ann Murphy, 70, underwent hysterectomy for endometrial carcinoma on 2 April 2008 at Royal Hospital for Women. The complex surgery was complicated by iatrogenic small bowel perforations. Post-operatively, wound de…
Female·Emily Ruth Leonard: multi-organ failure due to overwhelming sepsis from a perfor…
Two elderly women died following vaginal prolapse surgery performed by the same surgeon, Dr O., with similar mechanisms: bowel perforation leading to peritonitis and sepsis. Mrs Leonard (77) underwent laparoscopic surger…
Female·massive intra-abdominal haemorrhage caused by injuries to her right common iliac…
Heidi Maree Clarke, a patient undergoing treatment for ectopic pregnancy, died on 30 April 2009 from massive intra-abdominal haemorrhage caused by injuries to her right common iliac artery and vein sustained during lapar…
59y · Female·sepsis due to faecal peritonitis due to perforation of sigmoid colon complicatin…
A 59-year-old woman died from sepsis due to faecal peritonitis following a bowel perforation during laparoscopic oophorectomy for a benign ovarian cyst. The perforation was repaired during the initial surgery, but the re…
62y · Female·Haemorrhage caused by abdominoperineal excision of the rectum
A 62-year-old woman died of uncontrollable haemorrhage following an abdominoperineal excision of the rectum (APER) at a remote hospital. The coroner found the operation itself was inappropriate: performed for undiagnosed…
43y · Female·sepsis secondary to extensive acute peritonitis following perforation of small b…
43-year-old woman died from sepsis and necrotising fasciitis following small bowel perforation during laparoscopic tubal ligation. She was at high risk due to previous abdominal surgeries and adhesions. A 4-5mm perforati…
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