210 results for “falls risk”
63y · Male·Drowning
…cation between treating teams despite both being aware of his involvement; no family consultation to inform risk assessment or discharge planning despite documented family concerns and his impaired judgement; no psychiat…
27y · Male·ligature strangulation
…dmissions for medication non-compliance and psychotic relapse. The co-patient, classified as extremely high-risk for interpersonal violence, was released from seclusion after only three days despite documented difficulty…
3y · Female·Drowning
Lauren Harris, aged 3 years, drowned in a non-compliant backyard swimming pool in September 2008 after gaining access to the pool enclosure while unsupervised. The pool barrier failed to meet Australian Standards due to …
75y · Female·Plastic bag asphyxia in the setting of blunt force head injury
EW, aged 75, died from asphyxiation in July 2019 after being struck by her husband MW, who then took his own life. EW had advancing dementia and severe mobility limitations, with MW as her sole carer. The coroner found t…
Multiple severe internal and external injuries as a result of multiple compressi…
…conveyor and pumps; inadequate emergency stops; poor maintenance practices; absence of holistic engineering risk assessments over 30 years; inadequate operator training; and systemic failures in safety management. The in…
61y · Male·Lymphoma (CD30 positive T-cell lymphoproliferative disorder), medically managed
A 61-year-old man died from CD30-positive T-cell lymphoproliferative disorder (PTCL) after being incorrectly diagnosed and treated for Hodgkin lymphoma. Critical diagnostic information—a negative PAX5 immunohistochemistr…
32y · Male·Asphyxia in a man with Friedreich's Ataxia due to positional asphyxia; unable to…
…ecks if services are not delivered; and capacity assessments must address declining function and associated risks.
42y · Male·Extensive blunt trauma injuries sustained during the course of rescuing an injur…
…m) paramedic, died from extensive blunt trauma injuries sustained during a rescue operation at Bridal Veil Falls on 24 December 2011. A canyoner had fallen and required winching extraction in difficult terrain. The crew…
Female·Miranda Howard: aspiration pneumonia complicating overdose of prescription medic…
Two young women with borderline personality disorder (BPD) died by suicide after inadequate mental health care in South Australia. Miranda Howard (22) died from aspiration pneumonia following overdose; Aurora McPherson-S…
9y · Female·peritonitis due to perforated small bowel due to blunt abdominal trauma
…ever diagnosed. At a rural hospital, a GP appropriately referred her to a tertiary centre after recognising risk of internal trauma. At the Women's and Children's Hospital, a registrar misread her temperature (38°C as 36…
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