30 results
78y · Female·Complications of mandibular fractures sustained in a fall, in the setting of mal…
Frances Hayden, 78, died from complications of mandibular fractures sustained in a fall at an aged care facility. She had long-standing schizoaffective disorder with associated anorexia, resulting in severe malnutrition …
84y · Male·Ischaemic heart disease and coronary artery atherosclerosis in the setting of ty…
Jonathan Uphill, an 84-year-old man with extensive comorbidities including type 2 diabetes, hypertension, and prior cardiac risk factors, died of ischaemic heart disease with coronary artery atherosclerosis. He underwent…
51y · Female·Methemoglobinemia in the context of lignocaine use
Danielle Cadan, 51, died from methemoglobinemia following a tooth extraction under lignocaine anaesthetic at a regional health service. The lignocaine was administered in normal therapeutic dose but triggered this rare l…
54y · Male·Hypoxic/ischaemic brain damage caused by blood loss and airway obstruction due t…
A 54-year-old male was assaulted in a nightclub with a single punch causing orbital and facial fractures and posterior epistaxis. He presented to the Royal Hobart Hospital ED with active bleeding. Critical deficits in hi…
20y · Male·hypoxic ischaemic encephalopathy secondary to displacement of tracheostomy and p…
Adam Fitzpatrick, a 20-year-old with complex facial and skull fractures from a motor vehicle collision, underwent emergency tracheostomy placement. On 22 August 2020, 13 days later, his tracheostomy tube became dislodged…
59y · Female·complications of abscesses following dental extraction, in a woman with cerebral…
Angela Cuthbert, a 59-year-old woman with severe cerebral palsy and dysphagia, died from complications of abscesses following extraction of all 14 teeth under general anaesthetic. Surgery occurred 20 June 2022; she devel…
65y · Female·undetermined; possibly ischaemic heart disease or squamous cell carcinoma of ton…
A 65-year-old Malaysian woman with advanced squamous cell carcinoma of the tongue refused medical treatment due to visa concerns and preference for alternative therapy. She deteriorated over months with worsening oral sy…
71y · Male·Complications of metastatic squamous cell carcinoma (terminal palliation)
Leslie Shortte, a 71-year-old life prisoner, died from metastatic squamous cell carcinoma with complications. Critical failures in his prison medical care included: failure to complete annual health assessments after 201…
60y · Male·sepsis and aspiration pneumonia in a man with oral squamous cell carcinoma and m…
Henry Allen, a 60-year-old man with oral squamous cell carcinoma, lung cancer, and multiple comorbidities died from sepsis and aspiration pneumonia while in prison custody at Fiona Stanley Hospital. He received appropria…
0y · Male·Hypoxic ischaemic encephalopathy secondary to post-operative respiratory distres…
A 10-month-old boy died following elective cleft palate repair surgery complicated by post-operative respiratory distress and subsequent cardiorespiratory arrest. Initial laryngospasm led to suspected post-obstructive pu…
36y · Male·Cardiorespiratory arrest complicating propofol administration for endodontic pro…
Michael Anderson, a 36-year-old obese man (BMI 38.5), suffered cardiorespiratory arrest during a root canal procedure under conscious sedation with propofol administered by Dr S. in a dental office setting. He had undiag…
73y · Male·Disseminated malignancy (advanced lung carcinoma and mouth carcinoma) in a man w…
Robert Craig, aged 73, died from disseminated malignancy (advanced lung and mouth carcinoma) while in prison custody. He received suboptimal cancer treatment at Fiona Stanley Hospital due to communication failures betwee…
47y · Male·bronchopneumonia and upper airway obstruction in a man with end-stage oral cance…
James David Hector, a 47-year-old Aboriginal man, died of bronchopneumonia and upper airway obstruction related to end-stage oral cancer. He had a 13-year history of squamous cell carcinoma of the mouth with multiple rec…
76y · Female·Ludwig's angina
A 76-year-old woman with Ludwig's angina presented to urgent care with facial swelling and fever. She was appropriately diagnosed and arrangements made for transfer to a tertiary centre. However, staff failed to recognis…
82y · Male·Complications of multiple injuries (palliated), sustained in a quad bike inciden…
An 82-year-old man died from complications of multiple injuries sustained in a quad bike incident. He had failed a VicRoads eyesight test two years earlier, losing his driver's licence, yet continued riding an unregister…
56y · Male·Pulmonary embolism with deep vein thrombosis an antecedent cause; coronary arter…
Peter Robin, a 56-year-old man with a medical history of hypercholesterolaemia, hypertension, obesity, and depression, underwent elective dental surgery on 28 October 2015 to remove four wisdom teeth and resect a cyst. H…
35y · Male·Hanging
Travis Lee Fernandez, aged 35, died by hanging in custody at Dhurringile Prison in November 2014. He had sustained bilateral mandibular fractures in January 2014 treated with open reduction and internal fixation (ORIF). …
22y · Female·septic shock complicating osteomyelitis secondary to cellulitis in a woman with …
Sarah Hammoud, aged 22 with cerebral palsy and intellectual disability, died from septic shock complicating osteomyelitis secondary to cellulitis. She resided in a supported residential service and had recurrent elbow in…
84y · Male·Gunshot wound to the head
Raymond John Cox, an 84-year-old man with Alzheimer's disease, depression, and cognitive decline, died from a self-inflicted gunshot wound to the head. His wife had approached police in 2013 seeking assistance to remove …
35y · Male·Intraoral shotgun wound
Neil Lawrence Williamson, aged 35, died from a self-inflicted intraoral shotgun wound on 4 April 2015 at Ravenswood rest stop after a lengthy police negotiation. He had a history of depression, childhood sexual abuse, an…
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